Isaac Small, Gavin Riggall, and Margaret Kwak struggle in their own ways with the current health-care system.
The three area residents have different views on whether the overhaul President Obama proposed Wednesday would solve their problems or make them worse.
But they have this much in common: They are desperate for a solution, and, like much of the country, they are eager for details about what the president's plan might mean for them.
"I need to know more," said Kwak, 45, an unemployed engineer and mother of two who lives in Downingtown.
Small, a home health-care aide, spends his days helping other people. But the 58-year-old Germantown man has no health insurance and worries about what could happen to him if his luck ran out and he got sick.
Riggall lost his job as a designer at an architectural firm in December and has been getting by with $200-a-month health insurance. It's cheap enough, but the 36-year-old Fairmount man knows the bargain doesn't last as you get older. He looks no further than his own mother and sees skyrocketing health premiums.
Kwak was laid off in June. The prospect of paying for her family's health care while unemployed has her thinking she may have to sell her house.
Before anyone has answers, a lot could change. With competing bills in the House and Senate and lobbyists of every stripe weighing in, the final plan may not look very much like Obama's outline.
Or a plan may not pass at all. So trying to predict how much the typical family's premium might change is impossible.
One certainty: Overall health-care costs will not go down. But a system overhaul that wrings inefficiency and unproven practices out of medical care could mean prices rise more slowly.
Obama's plan has several key elements:
Almost everyone would be required to obtain insurance.
Businesses with more than 50 employees would have to provide insurance for workers or pay a fee.
Insurance companies could not refuse to sell to customers with prior health problems, drop customers after they got sick, or arbitrarily cap yearly or lifetime benefits.
An exchange where individuals and small businesses could buy health insurance would be created.
Pennsylvania Insurance Commissioner Joel Ario said most proposals under discussion included a "set of core commonsense insurance reforms" that would make insurance more stable and secure.
Two groups that would benefit: people who buy their own health insurance and those who work for smaller companies that provide it.
Under the current system, Ario said, those people are "just one illness away . . . from having rates skyrocket."
An overhaul could lead to higher premiums for young, healthy people, who can get good buys on the private insurance market now, but the new rules likely will make insurance more affordable for older people, he said.
The most controversial proposal is the addition of a public-insurance option similar to Medicare for people who are uninsured.
Robert Field, a Drexel University health-management professor, said he was not sure why the public option generated such strong emotions.
"The irony is that we have a public plan. It's called Medicare, and that's the most free-spending system that there is," he said. "We actually do have a rationing system, and that's the private sector."
Several experts said they believed lawmakers would compromise on the issue via provisions that would trigger a public plan in markets where lack of competition leaves too many uncovered.
In the meantime, exchanges that allow consumers to more easily compare insurance plans, combined with subsidies for people of certain incomes, are touted as ways to make coverage more affordable.
The insurance exchanges are not expected to begin operation for three to five years.
Tom Getzen, a health economist at Temple University, said exchanges would make it easier for consumers to get two or three comparable bids on an insurance plan. Now, he said, "comparison shopping for your health insurance is really difficult to do."
Riggall said he was pleased to discover that doing it himself wasn't as challenging as he'd thought it would be. A few Google searches, and he was on his way to coverage.
He was surprised that buying his own plan cost about $300 a month less than getting insurance through his wife's workplace plan. Even so, it wasn't a smooth ride.
"I had people get angry at me when I asked for an e-mail explaining options," he said.
Many people simply find current insurance too expensive and filled with gaps.
Ira Pratt, 33, a home health-care aide from Northeast Philadelphia who is unemployed, decided to pay for his own medical care when he realized his wife's insurance wouldn't pay for his diabetes treatment because it was a preexisting condition. He spends $60 to $100 per month on his medicines and said he was thrilled to hear Obama say insurers would no longer be able to exclude people based on previously diagnosed illnesses.
When Pratt gets another job, he said, he still won't have insurance, one reason he has participated in rallies to push for better wages and benefits, including insurance, for home health-care workers.
Both Pratt and Small believe their work helps hold overall health-care costs down because it keeps people out of nursing homes, one reason they argue that workers in their field deserve coverage.
"We're doing care for patients who are sick, who are senior citizens," Small said.
Like many people without insurance, Small goes to a free clinic when he needs care. Others go to emergency rooms, often an expensive route. Governments and private insurers pass those costs on in the form of taxes and higher premiums to the insured, a practice that results in what Families USA, a liberal-leaning consumer-advocacy group, calls a $1,000 yearly "hidden tax" on American businesses and insured families.
Families USA executive director Ron Pollack said insuring more people could reduce some of those costs. He said he believed an overhaul could lead to savings over time if it supported research to compare treatments and drugs to see which were most effective.
"Some current treatments do no good and sometimes actually do some harm, and yet they add to the costs of the health system," Pollack said. "If we can do better research and disseminate that information to doctors and patients, we're going to reduce the wasteful expenditures in the system."
Even people who get their insurance through work at large companies have faced years of rising premium contributions, higher co-payments and deductibles, and declining coverage. According to the Kaiser Family Foundation, the average annual premium for employer- sponsored health insurance last year was $4,704 for an individual and $12,680 for a family.
There's little doubt that the cost trajectory is unsustainable, experts say.
"It's possible that the growth in premiums, which have approximately doubled over the last 10 years or so, could slow," said Drexel's Field.
He has grown skeptical about cost control, he said, because so many savings initiatives already have failed. Americans, he said, "simply can't get enough health care" and always find ways to pay for more.
"If nothing happens, we know what we'll get: bigger co-pays and deductibles, and more people being pushed into stingier insurance programs," Field said.
Kwak, on the other hand, isn't sure government intervention will change anything.
She worries because the Congressional Budget Office has predicted that Obama's plan would add $239 billion to the federal deficit over 10 years. (Obama has argued that the CBO has not accounted correctly for savings from the overhaul, and that the amount is minor compared with what the country has spent on wars and tax cuts.)
"I don't need the government involved in health care, because usually they screw things up," Kwak said.
Even so, she wants something better. She's just not sure what it is.
"We need reform, but we don't need it the way that he proposes it," Kwak said.
------
Contact staff writer Miriam Hill
at 215-854-5520 or hillmb@phillynews.com. To see more of The Philadelphia Inquirer, or to subscribe to the newspaper, go to http://www.philly.com/inquirer. Copyright (c) 2009, The Philadelphia Inquirer Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2009, The Philadelphia Inquirer