September 10, 2009

Health Insurance

Inspired by my friend Helen's recent blog post Here's how it is for me.

I've been self employed since 1995. Before that I had nice corporate health insurance (that I rarely if ever used). At that time, I accepted a voluntary separation package (ironically, I was working for a medical imaging company, and the downsizing was driven by the health care industry freeze-up at the time of the Clinton health care initiatives). I took advantage of Cobra for 18 months (I guess) and then I was out on my own.

In the past 14 years I have had a variety of health insurance plans ranging from:

* Cobra corporate insurance
* Crappy self employment insurance through NASE
* No health insurance
* Full health insurance through Anthem BC/BS
* A high deductible policy with a Health Savings Account (HSA)

This last is my present insurance. I switched over a year or so ago as the regular self employed health insurance premiums rose past $500 / month - I pay less per month, I sock away $3K per year tax-free towards some future health crisis, I get no deductible preventative care, and preferred pricing on drugs and stuff. Win Win Win.

It helps that I have been in good health these past 15 years - I don't really use health insurance. I have an annual check-up with my endo / PCP, an annual gyno appointment. Some fairly low cost maintenance meds. An annual set of blood work. Knock wood - so far nothing chronic, nothing catastrophic. And though I carry around estra weight, I also hit the yoga mat for a vigorous practice 4-5 times a week, hike walk, or bike regularly, and remain more or less physically active.

I will say that my health insurance leanings do run a little right of center, in a couple of ways.

A) Competition. When I had corporate or full health insurance, I'd go down to my local CVS to fill my prescriptions. I'd chaff a bit, because there was often a line of folks at the pharmacy of my big city CVS - most (judging by overheard copays) on some form of medicaid / medicare / state insurance. I, and they, never thought about about the price of our prescriptions - we were happy to lay out the copay. But when I got my HSA, and started to pay for my own prescriptions, I started to price shop. Came to find out that the CVS price was incredibly high compared to where I go now (Target); that because I was not incented to price shop, my insurance company was paying a higher price. In one case, my copay at CVS was higher than the full price at Target! And the insurance company was paying $30-$40 bucks a month on top of that!

So I'm all in favor of driving a little consumer awareness and incented price shopping into health care; of making it a little more financially painful for folks with health insurance to opt for convenient, yet expensive, consumer choices.

In another case, back in the day when I had health corporate insurance, I twisted my ankle. Pretty sure it was not broken, but I went to the doctor who confirmed that. But he wrote out a form for an MRI. "Why are you doing that?" I asked. "Just to be on the safe side...." he said. I interpreted this to be "cover my butt so you won't sue me" medicine. "And what happens if there is something there?" I continued. "We wait a few days for the swelling to go down, then come back and we'll decide how to treat it"

"And if I don't get the MRI?" Well, in a few days if the ankle is not feeling better, you'll want to come back, we can do an MRI then. So basically, the MRI was not going to change the treatment at all, but it made the doctor (or more likely, his malpractice insurance company) feel better. I signed a form saying "no thanks, and Imn not goign to sue you", and the ankle healed fine. Hundreds of dollars of health care expense avoided. So I am also a big fan of tort reform in the health care field. There is clear malpractice and then there is the art of medicine (where sometimes doctors do all the right or prudent things and the patient does not recover optimally) - and I'm sick of this "if something bad happens, I get a big check" society (this extends to accidents and injury as well). When I see those "get the money you deserve" ads on TV I begin to think Shakespeare was right about lawyers..... Just because we own a big freaking MRI machine does not mean we need to use it for every scrape and bump.

And finally, I'm all for incenting healthy lifestyles - be it around weight, exercise, preventative care, sin taxes on junk food, etc. You want your double quarter pounder with cheese or your blooming onion? It'll cost you an extra buck or two, with the proceeds going into the health care kitty.

I'm actually kind of in favor of a two tier system. I have no problem with a no frills, public health option that is heavy on preventive / basic care, and perhaps not so generous when it comes to extraordinary treatments (thinking things like transplants and aggressive cancer treatment with little hope of recovery). You want that stuff, and are willing to pay for the white glove insurance (or have the bucks to pay out of pocket), by all means.

And I *do* like the idea of death panels - because nobody wants to accept or embrace what is, for all of us, pretty much a sure fact. And I think someone with a little distance (and no financial incentive in terms of payment for services or procedures) ought to be able to suggest "hey, we think it's time". If you've never put a dog or cat to sleep, you are not qualified to make end of life decisions....IMHO. And if there is no factoring in of cost for these extraordinary procedures to extend life few more hours or days, with little regard for the quality of life, well - no wonder we are spending so much.

I don't say much about stuff like this on the blog - because I'm kind of a cold hearted realist in some ways who is a less afraid of death than most (go to an enlightenment intensive - join me!). So I accept the inevitability of my own death and the death of others. I embrace the needs of the many outweighing the needs of the few. I look at a heart transplant and think "hm....how many 100's or 1000's of lives can we save if we spend that money on pre-natal care". And that sort of thinking is dangerous and heresy.

But now you know.....

1 comment:

sandy shoes said...

Thank you for this post. Good thoughts.

I've always had traditional health insurance from my employer, or more recently Miles's employer. The only thought I've given to where to get prescriptions filled is convenience/location. I had no idea there were such crazy variations in price.

The system is broken in so many ways...