Single-payer Health Care Works Best for Singles...and Everyone Else

Today, Singletude was going to feature a review of Internet Dating Is Not Like Ordering a Pizza by Cherie Burbach, part of the gift basket giveaway contest ongoing till Sept. 28, 2009. However, with Congress in recess and the fate of the American health care system still up in the air, I feel compelled to address how our current options will affect the single population.

Unless you've been living in a cave and eating grubs with Geico actors, you know that President Obama has introduced health care legislation that would allow the private insurance industry to coexist alongside a so-called public option, which may amount to nothing more than a private co-op that could claim non-profit status but still behave like a for-profit company. (Don't believe me? Kaiser Permanente and a number of Blue Cross Blue Shield franchises are registered not-for-profits.) The proposal might accomplish a number of admirable things. It might make preexisting condition exclusions a thing of the past, forbid companies from dropping policyholders, cap rate hikes and out-of-pocket payments, eliminate gender-based discrimination, and insure single young adults for longer. It might provide a more affordable plan that would be subsidized for those earning up to 400% above the poverty line. But for all the good it promises, this "reform" is just as likely to make a bad situation worse. Especially for singles and, in particular, single women.

Singles are more likely to be uninsured than married couples are, and 49% of single women have no insurance. It's not a coincidence that single adults are also, on average, worse off financially than their married counterparts. Many if not most of these singles simply can't afford health coverage. Yet a main component of the health care reform under discussion would be an individual mandate to obtain insurance.

Although the aforementioned subsidies would help, they would phase out for singles making a little over $40,000 a year. In some areas of the country, a salary of $40k is just scraping by. Certainly in New York, an individual wouldn't even qualify for a studio on that income. What makes the government think that people in that position can afford to pay several thousand dollars a year toward health care? Some may argue that no one needs to live in a metropolitan region, but that's where the jobs are.

Switching gears to the lower end of the income spectrum, unless the government subsidy represents the full cost of the premium, how will people who already can't pay their bills bear the burden of yet another monthly charge? Some low-income adults, especially young, healthy singles, forgo insurance because it's a financial burden that doesn't pay off for them. They can save more money by paying out-of-pocket the few times a year that they need care. An individual mandate would force them to pay full price for a product they underuse. But, as we'll see, the suggested mandate is the least of our possible woes under this new system.

The reason universal health care works in other industrialized nations is because they have single-payer systems. That means there aren't any competing, profit-driven insurance companies, just one organization that covers health care expenses in each country. The people of these nations pay a tax for this, but they don't have to pay premiums, deductibles, or co-pays. Ever. There is no annual maximum on their benefits, after which they'd have to go into debt to pay out-of-pocket. They never have to get pre-approvals, authorizations, or referrals before they can receive the care they need. They don't have to worry that the best physician in town might be out of network. They're not kicked out of their hospital beds the day after surgery or told they can only have 10 treatment sessions, so they'd better hurry up and get well. Perhaps best of all, their health care decisions are made by their doctors, not some overpaid bureaucrats in an office far away. Good single-payer systems put the decision-making power in the doctors' hands because they're public services and, as such, are beholden to taxpayers, not Wall Street investors. To keep costs down, they reward doctors for improving preventive care rather than rewarding faceless managers for denying it. Sounds like utopia, doesn't it?

Single-payer health care works because it creates one enormous risk pool. The bigger the risk pool, the less any individual has to pay. It also works because it eliminates the tremendous expenses incurred by for-profit insurance providers and the medical personnel who have to deal with them, both of whom pass on these expenses to consumers. In other Western countries, the pharmaceutical industry is regulated, too, which prevents price gouging. That's why Americans can get such good deals on drugs from international pharmacies.

