Two-pronged consideration is advocated here for a quick update to your view and where you’d like things to go and your ability to navigate healthcare as it is to save money.
Why read on? Because we’re finally paying attention to the fact that “insurance” and having it whether through Obamacare or through the private market is not necessarily going to protect either your health or your wallet in the event you become sick.
At a glance, can you can tell how things will go for you if you get sick by examining your out-of-pocket premium expense, co-payments, and co-insurance payments as well as your deductibles? Somewhat, but there is uncertainty. By now you know that the more expensive policies will cover more, but likely, you also know that even the expensive policies are covering less than they did in past times.
Our current insurance world is off-balance because the product supposed to cover uncertainty, insurance, is now focused on LIMITING insurance company coverage of the unexpected while the consumer, us, is left with the same or GREATER uncertainty in determining whether the money we pay to cover the IFs (premiums for health insurance) of life will actually cover those IFs.
Where O-blama-care codifies an already bad practice is that you never really know what you’re going to be charged ultimately for the medical care and treatment you receive.
A good VERY GENERAL consideration of some of the pitfalls are covered on the Kaiser Permanente website at http://info.kaiserpermanente.org/html/deductibleplans/qanda.html. For purposes here, it’s noteworthy that many of the questions address the fact that consumers cannot know what they’re going to be asked to pay before visiting a healthcare provider. That can be terrifying, unknown liability.
From the insurance company point of view, unknown liability is also a risk, how much will they be asked to pay? BUT, insurance is a product designed to account for that UNKNOWN by using payments from all people insured to balance out the costs of those who cost more because they’ve become sick. If health insurance cannot do this for any reason, then it is an ineffective product.
Instead, as we all listen to how insurance companies are reducing their risk of having to pay by either not covering certain medical care or treatment (EXCLUDED care and treatment), by covering a smaller percentage of the costs of various care and treatment (HIGHER deductible, Co-Payment and Co-Insurance), or by forcing people to pay full price through things like insufficient numbers of participating providers (forcing individuals to go out-of-network) or by incorporating more hurdles to qualifying for the coverage you pay for (The drug step program requiring use of generic or non-coverage of brand name, or preauthorization for treatment and tests which your failure to do will cost you more) we as consumers live with more uncertainty. The formula is backwards.
In terms of the blame-game, there’s enough to go around for this dangerous trend. Why read on? In January of 2008, before Obamacare, I wrote about this trend in the post, “An Ounce of Prevention is better than a pound of cure, but we still need to insure the cure,”
http://conoutofconsumer.blogspot.com/2008/01/health-insurance-as-education.html.
In that post of 2008 I concluded, “Health insurance is not to cover the costs of prevention, it's to cover the cost of the risk of illness. Prevention is a goal, but we don't buy health insurance coverage to prevent illness, we buy it in case we are ill.”
One of Obamacare’s biggest weaknesses is the codification of the requirement for people to purchase SOME insurance or face a tax, because many of those policies are inadequate to cover the cost of needed medical care and treatment if a person is sick, the ONLY REASON that a consumer should be interested in purchasing the insurance product. Further, Obamacare's heavy emphasis on prevention rather than coverage of needed medical treatment will leave many citizens who become sick this year with the unpleasant realization that the "free" checkups they love are not so free, exacerbating the problem of insufficient coverage.
When you hear about complaints put out by other stakeholders, insurers blaming the rising costs of illness on doctors or medical device makers or pharmaceutical companies, or even malpractice claims, this is NOT a consumer concern. What is a consumer concern is to force these stakeholders to examine their contribution to the problem and reject all of the “Blame the patient,” nonsense put forth.
If a health insurance policy cannot cover illness caused by WHATEVER, whether a patient’s conduct contributed to the situation or not, such as smoking or overeating, a patient’s age, or a patient’s lifestyle (yeah, there are certain activities that result in higher risk of injury) then the product fails.
Up until now and still now sometimes you’ll hear the argument that “I don’t want to pay for this bad habit or that of my neighbor,” which is fair, but irrelevant because if you buy the approach of insuring people based on the likelihood that they WON’T need insurance then you are really supporting the insurance companies rather than your fellow consumers.
As our healthy young and our unhealthy old alike are finding out, once given permission to try to limit what they pay out, insurance companies will keep trying to limit what they pay out and even those individuals who pride themselves as “GOOD” insurance risks will find themselves with insufficient coverage for their physical and financial health IF something occurs in their lives that requires medical care and treatment. They will not get a break based on their past “GOOD” behavior, they will not get more coverage because they’ve been a GOOD RISK over the years, the most they’ll do is realize that the insurance company whose approval they’ve enjoyed is NOT their friend.
The take away, consumers want access to affordable health care if they need it in a timely fashion, anything else is NOT in our interests. When you’re presented with doctors whining about their situation, remember doctors love insurance because it guarantees their payment, they’re usually just arguing about how much they can get from the insurance company. If you’re worrying about pharmaceutical companies and the cost of coming up with medications, take a look at their profits before jumping on the bandwagon.
If you believe it’s your neighbor’s fault then look in the mirror and ask yourself why on earth you’re buying insurance if you are not at all worried about ever getting sick? If the answer is simply to avoid paying the tax then I would advise you to use some of the new mental health coverage your policy likely has (yes, this is a somewhat sarcastic remark because currently the "tax" is lower than a year's premium payments, though I always advise you to have health insurance).
Health insurance that doesn’t sufficiently provide you with access to health care professionals, medication and services you need at a price that will not bankrupt you when YOU are sick is nothing, it is throwing your premium payments in the street.
Quick Fix: The quickest fix would be to allow policies to have clearly communicated coverage for preventive care just like other services rather than "free" checkups because preventive care costs are finite, a checkup or an exam. This would be a return to pre-Obamacare. I believe this is necessary for two reasons, first because insurance companies are using the coverage of these finite costs as an excuse for raising prices, which is NOT what insurance is about, insurance is about covering uncertain costs in the event something happens,and second because once a service is covered by insurance prices go up, so that I anticipate a huge increase in the costs of these preventive services charged by providers, which will feed into even higher costs going forward.
