AmericanHealthPlan.org

A pair of great newspaper stories this week measures the health care crisis better--and way more readably--than any spreadsheet or white paper. I sure hope the next president has read them. One, in the New York Times, offers the news that women pay 20% to upwards of 40% more for identical health care insurance, even when the policy doesn't cover maternity care. The other, in the Los Angeles Times, is the story of a middle-class truck driver essentially sentenced to death by private insurers, then failed by the state's own health care safety net.

They're both examples of the dogged reporting that we'll lose if newspapers keep weakening.

The most striking thing about the women's price disparity is that the insurance companies see no problem with it. 

Thomas T. Noland Jr., a senior vice president of Humana, said: “Premiums for our individual health insurance plans reflect claims experience — the use of medical services — which varies by gender and age. Females use more medical services than males, and this difference is most pronounced in young adults.”

Health insurance companies treat the data on which they base their pricing as a trade secret, so it's impossible to verify their claims. But the excuses seem fishy. As the NYT story noted:

Marcia D. Greenberger, co-president of the National Women’s Law Center, an advocacy group that has examined hundreds of individual policies, said: “The wide variation in premiums could not possibly be justified by actuarial principles. We should not tolerate women having to pay more for health insurance, just as we do not tolerate the practice of using race as a factor in setting rates.”

And here's the paragraph that sent me over the edge:

In addition, Mr. Noland said, “Bearing children increases other health risks later in life, such as urinary incontinence, which may require treatment with medication or surgery.”

Consumer Watchdog has also found that private insurers will not sell an individual policy to a woman who is or is planning to become pregnant. They will not even sell a policy to a man whose wife is pregnant. They won't insure a baby until it's born and pronounced completely healthy.

How can our politicians defend an insurance system that is so baldly discriminatory and anti-family? Yet there are proposals in both parties to give individuals tax credits (same size for both sexes, of course) to buy into this slice-and-dice private system, instead of offering real insurance to all of us. Ugh.

The Los Angeles Times story is about the utter failure of California's stingy, limited health insurance safety net program. It's supposed to offer affordable health insurance to people with middle-class incomes who've been rejected for "health reasons" by private insurance companies. It introduces the problem with a really shocking tale:

Dave Dunlap is a Kern County trucker with a failing liver. Like about 600,000 Californians, he is too sick to qualify for private insurance on the open market.

"I'm trying to fight to get a transplant," he said. "Everyone's waiting for me to have a way to pay for it. I can't even get on the donor list until I have a way to pay for it." ...

Dave Dunlap's problems have grown since he was diagnosed with Hepatitis C in 2003. Dunlap, a 54-year-old from Pine Mountain Club, about 60 miles north of Los Angeles, said the disease weakened him so much that he was in two traffic accidents and had to stop driving his 18-wheeler.

Cirrhosis caused by the infection is now in the most advanced stage, according his medical records.

His wife, Susan, said his liver has broken down so much that sometimes she can smell the odor of his body discharging toxins through his skin.

"I suppose in different phases it is controllable, but not when you're at the end," she said. "My husband is dying."

She said a liver transplant and a year of drugs to prevent his body from rejecting the new organ would cost more than $350,000.

The Dunlaps said they had never heard of the state's high risk pool, but given its premiums and benefit cap, it would be of little use to them.

"We couldn't afford it anyway," Susan Dunlap said. "I sell real estate, and obviously real estate isn't selling."

It's no surprise that the Dunlaps hadn't heard of the state insurance pool (which, by the way, has a yearly limit of $75,000, which an acutely ill patient could blow through in a week of intensive care). Of the estimated 600,000 people in Dunlap's position (not poor enough for public assistance, too poor to get treatment), only 13,000 are in the state pool. 

California is supposed to have a solution for people like Dunlap. It is one of 35 states that arranges health coverage for people rejected by commercial companies because they have blemished medical histories.

This group -- known as "medically uninsurable" -- accounts for about an eighth of the 5 million Californians who lack health insurance. Most are self-employed, work for companies that don't provide insurance or don't have a job.

But California's publicly subsidized high-risk pool, long one of the least generous in the country, has atrophied over the tenure of Gov. Arnold Schwarzenegger -- even as the governor put the plight of the uninsured at the top of his political agenda.

Rising premiums and limited subsidies have made the Major Risk Medical Insurance Program either unaffordable, unavailable or ineffective for many of those who most need health insurance.

The program now covers about 13,000 Californians -- about 2% of the medically uninsurable.

Enrollment has dropped by almost a third since Schwarzenegger became governor.

Schwarzenegger last month vetoed a measure that would have expanded the 17-year-old pool, overruling the bill's endorsement by the pool's own governing board, most of whom he appointed.