They’ve Got the Best Health Care Tax Payers’ Money Can Buy
For the Justices of the Supreme Court, and the members of the Congress opposed to the Affordable Care Act there is no risk for them if the ACA is knocked down. They will continue to enjoy very fine, very affordable coverage in a tax payer supported program that does as much for them as the ACA hopes to do for most citizens and more. But they have no reason to be personally concerned about throwing health care reform under the bus. They are covered.
Simply put, the ultimate goal of The Affordable Care Act, (a.k.a. Obamacare), is to provide most Americans with the level of care the President, Congress, the Supreme Court and most federal employees have for themselves and their immediate families.
I know about this care from my 30-year experience as an active (now retired) federal civilian employee. The plan is great. But you wouldn’t think so given what the GOP has put forth regarding ACA.
The GOP has so intensely and successfully embedded the notion that the ACA will bankrupt the nation while destroying the quality of our health care that there is widespread popular support for setting Obamacare aside. This obsession with the debt is curious when that same GOP had few problems with two wars, massive tax cuts, an explosion in the size of the government, Medicare D, and a host of supports for big business when their impact on the national debt has been and continues to be far greater than that of the ACA.
The $2 trillion cost of two wars which have reaped very few benefits over 8 years is acceptable, but the $1.76 trillion cost for health care reform over a 10 year period is deemed excessive. Furthermore, that $1.76 trillion cost is offset by explicit savings and new funding sources. In fact, the CBO projections show it reducing the deficit in the mid and long term. No such claims could be made for those two wars.
THE FEDERAL EMPLOYEE HEALTH BENEFIT (FEHB) AND HOW IT WORKS
The President, the members of the Supreme Court, the members of the Congress, and most of their staffs and other federal employees count on the FEHB to care for their health needs.
The Office of Personnel Management (OPM) manages the FEHB Plan. It negotiates costs with the insurance companies and health care providers for services to its members. It functions as an insurance exchange much like the one the ACA proposes to establish for those who are not privately insured or insured through an employer.
President Obama said early in his presidency that he wanted all Americans to have the same quality health care that he and Congress access. It’s the same kind of plan the Supreme Court now holds in its hands.
In the federal program the key is choice. Many plans are available from which to choose. They vary throughout the country; costs depend on location. I live in California. My plan offers Blue Cross/Blue Shield (BC/BS); Health Net; Kaiser, et al. I have BC/BS. Within that plan are several providers: Catholic Healthcare West (CHW), Kaiser, Sutter Health, etc.
Every year, from mid-November to early December, the Office of Personnel Management (OPM) offers Open Season during which members make changes in providers, adjust payments, select or jettison various coverage elements, and even change plans entirely without loss of benefit. A member’s plan cannot be cancelled unless personally requested in writing. If that choice is made, coverage is lost; the member may not re-enroll.
EXAMPLES OF SERVICES AND COSTS
The costs have always been reasonable and the coverage excellent even for Basic Medical. But for the first time, three years ago, OPM negotiated for Vision and Dental care, the costs of which, like Medical, are borne by members and deducted from current or retirement pay. Vision covers one exam per year with one pair of free glasses. MetLife Dental for a single person such as myself provides annual coverage of $10,000 including the rarely covered implants.
Here are the monthly BC/BS premiums for Basic coverage, reflected in its Service Benefit Plan manual. Fees are deducted from current or retirement pay:
So, when I had a vision problem here is what two office visits to my general practitioner and one referral visit to an ophthalmologist cost as billed on the same PHYSICIAN STATEMENT:
Total Charges: $682.00
Plan Allowance: $207.00
BC/BS Payment to Medical Providers: $132.00
MY DIRECT PAYMENT TO MEDICAL PROVIDERS: $75.00
The Plan Allowance is the OPM-negotiated cost. Great deal, yes?
How does the plan do with hospital related costs? Here is one example. In a cluster of four billings for my 2010 surgery, the surgeon fee, hospital care, in-hospital prescriptions, x-rays, MRI, physical therapy, two weeks in an assisted care facility, and six in-home nurse visits were billed at:
Total Charges: $79,888.00
Plan Allowance: $10,875.00
BC/BS Payment to Medical Providers: $9154.00
MY DIRECT PAYMENT TO MEDICAL PROVIDERS: $1,721.00
The cumulative charges (all billing) for the surgery/hospital/recovery was: $146,095.00. My plan allowance was $22,585.00. BC/BS paid $18,921.00. My out of pocket cost (what I paid directly to the medical providers) was $3,664.00.
THE BOTTOM LINE
The Bigger the Pool, the Bigger the Savings
Why was this so affordable? The United States Government is the greatest negotiator in the world. Insurance companies and health providers agree to accept specific maximum limits for their services, which are far less than they bill individual clients. Of course, this is also true of insurance policies in general. Most insurers pay 30 to 38 percent of the “billed” cost of medical care. Think of those medical bills in the same way as smart new car shoppers think of the sticker price on a car- only far more inflated.
The Federal Government gets the best rates because its pool is so large (FEHB plus Medicare plus Medicaid plus Veterans Affairs ). Imagine what National Single Payer (Medicare for All) would do?
This is why so many other developed nations with national health care programs get so much more coverage for so many more people for so much less money.
The SCOTUS, the President, the Congress etc. have an excellent federal health care insurance plan but when it comes to providing such a plan for most of its citizens, it seems that not only are the GOP in Congress, joined by a number of state governments, willing to throw the citizens under the bus, but the SCOTUS’s conservative justices may also be willing to drive the bus that runs over the rest of us.
Acknowledgement: The author appreciates the assistance provided by MurphtheSurf3 in research, editing and the publication process.