Art Letter, San Diego, California
Art Letter has been around the block a few times. As a civil servant and consultant for decades, he is intimately conversant with the way government works, and he even developed expertise on the state's health care delivery system when he served on an independent health commission in the early 1980s. So when Art's health care costs shot through the roof last year, dumbfounding him with their steep ascent, he thought he would have little trouble getting to the bottom of why it happened.
Despite his expertise, however, Art ran head-on into a stonewall. He was flabbergasted by the runaround he encountered. Insurers pointed the finger of blame at doctors, who pointed at politicians, who pointed back at insurers. It was a vicious circle of evasion. The hands that weren't pointing were covering a rear end.
When all was said and done, Art discovered this: Nobody is effectively regulating health care in California. "They can do whatever they want. It's outrageous what's going on."
This is the first time Art, now 60, has homed in on how bad things have gotten in the health care industry. A native New Yorker and current resident of San Diego, he is celebrating his 30th year in California. He was director of governmental relations for the San Diego Association of Governments and in the 1980s served on an independent health commission that had regulatory control over medical costs. The commission was eventually dissolved and its duties supposedly absorbed by the government.
A self-insured consultant, Art has been covered for 10 years by Blue Cross. He was used to them raising his rates regularly as well as changing the coverage. But he bobbed and weaved with each new Blue Cross move, keeping expenses in line by adjusting the nature of his coverage.
This year, however, no amount of maneuvering could help. Art's costs went up 40 percent. His monthly premiums rose from $231 to $323.
When Art opened the notice from Blue Cross containing the bad news, he set out to discover why this boost had taken place. "I did a whole bunch of research," he says.
The Blue Cross consumer representative said she thought the state had approved the increases. - the Department of Health Services. He checked with DHS: no, they said, it wasn't them: try the Insurance Commissioner. It wasn't them, either. They told him to try the Department of Managed Health care - which turned out to be another dead end. This bureaucratic game of Where's Waldo produced nothing more than a circle of people busily avoiding responsibility for sticking it to the health care consumer. "They all point to and blame each other," he says.
Art wants a change and he wants it to be far-reaching. "I feel passionate about this," he says, and not just for himself. "What's happening to me," he says, "is happening to a lot of people."
He wants to see an independent commission that would monitor and have regulatory control over cost increases. He also would like to see it gather specific information that it would provide to governmental leaders. He supports Sen. Liz Figueroa's bill.
The time is now, Art says. While some health care insurers and providers are on the level, "for the most part these people are ripping off the system in an incredibly ugly and arrogant way." The people we elect let it happen because the insurance lobby has plenty of money to spend on politicians - money they gouge from consumers.
Politicians "can't stand up to these big lobbying organizations," Art says. "Big money is controlling our democracy. It's poisoned the system."