Saturday, December 04, 2010

God Bless the American Health Care System

It's that wonderful time of year at my company known as open enrollment. This means:

a. We get to waste an hour and a half of precious working hours attending mandatory HR benefits meetings explaining our health insurance options to us, even if we are planning to opt out of them.

b. We get to spend precious working (and nonworking) hours comparing options, trying to figure out what our best choice is, and praying we've made the right one. (In fairness to the company where I now work, this process isn't anywhere as nightmarish as it was at the last company where I worked.)

Luckily, I am freed from "b," because I get all my medical benefits through Bob. The Presbyterian Church USA very generously provides these free to all ministers and their wives for life. But let's say I weren't so lucky. Here's what would be happening.

My employee co-pay would be going up yet again. This has happened every year, everywhere I've worked, for at least the past eight years or so. Note: no one has gotten a raise anywhere I have worked for the past three years. Still, we are expected to pay higher insurance co-pays every year. This means everyone I've worked with who has opted into the medical benefits plans offered by these companies has actually been getting pay cuts for three years.

I would have to pay $400 a month for medical, dental, and eye insurance for Bob and me. (Oh, and if Bob could get insurance elsewhere, say from The Presbyterian Church USA, but we chose to put him on my plan, we'd have to pay an extra $50). We'd also each have to pay a $500 deductible before anything other than a routine office visit (each of those for a primary care physician would cost us $20. To see a specialist would be $30) would be covered. That's $4840 in medical expenses in 2011 if all Bob and I do is each visit our doctor once for a physical, don't get sick at all otherwise, and have absolutely nothing unusual show up in those physicals that requires other tests.

Now, let's say Bob is fine and doesn't need to see a doctor the rest of the year. However, something odd does show up in my physical, and I have to go see a specialist ($30) who prescribes some tests. Let's say those tests cost $500 (not at all out of the realm of possibility). We now have to tack on $530 to that $4840 for a grand total of $5370 (because, of course, my deductible has to be met, so I'm responsible for that full $500). Now, let's say I need some sort of treatment, and let's pretend the treatment costs $3000. We'll be kind and also pretend the insurance company agrees to pay for it. They will only pay 80%. I have to pay the other 20%. Tack another $600 onto my health care costs for 2011. We now have a total of $5970.

All that is if I stay within the network of doctors who participate in this particular insurance plan. I will have to pay way, way more if I visit a specialist who doesn't participate. My insurance company will only pay 50% of the average cost of a particular procedure, no matter what the doctor charges. That's just great, isn't it? Let's say the doctor charges $3000, but the insurance company tells me that the average cost of that procedure is $500 (and how am I going prove otherwise without spending hours and hours doing research?). I'm stuck paying $2500.

That's just medical plans. Let's not talk about dental plans. Bob and I do have to pay a little for one of those, again offered through the PC(USA). Most dental plans have annual caps of about $1500-$2000. Anyone ever have a root canal and a crown? Poof! There goes $1500+ right there. God forbid you get that toothache in January. You're basically without insurance for the rest of the year, despite the fact you're still paying for it.

And then, there's eye care. If you happen to be a contact lens wearer, you can get either glasses or contacts, but not both. Despite the fact every eye doctor I've ever seen has insisted contact lenses correct vision better than glasses do, insurance companies still think of them as "unnecessary." Come to think of it, most dental insurance companies also think of bridges and implants as unnecessary -- we're all just supposed to go around toothless, I guess.

Luckily, as I said, I don't have to worry about paying for medical insurance. However, let's look at something that happened to me this past year despite the fact I'm insured. I had an annual mammogram that indicated something was not quite right, and I needed to have another mammogram and possibly an ultrasound. I went and had both this second mammogram and an ultrasound. Who wouldn't? We're talking about breast cancer here. I don't see this as some frivolous procedure, something like Botox injections.

(Thank God) everything was okay, but then, about a month later, I received a huge bill in the mail from the hospital. The bill indicated that none of the charge was being covered by my insurance company. Bob called to see what was going on. He was told that our insurance company only pays for one mammogram a year. Again, so sorry if you've got cancer, and it's only June. You'll have to wait till January to find out, by which time your tumors will have had a chance to grow. As far as I'm concerned, that's not just outrageous: it's criminal. It's also stupid. The insurance company would be far better off, if it is cancer, paying for early detection and treatments than having to pay for the sorts of treatments and hospital stays they might have to if the cancer gets to more advanced stages.

Again, I am lucky. I could afford to pay for that second mammogram, but I am very aware of the fact that many in this country can't. And that's why, I don't care what you say, you will never convince me that we have "the best health care system in the world." Well, actually, it may be the best, because it certainly seems like it might be the best system for getting the rich richer while depriving critical care to those who need it.

I wonder what would happen if every American were to decide not to buy into health care insurance. If no one supported the insurance companies, would things finally have to change? Unfortunately, of course, it will never happen, because too many have been duped, often by false fears, into believing it's a fine system, that the insurance companies all have our best interests in mind. Still, I can fantasize...

