Health insurance sucks

So it is open enrollment time for health insurance, both for those on Medicare and those who are self employed.

The United Healthcare CEO, Brian Thompson just got assassinated.

For most of the last 20 years, my family has purchased health insurance through the New York State of Health.

Most years we end up with a shitty high deductible plan where we need to budget for $5,000 or $10,000 in case we need care to satisfy the deductible. We come out of pocket with a monthly premium that exceeds any other bill in our home. That was even true back when we had a mortgage. Today, our biggest bill is property taxes but health insurance will cost more in the new year.

A few years ago during one of those times we were changing insurance companies, we signed up for Fidelis Care because it was cheapest. Then we found we had to change doctors because our existing physician would not accept that insurance.

A year ago, Beth got a solicitation from her primary care physician suggesting she should retain his services and sign up for “Concierge Care” with MDVIP and if she didn't, he would no longer serve as her doc.

The idea was you would have immediate access to your doctor any time you needed her and it would only cost about $2,000 annually (of course, in addition to your health insurance premium and deductible.) You can call any hour and receive an actual response from the provider. Office visits will be tripled in length rather than 10 minutes of droll buffoonery from a burned out nurse practitioner eager to get through her overrloaded schedule.

She said no. Why would we spend an extra $2,000 annually in addition to our premiums? Then we started doctor shopping. We had Independent Health this time. We found a doctor we liked and felt good about it.

She took 45 minutes with me on a first visit. She was short, obese and asked how often I check my blood sugar. “Truthfully not often” I said.

“That’s pretty common,” she said with a clarity that led me to believe she doesn’t check hers often enough.

She was empathetic. Thrice in the last 15 years I have had health crises that cost at least $7,000 in addition to premiums. Luckily we had the means to pay.

I asked the new physician, who is wonderful, about concierge medicine.

“So what do you think about this MDVIP thing?” I asked. “It seems like ‘care rationing’. Those with money are first in line. Those who choose Fidelis are screwed.”

She disagreed, pointedly, noting it allows physicians to provide better care and achieve better outcomes.

She also set me straight in the decided way only someone with Italian roots, and time in the old country, could.

“If I need to do a sonogram on a patient, a $15 procedure, it needs preapproval with Fidelis and paperwork that takes more time for my staff than it is worth. It is not worth the hassle. It is easier to tell people to never use Fidelis.”

I didn’t say a word because I realized the error of my assumption. Fidelis Care was the bottom rung of health insurance companies. If you are working poor, and paying out of pocket, it is the lowest cost option but you get what you pay for.

For years, we have framed care decisions in terms of economics, always asking “what will that cost” before making decisions to move forward. Providers return blank stares and usually have no clue because medical school doesn’t offer the same life skills taught by Boy Scouts in the personal management merit badge. There is too much anatomy to consider economics.

I tossed this about as I endured the open enrollment procedure knowing our state would pay more of our insurance premium than Mass Mutual, CNHI or Northwest Savings Bank, the last employers I had who contributed a dime.

That’s the thing. Health care is a basic right. Insurance is broken. The Affordable Care Act got one thing right when it made preventive care like mammography and colonoscopy free. It still leaves a vast majority making tough decisions about important things like “do I pay a few $1000 for a sleep study because of my apnea? What about my deviated septum? Or should I just say 'it's not that bad' and live with it.”

There is a reason medical bills are the leading cause of bankruptcy in the United States and it is not because the insurance system is working even if we have great health care.
All this angst over insurance resulted in a weird spin this week. Less than 24 hours after United Health Care CEO Brian Thompson was assassinated in Manhattan, even mainstream media was writing about for-profit healthcare, medical bankruptcies and the need for reform. They were also writing about is compensation, which including salaries, bonuses and stock options was $10.2 million last year.

The narrative switched quickly from “someone killed Brian Thompson and we have to find out who” to “the real problem is health insurance. It is understandable someone shot the bastard.”

That is as unconscionable as the Conservatives after Oklahoma City empathizing with Tim McVeigh because of government overreach at Ruby Ridge and Waco.

Thompson’s life matters, and his killer should be prosecuted, but we also need to address the insurance crisis as a nation.

https://www.npr.org/sections/shots-health-news/2024/12/06/nx-s1-5217736…

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