Thursday, July 30, 2009

Ok, NOW I've got something

....and it's about health care. Those 2 words are ALL over the news, the internet, and every other conceivable place these days, as President Obama and the Congress struggle over "reform" of the US health care system. So in my typical nerd fashion, I've been thinking over this topic, and there are lot of things I don't understand. I'm gonna throw some of them out here, and if you have any health care background or actual knowledge of the topic (as opposed to my ramblings, LOL), please chime in and educate me. :)


I am a teacher by trade, and a mom. Not a nurse, doctor, insurance agent, accountant, or anything else that might give me actual understanding of the following topic. The ideas to be stated here are mine and not the intellectual property of anyone who understands how the system truly works!

Since becoming an adult, I've had exactly ONE kind of health insurance--the kind offered to employees of my state. As a teacher, it was just a given that I'd enroll in this insurance when hired, and I've kept it ever since. When I stopped being a state employee (at Mr. L's birth), K just took us onto his state-employee policy, and now he covers all 4 of us. So I'll freely admit to not being an expert on the various types of policies, coverage, or options.

Our insurance is pretty good, I suppose, as these things go. Even with the catastrophic health situations that have occurred for us in the last 8 years, we've not had to declare bankruptcy or sell any vital organs to pay anything that insurance didn't cover, etc. And because the boys were born in a state hospital, and this is the state insurance..........they scratch each other's backs, I suppose, and charge lower rates to each other than they would ordinarily. Energizer is the one in our family for whom the insurance has paid the most over the course of his life.....his total is about $175,000 right now, lifetime. And that covers a traumatic birth at 27 weeks, and 11 weeks of hospitalization. Mr. L's is about $100,000, mine's about $40,000. K hasn't used it nearly as much, since he's exempt from the whole pregnancy/childbirth/life-threatening illness thing.

But as I strain my brain to try and understand the ongoing debate over reforming the system, I've concluded that I must not really grasp the way things work, and why they work that way. We pay thousands of dollars per year in premiums for this insurance, whether we use the coverage or not. If we went into a typical doctor's office, clinic, etc, the first question we'd be asked is "do you have insurance?" If we said no, we'd likely be denied care. We could go to a free clinic (some areas have them), or the hospital emergency room, and we'd be treated no matter what, right? Am I pretty close so far?

Further, I believe it's true that insurance companies do not pay the doctors/hospitals the same cost for treatment that is actually billed, or what I would pay if I did it on my own. Say I needed to have a suspicious "spot" removed at the dermatologist, as I did back in the spring. I have the procedure done, the doctor bills me AND the insurance company. They'll state that the procedure cost $189 dollars, let's say, but that the "estimated insurance contribution" is $77. And I owe the rest. Or is it just 20% of the rest? Or is there a copay, then 20%? So somewhere along the line, someone's determined that what I had done is worth $189 and they charge that, but someone ELSE (likely with no medical degree) decides it's really only worth $77, and that's all they'll pay. But if I have already paid my "out of pocket maximum" for the year, then the insurance will STILL only pay $77........and the dermatologist just takes that and considers the account paid. Less than half of what was charged, but that's ok somehow. But if, by some strange chance, I did not have insurance YET was actually treated by this doctor, you can bet your sweet %&*#$ that I'd be paying the full $189, or becoming intimately acquainted with collection agencies.

How did we get to this point? It wasn't always like this, you know. Think back to old TV shows or movies you've watched about the Wild West or Little House on the Prairie. Back then, if you were sick or hurt, you got the doctor to come and he did what he could for you, which probably wasn't much that actually helped. You may not have had money to pay the doctor, but there was no such thing as insurance. So what would you do? You might give the doctor a chicken, or a bushel of apples, something you knitted or something you baked. How the hell did the system evolve from that to this?

The only thing I can come up with is this: As technology has evolved, and medical knowledge has improved, costs increased. In Laura Ingalls' day, it didn't matter if you couldn't afford intricate surgeries or expensive therapies because those things didn't even exist! So as costs increased, somebody thought up the idea of issuing "health insurance" to help cover the costs. People already had fire insurance, even back to the 1700s, so the idea was already out there. A few people got this new-fangled insurance, most didn't. Then more chose to get it, then more, and costs continued to go up. And as doctors raised their prices, charging more for the same service (whether warranted or not), the suits at the insurance companies did NOT raise the amount they'd pay for that same service. But the doctors took it anyway, figuring they'd still make out ok with that lesser amount AND that the people who weren't insured would be paying the higher rate anyway.

The premiums for insurance kept going up as well, even though the amounts they'd pay for your care stayed flat. Premiums reached a point that many people couldn't even fully pay for them, so employers began to "subsidize" the coverage for their workers. Then that got to be too expensive for the companies, especially small ones, so some began to drop their workers' coverage or require workers to pay 100% of premiums. Yet somehow it's reached a point that everyone is expected to....nay, required to have insurance. How did this happen? Costs just keep going up and up and up, so doctors figure that NO ONE could pay the full amount on their own...therefore, insurance is a must if they ever plan to get paid.

Here are some radical thoughts I've had: (bear with me, they might seem insane)

How much more money to spend on my family's health care would I have if we didn't pay for insurance premiums every month? Couldn't I use that $4,000-$5,000 per year to pay for routine care, and even a good bit of care beyond just checkups? Could the whole insurance thing just be scrapped altogether, or at least made much more optional than it now appears to be?

If doctors are ok with accepting insurance payments that are FAR below the billed amount that they charge for a service, couldn't they just charge that lesser amount to start with? If they can cover their costs with the $77 for my dermatology visit, why are they charging nearly 3 times that? When people complain so much about the "high cost of health care" and the fact that many do not seek the care they need because of cost, it has to make you wonder WHY the costs are so high? If the $77 rate is good enough for Blue Cross to pay, it should be good enough for me to pay too.

Well, I haven't created world peace or solved the pressing problems of our time. All that I've done is show how little I know about the topic of our health care system and its need for reform. But it does need reform, that's clear. Preventative and routine care is important, and everyone should be able to receive that, the way I see it. Even without insurance. If costs were more reasonable, it would put this kind of care within reach of a lot more people. I just wish, though, that the people "in the know" who are actually going to create, debate, and vote on any reform plans would come to this daunting task with an open mind, open heart, and caring spirit. A life is not worth less or less in need of saving just because that person is, what can we do to make sure appropriate care is available to all, not just some?

And the Rush Limbaugh/Glenn Beck/Bill O'Reillys of the world......SHUT UP! Quit spreading your crap about things that the health care proposals in Washington do NOT include! The bill does not require elderly people to make a plan with a government nurse about when and how they want to die. Please. :( Nor does it plan to "ration" care for anyone, or pay for care for illegal immigrants, or for abortions. So just stop the scare tactics, and try to actually use your brain and THINK about the topic at hand rather than spouting off ridiculous claims that just polarize the country even further.

So how was that? Too much of a heavy-duty topic for a Friday night? ;)