The Land of Ozz

Better Solutions

Educate people on how to seek jobs that offer good health care insurance plans rather than just giving them the plan for free. Then if employers don’t pony up the plans then they don’t get the quality labor. Like the bumper sticker says, “Share my work ethic not my wealth.”

Prove the cost saving first before banking a new entitlement program on a theory.

Restrict law suites against doctors so they can lower there overheard (liability insurance) and in turn lower costs for everyone. This would also help cut down on unnecessary tests that doctors often order simply to cover their back side.

Now those are common sense ideas.

Reasons why I don’t like it

Health insurance coverage for those who don’t need/want it results in care being slow to delivery for all. It is a natural progression. Some people will abuse the “free” health care because it has no value to them due to never having to work to pay for it. Unnecessary “free” tests for the freeloaders will force those who really need the tests for  the detection of life threatening illness to wait in longer lines at the very least.

This bill floods a struggling system serving the least among us (Medicaid).  Oh…and I don’t want my tax money paying for abortions…PERIOD.

It is estimated to cost approximately $567 per person from each of the remaining US citizens to pay for health insurance premiums for the 30 million uninsured that President Obama wants to cover with his plan.  Here is the math:

Yearly Premiums: $5,270 each*

Total Yearly Premiums for 30 million people: $158,100,000,000

Cost to the remaining US citizens:

$158,100,000,000/279,000,000** = $567 per year per person (every man, woman, and child) in taxes… if the cuts/savings in Medicaid and Medicare don’t work… and they won’t because any savings to Medicaid and Medicare will be consumed because both programs are are already underfunded and rapidly growing.

“The states and the federal government share the cost of Medicaid, which saw a record enrollment increase of 3.3 million people last year. The program now benefits 47 million people, primarily children, pregnant women, disabled adults and nursing home residents.” NY Times

*Based on average of annual premiums for all federal government Fee for Service Nationwide non-postal individual plans.  These are the same plans Obama refers to regularly when he says he will be “giving tens of millions of Americans the exact same insurance choices that members of Congress will have.” This number is actually fairly low considering the average spending per Medicaid enrollee is almost $7,900 per year.
**Estimated USA Population as of July 2009: 309 million (309-30 = 279)

Keep in mind that these numbers only estimate what it would cost to get these people covered with “health” insurance and not dental or vision which Obama has been saying verbally that he will deliver access to in his plan.  There is also the additional cost of deductibles and co-pays is not included in these estimates. Oh…and these estimates do not consider the FACT that all premiums will increase if insurance companies suddenly are required to cover pre-exiting conditions.

Related articles by TheOzz:

Health Care for Small Business – Obama’s Plan

Government Health Care – Personal Concerns

Mandated Car Insurance

“…Medicaid reimbursements covered only 65 percent of actual costs…The county’s Medicaid rolls have grown by 37 percent since 2001, and the program now pays for half of all childbirths.” NY Times

This may be the future of government run health care insurance.  The NY Times did not mention how this compares to what President Obama is proposing for the remainder of the uninsured Americans but some questions do need to be asked:

• How will doctors be able to remain in business if the government sponsored plans can’t even cover the doctors’ costs?
• How will government funded insurance accommodate surges in unemployment that causes record enrollment increases like Medicaid experienced last year?
• How does the Obama plan address issues of patients having to drive two hours to find a doctor to take Medicaid or other government sponsored plans?

The president just declared the H1N1 (Swine Flu) situation as a National Emergency.  My experience with H1N1 has been mixed so far and I am curious to see how this announcement affects things.

My 4 year-old Caden tested positive for H1N1 in August.  He subsequently spent 6 nights in the hospital with pneumonia. Since then he has never really shaken the pneumonia and is on oxygen at home (o2 only when sleeping) after another 6 more nights at the Medical University of South Carolina this past week for pneumonia.  His flu test was negative this time. Since August we have had him in and out of the pediatrician’s office and the emergency room with high fevers and trouble breathing.

