I was happy to see President Obama on TV last night talking directly to the American people about healthcare reform. He has seniors and children in his family and he understands problems facing the elderly and the young.

Healthcare has had runaway expenses for decades. And they won’t end until we change the way we reimburse hospitals and physicians.

Yet the American people are afraid of healthcare reform. Why? Because the insurance companies have been using scare tactics. They want us to believe that we won’t be able to choose our own doctors, we’ll have to wait to see them, and we’ll have to tolerate poor care.

Meanwhile, these same companies are earning vast profits while repeatedly raising the cost of insurance and denying it to those who need it. They remind me of the oil companies charging $4 per gallon while reaping record profits. But the carriers are affecting the health of our people, not just the cost of driving on a summer vacation. And no oil company ever shut off the pump just because you really needed gas.

We are all at risk of being victims.

It’s not just the poor. It’s everyone. A medical crisis can strike you or me at any point. We can be laid off or our child can be diagnosed with, say, diabetes. Then we need to ask ourselves: How do we get healthcare?

Cobra? It will help temporarily, but it is pricey. You suddenly pay the entire cost of coverage for you and your family. And the timing is always miserable. You face a big new expense just when your income has vanished and you still need to pay your mortgage and put food on the table.

But let’s assume you can afford it. What happens when Cobra runs out? Can you get insurance at all?

When your employer covers you, insurers don’t inquire into your health because they cannot deny coverage in a group plan. All that changes, though, when you seek your own policy. Then they ask pages of questions and they may deny you coverage because of pre-existing “conditions” which are scarcely conditions at all.

I have a friend who was a corporate attorney for a large company in Silicon Valley until she got laid off last year due to downsizing. Cobra covered her and her daughter, and luckily Obama’s ARRA paid for some of that cost.

But now her Cobra benefit is ending. She started researching the cost of insurance with Blue Cross, her current insurer. At first, she was told that she couldn’t get insurance at all because of a pre-existing condition. She’s 49 and has fibroids. They are benign and do not bother her and her physician recommended leaving them alone and monitoring them. Uterine fibroids are not unusual in women. In the last eight years, there has been no change in the fibroids.

She then went to a broker to get Blue Cross coverage and submitted an application. She asked the broker whether Blue Cross would accept her if she had the fibroids removed under her current Cobra coverage and then applied for individual coverage (without the fibroids). The answer was yes.

So to get health insurance with her current carrier, she needs an operation that her doctor recommends against, for a condition that does not physically bother her. Her current carrier would actually pay for it. She must incur the risk of the procedure, the risk of medical error, and the risk of contracting an iatrogenic illness, and she must endure discomfort for at least a few days and still take care of her daughter. All of this cost, trouble, and hazard in order to qualify for insurance coverage.

Is there any doubt about why premiums are going up? Is my friend receiving “quality healthcare” by having to undergo pointless surgery? What if the operation goes badly and as a result she still can’t get insured?

And why should a healthy person need surgery to get insurance at all?

Carriers are cherry-picking the healthy where possible. They are shunning those who most need help — and in the process, stranding many healthy people too. None of this happens with group insurance. As long as your employer pays, you can be insured without revealing your medical history.

So these are the real questions each person needs to ask himself:

  • Can I afford Cobra if I am unemployed?
  • Do I have any condition, even an apparently minor one, which might give an insurance company an excuse to deny me coverage?
  • What do I do if no insurer will cover me?

The real questions are not:

  • Will I have to wait a week before I can get non-urgent surgery?
  • Can I keep my own doctor? (Unless you know your doctor will treat you for free.)
  • Will I get true quality care? (Unless you can figure out a way to get quality care while getting no care at all.)
  • It could be you or your family or relative or friend who loses a job and faces a void in healthcare. What are they going to do?

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