Health Insurance in the Real World

I seem to have missed a few days, but as I was saying . . .

Last time I talked about insurance in general, and how what seemed like a good, socially responsible idea at the beginning had become corrupted into a scam to enrich the already-too-rich.

Today (tonight?) I'd like to explain what health insurance means to some people who were lucky enough to have it (ha ha ha!).

At my last place of employment, I worked as a contractor for a recruiter-contract house that I won't name.  As part of the benefits package for this contract house, they offered health insurance for me, my wife and my family.  I though that this was a nice gesture since, as a contractor, I would not otherwise be eligible for health insurance through the employer, even though this was supposed to be a contract-to-permanent position.

I should probably point out that, before that job, I had been disabled for almost ten months before I recovered enough to go back to work.  At that job, I had FREE health insurance coverage from my employer with a plan that covered 90% of most of my health care costs, with a reasonable deductible, low copays, reasonable prescription drug payments (discounted up front) and an annual out-of-pocket maximum expense per person and per family.  It wasn't ideal, but it was right up there with the best insurance I've ever had.  When I was disabled and went onto COBRA, I was able to get that exact same coverage for the entire ten months for less than $1000 per month, which wasn't too bad, all things considered.

Unfortunately, since there is no universal health care, or even universal health insurance, and there is virtually no regulation of what kinds of benefits an employer is required to offer (oh, my, God - that would be - SOCIALIST!!!!  NOT), this contract house was able to get away with offering the worst insurance coverage I have ever had - the deductibles were about the same, but the coverage was only 70%, with higher copays on office visits and NO up-front prescription drug coverage at all.  I have to submit claims to get reimbursed for my prescriptions, and they routinely take a little more than a month to pay, which means, if I'm lucky, I get 70% of what I need to refill a prescription within a week after the last dosage runs out.

Also, there's an annual maximum benefit.  This is not an annual maximum out-of-pocket expense for me, it is an annual maximum amount the insurance will pay before I get stuck with all the costs.  I'm not even 100% sure how they calculate it, all I know is that it hit me fairly hard last January and I had loads of fun for the next six months working around the limits.

One real hospital visit for about three days, and I will have to declare bankruptcy, and thereafter get "health care" from whatever free clinics I can find because my wonderful insurance won't cover anything.

Not only that, I get the dubious privilege of paying for this exotic coverage, to the tune of over $1200 per month.

I suppose I should quit my crying and just suck it up and act like a man.  The problem is that the job market where I can (almost) afford to live is pretty lean and I've been unemployed now for over a year.  My disability ran out and unemployment pays less than half of that, which was less than half of what I need to keep my house, my car cover transportation for necessities and, oh yes, HEALTH INSURANCE!

Maybe at this point you think I should consider dropping my health insurance altogether.  After all, if it's so bleaming expensive, it must not be worth it.  You may be right, so let's look at that.

One of the scams that our current health accounting (oops, I mean insurance) industry has managed to set up over at least the last 30 years is that they contract out to some approved set of doctors for discounts on their services.  If you have PPO (Preferred Provider Organization) coverage, you go to one of their doctors and get their services at a fairly steep discount.  (Makes me wonder just how good their services can be when they're getting undercut on their rates, too, also to the benefit of the insurance accountants, er, industry.)

If not, you pay through the nose (or whatever other bodily orifice you find most appropriate to consider for this).

If you have an HMO, you're in much worse shape, although, until you get sick, it seems to be a better deal.  If you're young and in good health, maybe you're better off.  I'm neither any more, and I trust HMOs about as far as I'd trust Tricky Dick Nixon and Ed Kaiser, who convinced the nation that HMOs were a good alternative to real insurance.  I'm not going there tonight (but I strongly recommend the movie SiCKO if you have not yet seen it).

So, if I go to see my regular doctors once a month, I pay $20 per visit, plus the $1200+ to cover my wife and kids for their visits.  Without insurance, I'd be paying around $200 per visit, and that does not even begin to include X-rays, lab work, MRIs (especially MRIs - yee-ouch!), outpatient surgery (with any kind of anaesthesia, nurses, ORs, surgical center fees, etc., etc., etc.) or, heaven forbid, an actual in-patient visit to a hospital.

That's the health insurance scam in a nutshell, and Congress is about to give away the store to the health insurance lobbyist industry because that what they paid our "representatives" to do.  If you don't believe me, go take a look at how much money Senator Ben Nelson took from the insurance industry to step on the "public option" (which is a whole other scam, but I digress), or how much Joe Lieberman, a name almost synonymous with Benedict Arnold in many people's eyes today, was paid.

Oh, wait, I forgot - they weren't paid.  They were given campaign contributions.  According to the U.S. Supreme Court, money is the same thing as speech, and we can't restrict the freedom of speech, particularly not for the legal fictions known as corporations, which are, believe it or not, persons with the same rights as individual human beings, under the law.

And that, dear readers, is the real scam in the guise of "health insurance," or any other kind of insurance, in another nutshell....