Where does it hurt? Opinions on health-care reform can be driven by personal experience
This article first appeared in the St. Louis Beacon, July 2, 2009 - When it comes to health insurance, these St. Louisans are among the "haves":
- Joan Brannigan, 66, of Olivette, a retired school district employee, is covered by Medicare.
- Mark Burgess, 44, of St. Louis, a self-employed information technology consultant, shoulders the full cost of medical insurance for his family.
- Jen Amunategui, 26, of Florissant, a single mother of two, says she's thankful to have employer-based health coverage.
Count them among the majority of Americans -- 69 percent according to a just-published Quinnipiac University poll -- who support some type of government-run health plan to compete with private insurance companies.
And their reasoning is largely influenced by personal experience.
Brannigan said she is concerned about her daughter who is among the nation's 47 million uninsured Americans. She has also watched the medical debt stack up for a sister-in-law with major medical problems.
"My daughter is in a real predicament right now,'' Brannigan said. "She graduated from law school and has not yet found a job, and she's without health care.''
Brannigan, a retired computer specialist with Parkway School District, said she and her husband, a Monsanto retiree, always had good coverage through their employers.
"Then I moved smoothly onto Medicare, and Medicare is fine. I wish everyone in the country could have Medicare," she said.
Brannigan said that she and her husband help their daughter with medical expenses, and she is concerned that people who have no health coverage often avoid getting check-ups that could prevent more serious issues later.
"We need to have everybody in the country well,'' she said.
Although his business has just one employee now, Burgess said he used to employ 15 people and understands the economic pressures of a small business trying to pay for employee health coverage.
"What we found was that every year our premium would go up by 10, 15, sometimes 20 or more percent -- every single year. You take that for a couple of years and then you switch to another insurance company, and they give you a better rate. And then the following year they bump it up by 20 percent,'' he said. "As a business owner you want to do the right thing for your employees, you want to attract good people so you provide good benefits, but it just becomes increasingly expensive. What we ended up having to do was to pass more and more of that cost on to our employees.''
With just one employee, Burgess said his business no longer provides insurance because it would be too expensive. To keep monthly premiums affordable on the policy he buys for his family, he purchased a plan with a high deductible -- more than $5,000 a year.
Burgess, who believes that universal health coverage is the right thing to do, said he realizes that his support for a tax-payer funded, single-payer health care system reaches beyond reforms called for by President Barack Obama.
"I'm kind of disappointed with him for not pushing that,'' Burgess said. "I suspect that would probably be his preference, but it's probably a nonstarter, politically speaking. I wish that would have had a little bit more guts. One of the reasons I voted for him was because he said health care was a right not a privilege.''
Burgess said he grew up in England, where there is national health care.
"Everyone's quite satisfied, though I'm sure there are always people who are going to complain,'' he said. "People over there can buy private insurance if they want to supplement what they have through national health care, so if you've got the money, you can get better attention, I guess. But the point is nobody goes without health care. No one goes without the medicine they need.''
Obama takes his case to the people
While Obama supports a "public option" for the uninsured, he stopped short of supporting a national single-payer plan for everyone.
"The way our health system evolved, employers provided insurance to employees through private insurers and for us to transition completely from a employer-based to single-payer would be disruptive,'' he told a questioner during a town hall meeting Wednesday afternoon in Virginia.
In the session, Obama once again took his fight for health care reform directly to the American public, inviting questions via Facebook, YouTube and Twitter, which he answered at the meeting streamed live at www.whitehouse.gov.
Obama reiterated the need to reduce the costs of health care by eliminating wasteful spending with "smart spending" -- stressing quality over quantity of procedures. He also insisted that increased efficiency will pay for two-thirds of his reforms, and the rest could be funded by capping itemized deductions for people who make more than $250,000 a year, thus increasing their taxes. A revised version of reform legislation announced this week by Sen. Ted Kennedy, D-Mass., and Sen. Chris Dodd, D-Conn., put the costs at $611.4 billion over 10 years. The Congressional Budget Office had estimatedthat an earlier version would cost $1 trillion over 10 years.
Obama assured a town hall questioner that he does not want to tax the benefits of people who receive employer-based coverage - a touchy subject with both politicians and voters. In a new national poll by Quinnipiac University, 63 percent of respondents overwhelmingly opposed a new tax on health-care benefits to pay for health-care reform. The portion of employee premiums paid by their employers is not currently taxed -- which amounts to a tax break.
Issues aren't new to small business owners
None of the current issues regarding health care reform are new to small business owners, says Brad Jones, Missouri state director of the National Federation of Independent Business.
Jones said that the cost of employee coverage has been the top concern of his group's members for 20 years. "Our folks are getting double-digit increases every year regardless of whether the economy is good or the economy has been bad,'' he said.
In the 16 years that Jones has been with the organization, he said rising costs have forced members to drop their employee health coverage at a rate of 1 or 2 percent every year. He estimates that 40 to 45 percent still offer coverage.
A strong point of contention has been whether employers should be mandated to provide coverage. A new version of the reform legislation, dubbed the Affordable Health Choices Act, includes a provision on employer responsibility that would assess an annual fee of $750 a full-time worker and $375 a part-time worker to any employer who chooses not to provide "adequate coverage" for their employees. Businesses with fewer than 25 employees would be exempt.
Congressional efforts to create such a mandate got a boost Wednesday when Wal-mart, the nation's largest private employer, endorsed the concept if it came with health-care efficiency provisions and a mechanism to ensure cost reductions.
Jones said his members remain adamantly opposed to any such mandate, which he calls a "job-killer" for businesses that already can't afford coverage.
"Just from an economic standpoint, something would have to give -- and from our perspective, that's going to be jobs. And it's going to hit the small business sector harder than anybody else,'' he said.
Members are also opposed to a public option for health care.
"As bad as it has gotten in the insurance field, we continually ask our members, 'Do you want nationalized single-payer health insurance, and they said not only 'no', but 'hell, no,' '' Jones said.
Jones said that because a public option would be government-subsidized it would undercut private insurance.
"If everybody ends up going to that option, we are going to have a single-payer system, and I think in the long run it's not necessarily going to be cheaper -- because we're paying for it through taxes,'' he said.
Jones said the group would support efforts to improve health-care efficiency and transparency when it comes to medical fees.
"And we would really like to get back to the economy of scale that we've discussed for years, which is allowing small businesses to pool together across state lines to buy insurance just like big companies do,'' he said.
"Something has to be done"
Despite all the politics and complexity, Obama continues to have the support of more than half of the American people. According to a poll released Wednesday by CNN/Opinion Research Corporation, 51 percent of those surveyed said they favor the president's health care plan, and 45 percent were opposed.
Jen Amunategui, who manages a coffee shop, said that health-care reform should not only provide coverage to the uninsured but should offer relief to people who have insurance but face high out-of-pocket costs, such as deductibles, co-pays and drug costs.
Amunategui said she spends nearly half of her income on child care, which doesn't leave much of a cushion to pay for groceries and other living expenses for her two sons. While she is grateful to have insurance, she says that sometimes she simply doesn't have $20 for the co-pay when she takes her sons to the doctor.
She said she knows too many people, including family members, who are uninsured and not getting the care they need.
"Something has to be done,'' Amunategui said. "I am not necessarily opposed to someone like the government taking control for a minute here, and making something better. Obviously, the way we're doing it is not working. And maybe this way won't work, either. But at least were trying to do something instead of letting it stay the big mess that it is.''