Insurance

Back when I was in the corporate world I didn’t worry about insurance. Someone in the organization was responsible for that and for making sure that we had it. I was paying for it in some sense, but since I never had to actually stroke a check for it, it just wasn’t something that I needed to concern myself with.

When we left that world and entered this one, insurance became something we had to take care of ourselves. We were able to find a policy that made sense for us. We chose a high deductible catastrophic coverage policy. Our philosophy is that insurance should only be to take the care of things we could not afford to pay for without it. We do not believe insurance should be used to pay for routine doctor visits, pharmaceuticals and the like. Insurance should be a safety net, something to step into if a health problem comes along that would otherwise bankrupt you. In fact, I believe it is the separation of the provider and the patient that has caused the runaway increase in medical care costs. If medical care itself was affordable, then health insurance wouldn’t matter so much.  But because almost all health-care expenses are paid for by third parties, it is not necessary for the provider to price services at a level the patient can afford to pay. Instead, they’re priced at whatever price they can get away with charging an insurance company or the government.

We were satisfied with our policy. We do our best to avoid any medical expenses, concentrating on preventative medicine and healthy living. We can afford the normal medical expenses we could reasonably expect in a year.  In the event of a “catastrophe” our insurance is there to protect us.

Under the new law we will no longer be allowed to have this coverage after this year. The new law allows only people under thirty years old to have catastrophic health insurance. Even though we don’t need a policy with a lower deductible, we are being forced to buy one.  As best I can tell, the reason for this is that the insurance companies need to collect as much premium as they can from healthy people, to offset the additional cost they are going to incur from the elimination of their ability to deny coverage to those with pre-existing conditions and the like. So we will be forced to pay for insurance we don’t want, or need. This might be less offensive if we were being taxed to pay for the medical care of those who can’t afford it. Being forced to contribute to the profits of an insurance company, however, does not sit so well with me.

Even though we are allowed to stay with our existing policy for this year, we decided to go test the “market place” on healthcare.gov. What we found was that the only insurance available to us would be considerably more expensive than what we have now, and that we are ineligible for “subsidies” (which we neither want nor need in any event), despite having very low income. That made no sense to me. Later I went back to the website and tried again. This time I got the equally startling response that we could get a policy with a zero deductible and zero premium – in other words, totally “free” medical care (the government would send payment directly to the insurer). Still puzzled by all this, we went back and entered our information a third time, and got a completely different set of results, this time again being told we are ineligible for “subsidies,” but being given an entirely different list of options and premiums, higher than what we’re paying now, but not as dramatically so as the first time we checked. Needless to say, our experience has not engendered great confidence in this system.

Our son’s experience has been equally maddening. Insurance is available through his employer, but it is too expensive for him to afford at his entry-level income. Because insurance is available through his employer, however, he and his family are not eligible for “subsidies” nor can he afford the policies in the “marketplace.” They are still struggling to figure out what they will do. It is possible they will, like many others, just pay the “penalty” they will be assessed for not buying a policy of insurance they cannot afford.  And they’ll still be uninsured.

I have found it very difficult to have any meaningful and intelligent discussions about this. The subject immediately draws out impassioned nonsense from the partisan fringes:  Obamaphobes who insist that he is a secret Muslim who is not an American citizen and who is plotting to take away our guns, and their counterparts who lambast “teapartiers” who would rather see poor people die than to pay their fair share of taxes. Even the partisans who are more nuanced and less ad-hominem in their responses usually just parrot back whatever talking points are currently being broadcast on their party- sponsored media. For one side the problems with the new law are cheerfully welcomed as more ammunition to use against their hated enemy, while for the other any criticism of the new law is tantamount to enlisting in the Tea Party.  People who are both informed and objective about this are as rare as hen’s teeth.

I believe I should have the freedom to make my own decisions about insurance, including choosing to go without insurance if I think that makes sense. I realize, of course, that creates the likelihood of “free riders” who can afford insurance but choose not to buy it, then later have catastrophic medical expenses the cost of which have to borne by others. I remember during the 2008 Republican primaries hearing Mitt Romney explaining why he felt it was necessary that all persons who can afford health insurance be forced to buy it. It was his Massachusetts program that pioneered the notion of government-mandated purchases of private health insurance. I understand the reasoning, but it still doesn’t sit well with me.

I realize the alternatives are not particularly attractive either. In a totally “free market” system of medical care, poor people will suffer. We’ve seen this at its extreme in Haiti, where people must pay upfront in cash for every step of medical attention they receive. For example, if a person takes a child with a severe cut to the clinic, before the physician will look at the wound he must be paid a fee, in cash. Then, if it is necessary to disinfect the wound, they must be paid upfront in cash for the disinfectant. Likewise for the stitches, and then the bandages. If the person runs out of money at any step along the way, the medical attention stops. It stops even if it means the patient will die. And they often do.

I’ve seen the other end of the spectrum in Israel. There, going to the doctor is like going to the library here. Medical facilities are government-owned and run, and the cost of medical care is covered in a person’s taxes. An Israeli friend of mine was astonished to learn that Americans have to pay out of pocket for medical care. Although private insurance and medical facilities are now available in Israel, when I was last there they were rare and considered to be something of an oddity (by my friends at least). In such a system, private medical care would be analogous to private schools here–whereas our taxes fund public schools, persons who can afford it always have the option to send their children to private schools instead.

I’ve rambled long enough about this. Hopefully over time the kinks in this new system will be ironed out so that it is not as messed up as it is now. I imagine the rollout of Medicare and Medicaid were probably equally messy, and those are now entrenched political sacred cows that are here to stay, which is probably for the best.

I do think it is unfortunate that we devote so much of our energy and resources to treating illnesses (and forcing citizens to pay for the treatment of illnesses) that are the consequences of voluntary lifestyle decisions. Under the new law the only thing insurers are allowed to ask is whether or not the insured is a smoker. Insurance companies are still allowed to discriminate based on tobacco use (which seems entirely reasonable and appropriate, as it certainly affects the risk they are assuming). But Cherie did some research and found that the cost of medical care resulting from obesity is greater than the cost of medical care resulting from tobacco use. As a society we have made the decision to create formidable financial disincentives to one, but not to the other.

Amidst all the angst and tumult associated with the new law, the bottom line remains that the best thing people can do to protect their health is not to buy insurance and contribute to the profits of some mega-corporation, but rather to exercise and to eat a nutritious diet, in moderation.

As Hippocrates said thousands of years ago, let thy food by thy medicine and thy medicine be thy food.