Saturday, September 27, 2008

Health Care vs. Health Insurance

I hope the debate about how to see that more people in the US have access to affordable health care acknowledges the difference between affordable health insurance and affordable health care. I don't know about yours, but my insurance works more or less like the mafia.

When I first began life as a grownup I bought a 'catastrophic'-type health insurance policy. You pay a little bit of money every month and don't get much for it, but if you're really in trouble, they do the heavy lifting. Then for years I was on an HMO - we paid quite a bit, but that covered almost everything; we just made small co-payments for services and prescriptions.

I'm just learning how things work with a PPO system, and the one we have does not impress me. The company rep who came to explain it to us and even the guys in our HR dept in HQ like to talk about all the stuff it covers. I have submitted a couple of claims and wondered how long it would take for my reimbursements to come back.

But silly me, I didn't realize it's really just the same as that catastrophic policy I had long ago. You make your payments, and then you ALSO pay for your own health care on top of that - unless you have some huge catastrophe or long-drawn-out illness, in which case they start picking up expenses. It's unlikely I will ever top the $1000/year deductible. Which means the question of what procedures or percentages the policy "covers" are moot.

Only now, what I used to pay for a year of my catastrophic policy is the same as the cost of just one month of this one.

OK, my company pays, technically, it's true: this is a "benefit." But since we all raise our own financial support - including salaries, benefits, travel, retirement, and employer- and employee-side taxes - one feels these things a bit more keenly. At times, over the years, I've found it helpful to think: wow, this is a big expense, but my supporters, they're so generous, they want me to have this. It is hard to maintain that attitude when it becomes clear that I don't have anything. The insurance companies are the ones enjoying my "benefit."

My mother - a very sensible woman - reminds me that it is far better NOT to get one's money's worth when it comes to insurance. True. I'm glad to be healthy.

2 comments:

Tony Novak said...

Excellent points. But consider that your comments are only the tip of the iceberg. Soon your employer-provided policy is likely to have a deductible much higher than $1,000. (Millions of us who work for the federal government or in the health care industry already have employer-provided policies with a $5,500 deductible now). Employer are getting out of the health care business, regardless of who wins the presidential election. Health care expenses will rival housing as the largest expense for many U.S. households before the end of this decade. My family already pays about $1,400 for health care each month vs. about $1,800 for the mortgage. I have no doubt the employer health insurance plus our supplemental insurance and HSA deposits will be larger than the mortgage within a few years. My company MedSave.com has seen a big increase in the number of people seeking supplemental insurance as an immediate response but few people have actually accepted the "bigger picture" that will require all of us to rearrange our lives to meet the new financial realities of health care costs.

Marti said...

Thanks for writing, Kim, though what you say is not good news! Yes, I do have it pretty good compared to some, or what might be. Although my insurance - yes, employer 'provided,' but as I mentioned I am a missionary so I raise the support for it - is already higher than my rent. And the fact that any health =care= I receive I probably have to pay for on top of that is a drag, but I do have the option of setting up an HSA, though I haven't done so.

Honestly, I would prefer to have some choice in the matter of health insurance. My employer requires me to go along with whatever plan they choose; I can't opt out and get something on my own. We even have to pay for mandatory life insurance, which is just silly for a single person with nobody whose finances will suffer if something happens to me. (My employer does NOT provide disability insurance, which would be a much more helpful benefit for someone like me - do you sell that, Kim?)

How common is this in other businesses, I wonder - to require full-time employees to be on the company insurance policy? Is that standard? I guess there are a few people in our office who aren't on it - they are the ones covered by spouses in other jobs.

Maybe I'm too naive or idealistic but the idea that "the bigger picture... will require all of us rearrange our lives to meet the new financial realities of health care costs" should be accepted or acceptable! My uncle in Taiwan gets very good health care for his family without huge costs... he already says he can't afford to move to the US because health care / insurance is too expensive here. Must we as Americans just "accept" that this is "necessary"?

I'll check out your site, Kim. Again, thanks.

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Given how the current financial crisis is unfolding I am glad I am not caught in the same system as so many Americans, with a life based on having or having access to credit. I suppose many feel they have no choice. I may not have lots of money but at least I don't owe nobody nothin.'