During one emergency room visit the nurse caring for my son began to “educate” me on H1N1.  The nurse tried to convince me of how much more dangerous this flu was for children.  I asked her if she had actually read any of the statistics and she said she had not.  I went on to explain that the majority of deaths were in the young adults age range.  Children and elderly were actually fairing the best in this strain of flu.  She seemed a little shocked because that was not what she had heard.  I suggested that she take a look at the CDC statistics for herself rather than going off of what she was being told.

Today my wife ran into a nurse from my son’s pediatrician’s office.  The nurse asked if we were going to the H1N1 shot.  My wife responded by saying that we had some concerns.  The nurse then said that every staff member in the practice had declined the shot for the same reason.

During our hospital stay this week our son was put on contact precautions.  This meant that every person who entered his room had to wear a disposable gown, gloves, and of course a mask.  This was even after my son tested negative for everything contagious that they tested him for.  The staff said it was hospital policy for any person coming in with respiratory problems.

The moral of this story is that there are some serious inconsistencies in messages depending on where you go even within the medical community.  How will things change with the announcement of the National Emergency for H1N1?

Also posted on my Wellsphere Page

My wife wrote a comment on Facebook that I want to follow up on. Mrs Ozz said:

“The idea of universal health care for our family is SCARY! At least we would still have Medicaid for Caden but who knows how that would change!”

While the Medicaid program that Caden is on works well for us college educated middle class folk…I seriously don’t know how uneducated (illiterate) people get it for their children.  The red tape and paperwork processes to get approved are horrendous.  You not only have to be able to read and comprehend the applications, but you have to have good records.  I was told to expect it to take 4-6 months to get Caden approved.  I had good records and followed the instructions and got the approval back in a few weeks.  The paperwork was heavy on the front end but has been almost non-existent on the back end.  These government run programs like Medicaid don’t provide specific benefit information like private health care.  You never get an explanation of benefits (EOB) from medicaid and from what I have seen there are no processes for reimbursement if you do pay for something out of pocket.

Caden has been covered by Medicaid (Katie Beckett – TEFRA program) since birth which was almost five years ago.  Children who qualify for TEFRA Medicaid are defined as follows:

These are children age 18 or younger that live at home and meet the SSI definition of disability for a child and meet the level of care required for Medicaid sponsorship in either a nursing home, ICF/MR or an acute care hospital. The parent’s income and resources are not considered in determining eligibility… Source

That definition gives me a reality check on how serious Caden’s conditions have been since birth.  What they are basically saying is that if the family is not willing or able to care for the child then they would likely be institutionalized if a suitable home could not be found.

This medicaid plan has worked for us but it has had some bumps in the road.  Beginning in 2008 the state of South Carolina began outsourcing Medicaid to private industry (HMOs) so this particular “GOVERNMENT” health care is no longer run by the Government in most cases.  We opted out of the HMO choices which were offered through SC Healthy Connections Kids and went back to fee-for-service Medicaid after being forced into an HMO that did not even provide coverage for most of Caden’s care.  The HMO we were auto enrolled into has only one participating hospital within 100 miles and it is not the Medical University of South Carolina (MUSC) Children’s Hospital where ALL of Caden’s inpatient, outpatient, and surgical work has been provided since birth.  As a matter of fact MUSC is the only hospital in the state that performs pediatric cardio-thoracic surgery. So why they choose an HMO for Caden, a child with congenital heart defects, where the only hospital in the state that can provide care is a non-participant in the HMO is completely illogical?

The scariest part of government run health care for me is the lack of equal value on life.  Many health care professionals believe that kids like Caden are a burden on families and society.  For instance, the women’s clinic where Mrs Ozz got most of her prenatal care went out of their way to make sure that we knew that we “had choices” during the pregnancy.  They made sure that we understood how difficult it would be to care for a special needs child and that we did not have to put our family through that.  Never mind that a life is a stake here.  They were basically saying that our family could have lived an easier life if we had chose to end our baby’s life at approximately 26 weeks in the pregnancy.

