Wednesday, August 08, 2007

...or are there only two types of health insurance: bad and none.

I have health insurance. I thank God and Dow Jones every day that I have it. I understand that at any time my insurance could go away and I would be forced to: 1) go to work (Aghhh!), 2) move to Canada (and I hate hockey) or, 3) pay about $800 a month for a policy. None of these are viable options. I am one of the lucky ones.





Nevertheless, "being covered" clearly isn't what it used to be. There was a time when a doctor visit or a routine procedure was fully paid for by your insurance company. Even with the advent of the "co-pay", "normal medical stuff" ( I will try to keep technical industry terms to a minimum) was paid in full.





Naturally, this epiphany arrives as a result of a personal experience. Like the folks at Jockey, I will attempt to be brief. I visited a medical facility recently for a somewhat routine test. Upon arrival, I was advised that Aetna Managed Care would cover all but $90 of the cost. Fine. I forked over the cash and away we went. A general anaesthetic was involved as was some lab work. All went well and I was on my way.





A few weeks later the bills started to arrive. $98 for lab costs; $51 for the gas-passer; and $40 for the doctor. The doctor bill surprised me so I inquired via the billing dept of the facility. My sarcasm was probably showing when I asked if I was the first patient with Aetna Managed Care to receive the procedure. If not, why didn't they add the 40 bucks to the $90 when I got there. A young lady informed me that the fee upon arrival was for the facility only. The doctor's bill was separate. Oh! Several additional questions leapt to mind but I knew that further interrogation was pointless. The overarching thought is that, even at $300 or so out of pocket, I was still pretty lucky.





It now seems that "fully covered" has gone the way of the nickel candy bar and morning postal deliveries. Having no facts at my disposal and even less interest in discovering any, here is my guess as to how we got to our present circumstance. First came medical insurance. You (or most likely your employer) paid a premium and you could go to the doctor at will. The doctor invoiced the insurance company for a fee that was considered "usual and customary". Insurance paid and all was well.





Then came the dreaded HMO. Doctors were restrained from billing for any amount beyond what the insurance company considered "fair". This was designed to limit the spiraling cost of health care and make a bundle for Blue Cross, Aetna and all the rest of the insurance companies.


Doctors protested. The cost of tongue depressors was rising every year, they said. Nurses want to be paid like medical professionals not Carmelite nuns. And don't even get me started on the cost of those paper night gowns.





Then it hit them. "We can charge whatever we like. Whatever the insurance company won't pay, we'll just charge the patient. When they see the bill that we sent to the insurance company for the operation or the x-ray (already seriously inflated) they'll feel grateful just to be paying $75 or $80."And so we have the birth of "medical cost creep". And I have it easy. I can just imagine what the parent of a sick child must have to deal with.

Employers have responded to the rising cost of insurance premiums by cutting benefits. Usually those most affected are workers at the bottom of the corporate ladder. Does anyone in America believe that the Fortune 500 CEO's are powerless to affect change if they felt it was in their best interest?



It doesn't have to be this way. Go see Michael Moore's "Sicko". (I'm sorry if you don't like his politics.) You will learn that other countries do health care better. None are perfect and no one wants to live like the Cubans just so we can get a free tonsillectomy, but ours is not the only way. If we would just look at how Canada, France, England and any one of 50 countries manages to provide care for all of their citizens, we might learn something.









Health care in America works if you are employed by a big corporation or if you work for the government (military personnel apparently excepted). It works (and most things generally do) if you're wealthy. It works if you were lucky enough to stay in the same place long enough to get long term benefits. (That would be me!).





Americans will go to the polls to oppose gay marriage and to exterminate abortion but no one votes for universal health care. I guess all those people in Kansas and Nebraska already have medical insurance. I hope the policy covers political myopia..

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