Unfortunately, Obama's health plan will do none of these things. It will just add another insurance option to the mix. He's betting that this lower-cost option will force private companies to reduce their premiums. A more likely and frightening outcome is that anyone who can't afford private insurance because they're high-risk (the poor, the unemployed, the unhealthy, and the elderly) will flock to the public option, which will go bankrupt before you can say "bailout." Meanwhile, the insurance industry and big pharma will keep on keepin' on, finding ways to circumvent the law and deny consumers coverage because these are businesses. They run on a business model. That means they can't make a profit unless they take in more consumer dollars than they pay out. That's why 77.9% of bankruptcies due to medical expenses are filed by insured Americans. For-profit insurance is an illusion of protection at best.

In 2000, the last year that the World Health Organization ranked the world's health care, the U.S. health system placed 37th, scoring behind countries like Andorra, Oman, Iceland, Colombia, and Morocco. Isn't that embarrassing? Meanwhile, the rest of Western Europe outlives us and loses fewer infants at birth. It's not because they drink wine with dinner, either. It's because they have access to free health care for everyone. Contrary to what fear mongers would have you believe, single-payer health care wouldn't mean extending the clunky Medicare program to everyone. It would mean totally revamping what we now call Medicare and remodeling it based on proven programs in other progressive countries. Yes, the government would have a hand in it. Just like it does education, law enforcement, the postal service, public transportation, and other services which--fancy that--work pretty well.

At this sensitive moment in time, we singles, both insured and uninsured, have a precious chance to speak up for health care for ourselves and everyone else. That's a big part of what we elected Obama for. Let's not sit by and watch a few greedy, self-centered politicians ruin it for the rest of us! When the House reconvenes, our representatives will finally be voting on H.R. 676, the United States National Health Insurance Act, which would create a single-payer health care system for all Americans. A health care system that doesn't discriminate based on marital status! No longer would any of us have to feel pressured to get married or stay married for access to medical care. No longer would our salaries subsidize the health benefits of married employees. What a monumental breakthrough a single-payer system would be, not even just for health care but as a precedent for dismantling legalized discrimination against singles!

Here's what you can do to spread the word about H.R. 676:
--Call and/or write to your representative.
--Write to President Obama.
--Write a letter to the editor of your local paper.
--Distribute flyers at a busy place in your town.
--Canvas door to door or on the phone.
--Write about it on your blog or web site.
--Leave comments about it on political web sites and blogs.
--Talk to your friends and family about it.
--Sign petitions.

To find out more about H.R. 676, including what you can do to help raise awareness about single-payer health care, check out these links:

Change.org: Free Single Payer Health Care
Dennis Kucinich: Universal Health Care
HR676.org
HR676.org Blog
Healthcare-NOW!
John Conyers, Jr.: Healthcare
SiCKO: What can I do?
PNHP (Physicians for a National Health Program)
Unions for Single Payer Health Care


What kind of health care system would you like to see the U.S. adopt? Why? How do you think the system you prefer would benefit singles?


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Do you have a question for Clever Elsie about some aspect of the single life? Have a rant or rave about singlehood? Write in, and you just might see your question in a Singletude Q&A or your rant or rave in a Singletude Sound-off!

Singles and Health Insurance, Part II

If you're single and uninsured, the specter of a health crisis takes on an added dimension of anxiety. Not only might your very life be in danger but your livelihood as well. And unless you have wealthy parents, siblings, or grown children who can bail you out of impending financial doom, it may take you the rest of your days to pay back that doctor you owe your life to.

When you're an uninsured single, it's easy to fall into a pattern of resignation and daily prayer or crossed fingers. It may not occur to you that just because your job doesn't come with insurance doesn't mean you have to go without. Here are six avenues to affordable insurance that you may want to investigate:


1. Medicaid
Medicaid eligibility varies from state to state. For example, if you live in New York, like I do, and are single, you can't earn more than $700 a month or have resources totaling more than $4200. You'll need to prove your eligibility by meeting with a Medicaid counselor and completing an extensive inventory of your income and assets. This can take several hours, both in preparation and at your nearest Department of Social Services, so be sure you meet the requirements before you apply.

