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:

Individual Coverage:
Medical: $121.88
Dental: $48.00
Vision: $24.00
Prescriptions $10.00
Total: $203.88

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.

Sources:
http://phobias.about.com/od/treatment/a/obamaplan.htm
http://www.aarp.org/work/employee-benefits/info-12-2010/benefits_what_does_congress_really_get.html?plckOnPage=2
http://usgovinfo.about.com/od/uscourtsystem/a/scotusretire.htm
https://www.pcip.gov/
http://content.healthaffairs.org/content/25/1/57.long

Acknowledgement: The author appreciates the assistance provided by MurphtheSurf3 in research, editing and the publication process.

23
Leave a Comment

Please Login to comment
5 Comment threads
18 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
5 Comment authors
AdLibKQµårk 死神BourneIDMurphTheSurf3choicelady Recent comment authors
  Subscribe  
newest oldest most voted
Notify of
AdLib
Admin

The GOP has always been the party of, “I got mine, you don’t need yours.” It’s now a cliche and a given to call Repubs hypocrites, in fact, you can pretty much depend on Repubs to be hypocrites on just about every issue.

As you well describe, Bourne, they are hypocrites on attacking the ACA. Add to that the deficit since the Ryan plan would blow up the “must-cut” deficit through tax cuts and their attack on government having too much power paired with their approving of government forcing women to be vaginally violated if they want to exercise a right Republicans disapprove of.

Maybe we need a new Constitutional amendment that allows the people to recall elected officials based on a pattern of hypocrisy. That would really put the GOP out of business!

Report this comment

MurphTheSurf3
Editor

Ad Lib….nice link between the Justices on the Right and the GOP culture of “I got mine and to hell with you.” I listened to the Romney Campaigns tele conference today on Women’s Issues and was stunned at how inept the Romney surrogates were- the most obvious points regarding equality of pay, access, and treatment were unknown territory to them. The hypocrisy is real…so is the ignorance….followed by the arrogance. And yet they are support, automatically, by 40 percent of the electorate…frightening.

Report this comment

AdLib
Admin

Cheers Murph!

It’s hard to get used to but Romney and the GOP will always be unable to provide sensible and convincing arguments to rebut their prejudices against women…because they support prejudice against women.

All they can do is clumsily dance around the truth and try to present their weapons aimed at women as “protecting” them from Obama.

It will never be anything other than awkward and transparent. They hold positions that are anti-women but need the women vote. They won’t change their positions so they instead try the infantile tactic of, “I know you are but what am I?”

Women are not stupid. You can’t take away their rights and violate them medically through government order then tell them how you believe in their equality.

This is an inescapable anchor for the GOP and Romney that keeps them down among women and thus the majority of the electorate. It’s kind of intertesting, before all of this I thought it would be the 99% argument that would doom Romney but his need to satisfy the Baggers took him so far against women, there is no full recovery possible.

He may reduce the gap but never enough to prevail in November. Being that he has cemented himself as a liar and flip-flopper, most women will never believe any assurances he gives to the contrary, that he doesn’t want to destroy Planned Parenthood, won’t restrict women from birth control coverage or will respect a woman’s rights over her own body.

We may be 7 months out but whatever happens with the economy, Romney is the walking dead when it comes to the women’s vote and losing that by a lot, it’s impossible to win the Presidency.

Report this comment

KQµårk 死神
Member

Bravo surf. I’m so glad you mentioned the FEDERAL EMPLOYEE HEALTH BENEFIT (FEHB). That’s what the exchanges will look like in most states including a non profit insurance plan of some kind. For the most part Obama delivered what he promised the same type of plan government has. People now forget the whole public option was mostly a post election plan.

CL and I argued when we had the Dean and Hamsher ‘kill the bill’ people that they wanted to kill the bill because they had no skin in the game. The same goes for GOP politicians like you said. The most ridiculous part is they have skin in the game and don’t know it. Their future premiums will go down with the ACA too because they won’t be paying for as many uninsured going to the ER who can’t pay their astronomical medical bill. We will all feel the pain when the country goes bankrupt without the ACA and it’s prescriptions to change Medicare.

But of course all that could be moot based on one or two men’s decisions who already have excellent healthcare coverage and we could be headed for a bigger healthcare disaster.

Report this comment

choicelady
Member

Bourne – very interesting assessment of the existing federal plan. I gather we live in the same area and you get SUTTER which was dropped from MY Blue Shield as too expensive. I have UCDavis which is fine if rather impersonal. Oh,well…

Today the ACA is actually better for lower income folks I think – lower deductibles, lower out of pocket than you’re paying. The premium (borrowed directly I think from CA single payer) is on a sliding scale of 1-9% depending on income from 134% to 400% of the Federal Poverty Level.

That’s an amazing subsidy very different from “Romneycare” that gave a flat premium subsidy and danged what it cost you as you got older, lived in the wrong place, etc. If the government gave you a credit of $200 but you had the marked incivility to be older and female and your premium was over $900 – well, toots, YOU have to make up the $700. And in exchange for the GREAT subsidy you ALSO had a $5000 deductible and an additional $10,000 out of pocket if you got sick. That’s an additional $15K per person per year. In MA too many people are using this as catastrophic care because they cannot dip into the deductible, they do not have the money.

ACA exempts dozens of things including colonscopies ($1800-3000 per test) from your deductible. People can use Obamacare, where they could NOT use Romneycare, to stay well or catch things very early such as pre-cancerous polyps that get removed and prevent harm.

The one thing I think does resonate with SCOTUS is the issue of health care as our obligation to one another. It is the only thing we are MANDATED to provide – we will not allow hospitals to dump you by the side of the road if you’re uninsured. BUT when you cannot or will not pay – WE have to. The forced payment via increased premiums or taxes that we all pay for uncompensated care is astronomical. Unless we want the Ron Paul audience’s “let him die” standard for America, the government can ask that people take personal responsibility NOT to be burdens on society.

What amuses and amazes me is those who think “you can always go to the ER” is perfectly fine where “I’d never take charity” they boast. Well, dumping your health care costs on us IS taking charity, is living off us, is dodging your obligations, IS a form of “welfare fraud”. The son of a friend got into a fight and broke his jaw – went to Kaiser that fixed him, no question, and set up a payment plan. And he skipped. He only had to pay $200 per month – but he preferred to bar hop rather than pay his bill. He drank that much up in a week. But it’s “unfair” to expect him to pay. Uh-huh. Right.

So I think the justices – at least some of them – got it. The intolerable burden of the uninsured passing their costs onto us is something even Roberts, Kennedy, and EVEN Alito alluded to or said outright. I’m hoping they realize that THEIR great health care might not survive if we don’t get people to accept their own weight in this health care debate. For alleviating that societal burden the government has every right to require that we accept our own responsibilities for our own health care coverage.

But – we shall see what the Great Minds of todays’ SCOTUS believe is the bottom line for government and the rest of us. But if they overturn the mandate they have JUST unleashed the era of absolute irresponsibilitiy, and for even most of these lightweight minds, that might just be too much.

Thank you for wading the waters of federal health programs for federal employees. I have a much better sense of it all thanks to you! But I AM peeved you get Sutter and I don’t! Rats!

Report this comment

KQµårk 死神
Member

Hi CL. Spot on 100% true as usual. The GOP hypocrisy on healthcare rises to a new lever.

But if they overturn the mandate they have JUST unleashed the era of absolute irresponsibility…

No truer words have been said.

Report this comment

MurphTheSurf3
Editor

Choice….as always you weigh in with a great data base and vast experience. I am going to read this through another time or two to get a better grasp on it.

Report this comment