This post has to do with health insurance, specifically that offered to America’s senior citizens, and so will be of limited interest to younger people. Nonetheless, it does not hurt to understand the concepts behind private health insurance. It can and does work in other places, notably Switzerland. It does not work here.
Here’s why: In Switzerland, everyone must carry health insurance offered by private companies. Unlike here ( before Obamacare), insurers are not allowed to turn anyone away. Further, Switzerland mandates basic care offered by insurers. Swiss citizens are free to buy better care than basic, such as private rooms and better meals, but decent and affordable care is available to all.
Here in the U.S., another game is in play. Insurers came up with the concept “preexisting condition” and refused to offer coverage to millions of citizens, leaving them high and dry. During the preexisting condition regime, hundreds of thousands of people died prematurely, or went broke trying to stay alive. The most common cause of bankruptcy during that time was medical bills. That may still be the case.
The solution was always easy but impossible in a business-run country: Government mandates requiring insurers to behave themselves, just as in Switzerland. No one can be turned away, and basic care is required, the richer able to buy more and better. Simple as it was to fix the problem, it was never done. And the reason is now apparent: America’s Health Insurance Providers (AHIP) wanted us to suffer, squirm, die early or go broke trying for a reason: They had written a bill we call Obamacare, and needed justification to pass it.
They got their wish, and we now have that anvil we must carry strapped to our backs. We are now forced to buy very expensive private health insurance. We are penalized if we don’t, and the penalties are severe and enforced. There is no escape. Those who cannot afford the exorbitant premiums are subsidized by the taxpayers, but AHIP still gets its pound of flesh. Worse yet, there is a thing called “MOOP,” of maximum-out-of-pocket. It seems like something meant to protect us, but it is there to protect insurers instead. It is the amount we must spend annually before insurers have to spend a penny. It is currently set at $7,900, or $15,800 for a family.
The real effect of MOOP is to prevent people from seeking medical care. Since they are already out-of-pocket for the insurance premiums, they are unlikely (unless wealthy) to see doctors for matters of basic care. So AHIP got its way, and Obama led them to safety. His administration, with ACA (AKA Obamacare) and AGW and ongoing wars may have been one of the most disastrous in American history. Democrats and liberals worship the man. I do not. He is a scoundrel. Even Al Gore looks at him as says “Geez, what a liar!”
I would rather not have the discussion about the efficacy of health care and the lying liars and criminals behind things like AIDS, PSA and prostrate, and chemotherapy. We can do that another time. I have another issue. But you’re free do to what you wish in the comments.
In 2017 I was in Chicago at an outdoor carnival, and decided to shoot some baskets to win a stuffed animal. I was allowed five shots. What I noticed was that I had no control over my right arm, and that the ball was going off in all directions. I was an OK basketball player before this time. (This sounds serious, but it is not, so don’t worry about me. It is just aging.)
Once back home I sought out medical advice, and was told that I was suffering compressed discs in my neck. That was causing assorted problems including loss of control of my arms. I was told that the problem could be remedied by surgery. I thought it to be inevitable, but decided to put it off as long as possible. At that time I was enrolled in regular Medicare and carried a supplemental policy with a $2,500 deductible. I can self-insure for that, and it made the premiums lighter.
I should have left well enough alone, but got clever, too clever. During open enrollment in 2017, I noticed that Humana offered a “zero deductible” policy under what is known as “Medicare Advantage.” Under that program, people leave regular Medicare and take insurance from private companies, the same ones that gave us the preexisting condition regime. But what the hell, I thought … if I need the surgery, I’ll be $2,500 ahead.
I later sought out second and third opinions on my condition, the last one a young doctor who looked at my MRI, and said that surgery was not likely in my future. After all, he said, I am in excellent health and physical condition, have vigorous exercise routine that strengthens all the muscles in that area. “You should see the broken down men your age that come in here,” he said. “You are doing great.” My neck will always be sore, but should not be anything emergent or dangerous. Aging is not for the weak of spirit.
I kept the Humana policy throughout 2018, as it (actually, Medicare) paid for routine office visits and stuff, and did not require that I carry drug insurance. I don’t take any drugs except an occasional sleeping pill, and anyway, don’t like being forced to buy things I don’t want or need.
