Monday, November 2, 2015

It's Beginning to Look a lot Like Frustration

That's not the finger I'd use. (Image via.)
I've come to fear this time of year. Open Enrollment used to mean very little to me. Although I've worked in the health insurance industry for 15 years, the annual review and selection of my own personal benefits never elicited more than a passing thought; except for recent years.

People can blame "Obamacare" (a colloquial term used for the seemingly never ending legislative regulations dictated under the Patient Protection and Affordable Care Act, or just Affordable Care Act), and say that the decline in the quality and availability of healthcare being experienced in tandem with an increase in cost for the same is the result of government intervention. But, in reality, it has little to directly do with it. Of course it's a factor that insurers are required to pay 100% of expenses now deemed "preventive care," a list that grows larger every year. But it certainly isn't the only factor.

Insurers have been hocking what they refer to as "consumer driven health insurance" for years now. This moniker sounds great, but it is misleading. Are we really "consumers" when it comes to our own healthcare? I don't think there is anything wrong with shopping around when you have the luxury of time on your side. Looking for a new doctor? Ask around, get recommendations, find a convenient location...but when asking your friends and family for the name of a great doctor, do you find yourself asking, "How much is an office visit?"

Gone are the days of the benefit-rich, low deductible health insurance plans. Hey, remember co-pays? Ah, fond memories...the real health insurance plans. These "consumer driven" plans have high annual deductibles and even higher annual out of pocket expense maximums. This is intended to give the subscriber pause to stop and think, do I need to see the doctor for this? Do I need this test that my doctor is asking me go get? Let's bring this back down to reality. Seeking medical care can be scary in and of itself without having to question your doctor. You are supposed to trust your doctor. Of course there are unsavory people in the medical field; there are billions of dollars lost annually by health care fraud, waste, and abuse (another reason why the cost of healthcare - and insurance - keep going up).

It's so disheartening when your adult child would rather struggle through an injury, hoping the back pain isn't serious, rather than make an appointment to see the doctor for fear of the resulting bill. The United States has the highest healthcare costs in the world. I know that I live in a state that ranks in the top 20 of the country's highest healthcare costs (according to the data in this 2009 study). It wasn't too long before our annual open enrollment began that I found myself googling "socialized medicine" to see what it was all about. And it turns out that, generally in these countries, you pay for your healthcare through your taxes (and only through your taxes). You don't get a bill in the mail from the hospital after you go to the emergency room, let alone a bill from the lab, imaging center, radiologist, and emergency physician that treated you. In those countries, healthcare is a basic human right, not a luxury. My maximum out of pocket through my health insurance this year is more than I paid for rent in the entire year of 2010. Let that sink in for a minute. I would have to incur $15,600 in medical expenses, of which I would have to pay $5,200 of, before my insurance would pay 100% of covered expenses for the remainder of the calendar year.

When you see the figures of the insane amounts of money earned by the big national health insurance companies and their top executives, it really makes you wonder why the costs keep rising if there is so much profit to be spread around? Having access to healthcare should not be in lieu of savings, or food on the table in some cases. To put a personal spin on it, I had outpatient cardiac surgery in 2007 (an electrophysiology study with multiple catheter ablations). I checked in at the front desk at 5 a.m. for my procedure scheduled for 9 a.m. that morning. The procedure went mostly as planned (there was a blood pressure incident, I recall the nurse quietly shouting that my BP was something like 28/17) and I was released the next morning after overnight monitoring. I received a bill - from the hospital alone, for the use of the surgical suite, supplies, medications, and the observation bed - for over $71,000. That doesn't even include the bill from the surgeon, the assistant surgeon, and the anesthesiologist. I was "fortunate" to have health insurance; however, between my deductible and out of pocket, I was still on the hook for almost $4,000. How do you justify that? It was a procedure I needed to correct the accessory pathways in my heart, to stop the frequent and often lengthy episodes of tachycardia in order to prevent possible cardiac arrest - or death. Should I have been grateful that my life only cost $4,000? Should I have been overjoyed when the hospital said that they would allow me to pay that in 12 monthly installments? I have to believe that the answer to both of those questions is, "no." And don't even get  me started on the $42,000 bill I received for less than 12 hours of care surrounding an outpatient pelvic surgery in 2011.

We shouldn't have to risk going bankrupt in order to get medical care when it's needed. And why should the cost of "insurance" keep rising in the face of obscene industry profits? Is it really still fair to call it insurance when the cost burden falling to the individual is so high? If we are paying a couple thousand dollars just for the insurance, and then we have to pay another $2,500 every year in deductible alone...what if you only need as much healthcare as it costs to meet your deductible? Other than those "preventive services" that your insurance is required to pay for at 100%, you aren't getting any benefit. In a year like that, you are not only paying for all of your own medical care, you are paying for insurance that is giving you zero benefits. How is that legal?

I'm now googling "places to live in the UK." Sashay away, US healthcare.

1 comment:

Be nice, now.