It's so complicated. Health "insurance" varies and can be anything from a high-deductible plan which means you pay everything until you hit $1000 or even $5000 and then insurance pays 100%, or a plan where they pay 90% of everything. Some people pay $5 for prescriptions (with ins.) and others pay $50 for the same drug (with a different ins.)
My biggest issue with our system right now is that it is tied to your job. My husband works for a small company that does not offer insurance. I work as a secretary making very little $$ but the place I work for offers good insurance. I hate working here and we are moving soon so I put in my notice and we immediately applied for an "individual" plan (independent of our jobs) and we were denied. We are willing and able to pay for health insurance but they do not have to accept us, even for one of those "high deductible" plans where they are not likely to have to pay for any expenses. They have an "underwriter" that looks at the application and sees that my husband has high blood pressure and I had surgery last year and stamps a big fat DENIED on it. The only other option is to go get a different job that offers insurance because they have to accept us on their plan. So much for those who choose to be entrepreneurs and be self-employed, or those who wish to work part-time like moms who otherwise stay home with their kids.
See, the way the laws work here, if you work at a job that offers insurance the insurance carrier is required to accept you into the insurance plan. Sometimes there is a waiting period of 1-3 months and sometimes the employer pays part of it and sometimes they don't. Sometimes they have good insurance where you can see any doctor (PPO) and some have HMO's where you can only see a certain doctor that may be 30 minutes away. However, if you do not have a job that offers insurance or if you are self-employed, etc. you have to apply for individual coverage and they are NOT required to accept you. Insurance is a FOR-profit industry and they have a responsibility to their shareholders to maximize profits as much as possible. That means denying claims and hoping that you don't fight them and denying anyone who has any sort of medical condition that might cost them $$.
Part of the problem is that it is inconsistent. When you go get an MRI it's like $1000 if you don't have insurance. If you do, then the insurance pays their "agreed" price to the hospital (say $600) and then you pay 10% or 20% of that as your "co-insurance" so you pay $60 or $120. Since people don't usually pay attention to this and get a bill for $60, they don't shop around for a better deal or pay attention to how much things actually cost. SOME plans just have a $20 co-pay and then people REALLY don't pay attention to how much things cost. My mom's doctor sent her for an MRI once (she had cancer a long time ago and they were worried about something) and the insurance refused to pay for it even though the doctor ordered it and said she needed it. They can do that, and there is nothing to stop them because you are one person and they are a multi-billion-dollar company with lawyers and politicians on their side.
It's true that they have to treat you at the ER, but then they send you an inflated bill. What ends up happening is people without insurance wait until it gets really bad before going, requiring twice the expense, or people who can't see a doctor (because many don't accept "self-pay" patients) will go to the ER for a sore throat.
The system is really messed up and the politics of it is disgusting. The politicians are all in bed with the health insurance companies. I'm all for personal responsibility and taking care of myself, but I shouldn't be forced to work a dead-end, low paying job just to get health insurance.
I think part of the solution is going back to actual INSURANCE not these 90% health care plans. I am perfectly happy to pay for my Dr. visit and antibiotic as long as I'm covered if I break my arm or I have to have surgery. However, doctors are so used to OVER-charging because their rates then get "discounted" by the insurers that everyone would have to go to this type of system before it became a competitive free market.
There is a bill in the works called HR676 that would allow anyone who chooses to to buy into medicare (which is the system provided to the elderly and the disabled). This would be a great option for diabetics, people with high blood pressure, people who otherwise are denied coverage. But the politicians won't let it go through. They are scaring people by screaming "socialized medicine" All I'm asking is that I be able to buy insurance to be on the same level playing field as my neighbor who has insurance through his job.
Another example of why this is unfair is that my husband is happy with his job so insurance through another job for him is not an option right now. Therefore I am the only one who can get a job that has health insurance. When we have children I would like to stay home with them, therefore loosing our health coverage at a very important time. There are no options for situations like this and it's very sad. Something needs to change and as hopeful as I am about a change in November, in order for this to change more people need to be outraged. Those who are just plugging along think things are just fine, until they lose a job, change jobs, have a baby, etc.
Oh, also if you change jobs and insurance your deductible starts over. You can't take your insurance with you from job to job. The whole system stinks. |