This year, 2019, was a wake-up. I had some dental issues, replacement of a couple of crowns, extraction of a tooth and a need for a bridge, all very expensive. Humana also offers dental coverage with their Advantage plan, said to be $1,000 per year. But the plan in reality does not cover anything but one checkup per year, paying $56. That is its only value. However, I did not expect much dental coverage. There really aren’t any good policies available, and with Humana it was a throw-in, an enticement. (They also threw in vision care, worth as much as $5 per year.)
But the tooth extraction was a surgical procedure, and so was covered under major medical. Here came the shock – I paid $825 for that procedure, and Humana “covered” it, but said that I was liable for the entire cost, as it was part of my “copay.”
This is where Humana stuck me … their “zero deductible” policy is actually a $7,900 deductible, the current MOOP. Had I had the neck surgery, I would have been in shock upon learning that I had stupidly switched from a $2,500 deductible to $7,900. Humana deceived me. They advertised “zero deductible” knowing full well that they had merely changed some terminology, substituting “copay” for deductible. It was false advertising.
I complained up the ladder at Medicare, finally speaking with a woman who grasped my complaint, that Humana had lied about its policy. I also complained to Colorado authorities. Medicare allowed me to “dis-enroll” from Humana, and effective June 1st I am again in regular Medicare.
I spoke with Colorado authorities, and they said that since Medicare had allowed me to drop Humana, the case was closed. I asked about the thousands of others who think they have a “zero deductible” plan. Here is the essence of the reply, and not the actual words: “We are afraid to mess with a powerful company like Humana. Folks are on their own.” Humana is powerful, regulators are weak.
America’s Health Insurance Providers, AHIP, are corrupt and dishonest. They were so before Obamacare. They wrote Obamacare. They don’t care. They are in it for the money, and only for the money. It is fortunate for me I got off for only $825. It could have been worse. Further, I am better off financially than most people, who when stuck with an unexpected $7,900 bill will have to go into debt to pay it. Humana-scam, that is what the policy should be named.
I just shredded my card. (The economic term for their behavior is “rent seeking.”)
24 thoughts on “Humana-scam”
“We literally grow up believing we are the fictional persona assigned to us at birth;
the name, the number, and the titles. But in Reality, we are commercial agents for a principal “dummy” corporation, our residential address actually a place of domestic (family) business. Responsibility is replaced by insurance. Moral virtue is replaced by strict law. And Reality is hidden behind several forms of artificial matrixes and systems designed to create a sense of false security. The strawman as a dis-ease is the avatar, the projected self image we play as actors in the fictional persona of that legal matrix, a silent weapon for a quiet war over our minds.” Excerpt from Strawman, Clint Richardson (2018), p. 303.
Swiss insurance is no more real than “American” insurance. State “benefits” enslave all takers.
Obviously we disagree. Set aside contrived diseases and poor lifestyles, where we might see eye-to-eye. There is a role for medicine, setting bones, healing wounds, removing tumors, draining ugly cysts … and on and on. What the American health care system has shown us is that the private sector cannot resist the urge to manipulate the system for profit, making everything crazy expensive, doing very little for actual well being. They are nothing but rent seekers and scoundrels. I am talking about the insurance industry, which has never so much as placed a band aid on a cut.
The Swiss system, and other state-run or single-payer systems are simply more efficient, entitling everyone to basic care, and for far less money than we spend here. The reason is simple – we pay retail, they pay wholesale. Illness or injury here is a great cause of worry. In other places, it is down the list a ways. Like way down.
I remember talking to a Canadian woman one time on a trip up there, and she said that their system is not without problems, of course, but that the nicest thing for her was that when her husband or kids were traveling, they were always covered no matter where in Canada. Their green card (or whatever color) was all they needed. Avoid the States, of course, they were told. That could be disastrous.
I do agree that the Swiss system is one of the best among state options. I see all state systems differently than I used to. I was a huge single-payer advocate. Then I learned about government investments in the very companies they supposedly regulate on our behalf. Nothing is done on our behalf without first satisfying the shareholders. When the major shareholders are the government, there’s no escape. We’re being played from both directions.
