Down the healthcare rabbit hole
Question for you.
A 58-year-old woman moves from Santa Monica to Studio City, keeps the same exact healthcare plan and has no change whatsoever in her health status.
Does her monthly premium:
A) Stay the same.
B) Decrease by $75.
C) Increase by $39.
D) None of the above; she loses her coverage altogether.
The crazy thing about healthcare is that no one would be surprised by any of those answers. Given the ulcer-inducing, profit-driven patchwork of incomprehensible factors governing medicine and insurance, we’ve all been rendered shockproof.
The subject of my little quiz is Susan Nord, a marriage and relationship counselor, who got hold of me after my column last week about a medication co-pay that went from $30 a month to $784 a month for a 10-year-old boy with cystic fibrosis.
Before I divulge the answer to Nord’s Alice in Wonderland experience, I’d like to share some other responses to that column, which served as a reminder that when it comes to this subject, everyone’s got a gripe and everyone wants a change.
“Premiums for my health care insurer have more than doubled in the past 2 years, from $489.10 a month to $1,030.67 a month,” wrote Sarah Forth.
“I spend probably 20-30 hours a month on the phone,” said Elise Free, whose 2-year-old daughter has cystic fibrosis. Free plays referee as Blue Cross, Medicare and California Children’s Services “battle it out with each medication, feeling the other party is responsible.”
Martha Stevens of Studio City went years without insurance after getting dropped from her plan because of breast cancer.
“I was so happy to turn 65" and get Medicare coverage, Stevens said.
My mailbag included testimonials from those who swear by Canada’s national healthcare system and from those who say it’s an overrated mess. And from a woman in Scotland whose brother moved to Los Angeles 20 years ago, then lost his health insurance and nearly everything else after being diagnosed with cancer, and returned home to take advantage of Scotland’s national health service.
Stevens had some ideas for how to fix things closer to home.
She said she likes Barack Obama’s plan better than Hillary Clinton’s. And she supports state Sen. Sheila Kuehl’s view that a single-payer plan would be best for California.
Kuehl (D-Santa Monica) doesn’t think much of the plan being pushed by Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Nunez, which goes before a Senate committee she heads next week. The plan would mandate coverage for everyone, but Kuehl thinks it amounts to a fat kiss on the lips of insurance moguls rather than the smack in the head they deserve.
I myself am a smack-in-the-head guy, and I suspected the case of Susan Nord’s move from Santa Monica to Studio City was good fodder the moment I read her e-mail.
“I am a Kaiser insurer’s dream,” she wrote. “Thin, exercise routinely, no smoking, good eating habits, blah blah.
“I have been completely satisfied with Kaiser for the last 10 years and basically have appeared there about 1-2 times a year for routine preventive stuff.”
Not that it’s cheap. Her monthly premium was $374.
Then she moved all of seven or eight miles to Studio City.
And got her monthly bill.
Are you ready? The new premium was $413.
A free tongue depressor to everyone who picked answer C above.
“I called to question,” Nord said. “The voice on the other end was as confused as I was. Finally she asked me if I had moved recently. . . . Well, it turns out that changing my ZIP Code from 90402 to 91604 (note: from a more affluent area to a less affluent area) INCREASED my monthly payment by $39.”
Why, Nord wondered, is it now illegal for car insurers to base rates on ZIP Codes, but legal for health insurers?
“No one at Kaiser can tell me where to go with this complaint, thus you are the recipient of my rave.”
Well, let’s see.
Could it be a pollution premium?
Too many Del Tacos in the Valley?
Not enough Pilates parlors per capita?
I found a Kaiser website where you can type in ZIP Codes and sure enough, if you’re buying individually rather than through your employer, the rates vary depending on where you live.
For a 54-year-old such as myself, buying Kaiser’s $25 co-pay plan, I’d be set back $351 a month if I lived in Santa Monica or Silver Lake, $369 in Watts, $388 in Lancaster and $406 in Bakersfield. A family of five would pay $955 in Beverly Hills and $1,005 in Watts.
So what gives?
The cost of providing care is different in each area, said James Larreta-Moylan, a Kaiser plan manager. All healthcare systems charge different rates based on geography, he said. Not just Kaiser.
Kaiser has divided Southern California into four rate regions, and Nord moved to the Valley zone from one that takes in coastal Southern California south of the Santa Monica Mountains, extending as far east as East L.A. and into San Diego. In each rate zone, everyone pays the same premium.
“We look at how much it costs to run a medical facility in one part of town versus another,” he said. “A lot of it is driven by the lifestyle and health of the population"--ahahhh, so it is the Del Tacos--"or on whether they . . . seek more services. Some of it is just basic cost of property and labor.”
Some areas may have higher birthrates, he said, which means higher delivery costs.
As a risk-taker, I’m willing to bet this month’s paycheck that the 58-year-old Nord won’t be having a baby in 2008.
Instead of for instances, I asked Larreta-Moylan to explain why exactly it costs Kaiser more to do business in Studio City than in Santa Monica.
“We look at that as competitive information and proprietary.”
Yeah, sure. It’s always the same story in this town.
Like they need another break on the Westside.
By the way, my chance of getting a key to the city of San Marino has become even more remote. In my Dec. 26 column, I reported that an L.A. County official told me San Marino had used federal funds for a playground improvement project. That official now says she was in error. San Marino applied for the grant but did not collect the money.