Insurance is a topic to which I’ve devoted many a ponderous thought over the years, but nothing says insurance like a nine-hour stay in an emergency room. Mind you, I didn’t want to be there. Although the doctoring profession is a noble calling, and many MDs are fine people, including the ones I know, I have an aversion to sickness in general and hospitals in particular. Past experience leads me to believe it is better to suffer through on my own. However, it is nearly impossible to ignore chest pains accompanied by extreme sweating, shortness of breath and nausea. True, these symptoms could signal menopausal symptoms, panic attack or Elizabeth calling me home from above to keep her and Fred Sanford in fine company.
I called my doctor, who told me to go post-haste to the nearest emergency room. Since my mother dropped dead of a heart attack at the relatively young age of 58, I thought it prudent to take as few chances as I could. So in my nearly all-day sojourn lying flat on my back on the stretcher from hell and strapped into place by monitoring wires, I had plenty of time to consider my insurance. My husband was fretting how much my ER stay was going to cost. (We are basically uninsured, having a crummy policy with an uber-high deductible. It covers little and is meant to kick in only when catastrophe strikes.) I am a writer never without pen and moleskin, so I was able to sketch out my insurance theories while they jacked me full of drugs and took out half my blood.
First of all, it doesn’t matter what type of insurance or its intended use, insurance is a sucker’s bet. The only winners are those who issue the policies, and they, with their wheelbarrows full of cash, are laughing all the way to the bank.
The premise of insurance is simple: you buy a policy to cover the value of your car, your house or your life, and when God forbid, disaster strikes, you cash in. Glory be, it’s like hitting the MegaMillions.
But hold the presses. Maybe that’s how it was in the olden days when the insurance companies might have been honorable as well as flush. Insurance companies weren’t in the practice of investing in derivatives and junk bonds like they do now. Back then, if you made a claim, you’d have more than a snowball’s chance in hell of recovery. I know this, since I have filed claims that thirty years ago were speedily processed. These days, insurance companies look to nickel-and-dime their customers out of paying claims.
This relatively new phenomenon has only been around for the last ten years or so. When a tornado topples a tree on your roof and the insurance adjuster says the damages are $1,060 and you have a $1,000 deductible, you may as well hang it up and get rid of your insurance. You certainly won’t process the claim for $60. Or let’s say your piano gets dropped upside down during a move and the homeowners’ policy won’t pay and the movers’ policy won’t pay. When your health insurance says this drug isn’t covered or that treatment is disallowed, you bite the bullet and pay it yourself. When your employee cracks up a company car, it’s far easier (and safer, if you want to remain insured) to eat the cost of repair or replacement rather than file a claim. This has happened to our family on numerous occasions. I’m already looking forward to the day when I might try to collect on life insurance only to find the insurance company has located a convenient loophole and I’m out in the cold. Oops! I guess those thousands of dollars I paid in premiums went for naught.
But NO… You can’t just swear off the insurance habit. If you have a mortgage, you are required to have insurance. If you license and drive a car, you are required to have insurance. Now the government is saying if you are breathing air and live in the United States, you are required to have insurance.
You say, “No insurance? That’s insane talk!” Is it? What would happen if there were no insurance? People would have to calculate potential loss on their own and save for the proverbial rainy day – what a quaint, antiquated idea! Some do that now. Let’s say you own an ’89 Dodge Omni or live in one of those splendiferous $1,000 houses in Detroit. Surely if you chose to insure at all, you would choose the bare minimum and hope for the best.
As for health insurance, a family would have to gauge what their medical needs would be and save to that amount themselves. Of course, standard medical providers would have to be able to price out their services. Right now, if I see my doctor using my insurance with zero co-pay (I pay 100%) and ask for a total from the receptionist, she returns the question with a blank look. She has no idea, just as she was confused by our health savings plan. Minor things like billing have to be funneled through the big admin office where they can doctor (pun intended) what happens in the end.
It’s obvious the clinic charges more if you have insurance. On the day I went for my flu shot, people were walking in without insurance. I overheard a telling conversation between the receptionist and a patient. Flu shots for those with insurance, even the crappy policy I have, are $65. Flu shots for the uninsured are $25. I figure there is $40 worth of paperwork in between. I believe it's the same with regard to prescription drugs, although the wiggle room there is much larger and makes no sense. My prescription of non-coverable Zoloft at CVS costs $31 — at Sam's Club it's $7 and change.
People with employee-based health insurance have no idea what the real costs are. In Michigan, our teachers and union workers pay a bare minimum in premiums, with the state or car companies picking up the rest. One local school district has bitched because the premium is going up to $30. Thirty dollars a month? Try living my thin checkbook at $900 a month.
It takes a lot of self-control not to blow the money on a boat or a fancy purse or a Cadillac and instead bank that money for a reasonable expense, like medical bills, but it can be done. Plenty of doctors operate and make big money outside the realm of insurance. I’m thinking of plastic surgeons, eye surgeons, therapists and psychiatrists, dentists, etc. The savvy consumer will shop around as they would for a refrigerator or lawn service. I’ve had to pay for my own child’s testing services, speech therapy, orthodontists and glasses. (That’s right, no dental or eye care in our policy either.) It takes some diligence and responsibility, but it can be done.
The noticeable lack of insurance companies raising a hue and cry over the health care debate, and their future business, leads me to believe that they are in bed with the government on reform. This means only one thing:
We suckers are going to get royally screwed.