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Our current health care system is broken in many ways. Many of us who are in the business of providing health care or health insurance prove the truth of the following quote:

“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”

Upton Sinclair

Our system is broken and doesn’t serve or poorly serves many of us. Many of the people I rub shoulders with believe that the problem will never reach their doorstep. These typically are hard working middle class people who always had coverage through their jobs.

Some of them are going to wind up like Wendy, a woman I spoke with a couple of days ago. “Wendy” is a woman with many different names but very similar stories. I speak with her frequently.  She breaks my heart every time.

She is in her fifties. Wendy started working when got out of college in her mid-twenties. Wendy took a low paying job as a mother of small children for a few years. The job was very satisfying but it didn’t pay well or offer an insurance package. During this time her husband’s employment-based insurance covered her and their children. She went back to work when her youngest went to school. At that point she got a job that covered her with insurance again.

Shortly after that, her husband left his job and started a small company. She has carried the medical insurance for the family ever since then. About five years ago she started a fight with breast cancer. She was out of work for a few months, but was able to go back to work until sometime last year. Now she is too sick to work. She lost her group insurance coverage and the coverage for her family because she got sick. (That didn’t make sense to her and it doesn’t make sense to me.)

She took her COBRA health insurance option so for the last year or so she has had coverage. It is expensive coverage, but they can afford it (just barely). She’s helping her husband with the family business, but she can’t earn the money she and her family had gotten used to. They’ve had to cut back on a lot of expenses.

This is when I entered the picture. Wendy called me when her COBRA was about to expire. I had to tell her that even though she had played by the rules all her life, she was now uninsurable in the private market. A  Health Reinsurance Association policy might be available to her, but the coverage would not be nearly as good as what she was used to and the price would be twice what she could afford.  The Charter Oak Health Plan might also be available to her after she has gone 6 months without coverage, but this is also a barebones plan.

We can help her get coverage for her family, but she is the one who is ill and has expensive prescriptions to fill. Due to her illness, she can only work part time and part time jobs that offer health benefits are hard to find in any economy.

She was technically insurable, but in a practical world, where mortgages, grocery bills and electric bills take precedent over medical insurance she was not insurable.

What is Wendy to do? In our present system she can do little but pray.

Health insurance benefits in America are typically tied to an employer’s plan. Employee benefit packages for small business and large businesses almost always require that an employee is working or has worked recently.  What does this mean?  It means that when health insurance is tied to our jobs, a sickness or injury that causes us to lose our job causes us to lose our insurance.

Health insurance that isn’t tied to a job isn’t much better. Although your insurance company can’t drop you as an individual because you get sick, they can raise your rates. I’ll blog about some of the problems with that system later in the week.

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Alston

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