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.”)