So, up until now, my posts in this forum have all been sort of quirky little tales of life. The thing is, the "blogosphere" is huge, so while I don't have any particular expectation of anonymity (I am, after all, posting to the Internet!), I also don't have any particular expectation that anyone will ever read any of my posts.
What I'm saying is, if I drastically change my tone, who the hell's gonna care?
My family currently has health insurance. This has not always been the case, but right now we have some health insurance. Actually, it's supposedly fairly good health insurance, "fee for service" health insurance, which basically means we can go to any doctor we want and insurance will help pay for it. This is bullshit. What it really means is that you can go to the doctor at your own risk. You can go to your GP and insurance will pay them and you will pay some co-pay, and you'll get the illusion that this is real health insurance. But if you have to go to some other doctor, there will suddenly be "preferred" doctors and "non-preferred" doctors, and the rules will differ depending on which you have, and you won't actually be able to find the "preferred" doctors because the list will be hopelessly out of date and in fact some of them will be found
never to have existed at all, and then when you finally find one, there will be massive disagreement between all parties about how much will be covered and for how many visits and what the deductable is and whether or not anything you're prescribed will be covered.
And the truly great thing about it is, you won't find any of this out for sure until long after your appointments are over and your prescriptions have been ordered. You'll get bills somewhere down the road many months after the care you received (such as it was), and you won't be able to remember what you agreed to well enough to put up any kind of fight about it, not that you'd have the first idea who to fight, come to that.
I could rant on at length about this, but the true diabolical beauty of this whole system is that there is
no choice but to deal with these institutions. You'd think you could just say "screw it" and go pay for this stuff yourself. Insurance doesn't cover that drug you need? Fine, just pay out of pocket. Insurance doesn't cover that therapist you finally found? Fine, just pay out of pocket. Don't have insurance at all? Fine, just pay out of pocket.
Obviously, having insurance pick up all or part of the tab is a nice thing, even if the bureaucracy of it all is enough to drive you to drink. But the thing that I find most richly unfair about the American health system is what happens to you if you need something that's not insured. We didn't always have insurance. And even now that we do, much of the more esoteric stuff we need isn't covered. And here's how it breaks down:
If you go to the doctor and you're insured, chances are you'll co-pay about $15 and insurance will pay another $50 or so for your appointment. If you go without insurance, that exact same appointment will cost you $100.
If you buy any brand name drug and you're insured, you might pay $25 or even $50 for a month's worth of medication. Insurance will pick up perhaps another $50 of that drug. But if you buy it without insurance, that exact same medicine will cost you maybe $350, maybe $500, for one month's prescription. I'm not talking about a drug you take for ten days and you're cured. I'm talking about the kind of medicine you're expected to take every day for half a decade and then they'll see how you're doing.
If you are diagnosed with sleep apnea and you get a CPAP machine to sleep with, that machine rents, through insurance, for $43 a month. If you lose that insurance, or if they don't want to pay? That exact same machine rents to you for $120 a month.
People without insurance, or people with less robust insurance, are not too rich to be bothered with insurance. They're not so foolhardy that they don't care about the consequences. They don't have insurance because they can't afford it. They either can't afford it on their own, or they don't have a job that offers it, or they have a job at a small company that can't afford full coverage -- in other words, these are the people
least able to pay full retail for their care, and yet they are exactly the people our society charges the most. This isn't just a matter of whether insurance pays or I pay. This is a matter of whether insurance pays forty cents on the dollar or I pay full freight.
I am a Republican. I am generally in favor of free markets, and I respect the bargaining power of a large purchaser. But something is screwed up with this system. This health care system amounts to a
severe regressive tax; it burdens most the people who can afford it least. And since it's health care, it is more than just a financial regressive burden; it is also a health regressive burden. Not only are the lower-income among us getting drained of wealth that could be otherwise leveraged, they're getting drained of
health that could otherwise leveraged.
Sure, get poor enough, and you could probably get Medicaid to start picking up your tab, but that hardly seems like the trend we want to be fostering as a country, does it?
I guess what I'd say is, let the big insurance companies bargain for the prices and fees they'll pay. And then let all the companies they bargain with charge their uninsured customers the average of the fees they agreed to in bargaining. As the system stands now, the prices the uninsured see are the ridiculously overinflated prices that doctors and drug companies use as their initial bargaining position -- it's analogous to the "retail price" of those stores that always have everything on 75% markdown (huge sale! buy now! regularly $1300!!). If we're not going to have universal health care in this country, then perhaps what we need is some form of market-based price controls. Go ahead and bargain for the best prices; go ahead and set those prices according to what both parties can afford. Just don't expect the rest of us to subsidize your good deal. We can't afford it at all.
