Affordable Care

It’s been a rough week. Not that I’ve been busy, or overwhelmed by work or personal things. Nope, I’ve spent half the week under the covers, or locked away in the bathroom. I actually took 2 days off work, and half regretted not taking a third. In the 21 years that I’ve been working, I can only think of one other time I called in sick to work. Four days later, and I’m still not back to 100%. My guess is food poisoning. Of course, the office rumor mill says I’m pregnant. Gotta love being a girl! Whatever it is, luckily it doesn’t seem to be contagious.

Being sick reminds me of what great benefits I have through work. I get 6 personal days (plus 10 vacation days) each year that I can use however I want. And, unlike paid days off at most jobs I’ve had, no one gets upset when you use them. If I were to become seriously ill (or pregnant), I have free short-term disability, which kicks in immediately, and covers 100% of my missed pay for up to 24 weeks, when my free long-term disability would kick in. I’m also on the company’s free health insurance plan, which offers a low $750 annual deductible, $3,000* annual out-of-pocket max, and 80/20 coverage. For $7* a week, I could upgrade to a premium plan, which only has a $250 annual deductible.

Yep, I have awesome benefits. But that hasn’t been the case for most of my working life. Actually for most of my working life I’ve had 0 benefits, other than 2 weeks paid vacation (which we were discouraged from using). In my twenties I never much saw that as a big deal. I was healthy, and not in a position to have children, so what did it matter? The few times a company plan was made available, I tried to be responsible and join, paying hundreds of dollars a month for mediocre coverage.

Once I hit 30, having health insurance seemed more important. At that time the company I worked for didn’t offer insurance, so I went through eHealthInsurance to find an affordable plan. I was able to find a fairly bare-bones plan that fit my needs (no maternity coverage, $2,500 deductible, etc). I held the plan for several years, until I was eligible for coverage with my current employer. During the last few months I was on the plan, I watched as my monthly premium went up over $100 per month, during the earliest fall-outs of the Affordable Care Act (Obamacare).

Long before the roll-outs of the largest parts of Obamacare went into effect, I watched as my premiums went up by $1,200 per year. Oh, but in a year or so you’ll get free birth control! And Free Annual Exams! Apparently, some people can’t do math; My pills never cost me more than $10 per month, and at most my annuals might run a few hundred, depending on what tests needed to be run. Even with the occasional added mammogram, ultrasounds, and biopsies (I’m prone to a variety of lumps), I don’t think I’ve ever paid $1,200 for female care when I was insured (including the one year that my follow-up mammogram was denied, due to the fact that the insurance felt I wasn’t old enough to require one).

I’m lucky that I’ve had insurance when I’ve needed it, and that I’ve always been able to afford the medical care that I’ve needed. I’m thankful for that, and very aware of the fact that this isn’t the case for everyone. This isn’t meant to be a political rant. I can understand the push to create a better health care system for everyone. I just don’t understand why the path to Affordable Care has to go through required Health Insurance. Isn’t that just adding a costly middleman?

In my mid-twenties, I took a few months to explore a career in sales. More specifically, Life Insurance Sales. In order to sell Life Insurance, the state requires you to be licensed in Health and Life Insurance. So, I took the required courses and tests. I had a wonderful instructor, who had a wonderful way of explaining things. His explanation of insurance has stuck with me for years. Insurance is like gambling, he’d frequently say. And if you break that idea down, it really makes sense. The insurance companies are the bookies, and the policy holder is the gambler. With a health insurance policy, you’re betting with the insurance company that you won’t get sick, or injured. It’s a very specific (and lengthy) list of illnesses and injuries that you’re betting on. You give them money every month, as part of the “bet”. You get cancer, diabetes, hit by a car? Jackpot! They pay for your treatment, as outlined in your original agreement.

