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Health care is a crisis that sees no party

If you're not one of the fortunate people with an employer-based insurance plan, the system is broken.

By JOHN HEWKO

Last update: October 21, 2009 - 3:13 PM

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I am a Republican who did not vote for President Obama. But I support his health care initiative because I have just experienced firsthand our system's dysfunctional wrath.

Recently, I left my job with the federal government and became an independent consultant. Although I have access to health insurance under the COBRA law, the premiums are extremely high and the coverage expires after 18 months. So I applied for individual coverage with CareFirst BlueCross BlueShield, the carrier that covered me while I was a federal employee.

I am a healthy 51-year-old male and an avid cyclist. I don't smoke or drink. During my last physical, my doctor told me that I was one of his healthiest patients in my age group. Apparently, being healthy and physically fit is not good enough for CareFirst. To my surprise, the company denied my application.

I have borderline hypertension that is well controlled with a minimum dose of medication, and I have mild stiffness in my left shoulder and right hip, for which I take an occasional Advil.

This combination of "preexisting conditions" -- conditions that millions of Americans my age experience -- was the basis for a complete denial of coverage. Not slightly higher premiums, not a short-term exclusion for the preexisting conditions, but a flat-out denial.

However, CareFirst was kind enough, in its rejection letter, to send me an application for a guaranteed coverage policy for twice the premium, with astronomical deductibles and a $1,500 annual maximum coverage for prescriptions. In other words, even though I am healthy, I can't get comprehensive individual medical and prescription coverage with this company at any price.

So I am forced to roll the dice with my health. What happens when my COBRA runs out? Will I again be denied when I apply for coverage after 18 months, particularly since my "preexisting conditions" aren't going anywhere, and many companies ask whether a previous application has ever been declined? Should I cancel my annual physical for fear that some new condition might pop up? Or, do I take a job, any job, so that I can get covered through an affordable employer group health plan?

And, even if I am able to get nongroup coverage, will my policy be rescinded later because I forgot to list a medical condition on the application, however minor or unrelated the omission was to the illness being treated?

William Kristol, in a recent commentary in the Washington Post, stated that "there is no health care crisis." He either has a cynical hidden agenda or is ignorant of what millions of Americans who don't have access to employer-based plans face. The system is broken.

No silver bullet will solve all our health care problems, but four measures would address one of the most glaring weaknesses of our system: mandatory insurance for all; subsidies for those who can't afford the premiums; a prohibition against denying or rescinding coverage for "preexisting conditions," and meaningful tort reform. Yet Congress continues to make the ideologically perfect the enemy of the desperately needed good.

To those Americans who are insured through their employers and are puzzled by all the buzz about a health care system in crisis, just remember: You are but a pink slip and a minor preexisting condition away from insurance hell.

John Hewko is a lawyer affiliated with the Woodrow Wilson International Center.

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