Why We Need Medicare for All: Reason #2
A couple of months ago, I left a position with a company and boss I love for economic reasons.
It was the only move that made sense to me given I hadn’t had a raise in going-on three years. I received a significant one after my first year, but, after that, no (not even small, cost-of-living) increases came. Two years after that first raise, I joked about another one with my boss, who became a bit defensive and told me to “have compassion for the business” when it came to money.
Why I Moved Jobs: No Raise Means Your Real Salary Decreases
I made the career move because I recognize that every year your income doesn’t go up, it goes down — health insurance premiums, rent, other costs-of-living almost always increase, eating more and more into one’s flatlined salary and after-taxes-and-other-basic-expenses “expendable” income.
I was very sad to leave. I’m especially sad that it was almost solely caused by a focus on profits over people.
New Company, New Insurance
After a couple of months in my new job, my benefits kicked in, so I canceled my $400-a-month COBRA insurance.
Now, I take a few different medications for my obsessive-compulsive disorder (OCD), which is — for good reason — an Americans with Disabilities Act-recognized disability. One medication, Lamictal XR, costs over $2,200 for a month’s supply if I pay out-of-pocket. Note that’s more than one of my paychecks each month for just that drug.
With my last company’s insurance, it was $75.00 a month after the less-than-$500 prescription-drug deductible. In an effort to preempt any issues my new insurance, Anthem, might have with paying for a nonsensically high-cost brand name drug (the varying quality of the generics they’d prefer to pay for doesn’t work for me), I filed a preauthorization for it well before my next refill was due. I thought I was ahead of the game.
$2,200 Drug, $6,500 Deductible
A couple of weeks later, when the pharmacy attempted to charge Anthem for my drugs (one a little over $100, the other the $2,200 Lamictal), they couldn’t process it. The pharmacist called the insurance company and then called me back to tell me that, apparently, my deductible was so high I’d have to pay the entire cost for my medications.
Of course, I, like the pharmacist, was stunned.
I called Anthem, a call during which I learned that my new health insurance plan applies all medical costs, including prescription drug costs, to the overall $6,500 yearly deductible (which also happens to be the maximum out-of-pocket expense for the plan). That means, until I pay $6,500 for my medications plus any doctor visits and the like, they won’t cover a dime.
The customer service representative couldn’t believe it. She even pulled up drug discount apps on her cell phone to try to find a lower price for me. No dice.
The best part? The deductible resets yearly. Even if I were able to reach it this year, I’d still have to pay it again next year. Essentially, nothing I pay before January 1, 2019 will get me closer to the supposedly post-deductible 100-percent coverage for my medications (betting that doesn’t apply to the Lamictal, but it sounds good).
I’m used to insurance plans with separate prescription drug deductibles. I wasn’t aware — and there’s only one policy to choose from at this company anyway — of this scheme when I canceled my COBRA and enrolled in this plan.
I emailed the CEO; her husband, the VP; and my boss an email politely expressing my concerns with this plan, given my medication costs. I asked if this is, in fact, how the plan works. I said I may need to consider other options, if so.
The VP pinged me on Hangouts and then called. After telling me my best option is to try to get back on COBRA (neither of us are sure one can do that after they’ve canceled it) for at least the rest of the year by contacting my old company’s human resources department (never a fast-moving section of that firm), he confirmed that that is, indeed, how the company-provided insurance works. He said it was the reason they were looking at other possibilities. (They’ve already said they’re reenrolling everyone in the current plan for 2019, though.)
Appreciation — Some
All this boils down to me paying at least $3,500 out-of-pocket on medications by the end of 2018, and then, over the course of three or four months in 2019, I will pay another $6,500 before Anthem picks up any of the tab for my monthly medications, or any other medical care, for that matter. Or, I will try the generic (they’re over $300 for a month’s supply) again and hope it works.
Fortunately, and much appreciated by me, my new employer does pay the full cost of my premiums, which are probably, annually, less than this deductible. Cost-sharing — some.
I appreciate the company’s owners are aware of the problem with this plan and trying to solve it. There’s one easy fix, though: increase the company contribution to employees’ health insurance expenses. Given the company is hiring, I doubt that move would break the bank. Yet I’m required to work 44–45 hours a week, according to the CEO and my boss. (Which brings me to another point: people died for the right to work 40 hours a week. Who are you to demand people work more?)
Private Property (and Profit) Above All
I understand the focus on private (not personal) property is highly valued. In fact, it’s a fundamental belief of neoliberal and/or classical-liberal-economics-believing/spouting ideologues (which includes most businesspeople, politicians, economists and knuckleheads). Profits are private property and, thus, though you greatly help the CEO earn them, are distributed solely at his or her discretion.
