20 January 2009

Watching for COBRA or Any Other Kind of Insurance We Can Get Our Hands On

It's not just my interest in health care insurance for Tom and me—it's the awareness that when unemployment goes up 1%, "un-insured" goes up 1.1%. In the coming year or two, that translates to a lot of families who will face difficult decisions about going to the doctor.

COBRA is our current protection against loss of insurance (typically caused by loss of employment) but the costs are legendary. If your former employer paid most of your premium (and most employers do), then you may not even know that
COBRA will cost $300 or $400 or $500 (or more) a month. That's for one person. Family coverage starts at about $1000.

In better times, you might not have even known or cared. Losing a job one month, but starting another job the next month, might mean your insurance "bridged" neatly with no uncovered span. Or if a span did occur (we'll pretend it took 3 months to get your next job), you might have relied on
COBRA for those 3 months or purchased short-term insurance with a deductible, and not gone broke. Not because the cost was any lower than it is today but because the cost was limited by the time span. If you had some savings (the emergency fund) or you lived on credit cards for a while, you bounced back without any great awareness of the real cost of health insurance.

COBRA was well tolerated by a lot of the folks who used it. Today, it's not working.

But today a new federal administration begins and the front-burner issues of the economy and unemployment are tied to a back-burner issue of health care. Immediate relief in the form of affordable health insurance is needed. No one knows what that will look like—or how immediate it can be.

Proposals will emerge and it's even possible that in a few hours we will hear a new president's preference. One proposal is to extend
COBRA beyond the current 18 month limit or somehow subsidize it so that unemployed workers and families can maintain the insurance they had when employed.

A Medicare-centered proposal would likely take more time to explore and approve. One such plan was proposed yesterday by the California Nurses Association: Medicare for All (Single-Payer) Reform. The plan is cast in terms of a stimulus for the economy, promising 2.6 million new jobs.

I cannot help but read of such plans with other news stories in my head: concierge doctors or, as my local TV station described the concept just yesterday, MDVIP programs. (Another term is boutique medicine.) Would you pay a physician an annual fee of $1500 (separate from your medical billing by her/his office) to insure access and leisurely appointments? Maybe even house calls? In exchange, the physician agrees to carry no more than about 600 patients in her practice. (That's probably a fourth or fifth of the doctor's previous practice.)

Excuse my cynicism, now: will the concierge doctor welcome a Medicare patient? I am certain I am not the first baby boomer to wonder that.

(I am not a critic of concierge medicine, by the way. Last year, when a surgeon gave me his cell phone number—and we even had to call it late at night—I had a taste of having a physician literally on call for you. It could be addictive.)

© 2009 Mary Bold, PhD, CFLE. The content of this blog or related web sites created by Mary Bold (www.marybold.com, www.boldproductions.com, College Intern Blog) is not under any circumstances to be regarded as professional, legal, financial, or medical advice. Or education advice. Or marital advice. Or even a tip.

1 comment:

Thomas W. LaGrelius, MD said...

As president of SIMPD, the Society for Innovative Medical Practice Design, the professional society open to all concierge and other direct practice doctors I want to confirm that the reason health care is so fragmented and disrupted today is the lack of excellent primary care America once had. That fact in large part results from the devaluation of primary care and its extremely low pay status under the third party and Medicare dominated payment system we now suffer under

The concept of "medical home" is a critical one. Every American needs one, a place they can access top notch primary care immediately and fully like one can access a concerned family member. And they need to buy that home directly, not with other people's money. When they do so the cost can be very low to the patient and the benefits very high to patient, primary care doctor and society.

The only payer willing and able to pay what a medical home will cost is the patient. Interest in concierge medicine is therefore rapidly growing. Starting with the first such practice about twelve years ago in Seattle and growing exponentially, there are now thousands of such practices in the USA, some are associated with franchises though most are independent. No mater what the government does, that is where the action will be in the future as our numbers grow from the current thousands to tens of thousands to hundreds of thousands.

Direct practice doctors and those who wish to adopt the direct practice model can join the society and get many benefits including up to 55% discounts on malpractice insurance, practice marketing help, national care networks and many other services. Our society is rapidly growing its membership. Direct practice doctors have much more time with their patients, make a better living, and virtually never get sued. That is why we get huge malpractice insurance discounts.

Patients can go to SIMPD's web site at http://www.simpd.org for information and to find such a doctor in their own community at the "find a physician" link. This is the ideal way for patients to get personalized, prompt, excellent primary medical care in a unhurried, pleasant setting. Money is actually saved on patient care in such practices because emergency room visits and hospitalizations are drastically reduced due to of the personalized, immediate, detailed care we deliver. The cost of concierge care, which averages about $150 per month, can be as low as $40 per month. This is affordable for most Americans, while the fragmented primary care most are now getting through employers or government third party interference in the doctor patient relationship is penny wise and pound foolish.

SIMPD believes most Americans can eventually be cared for in such direct "medical home" practices resulting in far better care. This will result in lower overall cost and a return of interest in primary care by students who now shun the field as undervalued, underpaid and undesirable compared with other medical specialties which for the same or lower levels of training and effort often pay double and tripple what primary care pays inside the insurance system. And I can assure you that Medicare patients are welcome in our practices

If any of you have further interest please contact me through the SIMPD web site. I answer all emails through that site personally.

Thomas W. LaGrelius, MD, FAAFP President, SIMPD http://www.simpd.org
Owner, SPFC Torrance, CA http://www.skyparkpfc.com