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Compared to some other Kaiser subscribers, the premium increase facing Sharon Fowler Jan. 1 is modest - "only" 10 percent, from $515 to $565 for Sharon and her husband, Barry, who both are self-employed in San Diego. Many Kaiser patients have seen fees jump by 40, 50, even, in some cases, 70 percent. But the fact that her boost barely made it to double digits does not make Sharon feel a whole lot better.

For one thing, the price increases in corollary costs - hospital stays, pharmaceuticals, cat scans and other medical expenses - are also odious. Furthermore, Sharon continues to see proof of Kaiser's fiscal sloppiness and mismanagement, especially in collecting payments from medical providers; mistakes that cost Kaiser hundreds of dollars in her case alone.

Sharon feels the entire system needs fixing and says Kaiser and other insurers are not going to improve matters all by their lonesome. That state must help by regulating costs and other aspects of health care delivery, she says.

Sharon and Barry joined Kaiser in 1997, just before she turned 50. Her husband is five years older. They were in a PPO and "dearly loved our old doctor." But he advised them to change, because "as you get older, it (the cost increase) is going to eat you up."

Sharon saw that first hand almost as soon as she signed on to Kaiser. When her birthday rolled around, "it went up a lot; 50 is the magic age."

Still, she and Barry have stuck with Kaiser. Now that they are 56 and 61, they feel they might be locked in because both have pre-existing conditions. "I'm not sure I can change. I have degenerative disc disease," as well as migraines and problems related to menopause. She notes that most people as they grow older develop pre-existing conditions. "Everybody is going to get arthritis. Everybody goes through menopause" with its attendant ailments.

When she got the Kaiser notice this month, Sharon was taken aback less by the premium than by the rest of the charges. "We were expecting the increase, but not the cut in benefits." There is a new $200 a day hospital fee, up from zero last year. There is a $250 deductible on brand name drugs, also a new charge. Cat scans and MRIs, which had been free, are $50. The out-of-pocket maximum is $500 per family, up from $300. Mental health, ambulance, co-pay all have gone up.

The timing could hardly have been worse for Sharon. Her small business is about to shut down temporarily because of the southern California grocers' strike. She provides glass vases to floral departments at Ralphs supermarket, and she is about to close for a couple of weeks, putting herself and her two employees out of work at the holiday season.

All these health care cost increases have made her apprehensive. Fear of the future, she says, "is always there. I'll think, if I'm OK till I'm 65" and can get Medicare, she might muddle through. "It's going to be tough. We're freaking a little."

Sharon's concerns do not revolve only around her own costs, however. She has seen Kaiser spending money foolishly. She cites shots she received three times, the year before last, of Imitrex, which helps alleviate pain from migraines. In June 2002 she had a shot in Ventura; it cost $95. Six months later, at Thanksgiving, she was at Lake Havasu City in Arizona and needed the shot again; the medical center gave it, and billed Kaiser $1,600. On New Year's Eve, the same Havasu clinic charged $600 for the same shot.

Kaiser balked at the $95 charge, although it ultimately paid. But it forked over the $1,600 and $600 to the Arizona clinic with hardly a blink. When Sharon complained, Kaiser led her on the bureaucratic shuffle, from one department to the next. She never has received a satisfactory answer about why Kaiser is wasting money this way.

"Kaiser is inefficient, and is paying out of town bills without even checking" with patients, Sharon complains. She wants reform in the system, and she has several ideas about where it should take place.

"We have a cost problem, " she says "and I don't think (the insurers) will fix it themselves. There ought to be a board to monitor all of this," beginning with the increases in costs and the accelerated take-always. Those all need to be justified, she says.

In addition, there's fraud. "People should look at their bills," Sharon warns. Barry does that, and has found Kaiser being charged for treatment he did not receive. "Bills should not be paid until they are reviewed by the patients."

Sharon also says the state should stop providing medical treatment to undocumented immigrants, which is costing billions, in her view.

The whole system is broken, she says. Like many people who are hurting financially and emotionally by health care cost increases and other abuses, Sharon is dismayed that the government and the country at large seem absorbed with other things. "The focus in America is skewed," she says. "It should be on education and on health care. We should all be horrified about the health care situation, the prescription situation."