The mentality behind government health care is similar in that there seems to be no regard for the life of the patient if cost high and end of life are possible anyway.  You may remember that President Obama has made it pretty clear that some life saving procedures may not be worth performing on some patients.  I see this attitude held by some politicians along with their lack of value for all life to be the precursor to a slippery slope into situations like the one Dr. Bernhard Moeller faced in Australia.  The doctor was denied a visa because his son had DOWN syndrome and that would have caused a drain on taxpayers through the Australian government health care system.  And where does it all go from there?  When does the government decide to stop prenatal care or even force abortions on women who are carrying babies with known life threatening conditions that will almost surely put a drain on the taxpayers if the child is allowed to become a citizen?

The assessment of Dr. Moeller’s family medical needs were likely accurate if his son’s care cost anywhere near as much as my son Caden’s care.  Our family takes out at least twice as much benefit from the health insurance system as we put in during an average month even when there are no major procedures or extended hospitalizations.  Major surgeries along with associated hospital stays are particularly draining on the insurance system when they do occur.  Let me provide some personal details to clarify by using the first two months of Caden’s life.  I stopped adding the bills when the total passed $330,000 so we will use that number as a reference since we know that the first two months was at least $330K for Caden’s care.  My current insurance plan premiums are about $13,445 per year for our family coverage for Blue Cross Blue Shied Standard (non-postal rates).  While I was not a government employee at the time of Caden’s birth my plan was similar in benefit and premium costs so the example here is fairly representative.  Like most plans I pay a portion and my employer pays the remainder of the premiums to the insurance company.  At $330K in bills for those two months of care that means that it took more than 24 employees worth of yearly insurance premium contributions to cover the first two months of Caden’s hospital care after birth.  Caden has also had several other major surgeries since birth so these first two months is only a small example of what health care costs for a child with complex medical conditions.  For example Caden’s regular ongoing care today totals in excess of $2,000 per month due to tube feeding supplies, therapies, medications, specialist visits, and associated tests.  That is nearly double the monthly premiums ($1120) being paid in total for my family between me and my employer.

So the scariest part of the government run health care model is brought to light in Australia’s denial of Dr. Moeller’s visa.  If that example runs it’s course in the United States then Caden’s care might be categorized as too costly and the system might have to drop him from coverage if the politicians and burracrates get too involved in the process.

Many Americans, especially those without health care coverage are concerned about how they might be able to get health insurance coverage.  There are a lot of promises being made about health care insurance and I want to take a close look at the one that looks the most appealing to many Americans.  I want to break down the cost of health care insurance for small business and their employees based on some conversations I have been having with small business owners who do not currently offer their employees health care insurance.  Barack Obama is quoted as saying, “since 1990 companies with fewer than 20 employees have created 80% of new jobs in America”.

Small Business Health Care Cost Example

To set the stage, let’s say a services related business grosses $500K and makes $50K profit after the expenses, taxes, benefits, and salaries (including owner/operator) are paid.  This business employs 16 people who average making a gross wage of $12 per hour.  Before we go too far let’s take a realistic look at what an employee’s household budget might be in this small business.

Employee’s Household Budget:

* Misc includes clothing, toys, cable, phone, entertainment, gifts, charity, savings, etc.

I created the above household budget example based on a single income family of four including two preschool age children where the mom cannot obtain a full-time job to make enough to pay for childcare for two young children.  I added $250 per month that might come in the form of overtime or an evening part-time job by mom or day that supplements the budget.

Barack Obama’s Promise for Health Care Coverage

Barack Obama’s says that his health care plan would provide small businesses “tax credits to cover up to 50% of employee insurance” premium costs.  How will that work for this company and the employee’s family listed above?  Let’s pull data from a very popular health care plan offered to federal government employees that is available throughout the United States.  Since that is what Barack Obama offers as example in his speachs it is only fitting.  One of the standard plans offered to feds is by Blue Cross Blue Shield and costs a total of $1027 per month in premiums.  That plan costs approximately $12,000 per employee in premiums per year.  Please note that the federal government picks up 70% of the premium and there are thousands of employees in this group plan.  To get this level of coverage for a company of 16 employees, you are almost guaranteed that employee coverage in this company will cost well above $1027 per month per employee.

