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Much of the health care debate has revolved around people without insurance or those whose insurance is not enough to cover their medical expenses. Then there are people whose insurance is so generous that the coverage is sometimes called a Cadillac plan. Jenny Gold of Kaiser Health News profiles two very different families with the kind of gold-plated medical coverage that some say should be taxed.
JENNY GOLD The term Cadillac plan usually brings to mind the most privileged Americans. People like the Stabbe family, whose income is in the top one percent in the country. Mitch Stabbe is a lawyer at a, D.C. firm, where he gets gold-plated health insurance with a hefty premium. The firm doesn't contribute, so the Stabbe's shoulder the entire costs themselves.
Mr. MITCH STABBE (Attorney): Runs about $19,000, $20,000 a year. Then right on top of it, of course, you've still got deductibles and co-pays. So by the end of the year the overall medical expense is pretty substantial - between $20,000 and $30,000 a year.
GOLD: What does that mean for your household budget?
Mr. STABBE: Well, that's a nice chunk of change.
GOLD: But so are his family's medical costs. Stabbe's 18-year-old son Bryan has Crohn's disease, a chronic condition that attacks the digestive system.
Mr. BRYAN STABBE: I'm on weekly oral medication, which is in conjunction with infusions of a drug called Remicade that I get every five to six weeks.
GOLD: Those infusions alone cost around $40,000 a year without insurance.
Mr. STABBE: In the balance of things, we're lucky to have it.
GOLD: The Stabbes can afford to pay a lot for their coverage, but it's not just the wealthy that benefit from high premium plans.
Mr. RUSTY LOVELL: I'm Rusty Lovell. I'm 54 years old.
Ms. DEB LOVELL (Secretary): I'm Deb Lovell. I'm 53, been married to Rusty for 34 years.
GOLD: The Lovells live in Concord, New Hampshire. Rusty had to stop working about a year ago, though he gets Social Security disability payments. Deb earns just over $30,000 a year as a secretary at a community college. But she also gets something extra - the same health coverage offered to all New Hampshire state employees. It's one of the most generous plans in the country. And she pays just $60 a month for it.
Ms. LOVELL: The insurance plan has been so important to us that we have often negotiated for keeping our insurance and foregone raises, for instance, year after year after year.
GOLD: For the Lovells it's been priceless. One night about eight years ago, Rusty woke up with severe chest pains.
Ms. LOVELL: Took him to the emergency room. The only thing that red-flagged was his white count was high.
GOLD: Rusty was diagnosed with CML, a form of leukemia.
Mr. LOVELL: The first question I asked Deb on our drive home from the oncologist's office was what do you do when you're 47 years old, and you're told you've got five years to live at best?
GOLD: But eight years, four chemotherapy treatments, three doses of radiation and one stem-cell transplant later, Rusty is still alive. And he's finally leukemia-free, though he's now in a wheelchair.
Unidentified Woman: Let's adjust your hand. Bring your weight forward. Bring your weight forward. Hips, hips, hips. Good.
GOLD: Rusty still goes to about seven medical visits a week, including three physical therapy appointments to help him learn to walk again.
Mr. LOVELL: When they first discovered the paralysis I couldn't move my leg at all. And now, with the aid of crutches and electronics, I can walk pretty well.
GOLD: Last year alone, he had over $1 million worth of care. The total cost to the Lovells was just $500 in co-payments.
Ms. LOVELL: Even if we'd had like a 20 percent co-pay, like a comprehensive or something like that, we would be millions of dollars or hundreds of thousands of dollars in debt, easily. We definitely would've had to sell the house by now. I'm not sure that Rusty would even be with us because I don't think we could've afforded to have all the fabulous care that he's had. We would have to have turned it down.
Mr. LOVELL: We just thank God everyday that we've had the friends that we've had to stand beside us when we needed somebody to lean on, and that we've had the insurance to pay for the costs that we could never afford.
GOLD: The Lovells have been paying attention to the health care debate and their reactions are mixed.
Mr. LOVELL: It's a two-edged sword, I guess. I know that there are people out there that have little or no insurance and need something better. On the other side, I don't want to give up what we've got, personally, for something significantly lesser to try to equalize.
GOLD: Lawmakers have discussed paying for part of the health overhaul by taxing expensive health insurance. The Lovells may or may not be taxed, but Deb says the idea worries her.
Ms. LOVELL: MY hourly pay is not that high. I'm not sure how much of a tax it could sustain and still have something come home in the paycheck.
GOLD: Washington lawyer Mitch Stabbe, on the other hand, says he'd be ok paying higher taxes to get more people covered.
Mr. STABBE: I'm willing.
GOLD: Stabbe is an Obama supporter and a strong proponent of a health care overhaul.
Mr. STABBE: Everybody should have some reasonable expectation that their basic medical costs are going to be covered so that they can get basic medical treatment. This is a country that can afford it. Now, can they afford to give everybody a platinum plan? Probably not.
GOLD: Two families, two different views, but both very much aware they've got some of the most valuable coverage around.
For NPR News, I'm Jenny Gold.
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