We all have the moment when we first enroll in health insurance. An insidious thought creeps into our brains and lays it’s eggs;
I’ve made it. I finally have health insurance.
In a lot of way, obtaining health insurance is the first time we can brag to our friends that we have a “good job”. “Hey, I’m no longer working part-time at the local Target! I’m a big boy with an insurance card now! I’ve got a good job!”. It’s a point of pride, and a sigh of relief; you no longer (you assume) live with the constant threat that a single accident can financially ruin you (again, you assume, because you’re 23 and you don’t know yet just how much the world really wants to fuck you, even if you did read Splinter, RIP.)
It doesn’t take a lot of time for the cracks to show in the wall. Imagine my shock when I upgraded from my shitty retail management job to a job in a bank, and then got smacked with the idea of a High Deductible Health Plan. It was irony at it’s finest; I had never been able to use my health care to go to a doctor with a 30 dollar co-pay when I worked in retail because I was constantly broke, but now I had a cushy bank job and I could afford to go to the doctor even less. I didn’t even understand what a deductible was until I got a bad cold and got smacked with a $130 charge from urgent care.
“But…but I have health insurance,” I said, exasperated, looking at my pristine ass health insurance card.
“You have a high deductible health plan, which means that you pay full price until you hit your deductible, and then the insurance company pays” the friendly-but-clearly-tired-of-explaining-this-shit-to-people receptionist said.
I still don’t go to the doctor enough. I got married in September, and when you get married, one of the things you have to decide is what health coverage you get. My wife’s health plan is better than mine; it will also cost her a shitton more to be on her plan. Every dollar that goes towards paying for me to have a health care plan that won’t completely bankrupt us in the event that something catastrophic happens is a dollar we can put towards our debts (breaking news: weddings are hella expensive), or towards our bills, or towards a vacation, or towards buying a home, or starting a family.
You probably realized the same thing at some point, when you got a bad case of the flu, or you had to rush your feverish infant to the ER, or you broke an arm. The kind of things that don’t necessarily kill, but definitely infect your every day life, as you slowly come around to the idea that it is far less expensive to muscle through your illnesses than go broke trying to cure or fix anything.
All this time you thought having health insurance was a milestone. Instead it’s a fucking albatross, just like everything else.
Part of what screws up the conversation around health care is the idea that people would be losing something that they earned if we go to a system of Universal Health Care. We’ve all been at a company orientation and gotten those pamphlets with smiling young people who look so happy that the cost of having a baby will only slightly spiral you into a mountain of debt that will claw away and eat at your marriage! It’s a lie that the system tells you; being healthy isn’t a right, it’s a privilege that you earn by good ol’ fashioned, American-ass boot-strap pulling.
This lie is something that gets peddled on both sides of our political spectrum, who assure us that the only way to be truly healthy is to struggle and struggle and struggle until you get to a place where you can somewhat easily tread water instead of straight up fucking drown. Barack Obama’s original pitch for the Affordable Care Act was “if you like your health insurance from your employer, you can keep your health insurance.” Joe “Probably Gonna Be President in Spite of Himself” Biden has more or less adopted that as well.
Of course, no one really likes the health insurance they have. They like the fact that they have it, and they like the idea that maybe the won’t die because they have it, and they like the fact that they’ve gotten to a point in life where they have it.
But the good ol’ fashioned Splinter approach of screaming “you’re dumb if you don’t want free health insurance and you should just shut up and do it” loudly and hoping the rest of America listens to you doesn’t work either. Instead you have to very carefully explain that Americans are paying for a “privilege” that is just an illusion.
It’s kind of a country wide cognitive dissonance; we hate that health insurance is so expensive and offers so little, yet we fear giving up for something demonstrably better because it feels like something is being stripped away from us.
It’s the JCPenny’s Conundrum; it doesn’t feel good to simply have something. It feels good to be a savvy shopper, to look at a string of stupid confusing charts and pick the option for medical, vision and dental that is the most cost effective. It makes you feel like a smart adult; universal health care as a right doesn’t give you the same warm fuzzies as finding a superb deal at Target does. And people will take the warm fuzzies over actually being healthy and warm every day of the week.
The other part of health care being viewed as privilege that blows? That people will fight to the ends of the earth to keep that privilege for themselves, and look down on those who were on in their shoes.
“I don’t want MY tax dollars going to help some LAZY jackass who can’t work for a living and get their own damn health insurance!” your uncle announces loudly at the Thanksgiving table, interrupting your next forkful of mac and cheese; you sigh and place your fork down, resigned to the fact that this will be the discussion for the rest of the night and that no amount of Honey Baked Ham is going to make the rest of the night worth it. “If they can’t work for it they doesn’t DESERVE to have it!”