9 comments:

Nigel Patel said...

Some of the best fantasies are of fighting corporate tyranny.

raych said...

This is appalling. Last year when I had cancer I had an ultrasound and a biopsy and two surgeries, spending a total of three days in hospital, and then a round of radiation which was another three days in hospital. When I wasn't thinking how lucky I was not to be dying I was thinking how lucky I was not to be paying a cent.

This fall I have seen my gp four times because I had some mysterious illness. Because the tests cost me nothing I am reassured that I don't have Lyme disease or mono or CMV or a pituitary gland eating into my brain or an infection or anything weird that I picked up from Turkey.

It's been hard enough to make medical decisions WITHOUT factoring in the cost. I don't know how your country does it.

Smithereens said...

Wow, this is terrible! I really don't know how Americans do. The choices seem much too large and the amounts at stake never fail to shock me. Our system is awfully bureaucratic but I'm thankful nonetheless.

Becca said...

Emily, just stumbled across your blog by way of Litlove, and was intrigued to read this because I'm in the midst of arranging for individual health care for myself and my husband. After being laid off in July 2009, he's now self-employed, and our COBRA benefits are running out. (We were paying $1,100/month to maintain our COBRA coverage!)

Having been spoiled by corporate group coverage our entire adult lives, I'm amazed at what is now about to happen. The very least amount we can spend is $450/month. That buys us Blue Cross with a $5000 a year deductible, and 80% co-pay on everything. We get two physician visits per year (at 80%) - anything else we must pay for 100%. There is no dental, no vision, no coverage for physical therapy or psychological counseling. (The lowest deductible available is $1500 - our monthly premium on that would be $1200, and none of the other benefits change.)

I've had the same thoughts you expressed about staging a rebellion against the health insurance system in this country. We have become like sheep who accept whatever ridiculous charges and regulations they throw at us. And no, they do not have our best interests at heart...it is a totally profit oriented system.

It's unfortunate, but health insurance is mandatory in today's world. One catastrophic accident, one major illness, and you can be bankrupt in no time - even with health insurance coverage. I firmly believe major change in the entire medical industry has to occur.

Sorry for rambling on - this is all in the forefront of my mind and experience right now. Thanks for sharing your thoughts on this subject!

litlove said...

This does sound absolutely awful. When I had my breast cancer scare I was simply terrified, and I don't know what would have happened if I'd had to think about how to afford big expenditure on top of all that. Just to add, Emily, that I am so happy to hear that there was nothing wrong with you. But really, this seems awful - when it boils down to it, you are just paying very high charges for most things. Goodness only knows the NHS has its faults, but at least people have the option of completely free care.

Stefanie said...

Amen sister! James and I each take individual coverage through work. I have a high deductible plan with an HSA account since I rarely get sick. Preventative care is covered 100% and I've got close to 2 year's worth of deductible saved up just in case. James has the best plan he can get because of his MS and it's expensive and still doesn't cover everything. He went to a couple of physical therpay sessions - not covered. And he had quite a few acupuncture session to help alleviate some MS symptoms - not covered. Then of course there are the copays for all the different drugs he has to take. My lovely crown a few months ago set me back $412 and that's with insurance coverage. While we may have the best doctors in the world we certainly don't have the best healthcare system. Healthcare should be a basic human right but in this country we treat it like it is a privilege.

Carrie#K said...

Health care costs have been so opaque for so long because they've been a fringe benefit from employers - but now employers (and employees) can't afford the rising costs. At least we can see what we had.
We need to divorce it from payroll - it's crazy when that's deemed "socialist" - it's either the government or an insurance company managing your health care - both bureaucrats - but presumably you you can vote one set out of office!
Sorry for the rant. Health care sets me off.

Emily Barton said...

Nigel, absolutely!

Raych, so sorry to hear about your fight with cancer, and I'm glad it turned out okay. Yes, having to worry about finances on top of fighting a deadly disease is a fact of life here in this country, and I don't really know how so many do it, either.

Smithereens, yes, I would take your system over ours any day (of course, the insurance companies with the help of the media here have managed to convince Americans that European systems are horrible).

Becca, no problem with rambling! I thoroughly enjoyed getting your insight.

Litlove, yes, it is awful, and even worse that so many Americans have bought into the idea that it isn't.

Stefanie, yes. It's terrible that we treat it like a privilege and not a basic human right.

Carrie, it sets me off, too, and I completely agree. Why does anyone think the government running things is going to be worse than the insurance companies?

Cam said...

Sad that one of my first reactions was "Only A $500 deductible?". Our Rx costs have risen so much this year (some over $100/month copay for generics) and yet we can get some for $4.00 through other programs. . I have a friend who had to drive > 1hr to go to a specific place to buy diabetic test strips - something that you can get at any drugstore. It seems like more plans are intentionally so inconvenient so that people won't use them. Which means you're really paying to NOT use them.