He or she may choose to use that money for more personal family vacations, reinvestment in the company (which could include increasing employee compensation or improving benefits), saving for a rainy day, among other options. Obviously, those profits can be used for more than just one thing. So, the business owner has quite a bit of flexibility in how he or she can deploy those excess funds.
Where Profits Go
What’s clear is that they haven’t been using those funds to increase wages over the past 40 years.
[D]espite some ups and downs over the past several decades, today’s real average wage (that is, the wage after accounting for inflation) has about the same purchasing power it did 40 years ago. And what wage gains there have been have mostly flowed to the highest-paid tier of workers.
Company employee retirement contributions are rarely very hefty, if offered at all nowadays. Employees at most for-profit companies can forget about a pension (unlike most government employees, including Republicans), and they’re lucky to get matching 401(k) contributions. And, of course, executives continue shifting the cost of health insurance onto employees.
Business owners clearly haven’t been reinvesting in their businesses — at least not in the most important aspect of them. Or what they like to publicly claim is the most important aspect to them: people. We’ve already been shown that profits are most important.
Heads of large companies are well-compensated and shareholders (who are, generally, already-wealthier Americans as most people don’t hold any investments) are paid off with profits earned by underpaid employees. Heads of small- to medium-sized businesses, if they aren’t planning to become large businesses, use their profits to pay themselves — and enjoy themselves. You’d be surprised by the number of CEOs I’ve interviewed who say their goal is simply to not have to work in their company — to have it just run itself while they sit on the beach and “earn” a high salary. That is, they want their employees to do all the work while they reap the profits. Some would call that exploitation.
Slavery is good for business, too.
Reason #2 for Universal Health Care: Of Course, Cost
A Truven Health Analytics-NPR Health poll conducted in 2017 found that cost is the reason most Americans don’t fill their prescriptions.
Even among those with insurance, 14 percent of regular prescription drug users chose not to fill a drug due to cost, according to a Consumer Reports survey. (Sadly, it also reported that “almost a quarter of regular prescription medication users said they are ‘not at all confident’ that they will have access to affordable medicine in the future.”)
The National Institute of Health-funded authors of the Agency for Healthcare Research and Quality-funded study, “Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions,” acknowledge that,
Higher patient cost-sharing has been shown to delay initiation of treatment for chronic conditions. Correspondingly, prescription of medications with lower copayments appeared to be associated with better primary adherence in two recent studies of single drug classes. These results highlight the importance of prescribing in compliance with a patient’s formulary, which was previously shown to affect refill adherence.
If people can afford their drugs, they are more likely adhere to doctors’ orders. Whodathunkit?
What’s interesting in the NIH-funded studies quoted above and below is that they never recommend in their conclusions that policy makers and researchers look into ways to reduce the cost of drugs. You know, since that’s the leading reason many people don’t take their prescribed medications.
The closest we get is when the authors of “Cost-Sharing and the Initiation of Drug Therapy for the Chronically Ill” write,” “Policy makers and physicians should consider the effects of benefits design on patient behavior in order to encourage the adoption of necessary care.”
Whoa-nelly! Those are some strong words.
Back to the Beginning: Another Cost
This brings us back to the beginning. The main reason I left my last company was because of pay. But my new company’s insurance deductible is, essentially, an immediate reduction of nearly half of the increase in yearly salary I switched companies to earn.
Indeed, had I known this, I never would have left my last company. I was under the impression I was getting a better deal on insurance with this company. I was wrong. I made a huge mistake in believing the CEO’s “all health care paid for employee” to mean I wouldn’t have to pay nearly $7,000 before I could really use the insurance.
What Will I Do?
I’m not sure yet.
I’ll likely try to take the generic version of Lamictal again and hope it works, at least to some degree. If its effectiveness is as poor as before and I can’t stand it, I guess we’ll spend the little savings we’ve slowly nickel-and-dimed together over the past year on the brand name out-of-pocket. Even that won’t be enough to cover the entire deductible, though. At worst, we may have to sell retirement investments once again.
A General Suggestion
This isn’t intended to bash my new — or my last or any — employer. But it is a direct suggestion to all business owners: if you can’t/won’t afford your employees the health care they need to be productive (whether that be through affordable-but-rich-in-benefits health insurance or higher take-home pay), you shouldn’t be hiring people.
Don’t like that statement? Then you, too, should support Medicare for All or some other system of universal health care. It takes that burden off your back in return for a (let’s be honest) slight tax increase, at most.
Why is Cost the Number #2 Reason to Favor Universal Health Care?
Cost isn’t the first or only reason you should support universal health care, though.
The number one reason to support universal health care — whether it be in the form of Medicare for All, an expansion of the Affordable Care Act or something altogether new — is that it’s the most ethical health care system on offer. It’s clear the capitalist, profit-driven health care system we have now is an utter failure for most Americans. It is ethically and morally indefensible.