As everyone knows, a lot has been happening the past few weeks related to health care and insurance in the United States.
The Health Insurance Marketplace, a major component of the Affordable Care Act (informally known as Obamacare), premiered but with lots of glitches and bugs that made it difficult or impossible to sign up. Health care consumers everywhere have been having heart-to-hearts with their doctors and insurance agents regarding the future of their health care and coverage. And of course, a good portion of the government shut down over an impasse where President Obama and Democrat lawmakers pushed for across-the-board funding, while Republicans pushed back with insistence that Obamacare be delayed.
This column is not about the ACA—at least not directly. It’s not about the government shutdown—not specifically. Rather, it’s my take on how we got here and where we should go from here on out.
First off, let’s be clear that the fight has been almost 100 percent about health insurance, not health care. Thanks to emergency rooms and not-for-profit hospitals and agencies, virtually all Americans have access to health care…and have for a long time. The dispute has been about who pays for the care and how.
In my opinion, we’ve been headed down this road for at least most of my lifetime—maybe longer. I think the path originated with some point in time where people began to equate health care with health insurance.
Did you know that once upon a time, and it wasn’t even THAT long ago, people went to the doctor and simply paid for the visit? No insurance card, no co-pay, nothing like that. You saw the nurse, you saw the doctor, you paid the bill and you left. There was insurance, but it was used only for the “big” stuff—major surgery, expensive treatments, etc.
It’s hard to believe, but it was once that way. Not anymore. Now, if you’re going to the doctor, you’re expected to trot out your card, file with your carrier, pay a set amount and, apparently, the insurance company covers the rest. It sounds good, but is it really?
If a window breaks at your house, or an electrical outlet stops working, do you file that on your homeowner’s insurance? Probably not. You call an electrician or a handyman and fix the problem (or do it yourself, if you’re handy) and avoid your insurance like the plague, because you don’t want your premiums to increase because of such pedestrian stuff. If a tree falls on your roof or your kitchen catches fire—THAT’S when you call for an insurance adjuster.
If your right headlight goes out or your left rear tire picks up a nail, do you call your auto insurance carrier? Nope—for exactly the same reason. Auto insurance is for the big stuff. You know, crashes, injuries, property damage, that kind of thing.
But for some reason, we insist on our health insurance carrier participating in every check-up, every physical, every prescription medication, every sniffle, every sore elbow, everything.
This has had a two-fold (at least) effect on the way we get health care. On one side, we end up involving a third party in virtually everything to do with our health and wellness. And on the other side, we’ve become disconnected with the actual cost of health care.
Go back to car or house insurance. If the car needs a new transmission, we know how much that will cost—or at least we can know, after calling two or three mechanics for estimates. If our old kitchen faucet goes bad and we need to buy a new one, it’s no difficult thing to get prices and options to compare.
But because someone else pays for most of our health care, we have no idea how much the health care really costs. We might see a bill, but the number we pay attention to is the one at the bottom—what’s left after the insurance pays. For a check-up or doctor’s visit over a minor affliction, we probably don’t have a clue how much it really cost. All we know is the amount of the co-pay, plus the patient’s portion of whatever prescriptions we use.
And because we don’t know the cost, and leave most of the payment up to a “middle man,” the cost is almost certainly higher than it would be if we simply paid as we went. After all, the insurance guy has to make a living, too.
I know it’s a pipe dream, but my solution has nothing to do with universal health insurance. Instead, I’d like to go back to the days when people used less insurance, but used it for the stuff that really requires it. Chemotherapy, major surgery, dialysis, that kind of thing—not the common cold.
By Eric Copeland • firstname.lastname@example.org