Why We Need Health Insurance Reform

Private Insurance Doesn't make any senseWhy We Need Health Insurance Reform

8/11/09

I can understand why a lot of people don’t understand how broken our health insurance system is yet.  After all – most old people get their health care through the government – which despite conservatives being sure can’t run anything – has the highest satisfaction rates of any health care provider.  Another large majority get their health insurance through their companies and let’s face it – unless you have to use it because of major injury or catastrophic illness – you have no idea how reliable your insurance is – and you probably haven’t given much thought to what you would do should you loose your job and as a consequence your health insurance. But for me and my family – we know. 

Thankfully – not because of illness – but just because we had to enter the private insurance market in 2001 and then in 2007 left it because we got employee insurance – then back into private because of loss of job (company sold my husband’s division off – everyone was let go), and then back into the private market and then back into an employee plan.  At the moment – my husband having just gone through an unemployment period – we are without insurance and our son is on Medicaid.  Good news is that my hubby starts his new job next week and it comes with employee sponsored health insurance.

It’s Just an Illusion

But – back to what is wrong with the insurance industry and why it needs reforms and regulations that they are fighting with lies and smears.  My impression of the insurance industry – both employee sponsored and private – is that it is a con game.  All you are buying is an illusion.

First – costs have skyrocketed.  It used to be in 2001 that you could buy a decent family policy for about $350 a month.  Now – you can’t get a policy for anything near that.  So, enter the Health Savings Plan.  You pay about $350 a month – and in exchange – you pay for all your basic health care.  Your insurance only kicks in if you meet your deductible – which for $350 would be about $10k per family member per year.  If you wanted a $6k deductible – you would have to pay $600 a month.  Oh – and don’t forget – all private plans include both annual and lifetime caps – so – if you did have something catastrophic happen to your health – they have told you up front – they aren’t really going to pay out.  It is just an illusion.

Health insurance is a deadly scamWhy this doesn’t make any sense.

My family – if we had to pay our health care costs out of pocket would spend about $2 – $3k a year – and that includes dental, vision, monthly prescriptions etc.  By contrast, if we had insurance – we would be spending $5 – 6k a year.  That extra $2 – 3k would go to the insurance industry to buy protection in case we ever had a major injury or illness.  The problem is that the insurance companies are highly unlikely to pay out.

So, why spend that money?  It is cheaper to pay out of pocket for your health care costs.  You pay because you think it would limit your financial liability if something bad happened – but since the insurance companies drop the policies of a good 25 – 50% of the people who really need them. Imagine if your home-owner’s policy took your money for 20 years and then refused to pay out when your home is burnt down in a fire – you would shout FRAUD! But this is business as usual for the health insurance industry.

So, purchasing your own health insurance in the private market is not worth it because – all you are buying is the illusion of coverage – what you are really doing is giving a con artist $3k a year (on average – for that illusion). You are better off saving that money yourself in case you ever got sick and needed it.

The Government Option

As I said before – my son is currently on Medicaid.  I was amazed.  They cover everything.  I have heard it is hard to find doctors who take it – but mine does – so, I haven’t had a problem.  But the list of benefits is superior to anything I have ever had.  He simply isn’t that well covered by private or employee sponsored plans.  And that is unacceptable.  We should all be able to buy into a government plan that actually provides coverage.  I want that for me and my family.   I am willing to pay a premium to participate.  I don’t need it for free – I just want that level of benefits and coverage without the fear of my policy being canceled just because we had the audacity to use it for anything other then annual physicals.

In order to get the insurance company to pay a claim - you probably need a lawyerLet’s Talk about Refused Claims

A few years ago – insurance companies refusing to pay a claim was kind of rare.  Granted – in 2003 some clerk at my insurance company felt that anesthesia was medically unnecessary for the emergency c-section I had (my daughter died), and that they weren’t going to pay for it.  It was traumatic to deal with that to say the least.  But easily fixed compared to what is going on now.  Now, if you try to use your policy for anything other then annual physicals – they refuse the claim and you have to argue with them and your doctor has to argue with them.  In fact, many doctors claim 2 full days of their week is spent dealing with these insurance clerks who have no medical training deciding what medical care you can and can’t have.

The net affect is that even if you win the battle, the hassle caused interrupts your health care.  I had a diagnostic test done last year.  It was refused by my insurance because I might have had a potential pre-existing condition – even though they issued their policy with no such preconditions.  I had to prove I didn’t – which took 3 months.  And it didn’t matter that my test came back negative.  The health care result was that because my insurance had suspended my coverage over this – I couldn’t go back to my doctor for follow up care.  An untrained clerk at an insurance company – for no reason at all – got between me and my health care provider.

Which is why, when opponents of health care reform claim you don’t want a government bureaucrat between you and your doctor – I have to laugh!  They must have no idea what really happens these days. I would MUCH rather have a government bureaucrat approving my claims then a for profit insurance clerk.  And here’s why.  The insurance clerks are being paid to refuse claims.  Any reason they can come up with – they do.  It didn’t use to be that way even just 7 years ago – but it is that bad now.

A government clerk – on the other hand –their job would be to help me with my claim.  Not to refuse it – so much better in my mind.  Seems to me that would be much easier to deal with then having to hire a lawyer in the vain hope you could get your insurance company to pay out what they originally promised you they would.

The other big problem with the current system

Say you decide not to carry insurance at all – because any policy you could get would be a scam and not worth the money you spend.  Even though your out of pocket for health care would be less – you would probably go to the doctor’s less often.  When you only have to pay $25 for a test- you tend to go.  If you have to pay $250 for the test  – you don’t.  That is just human nature.

And that is the big problem with people being uninsured.  We tend to put off preventative things until it can’t be ignored.  And by that time it is more expensive and the outcomes less sure. 

Long story short – the current system doesn’t work.  At all!  Unless you are already in a government health care program – you are not going to get the care you should.  My aunt was complaining the other day about some tests they had to have and how long that took to wait for the tests.  I thought to myself – wow!  I wish I could have diagnostic tests. Because if you have private insurance, if you want a diagnostic test, you have to pay for it yourself and then hired a lawyer in a vain attempt to get the insurance company to make good on their prior commitments to you.

We need health care reform now!What Reform Will Do

It will make it illegal for the insurance agencies to continue to defraud their customers.

It will give people a reliable alternative to the con artists that constitute the private insurance market in the form of a public option.

And it will provide money to streamline our records so that all the doctors treating you will have access to your medical files – which – trust me – right now – are scattered amongst every health care provider you have ever seen in your life.  This will help get us better outcomes.

In short – reform will get the private insurance industry out from between you and your doctor.  And that would save a lot of lives!