Health Insurance Disgrace

Yesterday, my accountant said something along the lines of, "If the American people understood the miasmic disasters that are private health insurance and the IRS tax codes, they'd storm Washington and stay there until both were dismantled."

I don't know about the IRS, but I well know the infuriation of buying one's own health insurance and receiving exactly nothing for it. To wit: my last plan, Blue Cross Blue Shield of Oregon, had a $7500 deductible; this plan cost me $232 a month. Before I'd even used it, it went up to $312. For this money, I received exactly one thing before the deductible was met: a mammogram, which I went and got--and then got a bill for, from both the hospital and the radiologist. I called BCBSO and explained there'd been a mistake, as I was looking at my policy and it said an annual mammogram was covered.

"Oh, we changed that in 2005," said the rep. "But it's covered once you meet your deductible."

I pointed out that brain surgery is covered once I met my deductible. Then I switched health plans.

Several weeks back, Malcolm Gladwell wrote about "the bad idea behind our failed health-care system." Here's a long excerpt:

    One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system. Six times in the past century—during the First World War, during the Depression, during the Truman and Johnson Administrations, in the Senate in the nineteen-seventies, and during the Clinton years—efforts have been made to introduce some kind of universal health insurance, and each time the efforts have been rejected. Instead, the United States has opted for a makeshift system of increasing complexity and dysfunction. Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average. Infant-mortality rates are in the nineteenth percentile of industrialized nations. Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita. Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy—a country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper—has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers.

I have debated this loyalty with others, who are quick to cite the waiting lists for services in, say, Canada and the U.K. And that providing health care for citizens at a reasonable cost somehow smacks of socialism and will, in itself, dismantle the free market. I think this is bullshit; I think we have been taken hostage by the current health care system, which gives us less and less for our dollar because of spiraling costs, costs that are largely administrative and/or pay for HealthSouth Corp. creator Richard Scrushy to rename a campus after himself because he feels "like companies in America need to give back." A give-back that does not include the estimated $300 million dollars Scrushy earned the HealthSouth fiasco.

Which is why I took some heart reading about artists in NYC bartering for their health care. Any dentists within driving distance of Portland: I can write and bake a mean chocolate chip cookie.

Comments

[david]

You should join the Authors Guild -- cost $90, and then yearly based on income (they don't check; they hope you tell the truth), and you can get health insurance as part of the group plan. The cost isn't small, but the deductable may be more reasonable. When my wife stops working and our corporate health insurance which started out as fabulous and has gotten steadily worse and more restrictive runs out, that's where I'm heading.

I'm also thinking about getting a cyanide pill put in my left rear molar, just in case.

[nancy]

When Din formed his new business, we qualified for a Group Plan, which I lunged at. Yes, it's an HMO--but Kaiser in Oregon is not the "seventh circle of hell/people denied heart surgery 'cuz, ya know, is it really necessary?" that it is in LA. Co-pays are $5, the deductible is $1000, and the whole family is covered for $404 a month.
And, at least you still have a left rear molar to put it in!

[Zev]

The arguments from Canada & UK are pretty strong. Why would we want to buy into that?

[Jackie Danicki]

You know what adds to administrative costs? Huge amounts of government regulations. Believe me, these are not the guys you want running the healthcare show. (Ask Antoine why he gets his asthma medicine OTC in the US. Hint: The stuff the government gives him wouldn't do a damn thing to save his life if he had an asthma attack. And yes, we do still pay for it, big-time. Oh, and good luck getting anything solved in the six minutes your doctor is allowed to spend with you. This system has to be lived to be believed, and as someone who lost a very dear loved one to the NHS waiting lists, I can tell you that I wouldn't wish it upon you, Din, Tafv or anyone else I care about.)

I agree, the American healthcare system is a nightmare. But this is not because there's not enough state control of the situation; the problem is exactly the opposite.

[nancy]

All I can say to Zev is, read the Gladwell piece. For many many Americans--myself included for a decade--it was not a matter of getting the care we could afford, it was a matter of not getting care because we could not afford it. Doctors no longer accept patients without insurance, and if you can't afford insurance, what do you do? I'll tell you what: you let the tooth rot, or put up with the pain until it becomes chronic. And I am not some backwards idiot; I was someone who earned less than 40K and had a child to support and simply could not afford to throw 20% of that pretax money at insurance. I would rather get some care--which is what you get in the UK or Canada--than no care. And if I want to pay on top of that for better care, I'll do it. Plus, who says the only way to create coverage is to "buy into" what they do in other places? There are many ways to skin the cat, but it will never happen here, because everyone says, ooh, don't want to be like Canada. Personally, I don't see a lot of disease-ridden Canadians walking our streets, but I do see seniors chartering buses bound for the border in order to buy their prescriptions. Also, when my daughter recently required better than $3,000 worth of dental work, I was advised by several people to cross the border--into Mexico--to get her teeth taken care of. My friend's mom had her eyesight-saving operation in Russia because the care was so much better and the cost so much less. The claim that we have the best medicine in the world is sort of pointless if a majority of Americans do not have access to it.

