Jonas Weisel seems like an honest enough guy, but lately he’s been having trouble getting people to take him seriously. "When I tell them about this, almost nobody believes me," Weisel says.
This is his latest notice from Kaiser, which came in the mail in early December. The health care insurer raised his rates from $564 to $955 – a jump of 69 percent.
It does seem incredible, but it happened, and Weisel figures he is not alone. He has done the math. Of Kaiser‘s 6.2 million members, 350,000 are in individual plans. Of those, 10,000 are in conversion plans. They are people who, like Weisel, have pre-existing conditions. Many if not all of them are receiving through-the-roof rate increases. "Ten thousand people may have gotten this (increase)," Weisel speculates.
These exorbitant health care costs are relatively new for Weisel, 54. A free-lance editor and writer, he, his wife, Meg and their daughter Chelsea were covered for years in a Kaiser group plan through their employer. The owner retired in 1999 and they went to an individual plan. Chelsea, 17, is covered under a personal advantage plan, which has reasonable rates and moderate increases.
For the elder Weisels, the rate boosts under their conversion plan were manageable at first: 22 percent and then 25 percent. Then came this year’s 69 percent.
Why couldn’t they, like their daughter, go on a personal advantage plan? Because they have pre-existing conditions. In Weisel’s case it is asthma and for Meg it is an intestinal condition. So Kaiser disqualified them from "personal advantage."
This angers Weisel because he and his wife manage their health problems carefully and rarely need a physician. Yet they are being made to pay more because Kaiser actuarials have placed them into a category of people.
"The criteria they use to select people for higher rates is flawed," Weisel says. "It doesn’t allow for people who don’t use (Kaiser‘s) services. If you are labeled, you are going to be lumped into a conversion plan."
Weisel believes that Kaiser actuarials are using the same logic that insurers apply to teen-agers who buy car insurance: they have more accidents so you charge them more. Kaiser believes older people use health care more, so you charge them more. But each older person is an individual, he notes and they don’t all use health care services excessively.
Weisel, like many people in their 50s and older who are receiving these notices, thinks something else is at play here: "a desire on their part to remove people" from their health care plans.
When that happens, of course, it "it becomes a state problem" as Kaiser and other providers shift the cost of providing older people with health care to the taxpayers.
Asked what he would do to fix health care in California, Weisel bristles. "It’s not my job to solve the problem," he says. California, which has turned its innovative and creative energies to create Silicon Valley and other technological and social marvels, should apply that creativity to building a rational, reasonable, and workable fee and insurance structure for health care, he says.
He thinks, however that there is a lack of political will, brought about by the fact that most people, covered through their employers, don’t realize the gravity of the situation. "Most people are oblivious because they belong to a group (plan)," Weisel says.
As to politicians, "it’s not their problem. It’s not anybody’s problem unless they’re paying it themselves."
The self-employed, Weisel adds, are increasingly choosing to go without medical insurance altogether or opt for major medical – a dangerous state of affairs for them personally and for the state’s and nation’s economy if it happens across the country, as Weisel believes is happening.
"Everyone feels like this is such a complicated problem" Weisel says. "No one is willing to solve their piece of it. It’s become this complex problem that doesn’t have a solution. It doesn’t have to be that way.