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Here is an essential element in trying to devise a fair and efficient health care system. Picture Harvard, and two people employed there, a janitor and a professor of physics. Each live good clean lives, and each come down with, say, leukemia, something often curable these days. In a system where we have insurance in some form (preferably single payer),each person gets the same treatment. In a system where we don’t have insurance, one dies, the other lives.
I don’ always understand what you mean when you say we are owned … the concept of insurance works well in casualty and property, not as well in health care. But some form of shared loss is preferable to every person for himself.
From Clint’s work we are definitely “owned” by TPTB. We, common, ordinary men, are not “we the people” that phrase is reserved for the framers of the constitution…we are slaves and that is in large the goal of the civil war.
I do not see it. I do not accept “Clint’s work” as anything definitive. It is wordy and hard to follow. Yes, we have to negotiate the rapids, but we are not helpless. The concept of insurance came from China, farmers and artisans sending their stuff to market in cities on dangerous rivers in boats, and each spreading their goods over many boats so that if there was a boat that went down, everyone suffered a little, but no one took the whole loss. That is the concept. I do not see “TPTB” running that system. I don’t even know what that means.
The health care system does not lend itself well to the insurance concept except in major events. Health care is many little events, and not a few big ones. Insurance dies not work well, as we are just trading dollars. That is why single payer can work where the insurance concept does not.
When I say we are treated by government as property, it is not only my opinion, but clearly stated in the man-made laws of the land we call the United States of America. If we agree to follow state law, we have lost, voluntarily, command of our own mind, body, and soul. This is a/the classic battle of the ages.
Funny you would choose the word “definitive” to characterize Clint’s work. Definitive is synonymous with unambiguous. The difference between ambiguous and unambiguous holds a key to understanding which law one chooses to follow. Which law we follow (believe) makes a big difference in who we are, compared to who we think we are. How we exist — in reality or in fiction — depends on it. I am unaware of any way to make a case for any of this in few words.
I will not push this further, but will remain ready to do my best to help if you choose to explore further.
During my time before becoming eligible for Medicare, I often wanted to go bare, as I rarely see or need doctors. But I had a family, and had to be responsible. I disliked and distrusted insurance companies, but was forced to deal with them even as they are corrupt. I felt trapped. Once the kids were on their own, I still felt obligated to carry insurance, as any major expense on my end could drain my wife’s savings. Still trapped.
Turning 65 qualified me for Medicare. I was free at last of those onerous monthly premiums, and could accumulate some savings. I had flexibility and freedom I had not had before. But AHIP is cagey, and has been quietly working now for decades to get (healthy) people out of Medicare and back in their pockets. People do not realize that when they enroll in Medicare Advantage, they are merely assigning their Part B premium to a private company, and all Medicare benefits. In other words, Humanascam never paid out a penny for me. It just became a middleman, and collected payments and premiums from Medicare. It is called rent seeking. And yes, I fell for it.
I am again a free man, free of the private tyrannies called “health insurance companies.”
Your conceptual ideas about state ownership of humans, as if we are in bondage, is not lost on me. But I sense a bit of Randianism in it, as if we are all living in a jungle and competing with each other rather than a cooperative and mutually supportive society, one that has rules. Health care is nothing more than human compassion and support, made ugly by the rent seekers.The country doctor is gone now, and corporate hack is there, reading everything he does from his code book so that he bills properly and gets paid. It’s an ugly system. I cannot change it, but do not walk around feeling in bondage. Quite the opposite.
on this point we agree “The health care system does not lend itself well to the insurance concept except in major events. Health care is many little events, and not a few big ones. Insurance dies not work well, as we are just trading dollars. That is why single payer can work where the insurance concept does not.” We will have to agree to disagree on the remainder.
also, Clint’s work and knowledge goes way beyond insurance…just added that link to point out a portion of his work
I mean him no disrespect. He is just a little on the ethereal side for me, meaning I often don ‘t grasp what he is saying. My work also goes a bit beyond insurance, but it is a subject I know well, so I write about it. I try to keep it accessible, that is, if you understand that Obamacare was designed to prevent people from seeking health care, you’ll be your own best informed patient. How do they prevent us from getting health care? High premiums, co-pays, and the MOOP. All of that drains teh very resources we need to get medical care.
