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...