Again, it plays into the idea that we lose something by gaining something else. By extending a hand to help someone up, we lose the ability to look down on people. Feeling good is always preferable to being well.
It’s the same argument that pops up in relation to how we pay for health care. “YOUR TAXES WILL GO UP!” Joe Biden and Pete Buttegieg squawk like oh-so-much Republican bullshit. And again, it ties less into your sense of logic than it does you sense of emotion. It sucks looking at your paycheck and seeing that, to your eyes, your paycheck has gone down.
No one thinks to take a second look and consider that a huge chunk of their money goes to — you guessed it — health insurance. There’s a premium for medical insurance, one for vision, and one for dental. Maybe you’ve got an HSA or an FSA, money that you can put aside tax-free (YES!) that only use for select medical expenses (oh.) You need aspirin? Too bad! Can’t buy it.
No one seems to be able to articulate that Americans are already being taxed for health care. The only difference is that instead of that tax going back into the system and, you know, actually paying for people to be healthy, it goes into corporate pockets.
Better it goes into the pockets of corporate stooge than go to a child in need, I suppose. In America, they don’t say that nothing is every free; they say nothing deserves to be free. “Freeness” implies cheapness, as if Medicare-for-All was something left up OfferUp, given to you by a shady dude who swears he has the new iPhone, “DON’T PAY ATTENTION TO THE CHINESE WRITING, IT’S REAL, I SWEAR!”.
But the second you start to attribute a real cost to health care, there’s no shortage out media outlets and politicians — the ones with “Ds” next to their names along with all the others — crowing about how much money you won’t have in your paycheck and “HOW WILL WE POSSIBLY PAY FOR THIS!”
Maybe it’s a bit glib to say that America has faced challenges much, much harder than “paying for it’s citizens to be healthy” (putting a man on the moon, surviving two acts of national terrorism on a scale the country had never seen before, ending slavery, allowing gay people to marry, etc.) but that’s not really the point. The point is to trivialize health. It’s to make people questioned their worthy of their own wellness, and to value their own wellness over that of others.
“If I made more money, I could afford better healthcare, and then when I get better health care, the people beneath me need to work as hard as I worked to get the same level of care. I’m not worthy of my country taking care of me. My take home money is more important than being able to live a long and prosperous life.”
That’s the American way.
Healthcare is a right. Period.
We’ve treated health like a commodity to be traded on Wall Street stock exchanges for too long. We have the infant mortality rates of third world countries; we stack medical debt on top of student debt and credit card debt and hope we get the one lucky lottery ticket that allows us to pay it off.
America can do better, but only after it gets over the idea that “not dying from the flu” isn’t something you fuckin’ earn. It’s something you should have from birth.
Healthcare is a right. Period.
Maybe-Don’t-Die-If-You-Can-Afford-Not-To Care? That’s the privilege right there.
You nailed it. The corporate media will not call out the bullshit of our health care system as they make so much money on advertising from them. Our Republican-lite candidates spout the same bull. Nobody likes their insurance, they like their doctors or NPs. Not all providers accept medicare patients which does cause some problems but if we had “medicare for all” they definitely would have to accept those patients. It would be nice to see something like the Michael Moore movie Sicko used in the campaigns of Bernie & Elizabeth (is their anyone else left that supports medicare for all?)to explain what it would mean for the country to have a system like Europe. I have lost too many friends from cancer that would have been treatable if they had found it early but they didn’t get regular checkups because they couldn’t afford it. That needs to stop but won’t until we take the greed out of healthcare.
“Nobody likes their insurance, they like their doctors or NPs.”
I have one mine quibble with this, but I’m also a pretty strange case, because I hit my deductible EVERY year, if I actually take care of my health. (I had a lump in my pancreas for nearly a decade before it came out. Luckily it was benign, but I’m now diabetic, because the remainder of my pancreas can’t produce enough insulin, so with the ‘beetus and pancreas follow-up–mostly CT’s & MRI’s, I cap out every.single.year).
Having had GREAT insurance for my first plan (Medica), which covered EVERYTHING my MD requested and would’ve covered second opinions at Mayo (I live in MN, obviously); then having gone to Preferred One at that same job (and also my second), which required pre-clearance on practically everything & was out of network specifically for Mayo; and then *back* to Medica while poor & on the state’s healthcare plans, before Medica dropped state plans & I got stuck with Health Partners–which refused nearly *everything* I needed for my care; and on to Blue Plus, which only refused about *half* of my needed care; when i was looking for my current day job, I specifically chose a school district who offered Medica as their provider.
I also learned, at that second job, after consulting with our bookkeeper, to ALWAYS take high deductible plan. ESPECIALLY if there was any sort of HSA match, because it’s guaranteed that I’ll tap out on the deductible, and if I can plan my CT/MRI/Endoscopy for the first month of the plan year, I just have to pay on *that* bill for the rest of the year, and end up with no more copays.