2. Low-cost State Insurance
If you're not eligible for Medicaid (insurance at no cost), you may still be eligible for a state-run plan for low-income residents (insurance at low cost). A handful of progressive states now offer policies with discounted premiums for those who can keep themselves out of a homeless shelter but won't own a McMansion anytime soon. These policies are usually the dreaded HMOs and may provide only basic, no-frills coverage, but they're better than nothing. For example, Health NY, the New York State plan for singles who make no more than $2,167 a month, regardless of their assets, covers diagnostic and treatment services, including surgery, for a wide range of medical conditions, but it doesn't cover dental, vision, mental health, or "preventive" care. Premiums vary based on the details of the chosen plan but are in the $200-300 range. Massachusetts, Maryland, North Carolina, Illinois, Washington, and Oregon are among the states with similar plans.

3. Catastrophic Coverage
If you don't qualify for a low-income plan, consider obtaining catastrophic coverage in case of a medical emergency. These bare-bones policies generally cover hospital visits only, but it's that unexpected trip to the ER that's most likely to bruise your bank account. Since you're only expected to use your benefits in a crisis, your deductible will probably be high, in the $500-2,000 range. Premiums are about $100 a month. Blue Cross Blue Shield and GHI are two insurance companies known for their popular catastrophic coverage, or hospital indemnity, plans. This PDF edition of Managed Care Week lists many more around the country.

4. Union Plans
Perhaps you're self-employed and are a member of a union. If so, your union might offer low-cost insurance options. The Freelancers Union, the National Writers Union, the Screen Actors Guild, and the American Federation of Television and Radio Artists, are a few unions for creative professionals through which members can access health insurance. Believe it or not, there's even a new National Singles Association promising medical benefits on the horizon! Whatever your line of work, if you're an independent contractor, check out Unions.org. It has a comprehensive list of unions in all industries. A reasonable annual or one-time membership fee could be your gateway to healthcare.

5. Small Business Plans
Or maybe you're an employee at a small business, and your employer can't afford the average $7,000-8,000 yearly cost of an individual plan. Your employer may be interested to know that a number of insurance providers have recently created plans for small businesses of two to 50 employees. Some low-cost state programs, such as Healthy NY, also allow small employer contributions. If your employer doesn't have the resources to pay for your premium in full, talk to him or her about sharing the burden 50-50 or 60-40. Use your irreproachable track record as leverage! Small business owners hate to lose good workers.

6. Short-term Insurance
If all else fails and you're getting desperate, short-term insurance can give you peace of mind while you plan your next move, especially if you're starting over after losing a job or a spouse. Your deductible will be sky-high, and you won't be able to participate for more than six months or a year, but your enrollment will guarantee that if this is the year you win the anti-lotto and lose your job and your health, you won't also lose your life savings. Short-term Health Insurance, eHealthInsurance, and ConsumerBenefits.net are a few of the sites through which consumers can purchase temporary insurance.


And then there are those who slip between the cracks of the system. The freelancer who makes too much for state insurance but not enough to purchase his own. The loyal sole employee of a mom and pop store that can barely break even, much less offer benefits. The laid-off worker whose temporary coverage ran out before a new job arrived. The cancer victim who gambled on a high-deductible policy and lost. What happens to these singles when the medical bills pile up?

Next time, Singletude examines alternatives to traditional health insurance. Check back here to find out where uninsured singles are turning to pay the guy with the caduceus!


Have you ever been insured through one of the above providers or known someone who has? If so, what was your/their experience with this insurance coverage? Can you think of any other methods for an uninsured single to obtain insurance (besides getting married, of course!)?


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Singles and Health Insurance, Part I

Some 17% of the U.S. population wakes up every morning praying that today is not the day they get hit by a car or trip on the stairs or hear the doctor say "cancer." Because again today, they are uninsured, and a visit to the emergency room could bankrupt them.

Sixty percent of the uninsured are single. This probably surprises no one, but it should outrage everyone. Single adults in this country are the only minority who can still be discriminated against with the blessing of the law, and nowhere is this more obvious than in the private healthcare industry, in which singles subsidize the right of married employees to cover a spouse under their insurance plan.

