You Don’t Have Health Insurance, But I Do
I’ll start by saying that I think Obamacare will wind up being seen similar to how No Child Left Behind is now: something that was a great idea at the start but through the political machine turned into a steaming pile of insert-your-favorite-noun-here. “Healthcare for the poor” and “all kids getting a good eduction” are talking points everyone can (mostly) get behind. In the end, they’ll screw us all.
Ok, hopefully that keeps this from attracting all kinds of “you hate Obama” comments. I might hate him, but I don’t hate him and his administration any more or less than I hated the last guy and his administration. And I might not hate any of them.
Now, on to my point: you don’t have health insurance. At least you probably don’t, and you almost certainly never have. I have health insurance, and it works quite well for me and my family. It’s not perfect, but it allows us to really see what we’re spending and where.
You have car insurance, or at least you probably do. You carry that insurance to do what insurance is meant to do: protect you from bankruptcy in the event something unexpectedly bad happens. If you get into an accident or mow down some children, insurance kicks in to save you from losing your house.
But you don’t pay a $10 co-pay every time you get an oil change. And if you go in for a tune-up you don’t choose your spark plugs based on which ones your car insurance company covers. No, of course you don’t. That’s not what insurance is for, and you probably don’t buy a third-party maintenance plan for your car.
When you go to the doctor, though, you do think about things like that. You probably don’t know (or care, even worse) what an office visit costs. You just pay your co-pay and go on your way. You also may not know what your prescriptions cost for the same reason, but you darned sure make certain that the version of the drugs you’re taking are on your plan’s formulary.
That’s a maintenance plan, not insurance. Yes, that maintenance plan includes an insurance-like component (because it also protects you from bankruptcy), but it does a lot more, doesn’t it?
I have health insurance, nothing more. My family of four pays just shy of US$500 per month to ensure we don’t go bankrupt in the event something catastrophically horrible happens. When we go to the doctor we pay for it. When we get a prescription, we pay for that, too. It all goes against a very high deductible.
I’ve done the math: it’s cheaper for us to carry a plan like this and pay out of pocket than it is to have the comfort of a flat fee/co-pay for all of these things. It makes managing money a little more difficult, but that’s OK by us. It’s our choice.
From the looks of it Obamacare is going to force us to lose this choice. We’re going to be forced to carry all kinds of things we don’t want or need (like maternity coverage, and maybe even sick doctor visits), and that’s going to possibly double our premiums. It’s terrible.
And yes, Obamacare will (hopefully?) solve the problem of “the uninsured” getting coverage.
But why is it that the uninsured need coverage? Maybe they don’t have coverage now because they don’t have enough money to care about what happens if they’re sued into bankruptcy by some hospital that has to treat them regardless. If I didn’t care about that I wouldn’t have coverage.
Regardless, Obamacare does absolutely zilch to solve the real problem: here in the USA we pay a fortune in medical costs (go ahead, watch the video. I’ll wait).
Yup, you heard that right: we pay WAY more than any other country, regardless of their health care plans. And Obamacare isn’t going to solve that. It’s not even trying to solve that. It’s solving a completely different problem, and what it results in is the medical industry making even more money from the rest of us.
If you really want to solve our “healthcare problem” in this country, do at least one of these two things:
- Reduce our actual costs for medical procedures and pharmaceuticals.
- Reduce the doctors’ time and costs incurred when processing insurance claims.
Do either of those things and you’ll be my hero. Like this guy.
September 30th, 2013 at 9:10 pm
Spoken like a true New Hampshire denizen. Live Free and Die, right?
September 30th, 2013 at 9:14 pm
Nice summary, Dave. The one thing you did leave out of your fixit recommendations is ENACT TORT REFORM. Lawsuits drive up malpractice costs for doctors, and guess who ends up paying for their premiums. Right, the patients. Moreover, to avoid being sued…doctors send you for batteries of tests that you probably don’t need, just to prove they did their due diligence to the magistrates. This, in turn, drives up costs for the insurance companies and therefore the insured (patients).
Kenny Lee
Middletown NJ
September 30th, 2013 at 9:36 pm
A couple of thoughts;
1: you have a right to seek out health care; you do not have the right to have it forcefully provided to you.
2: insurance companies are not operating in a free market environment and therefore do not have to compete. That needs to change.
3: the reason their malpractice premiums are so high is because what they do is dangerous, very dangerous. Not holding them accountable for the damage they cause perpetuates the problems and denies the injured just compensation.
4: for the most part, our society cares little about prevention, for instance, pretty much everyone understands exercise is important yet less than 20% do so.
September 30th, 2013 at 11:48 pm
Dr. Scott, point 1 we fully agree on. Point 2, not so sure. There are lots of options out there if you’re willing to pay for them. Point 3, not everything is dangerous. I agree that people harmed by neglect or true malpractice should have a right to sue, but somehow, these suits should have to get through some kind of "grand jury" process to weed out nonsense. There are, in this country, lots of people who find suing people to be a lucrative and stress free alternative to working for a living. Point 4, probably so, but insurance companies don’t encourage this behavior with FINANCIAL incentives to do so. More people would go for a morning jog, eat healthier, whatever, if it meant lower healthcare premiums.
