The Personal Dide of Health Care
by Karrie Andes, Employee Benefit News
Staring down at the toilet in the hospital restroom, it became painfully clear to my stepfather that his yearly routine outpatient test had turned into anything but routine. Although he had been through this test a million times before, this time he was making friends with the hospital commode.
The outpatient staff, anxious to get him to leave, swiftly explained that nausea and cramps were sometimes side effects from the anesthesia, and he might throw up in the car on the way home. They handed him a little blue plastic baggie.
It was 5:15 p.m., 15 minutes past closing time, and the outpatient office staff clearly made it known they were ready to leave – the lights were turned off, the beds made, and they paced outside the bathroom door waiting on the last patient.
My mother hit her limit. She not only was angry and resentful of the outpatient staff’s attempt to shove them out the door, but also felt remorse on how much the whole ordeal was going to cost. This visit – coupled with the bonus of rude treatment – would cost them dearly in deductibles, copays and coinsurance. In just a few hours, they spent more than some spend in a month for mortgage or rent.
If you met my stepfather, you’d be greeted by a smile that brightens the room and a handshake that makes you feel like family. You’d also notice he’s missing an eye. What you wouldn’t see, though, is the display of “railroad track” scars under his shirt and the metal plate in his head.
Serving as a radio control man during the Vietnam War proved to be hazardous duty when he stepped on a landmine. He conveys an appreciation for life that I can never comprehend. Working for a local school district for more than 38 years, he’s held a variety of jobs in the building and grounds division. He’s cut grass, plowed snow, delivered supplies, cleaned schools and greeted the police in the wee hours of the morning when the building alarms went off.
And he’s always going to need health care.
As reported by The Heritage Foundation in June 2008, manual labor occupations represent 28.7% of the workforce, while those who work in the service industry represent a whopping 44.3%. These people work in low-skill or labor occupations. These are the occupations that keep our country running and are essential to our economy. It just so happens that my parents fall into this category.
Perhaps it’s my humble upbringing – being raised by a single mother – or maybe it’s because my job makes me acutely aware of the annual wages our lowest-paid workers receive, but every time I make a health care decision, I look for any alternatives I can find that help negate costs.
There are several ways to bring down costs without pushing the burden. If you have 200 or more lives on a plan, consider self-insurance. Roll up your sleeves and dig into disease management. Implement a mandatory generic drug provision. Negotiate prescription rebates, subrogation, recovery services and transplant networks. Exclude experimental services. Hire professionals to view high-dollar claims and audit the rest. Shop for a new provider network and aim for the big discounts. Go out to market. Find out what the hot buttons are in your group and work toward fixing them. Educate the group on areas of savings for them – it helps your health plan, too. There are tons of management areas that can be tapped.
In the recognition section of a popular human resources magazine, I saw a picture of a benefits manager who worked for a major corporation. The article highlighted her accomplishment of moving their blue-collar manufacturing workforce to a consumer-driven health plan. Although the company’s shareholders sang her praises for saving the company millions, my heart sank.
I wouldn’t have been proud to have implemented such a plan. I’ve never liked CDHC plans and never will. To me, it’s simply a way to cost-shift and reduce utilization in the plan. Whether to implement CDHPs, I believe, will always be a debate. Let’s just leave it at that.
But what I won’t leave behind is my responsibility to the people that I make decisions for. Someone once said to me, “Karrie, the biggest comment about you is that you are an employee advocate.” I remember thinking, “What’s wrong with being an advocate?” It helps the employees and my company. To me, it’s the best of both worlds.
Being a vet, my stepfather will always need health care. He doesn’t smoke or drink. He isn’t overweight. He’s active and eats well. He doesn’t drain his health care plan or overuse services. He simply takes his medications and knows he has several outpatient tests that he’s going to need on an annual basis.
I cringe each time his open enrollment period comes up. My parents call and ask for my advice. Each year, the premiums go up, the deductibles and copays go up, and their spirits go down. I try to be encouraging, but deep inside I know they don’t have a person like me analyzing their plan, trying to squeeze blood out of a turnip.
Perhaps the next time you’re faced with making plan design changes, you’ll try to protect workers and retirees like my stepfather.
