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Publisher's Note - from Paris
As I reviewed the details of our new medical plan here at work, I realized that the medical industry has copied a page from the playbook of the insurance industry. Deductibles are now part of the game.
Not only do I pay for the plan itself, but I pay a copay when I get a medical service, plus — now, there’s a deductible. The deductible works this way: I pay everything up to the amount of the deductible. Then they pay for anything beyond that.
So a scenario exists where if my medical expenses for the year don’t top the deductible amount, I pay for the plan, I pay the copay, I pay the medical bill and the plan pays nothing.
There’s a lot of fine print. Yes, some items are excluded from the deductible. Yes, this year the company will pay some of the deductible for me. Yes, some items are excluded from the copay, but that’s not the point. The door has been opened. Now, each year, in addition to the plan amount going up, I can expect the deductible to increase and the copay to increase, gradually reducing the services actually paid by the plan.
Put this together with Massachusetts’ mandatory coverage law, and I’m being forced to pay for a plan, that, if I’m fairly healthy, could very well pay for nothing.
So I’ve started investigating what kind of coverage I can get that will satisfy the regulation that I must have coverage while keeping my expenses to a minimum. Frankly, I’d be happy at this point to pay my own way. Why? Because I maintain my health. I feel more and more as if I’m being penalized for being healthy. Never have I felt more strongly that our health care system is completely broken.
If you feel that I’m on the wrong track with my thinking, email me at paris@manyhands.com. I’d like to hear from you.
— Paris Finley
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Good bit of writing, Greg*.
Good bit of writing, Greg*. Thanks for bringing your thinking to the party!
I agree with most of what you're saying, too. What I object to, primarily, is the erosion of recompense from two ends: copays and deductibles.
--Paris*
*I'm a former high school English teacher, 20 yrs!
I'm responding to your invitation
Dear Ms. Finley,
I'm responding to your invitation to comment on your publisher's note in the current issue of Many Hands to defend the notion of forcing the healthy to buy insurance coverage they will likely not need. This is because the nature of insurance is such that it doesn't function like most other goods and services. This is because insurance isn't something like a car, or a meal, or a massage therapy session, but is rather an odd sort of gambling (or, to use a politer phrase, risk management), in which the customer tries to hedge against the risk of a serious medical malady, and the insurer attempts to make enough money from the customer premiums so as to cover the losses it incurs when it has to pay out benefits. In other words, the odd thing about insurance is that the company is selling the promise of a service it which it does not want to have to provide.
Here comes the mismatch: The people the insurance companies want to insure are the healthiest people with the littlest risk of any sort of problem; that way, the company can collect money from premiums and have to pay out little if any in benefits. However, the customers the companies want aren't the same as the customers that want to buy insurance--it's mainly those people who need or believe they are very likely to need coverage against serious health problems who wish to get insurance. The insurance company, faced with this pool of expensive customers, will either lose too much money and have to go out of business (meaning nobody gets insurance coverage), or else they'll have to charge these customers a very large amount of money--which is usually what happens now, and is what prevents the poor (and even middle-class) from getting good health insurance (those people who are rich and at risk of health problems may simply decide to stay uninsured and pay out of pocket).
Now, the most obvious solution (in my opinion) to the problem is that we should have the government provide health care, because it's not something the market system is equipped to handle. But since that's not currently going to happen, the next best thing is to correct for the market failure by requiring everyone to pay into the insurance system, so that the companies can make enough money to continue to providing care to as many people as possible at somewhat better rates.
It might not seem fair, and in some ways it isn't; but if it makes you feel any better, at least some of the additional money you're paying may well be making it feasible for someone else to get the help they need.
Yours,
Greg Bordo, Amherst