But it took me a good 5+ years of having insurance, before I learned how to… not really “game” the system, because these ARE costs that both my insurance & I WILL have to pay every.single.year…. but I guess, before *I* learned that I can work things so I’m NOT fucked over every year (like how the first 2-3 years, I had my CT’s in October/November, rather than January–and played out of pocket ALL year on all my Dr visits & prescriptions).
I love the fact that I KNOW my insurance provider will cover almost all my prescriptions the first time, *without* question. There ARE the occasional hiccups (I’m dealing with one right now, because I was put on a new ‘beetus med at a different dosage), but *so far* I’ve never yet been outright denied, it just takes a bit of back & forthing between the Pharmacy, my Provider (MD/PA/NP), and the insurance folks.
This is also why, when my mom–who’s elderly & disabled–had the chance to choose *her* plan, I guided her to Medica. In MN they just cover more, with less hassle than the other plans do.
The hard part is being able to *access* Medica’s plans, because aside from a limited number of elderly (Medicaid? Medicare?) folks, they mostly only ever work with large businesses/school districts/entities anymore, where the costs for plans can be distributed over LARGE groups of folks–many of whom *won’t* tap much of their plans.
Sorry to hear about all your medical issues and happy for you that your insurance is working well for you. The problem is you are part of a small minority. The other very real issue is at any time they can drop your favorite doctor/NP from their plan or change the plan completely. We have had this happen several times. I hope that never happens to you but if we changed to a system closer to the top 25 in the world you wouldn’t have that worry.
https://www.photius.com/rankings/healthranks.html
“but if we changed to a system closer to the top 25 in the world you wouldn’t have that worry”
I FULLY agee with you, and would DEFINITELY prefer that sort of system over the patchwork b.s. we have here in the US!💖
Especially because most folks DON’T have good insurance, or any possibility of getting good insurance.
I know I’m in an extremely tiny (and incredibly lucky, tbh!) minority, and am mostly just grateful that I live where I do.
There *is* a very tiny risk of my insurer dropping my care providers, but because i stay within the one particular hospital system that used to be a part of Medica’s original care system, it’s very unlikely to happen (Allina & Medica were 100% aligned years ago. Just like Health Partners Clinics were part of Health Partners Insurance/HMO, back before the state of MN broke up the old HMO system here).
If I were to move to certain other parts of the state though, I could definitely run into a bunch of provider difficulties.
#nailedit
Thanks for this.
I am tired of this simulation and want to leave now…
Also what part of “Life, Liberty, and The Pursuit of Happiness” does Healthcare NOT fall under!? Please, someone explain this to me.
“No one seems to be able to articulate that Americans are already being taxed for health care.”
I think this is the main line of argument that public option promoting politicians should follow. The average American already pays for healthcare with income taxes (and other taxes) in addition to paying for healthcare with their own earned revenue. The amount paid is more than the average tax expenditure of several other developed countries. So we’re not saving money compared to France or the UK or Canada, and we’re not getting an incredibly better product than customers in those countries, so why are we okay with being suckers?
At the end of the day inertia is the only reason why the US healthcare system is as expensive and inefficient as it is. I mean, other than good old fashioned greed and corruption.
Fully agree – I came down here with that line ready to paste into a comment.
Well said. And this has been going on so long, Truman tried to do a form of universal health care and got shot down. It’s way overdue.
Thank you for this. Well done!
It seems insurmountable for the messaging to get to the American people that they deserve basic rights other countries enjoy. Capitalism, this system, gives them less rights in the “home of the free.”
Who the fuck are these people that ‘love their healthcare plan’? I don’t know them. Are they fuckin’ rich?
Congress. The Senate. Former same.
A VERY rare handful of us, who tap out on our deductible cap every.single.year, and who are in the extremely lucky position of having that cap be relatively affordable (mine’s right around $1,250-1,500 for the year as a single person).
I replied much longer above, but this is the 3rd time I’ve been lucky enough to have this particular insurance company (Medica, in MN–in MN all insurance companies are nonprofits, too, fwiw), and they simply cover more things– both procedures *and* medications–with much less hassle than ANY of the other insurance companies I’ve had (Preferred One, Health Partners, Blue Plus).
I specifically chose the job I have right now/this particular school district, because they offer Medica with a low/free monthly fee, and a “high deductible**” plan.
**high deductible is a term which makes ZERO sense to me, because–in reality–the “High Deductible” plan I’m on has literally the lowest out-of-pocket cost of ANY of the plans my district offers.
In my case, there IS no monthly cost from *me* for the insurance, I pay 10% of any costs until the deductible is hit, and I have a total deductible of between $1,250-1,500 depending on which year it was, with the option of using an HSA for the deductible…
My plan, even though it was described as the lowest offering” on the list of choices we were given, is actually the one with the *least* out-of-pocket costs IF you have a chronic health condition & can manage to work things so you can blow your cap out, right away in the first couple months of the plan year.