[nancy]

I do not have a boner for state control--they will surely screw it up more than anyone. But I also don't want what we have.

When I was little, my mother took me twice a year to the doctor; $10 a visit. (Hey, no wisecracks: this was the late 1960s.) I had my appendix out in 1971 and stayed in the hospital five days: $900. My parents paid cash. When Tafv was born in 1989, I got an itemized bill from the hospital: Pacifer: $308. Baby thermometer: $602. When I called to say, there's been some mistake, I was told, this was the way they needed to break it down for insurance. This is not a working system.

I would love it if competition and a complete absence of government intervention could be put in play. And I suspect, because this system would treat the ill and the desperate, that pretty soon the people running it would find ways to lie and steal and price-gouge. Why? Because free marketers, too, are human beings.

I don't want to rely on the state for care, and Jackie mentions losing a loved one to NHS. And it's horrible, as is not being able to get on any roster for care because you can't afford insurance. Or, and just about the worst, paying premiums for years and then being told, sorry, we won't cover what you just contracted. Every day there are stories in the paper of people fighting both cancer and their insurance companies, in order to get the care they paid for and were promised. And of doctors who are hamstrung by paperwork and who must increase their workload two, three, five times just to make the same amount of money they made a decade ago.

As for the six-minute visit: this is three minutes more than my buddy, who works for and whose insurance is through Lockheed, gets with his physicians.

[FoodDude]

Consider yourself lucky. I pay $262 a month for Bluecross/BlueShield and have a $1000 deductible. It pays 50% of my prescription costs which run $2,200 a month before they pay their part.

[Amy Alkon]

I think smokers and obese people should have to pay much more than the rest of us. An idiot tax, if you will -- unless there's some weird rare genetic reason why you weigh 300 lbs. My Kaiser insurance is $235 a month -- for a healthy, 41-year-old runner whose blood pressure number, etc., always has the nurses impressed out of their socks. Ridiculous.

[Amy Alkon]

Oh, and PS Jackie is absolutely right about "free" health care by the state. It is pretty good in France, according to my friends there...then again, I reminded my one friend that it isn't "free" at all if he has to pay 65% of his income in taxes -- which he did last year. At that rate, they should massage your feet and give you a blow job with every physical!

[eric]

Just curious Amy-

Do you happen to have one of those French nurse uniforms?

[Greg Dewar]

I've often joked that we don't have anyone in the "health insurance business" anymore - we have large "check cashing" businesses instead. you send in your premium check, they cash it, then do absolutely nothing in return.

Thing is, I wonder if "insurance" or "health care" can be both a viable business AND treat people who need it. I mean really, if I was starting up a health insurance company, Id' want to only insure people who are super duper healthy - so they pay the premium and I pay nothing (or next to nothing) out.

there's no cheap way to treat cancer, there's no cheap way to treat a neck injury, some things are just expensive no matter what.

But what we have now is a lot of money being spent not on the health CARE, it's on the middle managers and of course the huge salaries they pay the folks at the top. 100s of Millions in salary for morons at the top and meanwhile Everyone Else is screwed with big premiums and no real service.

The Magic Wand of the State may not be the answer, but really, can anyone argue now that what we have is working in a way that's beneficial for the great majority. No.

Surely if we have geniuses that can figure out how to get paid to do nothing, we've got to have some that can figure out how a system can work better than what we have?

[nancy]

What Greg said.

[Emmanuelle]

Such an interesting post Nancy! My two cents: I've never experienced waiting lines at all in France in 22 years of living there and it's never brought up by my friends and relatives who undergo care.

I used to think that Canada had a quality health care system pretty much like France, until I saw "the Barbarian invasions", that won the oscar for best foreign film a few years ago. In the film, a terminally ill patient gets treated in terrible conditions and fights with his son who wants to have him treated in the US instead. I interviewed the director who told me that the film was inspired by the true story of his parents in Canada. I was quite incredulous: I mean, come on, it's Canada, not the third world. It can't be that bad! But he replied that, unfortunately, the Canadian system can be very bad as bad as described in the film.