Just saw the CNN report on 13 million uninsured 20-somethings in this country. New to the job force and turning down their health insurance.

What are they thinking?!?! Do they believe that they can just go out and buy what they need in terms of medical goods and services on the free market? Good grief! This is America for goodness sakes.

So what are they doing in lieu of buying insurance?

Radical things like minding their health– watching what they eat, working out, bundling up before they go out in the cold, washing their hands (oh, these kids – they’re like modern day hippies shunning the norms of society).

They go to the doctor only when absolutely necessary instead of for every little ache and pain. They go to retail clinics (like Minute Clinic and The Little Clinic) where they know the costs BEFORE they buy (oh my, what are these kids coming to wanting to know the price before they blindly incur the expense). They look things up on the internet (It may be MY chronic disease but shouldn’t the doctor know more about it than me? He treats it, and I only live with it…every single day of my life).

But why should these 13 million have insurance? In case something happens.

Hellooooo – they’re 20-somethings and invincible.

But seriously, why should they? Because it underwrites the rates of the older portion of the population. If they don’t get healthcare, they don’t offset the risk pool – they don’t underwrite the older segment of the population. And we know what that means – our rates will go up because they aren’t contributing monetarily (and taking less out than they put in) as we expect them to do.

But we can still get them. In New Jersey, children can stay on their parents insurance to age 30! Thirty!!!! In many other states it’s only 24 or so.

So now I’ll set aside the sarcasm.

What we are seeing is the revolution. The new generation is taking a stand. We have a product – health insurance – AND THEY ARE NOT BUYING! The business world should get the message here. These folks are going to opt for surgery overseas, retail clinics and internet consults. They are going to cost shop prescriptions and doctors. They are going to demand affordable access to care and they are going to want to know the price AHEAD of time. And they are going to return health insurance to truly being insurance – a safety net for catastrophic situations instead of the all you can eat buffet for $20 we have bad for soooo long – too long.

Do NOT think that it is the sage old regime of healthcare executives and politicos in D.C. who are going to change healthcare. It is the 20-somethings. They alone are able to break out of the old ways of thinking. It has been that way generation after generation. THEY have the new ideas. THEY are taking a more rational approach. They are getting organized and THEY are not content to go along with the system as it has been.

Yes, they are 13 million without health insurance…and growing. THEY will change healthcare.

I have learned not to put complete blind faith in my Insurer. I do NOT blindly pay outstanding balances from providers and assume that my Insurer processed the claim properly, and neither should you as this story will show. Even though I’m a pretty savvy healthcare consumer (this IS what I do for a living – understanding the healthcare industry), this one had me confused for while.

My wife took my kids to a Clinic for their flu shots (No, I didn’t go and get mine, and that makes me far less of a person than those of you who did). Flu shots fall under “well care” on our plan, so there is no charge.

But then I got a bill from the clinic, an in-store deal – very convenient (I know, I should have gone too, stop already). The bill must be a glitch I told myself. I decided to wait and see if they figured it out rather than spend time on the phone with them and with my insurer. Then I got a statement for the bill again. Odd, I thought.

And then, I got a nice letter from Insurer asking me to confirm if I had another insurance plan. I procrastinated, was moving residences, etc. and did not answer that letter. I did not make the connection.

Doing something else entirely, I logged in to the online view of my insurance account (which I must say is a weak “silo” view of the information my insurer has). They only had two claims for the past year. That was wrong, I knew. Hmmm. Must’ve logged into the account for our previous policy (still active 2 years after moving off of that plan – can you say “we never update”). Yup. Logged out and logged in with the other username/password combo and suddenly, there are my claims for the year on my current plan.

Only then does it dawn on me. The clinic submitted the claim on the old insurance and did not confirm new insurance, or if they did, they simply accepted that my insurance info was current with them. My previous plan and this plan were with the same Insurer, so it’s an honest mistake.