Health Care Cost:

Now remember that the business only has $50k profit to apply to the Net Premium Left to Pay.  If the employer decides to purchase as much premium as possible, each employee will still be required to come up with at $256 for in premiums.

With Company Help (No profit left to grow company)

$98k prem – 50k profit = $48k remaining

$48k remaining / 16 employees = $3k per employee per year

$3,000 per employee / 12 months = $250 per employee per month

No Company Help ($50k profit used to grow company)

$98,592k prem / 16 employees = $6,162 per employee per year

$6,162 per employee / 12 months = $513.50 per employee per month

The employee’s household budget will not support this premium and will likely not choose to purchase health care insurance in a similar scenario.  This is not just a speculation for small business employees that I know, but this is a fact.  These are the Plumber Joe type of folks who are already running on tight budgets and will likely pocket the $250-500 per month and pray that they don’t have health care issues that cost more than they have stuffed in the mason jar.   Every employee who has been offered health insurance where they would have to sacrifice premiums out of their check has passed on this option. The result shows that the average small business employee cannot afford health insurance even with Barack Obama’s health insurance plan for small busniess.  The average family making wages in the range listed above simply cannot afford to fork out $250-$500 per month in heath care premiums if, IF the employer can get decent health care coverage at this price per employee.

Barack Obama says that for small businesses he will “help them not just create new jobs but good jobs with health care”.  What we can clearly see it that Barack Obama is out of touch with reality when it comes to how many small businesses and households operate in this country.

References:

http://www.barackobama.com/issues/healthcare/
http://www.opm.gov/ [PDF] – U.S. Office of Personnel Manaement

My big boy Caden was hospitalized yesterday.  He was admitted for a “fever of unknown origin”.  The 104 degree fever popped up while Caden was already on a pretty strong antibiotic for a sinus infection.  A major concern is that this illness could jeopardize the scheduled heart surgery that could take place as early as 9/22.  I am keeping my twitter pretty current if you want to follow more real-time progress.  I will be also be updating Caden’s Page with major changes.

The doctors are trying to identify the source of the fever so they can treat it.  We also have to consider potential evacuations with Hurricane Hanna if we do not get discharged before the storm arrives here in chucktown.  The latest predictions have it headed this way (Charleston is in the center of the five day forecast track). Apple pick’n in NC is looking better by the minute.  I just hope we can blow this Popsicle stand in time to beat this storm to the county line.

The good news is that Caden has O2 sats of 96-100.  The bad news is that it is taking 10 liters of blow-by oxygen to get the sats up.  Please keep Caden in your prayers.

How the IRS helps me save 50 cent per gallon on gas.

The time of year has arrived when many US employers kick off what we call in the civil service “Open Season”. This is a time of the year when employees are allowed to make benefit changes that may not be allowed at any other time during the year, with a few exceptions called qualifying life events. (i.e., death, birth, marriage, adoption, etc.) One of the most useful, but often overlooked optional benefits that many employers offer is the Health Care Flexible Spending Account. Through these accounts the IRS allows for tax payers to have money withdrawn from their paychecks pre-taxed to later be used to reimburse medical expenses. In 2003 the IRS extended the coverage of these accounts to include over the counter medications and medical supplies. Many employees avoid this program because they do not fully understand it and are scared of the possibility of loosing unused money. This is a valid concern, but in y opinion, those who avoid flexible spending accounts are leaving money on the table.

So what does a flexible spending account have to do with gas prices?

I am glad you asked. One of the allowed categories of medical expenses in the flexible spending account is called transportation. The general guidelines for the transportation category are as follows:

“You can include in medical expenses amounts paid for transportation primarily for, and essential to, medical care.

You can include:

• Bus, taxi, train, or plane fares or ambulance service,
• Transportation expenses of a parent who must go with a child who needs medical care,
• Transportation expenses of a nurse or other person who can give injections, medications, or other treatment required by a patient who is traveling to get medical care and is unable to travel alone, and
• Transportation expenses for regular visits to see a mentally ill dependent, if these visits are recommended as a part of treatment.

