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Proviso Probe

Wednesday, September 09, 2009

U.S. health insurance is crap: reform it or scrap the system

Talking Points Memo published an email from JB about her health insurance policy.

Her and her husband retired early and after shopping around they pay $1260 per month in premiums. Both husband and wife pay for the first $1,500 of medical expenses in a year and then the insurance company pays 70%, leaving them on the hook for the other 30%.

Many people get health insurance with their jobs. And the costs are onerous to employers.

But let's look at some scenarios.

Healthy year: $250 for physical, $250 for optometry, $250 for dental, plus $15,120 for insurance

$2,500 malady year would cost $15,120 (insurance) + $1,500 (base deductible) + $300 (deductible for expenses over $1,500) = $16,920 (customer share) + $700 (insurance company share)

$5,000 malady year would cost the customer $17,670 and the insurance company $2,450

$25,000 year would cost the customer $23,670 and the insurance company $16,450

$75,000 year comes to $38,670 (customer) and $41,450 (insurance)

So, you have to have a major medical condition before the insurance company is even paying as much as you are.

And here's part of the equation.

If you use an insurance company, you have to jump through their hoops before getting medical care. And you still get jerked around about the money afterward.

I went to the doctor because I was sick. He sent me for a chest x-ray because I had pneumonia. At every step along the way it said I was responsible for paying my deductible at the time of service.

A few weeks later, I got a bill telling me I still had to pay more money. I spent time on the phone trying to understand how I owed money if I was insured and paid my deductible at each step along the way. After getting explanations that didn't make sense I finally stopped trying to understand and ignored the bill.

Later, I learned on a blog that I was the victim of "balance billing". See Business Week (Chad Terhune). "Balance billing" is when health care providers have agreed to a rate for providing the medical service with the insurance company, but the health care provider would like to be paid more. So, the health care provider sends a bill to the insured patient and hopes that through trickery and scare tactics about credit scores the health care provider can get money from the patient.

How's does being uninsured work?

If you have money and don't get $25,000 sick, being uninsured is a good deal.

Say you have a problem that requires seeing a specialty physician. You don't have to waste time and energy with your primary care physician. You just make an appointment with the specialist and put your money or credit card on the table. It's rather simple.

To review how being insured works.

1. You get jerked around about getting care in the first place, especially if it's any kind of condition where the insurer can justify delaying care. For example, the insurance company gives a list of eight providers, none of whom are taking new patients.
2. There is an extra layer of bureaucracy because you have to deal with a primary care physician when you need a specialist.
3. The insurance company is making huge amounts of money from premiums and paying a sliver of that back in benefits.
4. And you get harassed about bills you have no obligation to pay.

President Barack Obama and the Democratic Party have agreed to allow insurance companies (who don't add value to the health care process) to continue to exist, and still they won't embrace reform that make health care universal, contains costs and allows people to have the option of buying health coverage through the government.

Why don't insurance companies want you to have the option of buying coverage through the government?

Is it because they know the policies insurance companies sell are crap? And their crappy policies that expend a big chunk of the money on overhead and profit are inefficient? And that the experience of getting health care while insured, unnecessary bureaucracy on the front end and harassing billing on the back end, sucks?

If we don't get health reform that's a good deal, I want Illinois legislature to regulate the insurance industry and the rest of the medical industrial complex so completely, they'll be begging for reform.

Fuck me? No, fuck you!

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  • How says:
    Nice analysis of insurance issue.
    "Balance billing" is a problem. Even my mom, who is on Medicare and has medigap insurance gets billed. And yes, she still feels she has to pay.

    By Anonymous Anonymous, at 8:31 AM, September 11, 2009  

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