So now my Insurer has denied the claim on my old insurance plan. The clinic wants their money because the Insurer denied it. Now I’ve got to go and straighten out both of them because my insurer who had BOTH policies is not able to do a simple lookup on my SSN and determine yes, I do have another policy AND LO AND BEHOLD IT’S WITH THEM!! Who’d a thunk since they only have 65% of the entire health insurance business in the state.

It’s only $60 bucks – 2 flu shots at $30 each, but it’s my $60. It’s money they planned on spending in the plan, so it’s paid in. Most folks would have simply assumed that the shots weren’t actually covered and paid the $60.

Thankfully, I called the Clinic’s 1-866 number, and Mona was very helpful and walked through things with me and resubmitted the claims.

Don’t put too much faith in your Insurer.

Good thing I have health insurance… cause I’m not ready to be married!!! Seems in a recent article by the New York Times “Health Benefits Inspire Rush to the Alter” that 7% of adults say that someone in their household had married in the past year to gain access to health insurance (according to a Kaiser Family Foundation study).

Now at first glance that doesn’t seem like a large number, however I think it is important to not consider the actual amount of individuals who have married for insurance, but rather that they are willing to make a life changing decision in order to obtain health insurance coverage (the Foundation also cautions not to take the number literally).

I find this to be so interesting, and admittedly it could be due to my young age (23). But I simply cannot decide if it is better to be without health insurance coverage for myself (I am sure many of these decisions involve children) and suffer the burden of a system that shuns individuals without coverage, piling on bill after bill, or to get married. To marry or not to marry - for health benefits???

Ok lets get back to the basics - money and marriage are undeniably linked. The government provides tax “incentives” to married couples, some people simply marry for money, and dowries existed for centuries. But I feel pretty good in assuming “marrying for health insurance” is something that has recently taken flight due to the consistent increase in insurance premiums and healthcare costs.

The distress caused by these issues makes me nervous.. first for the upcoming election, and the next presidents willingness to address and hopefully solve these problems. Second, because I do not feel like we (American citizens) have a tangible grasp on a solution to rising healthcare costs. And third, not everyone is feeling the pain. This means that some people are struggling with their healthcare costs daily, while others are still frivolously accessing the system, paying their $20 copay, and having no idea of the real cost of their care.

Here’s an example of the other extreme. Mr. Moulton and his wife, who has liver damage, considered divorce. This was the only way she could qualify for affordable health insurance coverage which would have been provided and subsidized by the state. She said, “Nobody should have to make a choice like that. What happened to our country? I don’t remember growing up like this.”

Scary… gives me chills. Core family values are hard to maintain when you are broke, sick and uninsured. It makes me wonder what will happen to my generation if we do not get involved, control our costs, find a solution - but most importantly try to make a difference. I mean we are already marrying for health benefits… what’s next?

So with the high cost of energy and that subsequently driving the cost of many things including delivering goods and services, it is small wonder that healthcare is starting to see people cut back.

I’ve seen a good number of articles already on people allowing their insurance coverage to lapse. They are forgoing the premium cost in an effort to save money. That’s a big short-term gamble. It’s a HUGE long-term gamble. Chances are, if someone drops their coverage, they won’t see a need to pick it back up until, well, they really need it. And then it’s too late.

And people are starting to cut back in other ways, too. In the face of efforts by employers to implement wellness programs and disease management programs, people are starting to act counter to that arguably wise practice. A recent WSJ post documents how Americans have begun to forgo those screenings and well care visits. that’s like not putting a new roof on a house until the rain water coming in has rotted out the floors from the leaks.

There are lesser ways to cut healthcare costs. Find a lower cost provider of the service you require (sorry for the shameless self-promo, but it’s what we do). Find a provider closer to you, so you don’t incur the fuel costs (again, sorry for the shameless self-promo, but…). Shop your prescription prices (um, sorry…). Just get engaged with your health and be aware instead of being passive. After all, it is your health, and if you don’t have your health, what do you really have anyway?