When a married worker loses a job, chances are she can be covered under her husband's plan. If she can't, she has the cushion of her husband's income to fund COBRA until she can find another job. When a single worker loses a job and can't afford the aptly named COBRA, whose provisions are leaner and meaner than a viper, she has no recourse but to join the ranks of the uninsured.

That's if she had insurance to begin with. About three in five low-wage, hourly employees are single, and these low-income jobs are the least likely to offer health benefits.

But let's talk about a different single, who lucked out. He has a stable, salaried position that, up until a few years ago, provided full benefits. But in 2006, along with two-thirds of large corporations surveyed by Mercer Human Resource Consulting, his employer shifted part of the cost to him. Now the discrepancy between what he and his married coworker pay for insurance is visible in the big, boldfaced numbers on his paycheck.

According to a 2005 survey of 80,000 policies sold by eHealthInsurance, the national average on a monthly premium for an individual policy was $148, while the average for a family policy was $110 per member. That means our hypothetical corporate peon loses $456 annually to his smugly married coworker. If Single Schmo and Smug Married are chained to their desks for another 40 years, Single Schmo will shell out $18,240 more than Mr. Smug! In the meantime, Mr. & Mrs. Smug Married have two incomes to cover their substantially discounted premium, whereas Single Schmo has just one for his full-price coverage.

Let's not forget, either, that while a married employee is free to add a spouse and a whole gaggle of kids, singles are much more limited when handing out the healthcare goodies. Extending coverage to a parent, sibling, grown child, or other relative is simply out of the question. That's right. A single's blood relatives, his birth family, are deemed far less worthy to reap his benefits than an unrelated woman he's known perhaps a few years whose most durable tie to him is a piece of paper called a marriage certificate. And though some employers have seen the light and now cover unmarried domestic partners, that coverage is taxable. If the domestic partner were a legal spouse, he or she would be covered tax-free.

Then there's the double whammy of inadequate coverage, literally adding insult to injury when singles are already paying through the nose every month. Among the medical necessities that are often labelled unnecessary by the private healthcare sector are treatment of "preexisting conditions," dental work, vision care, mental health services, birth control, prescription medication, medical devices like pacemakers, wheelchairs, and prosthetic limbs, blood work, xrays and other scans, chemo and radiation, ambulances, emergency room visits, and that catchall category under which everything else falls, "preventative treatment." Little leaves a single as defeated as the realization that, after he's coughed up five or six thousand dollars a year for the last two decades, he's also going to have to cough up a lung before he gets coverage for a life-threatening disease.

For instance, last year I was evaluated for a genetic condition that would have required multiple risky, invasive surgeries had I tested positive. After testing negative on two out of three measures, I was advised to have one last exam to be sure, for which I was referred to a specialist in ophthalmology. However, when I called the ophthalmologist, I was informed that they wouldn't be able to conduct the test without also performing a standard intake exam. Unfortunately, a standard eye exam was not covered by my insurance policy because this was, you see, "preventative care." The out-of-pocket cost of this exam was about $300. I agonized over this for months until, one day, I found myself at the optometrist's to renew my contact lens prescription (also not covered, of course), and the sympathetic doctor agreed to perform the test at no extra charge. (It was negative.)

I don't know what I would have done if Lady Luck hadn't come to my rescue. I suppose I would eventually have forked over the cash--150% of my monthly premium--to ensure my peace of mind. But if that test had cost thousands instead of hundreds, or if I had been worse off financially, I might not have had that choice.

It's no wonder, then, that singles who can barely afford rent, transportation, and the pinstriped shirts on their backs are opting out of pricey premiums and applying that money to personal emergency funds instead. But unless you can hoard away a cool million or two, relying on personal savings is still a gamble.

So what's a single person to do? Anybody who claims there's an easy answer for this one would be lying, but if you're single and uninsured, Singletude can point you in the direction of some viable options. To find out more, check in again tomorrow!

Are you single and uninsured? If so, how did you lose your insurance? Do you agree that the current healthcare system discriminates against singles?



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