Car expenses. You can include out-of-pocket expenses, such as the cost of gas and oil, when you use a car for medical reasons. You cannot include depreciation, insurance, general repair, or maintenance expenses.” Source: IRS Publication 502

With this one benefit our family is able to offset our gas costs by an average of 50 cents per gallon based on $3 per gallon prices. I will add a disclaimer for our situation, but that does not take away from the fact that an average family can cut gas prices by 25 cents per gallon or more with a flexible spending account. My disclaimer is that our son Caden sees an above average number of doctors on a regular basis so our transportation expenses are more than double that of a normal family of the same size as ours. That said, I have broken out a separate line in my calculations to show how a “normal” family would be saving 25 cents per gallon on gas even if Caden had not seen so many doctors this year. The “extreme” column represents our situation with Caden’s appointments.

The IRS allows for 20 cents per mile to be reimbursed through the flexible spending accounts. I have included a little chart to show how much gas costs per mile based on a vehicle’s MPG rating and the price per gallon at the pump.

Below is how I calculate the 50 cents per gallon savings on the year. The numbers used here are based on six months worth of transportation expenses with an average of 16.5 miles one-way to our medical service providers. I used Google maps to determine the distances. We completed 55 trips for medical purposes at 33 miles round trip on average for a total of 1814 miles in approximately six months. (Shown below in the “Extreme” column) There were 29 trips averaging 28.6 miles not including Caden’s appointments. (Shown below in the “Normal” column)

You will notice that our adjusted price per gallon of gas price is now at $2.51 based on the original $3 per gallon purchase price.

There are a few notable items.

1. The better mileage your vehicle gets the more you will save per mile. I actually used conservative numbers for our car so the actual savings for us is well above 50 cents per gallon on the year.
2. The vehicle that my wife drives averages less than 10K miles per year of driving. The higher the percentage of miles driven for medical purposes will increase your savings. If your vehicle is used only for medical purposes, then you would likely end up making money.
3. Higher gas prices will mean less savings unless the IRS adjusts the mileage rate for 2008. The rate went up from 18 to 20 cents last year.
4. If you drive a vehicle that gets terrible mileage or if the price of gas goes up faster than the mileage rate, then you would be better off taking the actual expenses in reimbursement instead of the 20 cents per mile allowance.

Participation in a Health Care Flexible Spending Accounts should be approached with some caution. Any money put into the accounts pre-taxed must be used for expenses within the plan year or the money will be forfeited at the end of each year. I had planned to get an implant this year that was going to cost about $1800. The implant could not be scheduled this year so I ended up with $1800 more in my flex account than planned. This led me to start combing through the list of reimbursable items allowed by the IRS to see what I could use to retrieve some of my cash. The transportation expenses were a great discovery that I was not aware of even though I have been a faithful flex plan participant for more than 10 years. The transportation expense reimbursement along with regular co-pays, over the counter medications, deductibles, and other medical expenses is allowing for me to utilize the entire $2100 that I diverted into my flexible spending account pre-tax this year. My total tax savings will be as much as $588 based on a 28% tax.

I encourage you to investigate your benefits package to see if it includes a Health Care Flexible Spending Account. If you are already a member, then I hope you are making use of the transportation category to save you some cash on gas.

It has been a rough few days for our family.  My son Caden remains hospitalized after a surgery that he had on Wednesday.  We expected to be discharged in less than 24 hours.  We are in the middle of night three at MUSC.

It has been reassuring to read 2nd Timothy this week during daily reading. I found myself reading one of my favorite verses in such a timely fashion. I have spoke this verse out loud during several prayers since Wednesday.

“For God hath not given us the spirit of fear; but of power, and of love, and of a sound mind.” 2 Timothy 1:7

Remembering this truth and reading about Paul’s sufferings and his encouragement for Timothy has helped to keep things in perspective this week.