So the Mass. attempt at “socialized” healthcare turned one year old today. CONGRATS!

Our resident Bostonians on staff @ change:healthcare, George and Vic, must be so proud. Oh wait, they’ve already fled the state to be here.

Nevertheless the plan seems to be working well according to Julie Appleby of USAToday - residents are getting better coverage…and premium rate increases of 5.1 to 9.4% unless you take the person profiled in the article who got a 45.7% increase in premium over the first year’s premium. Wow! Even the private insurance industry is hard pressed to pull that one off!

An excerpt from the article: “I almost fell on the floor,” says Pelletier, 55, of Newbury. “Costs are getting out of control.”

No kidding.

People will eventually make the connection. The decisions you make regarding their healthcare - when to go, whom to see, and what to pay - are what ultimately determines the premium. The premium is an effect, not a cause.

Happy Birthday!

So it turns out that I have been living under a rock the past week and did not hear about the Walmart vs. Shank story until yesterday when Walmart reversed its position. For those of you who have been living under a rock as well, here is a recap:

Ms. Shank signed up for Walmart’s health plan which contains a clause that states that Walmart may recoup money from an employee for medical expenses if said employee collects damages from an injury suit.

Ms. Shank was enrolled in Walmart’s health plan for about 3 months when she was in a car accident that put her in a wheelchair and caused brain damage which took most of her short term memory.

Walmart paid about $470,000 for her health care.

The Shank family sued the trucking company responsible for her accident and received a $1 million settlement.

Walmart then sued the Shank family to recover their costs for her health care. They just decided yesterday to reverse their position.

Now I know that all of the blogs and comments on various news stories are ripping on Walmart for wanting the money.  Everyone seems to be considering the age old question of who needs it more… a disabled woman, or a company with a net profit of around $11 billion.  My background in philosophy and my own moral beliefs tell me that the woman obviously wins.  But there is so much more to consider here…

Last year Walmart paid $5 BILLION to cover their US health care costs.  They provide health insurance policies for full time workers after six months and part time workers after 12 months.  I hate to argue this point, but I would guess that the majority of these employees were previously uninsured and are now even able to provide health insurance for their children and spouses.

I hate to stereotype, but there is this American mentality that health insurance should be covered and paid for by employers… and this lack of social responsibility concerning how much YOUR health care REALLY COSTS.  Yes I believe that our country will remain better off the less that the government is involved in our health care, and that employers should continue to be offered tax breaks and rewards for providing employees with insurance coverage.  However, I also believe that everyone should get more involved in staying healthly, researching their health insurance costs, and  paying more out of their own pocket for health care… cause unfortunately when it doesn’t hit YOUR POCKETBOOK, you don’t seem to care how much it costs.

Now I am not saying that Walmart should be entitled to receive all of the money back for Ms. Shanks health care.  However I think that we need to consider more about what it means for a company (in our capitalist society) to pay $470,000 dollars for a worker who will never work for that company ever again.  As much as we want to make Walmart out to be the big bad wolf, I imagine that situations like this, and the fact their health insurance premiums are increasing anywhere from 8-15% every year (if not more), make them reconsider how their health insurance policies are offered.

So is your company entitled to part of your health or disability settlement??? I would have to argue that in some ways yes they are.  If nothing else they are entitled to a big fat thank you letter from you and your family.  Even though the Shank family has a long road ahead of them, they should be thankful that at least part of it has been paved by a company that offered their family a health plan and paid $470,000 of Ms. Shanks health care costs.

Walmart made the right choice in reversing their decision to take money from the Shank’s settlement, situations like this need to be considered separately within their policy due to the terrible circumstances surround this case.

However, Walmart has to set a precedent, and I think they did exactly that.  They maintained that they’re entitled to the money, but allowed the Shank family to keep the settlement.

I regret that this precedent had to be set in such terrible circumstance, however I applaud Walmart for the decisions that were made.