Unlike most gambling scenarios, with insurance you’re both hoping for the same outcome: That you or you’re family don’t get sick or injured. In which case, the insurance company keeps the money, and you, well, don’t have to be sick or injured. Same with Life Insurance; You’re betting on your life, but both sides are hoping you live. And, like any form of gambling, the bookie is only interested in the bet if he can make money. After all, that’s the whole point of being a bookie, right? The odds are greater that an obese person will get diabetes. So, you charge that person more, since you’re more likely to “lose that bet”. And some bets aren’t even worth taking. Of course, not all insurance companies are founded to make a profit. Originally insurance companies were founded by groups of people, looking to spread their risk across a greater base. Like farmers, who used to pool together funds to insure each other’s farms. It creates a larger pool of money to cushion the blow of larger losses.

Health Insurance companies, by design, are middlemen between patients and healthcare providers. They have their own expenses; Buildings to operate and maintain, employees to pay, shareholders or owners to please. Add in all of the additional paperwork and man hours needed to communicate between the insurance company and the healthcare provider, and then from the insurance company to the patient. Don’t get me wrong, I love that I have health insurance. As I’ve already said, I’m extremely thankful that I have great, truly affordable health coverage. But, I can’t help but wonder, as a nation seeking to provide affordable care to its people, Why health insurance? Why setup a healthcare system around spending billions and billions of dollars on a middleman?

It’s a complicated matter, and I know there’s so much more to it than I know. And I’m not trying to make this political. There are valid arguments on both sides about whether or not it’s even the governments place to be involved in healthcare at all. But, if that’s the direction we’re going in (and, since the Affordable Care Act has been passed, it is), wouldn’t it have been better to cut out the middlemen (i.e. insurance companies)? Spend more money directly on healthcare?

I’ve read numerous articles and blog posts discussing the implications and costs of Obamacare. High end doctors are turning to “Concierge” type services, some even refusing insurance all together in favor of simpler, more cost-effective relationships with their patients. Dealing with insurance companies adds a lot of red tape, paperwork, and costs to operating a healthcare facility. The more involved the government becomes, the greater these obstacles become. I’ve seen a tremendous impact over the last few years at various healthcare providers as they try to adjust to all of the changes. I’m currently looking for a new primary care physician; The practice I had been a patient at has lost the last 3 female physicians that had been working there. It concerned me that the practice wasn’t able to hold on to good female doctors. I later found out that it wasn’t an issue with the practice, but rather with the required changes. New regulations mean that most doctors spend more time in front of a computer than in front of a patient. Doctors are working longer hours, and cutting the time and attention each patient receives, in order to maintain a profitable level for the practice. The three female doctors who left all had young children, and were struggling to maintain a work-life balance and give the quality of care they expected to their patients. Each left for either smaller, more remote practices, or for urgent-care type facilities.

At the same time, I’ve been to 2 male physicians who have adjusted in a different way to the changes. Both are specialists (in very different fields, at very different practices), who are locally known in their fields, and I would guess them both to be in their early 60’s. Both were great doctors, spending a lot of time with their patients, very focused. And both were followed from exam room to exam room by a girl with a laptop, who typed away throughout the exam, making notes, recording diagnosis, and ordering prescriptions as called out by the physician. In each case, the doctor introduced the assistant, with a simple explanation of “I don’t have the time or patience for all that computer stuff.”

And I have to wonder if what I’m seeing is the new wave, or if it’s just an anomaly? Is the new system creating a divide between male and female practitioners? Are male practitioners adjusting to the changes by demanding more staff, while female practitioners are resigning themselves to other positions?

Like the rest of the nation, I’m watching with interest to see how this all progresses. I feel lucky that the changes won’t have an immediate financial impact on me. But it will definitely play into the choices that I make going forward. Instead of feeling freer, knowing that I’m guaranteed insurance coverage, I personally feel more trapped, knowing that the coverage won’t be as affordable for me as it once was. I worry about how the changes will affect the way that the healthcare system operates. And I continue to wonder about the choice to make insurance the central focus of a national healthcare system.

Am I off my rocker? What changes have you noticed in the healthcare system that aren’t being addressed?

– Cindy W.

* I was mistaken on these numbers, and have since gone back and edited them. 

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