For myself, I go to a small clinic down the road, and my “personal physician” is actually a PA, as I don’t care much for doctors. PA’s are intensely trained in many areas. often called “drinking from a fire hose.” They know a little about a lot.
No, believe me, I understand…Clint goes into so much detail and his articles are more like books than articles…but he is very knowledgable about how the govt works and his CAFR (comprehensive annual financial report) work is splendid…Obamacare was more or less an investment scam…making the 1% richer…here is another long Clint article
here is a short 18 minute youtube that sums it up, I highly recommend watching it…the govt lies and they invest in all large corporations and is very wealthy but lie to us – as we all know
And since the Coronavirus scam, they have grown more obscenely richer off of millions of taxpayers through subsidies, bailouts, and other handouts. This is what happens when a nation of idiots allow a bunch of ruthless, greedy psychopaths to run their lives.
After my recent illness and hospital stay I am so glad I switched from an HMO to medicare with a United Healthcare premium plan….exorbitant price, but no co-pay or deductibles – except for small co-pays for generic meds….still extortion though
Not old enough to be eligible for Medicare my wife and I decided to continue with her company plan even tho she’d retired. It costs us $1800/mo. but the deductible is only $500 and I’ve never found anyone with a better plan.
The “company” then sent out a paid sales person to persuade us to drop the plan and bridge the coverage until we both reached 65. I politely told them to f*ck off. In fact we’re keeping them as a supplement with Medicare.
It’s expensive, but we’re worth it.
OK, $1,800 a month is $21,600 a year, and a $500 deductible means that you paid a huge price to cover a lot of little issues. I see you spending $22,100 a year before your insurance offers one penny in help. In other countries you simply pay a little more tax and walk in and out of clinics and hospitals without being out of pocket. You remind me, Swede, that if we overthink things too much, we buy off on anything. You got a raw deal.
First of all the length of time we’ll be making the payment will be less than two years. Secondly, my wife’s and my health insurance premiums and related costs are covered by a trust set up by my departed parents.
I heard too many horror stories like yours who left a plan they were familiar with only to find small print surprises. If we leave the plan we can’t come back to their generous supplement package with a $200-$300 monthly payment.
If u do the math over the long run you’l find our health care expenditures to be very minimal. We both were covered for over 40 years with small copays.
Spreading those costs over our lifetime is still a bargain.
Obamacare is an anvil. A huge cash outlay for most people, very little “health care” in return, mere rent seeking.
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i escaped the grips of AHIP and foolishly stepped back in, my point. They got me.
Family of my wife lives in the US and when I heard about the medical insurance costs I was flabbergasted. You guys have an insane system. It’s probably better just to take no insurance and in case something happens pay cash.
I know some insurance companies have a contract with the excellent medical care in Colombia and they send their patients to Medellín with hotel and flight included and a good care. Much cheaper than participating in the insane scam you have over there, see below.
The US American family member (husband of, now passed away) paid 6000 USD (!!) in monthly insurance costs. That is insane, and I wonder how people can even afford such a thing.
Public care here can be crowded and not so great, but private health care is more than excellent in Colombia.
No fake news this.
Americans do not understand how good health care systems are elsewhere. We are continually fed propaganda about how bad it is in places like Canada or France, but those systems continually score above the US in terms of efficacy and cost, and of course serving 100% of their populations, which always creates crowding issues (as Colombia experiences). We are told that Canadians come to the US to avoid their system, but the evidence is sparse. Many Americans now escape to Mexico for health care, and Costa Rica is great for dental care.
But then, Americans are among the most deeply propagandized people on the planet. What else is new.
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“MedicalTourism.com does price estimates on various medical procedures. In 2015 the cost of a hip replacement in the U.S. averaged just over $40,000. In Colombia, the same procedure averages only a little over $8,000.”
Very true, I had a friend in the bay area of San Francisco that took a “vacation” to have a facelift in another country…cost a lot less than USA