It’s that time of the year where we are all federally mandated to pick out a health insurance plan, whether it’s in the “marketplace,” or though federally or state subsidized programs. We have approximately four months to do our research and start our new plans. This also coincides with what is rather a pressing health concern I have, one which if my suspicions are true needs to be addressed sooner, rather than later. But unfortunately that’s not how our healthcare system works. Unfortunately our health care system has turned into something much like paying for a new car, but getting a used car on delivery. I wonder why more people don’t talk about the problems with health care and health insurance? It can’t just be happening to my family. So in honor of the season it’s time to take some time to talk about the so called improvements and dispel the myths of affordable health care.
Myth: Health care and health insurance is now available to everyone.
My 20 year old daughter moved to Texas. Unhappy about it her father removed her from his health insurance. Here’s the thing, she was working and attending school. Her ability to be on his insurance was dependent on attending school. Her presence on his health care DID NOT even increase his rates as he paid a family rate, no matter how many he had on the plan (up to so many). But simply with one phone call he could remove her from the policy.
She attempted to get health insurance and was told that her $600 a month was too much to qualify for funded assistance (state health care). Her premium would be $130.00 a month. Add in her car and car insurance payment as well as her cell phone (necessary so that she can work) and she has no choice but to live at home. Her “fine” for not having health insurance was graciously waived and she has a form to include with her tax return, but now we are back to where we started, no health care, threats of fines and no health care that she can afford.
Myth: Health care and health insurance are more affordable
Have you looked at your premiums? Your deductible? Your out of pocket? I sat down today and I am currently paying DOUBLE what I paid two years ago for health insurance but I’m actually getting less. Here’s an example using approximate number:
$6000 for health insurance
$4000 in benefits
So I’ve paid $2,000 more than what I received.
Now I understand that is part and partial of health insurance. But to do this for three consecutive years and continue to see an ever widening gap between what I’m paying for and what I’m receiving, is astounding. It would almost be more cost effective to pay for my own health care and pay the fine of $2500.00. I may break even.
Instead I’m doing this:
- allowing health insurance companies to profit more
- offsetting the so called “losses” by health care insurance companies and providers
- paying more so someone else can afford health insurance
And as for affordability, just talk to anyone who has recently had surgery. A friend went to the emergency room, her gall bladder had burst and she required immediate surgery. Her out of pocket expense, $42,000, on top of the approximately $700 a month that she is paying for health insurance.
Myth: Everyone will receive better healthcare with affordable healthcare.
Actually I’m noticing an ever widening gap in health care. My insurance requires a primary care physician. This physician must be consulted and a referral obtained before I can do anything. Here are several problems with that scenario:
- The PCP “assigned” to me (randomly chosen from my area by the insurance company) is awful. I’m basing a lot of that on the reviews I read online and discussions in my community boards. But when you consistently see “I wish I could rate a 0, but I’m giving her a 1” then there is a problem. Especially when it happens in 8 different places.
- The PCP I want, well she doesn’t take my insurance. My insurance company says she is on the list. Here’s the kicker,
Doctors can be on the list, but they have the right to refuse to actually accept patients with certain types of insurance.
- She isn’t the only one. I’ve been looking for 6 weeks for a doctor who takes my insurance and that is highly rated. Basically the higher rated care providers are simply not accepting the insurance plans most of us are using, resulting in worse care and higher expenses.
- With the need for a referral care is delayed. These delays actually make many conditions, injuries or illnesses WORSE. This means that instead of possibly have a small in office procedure, by the time someone actually gets treatment it has turned into a more serious condition.
Insurance companies are simply saving money upfront, hoping that maybe we will just give up and pay for a doctor ourselves (win win for them we paid insurance and we paid for the treatment). I’m frightened to even think of what other actuarial tables they consult when creating these premiums.
There have been a few small improvements with the changes in affordable health care. One most likely to be of the most benefit would be the elimination of providing care based on “pre-existing conditions.” However, while that may be a benefit, there are a lot more things that outweigh the good that does. Don’t get caught up in the myth of a better health care system. There is nothing better about paying more for a lesser product.