Friday, May 29, 2009

Let's Talk About Healthcare

I was reading on the Internet where someone was bemoaning the fact that they couldn't afford health insurance and needed government controlled health care for a surgery that was needed. Without realizing where the problem with affordable health care started this person was inviting the very cause into the problem.

See, once upon a time, health insurance paid for medically necessary treatments in order to save a life or whatnot but not much else. Then the benevolent government came into businesses and demanded more with group health care and certain rules and regulations about what is to be paid for with that group plan. Then the benevolent government said to the employers not only will you offer it but you have to cover at least 50% of the employee's portion if you offer it. Everybody will have relatively the same coverage with deductibles etc.

Also, government forced insurance companies to basically do away with pre-existing conditions and in some sense this was wise though very costly. Really some situations should be covered even though it was pre-existing. The costs though to the insurance companies have been passed down to the insured through the premiums because it is all included in an actuarial table and the cost of doing business.

At the same time there was a move to leave paying for the medical treatment only, adding higher percentages being paid for well visits. Then there was a move to lower the cost of normal doctor visits so everybody could go for the smallest thing like a cold. Behind all that was a push to normalize costs and payments to doctors for services because medicare was being charged different charges for services than people with no insurance or limited coverage. So now doctors have to agree to charge a specific fee with certain insurance companies based on what medicare allows and pays.

Now generally speaking these were not terrible ideas being thrown out until you look at the group health plans that employers must pay 50% to offer employees. See every health care plan or group insurance plan must cover drug and alcohol abuse, payment for pregnancy, and other mandatory services that cost the insured and company when it may never be used or needed.

For example a group plan with two employees (which is very hypothetical because it requires more than 2 employees for group), one is married male 60 years old and wife is also 60 the other is 20 something non-married female. The coverage is the very same even though the needs are totally different. The 20 something female if taking the coverage will pay more for coverage than what she would actually use. The 60 year old may have a better deal when looking at cost verses usage, but he is having to pay for pregnancy coverage for he and his wife when that is not something they will use.

Both have to pay for the opportunity to use drug and alcohol treatment as well as mental health treatment when they probably don't need it or won't need it. The 60 year old must pay 100% of the insurance premium for the spouse. So the 20 something is basically subsidizing coverage for the 60 year old even though they pay the same, because more than likely the 60 year old will use the insurance more than the 20 something. See the premiums are based on the coverage included whether or not the individual uses it or even qualifies for the usage. Women with no male dependents on a group plan may have included PSA testing, as well as the man with no female dependents have covered OBGYN visits or mammograms. It is all included in the premium charge.

I realize insurance is a bet against the what ifs, but options would help both the individual and the companies financially. Instead the government with the all benevolent eye and the money tree in the yard thinks this would be unfair to give options to help with costs. Well, guess what, things aren't fair and never will be. Because of government regulation, insurance companies who are not government entities generally speaking and who are trying to make money are being forced to insure things for everybody when the issues may only apply to a few. Thus the cost of coverage goes sky high for everybody. I also understand that picking and choosing what to cover and not cover would be quite difficult to manage in a company too.

What does happen though is the 20 something female who is healthy may choose to not pay for the insurance through a company because it is cutting into her lifestyle, and she is relatively healthy without realizing the chance that health can change. What she needs would be a major medical only option where the 60 something would need everything except the drug/alcohol abuse and pregnancy options thus being covered for needs without extra cost. I believe there is a way to give the options saving everyone money.

The majority of people who are uninsured are uninsured because they can't find insurance to cover what they need instead having to pay high premiums to cover things they will never use. Some of them are employed and choose not to take the company insurance due to the cost because the unused services are already factored into the plans/prices. I can't say that I blame them. I would rather pay a house note, groceries, a new car, vacations etc than to pay for health insurance coverage I won't use.

The health insurance industry needs to be overhalled true, but not by the government. The government caused the problem in the first place. Because of all this government regulation, you will be hard pressed to find a doctor's office who can help adjust prices for you if you aren't covered. 50K for a surgery is a lot if you aren't insured, but hospitals and doctors can help set up payment plans.

I think Americans need to also overhall their own thoughts about insurance. Look at car insurance, oil changes and general maintenance are not normally covered. Think of your own health the same way. It isn't the oil changes so to speak that will break you. It is the big car wreck without insurance that will. The major illnesses and accidents in life that will cost the most. A $120 wellness visit once a year can be planned and saved for. A $360 dollar total female exam can be saved for once a year. But $100,000 cancer treatment can't, that is when you need insurance. Yep, I know Rx can run a pretty sum, get your doctor's help in giving samples when possible, generics, or lower cost drugs with the same effect.

If you are in a situation where you can't afford group insurance or full coverage insurance then find a major medical only policy to get covered. The higher the deductible the cheaper the plan. Work the payments out for the deductible with the hospital or what not. They are out there. Generally healthy people without illnesses like diabetes or other types of maintenance required illnesses, can get relatively inexpensive or affordable coverage if you aren't looking at getting all the bells and whistles. There are also co-op health care programs that can be found if you take the time to look.

And G and I are insured for under $200 a month but pregnancy isn't covered and neither is some issue with her eye right now. If she needs surgery I will be totally responsible for it. Being unemployed doesn't make me like the idea but if she needs it I will do what it takes. Right now we have time. I can become employed soon hopefully and start a savings account for her eye. Her eye doctor has already suggested that she would work with us on it too. If we get really sick though we are covered. If we are harmed in anyway, we are covered.

For a different perspective on Obama's government proposal of health care reform go here.

1 comment:

Anonymous said...

But if for whatever reason she may need surgery, you will either have to refuse or head into severe financia trouble/bankrupcy.