For decades I’ve been the legal representative for several Taft-Hartley trust funds (these are collectively-bargained plans that provide benefits to unionized employees much in the same way as traditional insurance companies, but are nonprofit). I am also among the chronically ill–over the last 10 years I’ve averaged about three hospital admissions per year, and I have some kind of health care appointment at least once a week. I’ve learned a lot about health benefits and the way the health care system works.

It’s true that copayments (the amounts an insured patient pays out-of-pocket when he or she has an office visit) have increased over time. But the increase in those those copayments has been less than the increase in the cost of the underlying office visit which the insurer must pay. It’s been years since any of the plans I represent, or my own insurance company, have increased copayments despite rising health care costs.

Further, none of the plans I represent charge any special copayment for diagnostic services. Nor does my own insurance plan require any such copayment. Two weeks ago I had a CRT scan. No charge was made to me for this. Generally, copayments aren’t charged when the diagnostic service is authorized by the patient’s physician.

Further, I don’t know of any health plan that increases the amount of a copayment with increasing frequency of use. My office visit copayment ($10 for my family doctor, $20 for a specialist) is the same regardless of the number of visits I have. In fact, some plans limit out-of-pocket expenses than an insured may have to pay in any year. So I question the reference to “increasingly prohibitive copayments”

Also, a word about that $900 billion that this is going to cost us. If as the President says the amount will not be borrowed, then as you say it will be paid through an increase in taxes. In 2008 the total income tax paid by individuals and corporations was $1.45 trillion. If the additional taxes required for health care reform are apportioned among the taxpayers in the same way as the 2008 income tax lliability. then each taxpayer’s share of the $900 billion will be about 62% of his, her, or its 2008 income tax payment.

And if you think the cost will be limited to $900 billion over the next decade you will almost certainly be wrong. Historical long-range estimates of the cost of Medicare and Medicaid have been a fraction of the actual cost. There’s no reason to expect this to change.

Also, I personally know too many Canadians, and a couple of Norwegians, that had their lives saved because they came to the US for treatment which would have been too late in their own countries. Those systems may balance out due to the unhealthy dying off.

We need to start by cutting costs and encouraging the medical professionals to enter the field. When we have enough professionals available, perhaps competition will help lower costs. If not, at least we will have treatments available.

Quite frankly, I feel much less safe now than I did last year. If the proposed system would work as it is visualized, it would still not be much of an improvement, and certainly be worse for the currently insured.