A Call For ‘Radical Change’

President Bush’s State of the Union address may not have done much to improve his popularity. But it did succeed in jump-starting debate over one of the leading—and most contentiously lobbied issues—on his domestic agenda: health-care reform. In his speech, the president proposed offering tax subsidies to encourage more people to buy their own health insurance. The goal: to provide equal treatment to those who buy insurance on their own, and those who get it through their employers. Under the Bush plan, the administration estimates that 80 percent of workers with employer-based health plans would pay lower taxes—while 20 percent of those with more costly workplace plans (branded “gold-plated” by Bush) would see a tax hike, unless they decreased their coverage.

Democrats on Capitol Hill, along with labor unions and consumer groups, pilloried the Bush plan, arguing his proposal would do little to help America’s nearly 47 million uninsured—and could wind up hastening the demise of employer-provided healthcare. (In his weekly radio address, Bush called the criticism “reflexive” partisanship and called on Congress to cooperate with him to find a solution.)

But it wasn’t just folks in Washington who were upset. Nathan J. Wilkes of Greenwood Village, Colo., was so worried about the possible effects of Bush’s proposal on his ability to provide coverage for his chronically ill son that he decided to travel to the capital to make some noise. A computer network security expert who earns over $100,000, Wilkes works for a private firm outside of Denver which fits into the large-group insurance category and is allowed to shop around for different providers each year. But when his son Thomas, born with severe hemophilia, developed a resistance to treatment at age 1, Wilkes’s claims soared; his company’s insurance provider, Wilkes says, soon began hiking premiums 40 to 55 percent each year, and introduced a lifetime cap of $1 million for all employees and their families—including Thomas. Soon, Wilkes says, no other insurance companies would offer to cover the company. Worried he would no longer be able to provide coverage for his son, Wilkes turned to state and local groups for help. Physicians for a National Health Program took up his cause, and brought him to Washington, where he hoped to persuade Congress to reject the Bush plan in favor of universal health- care legislation. Wilkes spoke to NEWSWEEK’s Eve Conant about his trip. Excerpts:

Nathan Wilkes traveled to Washington to lobby against the Bush health-care plan

NEWSWEEK: You have a good income and your employer gives you and your family comprehensive health insurance. So why are you so worried about coverage that you’ve come to D.C. to lobby for universal coverage?

Nathan Wilkes: Why am I worried? My son will no longer be insured in a month’s time. His claims have increased health-care costs for everyone I work with. My company is very socially responsible, but because of our high claims, no other insurance company will touch us. We’re trapped with the same provider, which keeps raising prices and last year introduced a $1 million lifetime cap on coverage. Even if my son has no injuries, we’ll hit that cap in the next one to three months. With hemophilia, the problem is internal bleeding. We know it’s happening if he complains of pain, or stops using one of his arms or legs. Even if we treat him at home the cost for medicine can run up to $3,600 every few hours. Because of insurance limits we often delay follow-up treatments—to see if his injuries will clear up on their own—simply to avoid getting closer to the million-dollar mark. The aim of private insurance is to weed out high-cost patients like my son.

And what happens when you delay treatment?

Sometimes it works out fine. Other times he gets worse. Even at our most frantic we have to worry about the cap. We’re told he may have permanent nerve and joint damage because of the times we’ve had to delay treatment. We do everything we can, but he’s a 3-year-old, he wants to walk around and try to jump off the couch.

Did you watch the State of the Union? What do you think of Bush’s health proposals?

His strategy is to manipulate the tax code to make it appear as if you’re insuring more people, when in fact, you’re not addressing the real problems of the private insurance system: cost, access and the underinsured. Continuing with private insurance just feeds the monster. This won’t bring down the cost of drugs or reduce the overhead and profits taken in by the insurance companies. It only serves to free up more money in the consumer market to feed back into a broken system.

What will you do when your son’s insurance runs out?

The race has started; it’s like an hourglass with a finite amount of sand. We have to think of something else, but all our options would give us only a year at most. I’m told I can quit my job and try to join a larger company so my son’s chronic illness won’t be noticeable to their insurance company. But that might only buy a little bit of time. My wife could try to get a job, but that would mean the cost of putting three children in day care, including one who is ill and needs intensive supervision. I can’t get on Medicare or Medicaid because I make too much money. I’ve also been advised to divorce my wife, so that she and the kids might qualify. But that creates another set of bureaucratic problems. The best option is Colorado’s high-risk pool insurance (individual insurance for the uninsurable), but that also has a $1 million cap. That could last us a year, or, if my son has any bleeding in his head, could last a few days. One of my last options is to lobby for universal health care; I think I’m a decent example of what is wrong with private insurance in the U.S.

You’re one of those people with what Bush described as a “gold-plated” insurance policy, right?

I find that a pretty offensive term. Calling what I have gold-plated is just a way to shift attention away from real problems. My employer has done [its] best, so that we have minimum or no copay. But over the years, they’ve been forced to shift more of the burden on my co-workers and me. Gold-plated just means more attention on preventive care, which avoids the really costly problem of people only getting treatment in the emergency room. I’ve been insured my whole life, but we’re going to lose it because private insurance is about making profits, not keeping people healthy.

There’s a lot of political momentum on health coverage right now, but in the past that momentum has fizzled out. Do you think there’s a difference this time around?

My son has hemophilia and is immunosuppressed from his chemotherapy treatments [chemotherapy, in some extreme instances, is used to fight the immune system’s resistance to hemophilia treatment]. He’s the kind of person that is supposed to be first in line in the emergency room. Instead, we wait for hours in packed emergency rooms where the uninsured are piled in to get basic care. I think what we’re seeing in Washington now is a different momentum. If you keep piling snow on a mountaintop, there will eventually be an avalanche. This issue has been pushed under the rug before, but every other industrialized nation has some form of national health care. The system now is nothing short of an abomination. I think there might be enough political will now for a radical change.