October 1st, 2013 at 12:39 am
Dave, I would suggest that not knowing what we are paying for a service or a product leads to lack of downward price pressure. This is the same way tax withholding works. I didn’t really understand how much I was paying in taxes until I became self employed. Then I was shocked. I knew before that, but vaguely. Writing a check makes things a lot more obvious.
Were we to have to write a check for a procedure or a visit, we would really be better consumers.
October 1st, 2013 at 1:54 am
The rest of the world looks on in wonder and horror at this whole débâcle – that ideological opposition to a still market-driven but slightly more affordable (for many) health system could bring the government to a standstill.
Personally I don’t get either option. I don’t have health insurance, as you guessed in your headline, but for a completely different reason: I pretty much don’t need it. A doctor’s appointment costs $NZ45 (at $US0.81 = $NZ1); a scrip on a prescription is $NZ5 up to a maximum of $NZ100 per household (not $7 as he said!) (after that it’s free); hospital visits and operations are free for citizens and permanent residents. Ambulances are free, run by charities and subsidised by the government. And how is that paid for? taxes.
The prescription thing is interesting. Pharmac (www.pharmac.health.nz) was set up twenty years ago to decide on behalf of the District Health Boards which medicines would be subsidised. And as I said above, there is a limit per household on how much will be spent on these medicines. The pharmaceutical companies hate it, but it works really really well at keeping costs down.
As for malpractice suits – they don’t exist. The Accident Compensation Corporation makes it impossible to sue anyone for malpractice. So if something goes wrong, ACC pays for the remedial treatment. ACC’s other role is to ensure as far as it can that things don’t go wrong.
The cost for society, because no man is an island, is lowered: sick people (in theory at least, and largely in practice) are treated earlier than if they are taken to hospital in an emergency.
It’s not all a bed of roses. Waiting lists for care can be quite long for some problems. Not all drugs are covered – especially those required by only a very small number. Sometimes people must travel to Australia or the US for treatment which is not available in a small country. But these are problems on the margin.
Generally though, I’d say that things are much, much better here than in the US. Wonderful country it is in so many ways, but in others less so.
Kia ora (lit. be well),
Laurie
October 3rd, 2013 at 2:14 pm
Dr. Scott: I think you do have the right to be forced to have health care, just as your forced to have car insurance. If you don’t have your own health care, then the state/government has to pay for you when you sick. (One can’t just let people die.)
October 3rd, 2013 at 2:41 pm
Just a correction, Kirk: No government forces me to have car insurance. Most banks will force you to carry insurance on your car if you have a loan out on the vehicle but, after that, no insurance is mandated by the federal government. Some states mandate it, perhaps, but certainly not all of them.
October 8th, 2013 at 1:11 pm
It’s actually "Live Free or Die".
October 8th, 2013 at 1:59 pm
Hi Dave, I responded via a blog post: http://islandinthenet.com/2013/10/health-insuran…th-maintenance/
October 8th, 2013 at 2:01 pm
Hi Dave, I responded via a blog post: http://islandinthenet.com/?p=10938
October 24th, 2013 at 2:22 pm
The difference between Health Care and Insurance is that most insurance works on the basis that most people wont need it in a big way. The house probably wont burn down, the care won’t get destroyed. Over the life of a policy maybe no claim is made ( pure profit for the insurer ) or more likely a fender bender or burst pipe cuts into the revenue a bit. Only a few poor souls have to make major claims, and for them its a life saver.
Trying to Insure people’s health for profit is crazy. Everyone is going to get sick. Everyone is going to need care. And in a technologically advanced society which is tending to extend life for more and more people that care is going to be expensive.
Add to that the tendency of many health care professionals in the US to feel the practice of medicine should be a HUGE corporate and individual profit center ( talk about having no option but to buy a service … trying bargaining in front of a cancer doctor ) and we have the recipe for well, …. what we’ve got.
We will all pay for our health care one way or another. Whether its in dollars, or living in a world of sick, poor or destitute people who can’t help themselves let alone the society they live in. So lets just all pay for it over the course of our lives. Just like we pay for an army to protect us ( why? No one is attacking me!), roads to drive on ( why? I don’t go anywhere! ), schools to educate our children ( why? I don’t go to school anymore! ), street lighting for safety ( why? I have a flashlight ! ), National Museums to make sure we don’t forget ( why? I have the History Channel ! ).
Call it insurance, call it a Tax ( I know it’s a loaded word in the US ) call it a Levy, call it a Donation, don’t call it anything… collect it from everyone along with income tax.
Make it cover a fair cost for required medical services provided to all. Allow doctors to charge more if they want, then consumers can either pay the difference or purchase insurance to cover it ( or a portion of it ). That way private, well appointed facilities can still exist and thrive … but care will be available to all no matter what.
This will allow control of a system that is out of control. It will permit "Emergency Rooms" to work as intended instead of being a de-facto catch-all for people with no other choice. The medical load will spread over many clinics and practices instead of converging on s few limited hotspots.
Wont happen because here in the US "Tax" is the most feared word after "Communism" … I’m sure some even think they mean the same thing! 🙂
What do I know?