And having had to deal with the other 3 insurance carriers I did, Medica is a breeze, because they just cover more shit, when you have chronic conditions like ‘beetus & reactive airways.
Also, VERY MUCH not rich. Just squeaking by above the poverty level, tbh! (Paraprofessional, and adult college student)
So you wouldn’t change anything about it? Don’t think it could possibly get any better? How do I get this?
Healthcare is a right. Period.
A-fucking-MEN to this!!!
It’s bullshit that in this country so many folks die from lack of care.
Also FUCK all the R-side talking points about simply offering “Access” to care.
All that means is that they’ll pay lip service to “offering” care, but won’t actually allow people the ability to *get* cared for.
If we cut even a *tiny* portion out of the abyss that is military spending, we could actually cover healthcare for Americans
Instead, we waste… billions? No one seems to know, really, and folks all over just die because they can’t afford care.
And most times one brings up a possibility of cutting out some of the graft & grift of the Military Industrial Complex/Military Subcontracting, the MIC & MS folx will scream “Whyyyyyyyyy do you haaaaateeee our troops?!?!???” To distract from the grifting.
https://www.rollingstone.com/politics/politics-features/pentagon-budget-mystery-807276/
I feel like I’m taking crazy pills in this conversation most of the time. Exactly what you say – who the fuck loves their insurance? I had very good insurance for a couple years and it was still ridiculous to navigate and understand. Also, the flip side of that was while it was part of my compensation for me, it was so insane expensive to put my husband on, who needs it more really, and so really it would have been cheaper if we had shittier insurance we both somewhat paid for, if you look at us as a household.
And sometimes, it’s cheaper to not have insurance, if you’re lucky like me.
I have very good and very expensive insurance. It’s so good my company stopped offering it for new employees last year, and I have it mostly because I now have a son (think the married insurance thing is a headache – just you wait!) Anywhoo, he got pneumonia a few weeks back and we did the “correct” patient order, I took him to his doc, she ordered a chest x-ray, I took him in and got a few hundred rads trying to get him to stay still for the x-ray, etc. I paid a pair of $20 co-pays, it was great.
Then I got a bill for $350, even though I *already* pay more than than monthly just for the privilege of having insurance in the first place. And there’s no explanation as to why I owe this, and were I to call, none would be forthcoming other than “You pay now” and/or “How soon can you pay?”
Anybody who “likes” their insurance has brain damage. The whole system is a madman stirring a cauldron of spilled entrails shouting out random amounts that people owe.
Side note to this comment: The JCPenney “thought experiment come to life” is one of my favorite social science moments of my lifetime. I, a non-pleasure shopper, thought it was a great idea. My wife, smarter, better-looking, and a sale hawk, said there was no way it would work. And she was right: People don’t like shopping; they like feeling smart because they found the best deal, no matter how untrue that thought is.
…wealth shouldn’t equate to health but it sure as hell looks that way when you look at it, don’t it?
Being wealthy adds nine years to life expectancy, says study
https://www.theguardian.com/society/2020/jan/15/being-wealthy-adds-nine-years-to-life-expectancy-says-study
Here’s a not-so-fun-fact: You know that bullshit Republican/DINO talking about about “moral hazard?” It basically says that people need to have “skin in the game” in order to use healthcare “responsibly” and not bankrupt the country by literally spending every day of their lives sitting in a doctor’s office, because that’s so much fun. When I was working on my master’s degree, I came upon this little gem, which proves what anyone who works for a living already knows: that putting too much of the cost of care onto the shoulders of the individual makes that individual–even if they are insured–behave more like the uninsured. They put off getting necessary care because of the cost, which then creates added morbidity and in many cases, mortality, which is a hell of a lot more expensive than simply being able to just go to the damned doctor when you need to.
https://www.ncbi.nlm.nih.gov/pubmed/?term=Moral+hazard+and+consumer-driven+health+care%3A+a+fundamentally+flawed+concept.
…& by such marvelous feats does the US manage to spend more per capita on healthcare than most places could afford while failing to avail itself of the kinds of outcomes some (notably often cheaper) models manage to produce
…thanks for that link, though – much appreciated
Hell, we don’t even really have to try and shoehorn an argument using other national models because we have Medicare. Researchers from the Commonwealth Fund found that those with either private insurance or employer-provided insurance had a much higher likelihood of rating their insurance as “fair or poor” than those with Medicare (Private Insurance, 33%; Employer-Provided Insurance, 20%; Medicare, 8%). In addition, those with Medicare enjoyed much better access to care and fewer problems with billing. Only 23% of people with Medicare went without needed care due to costs, in contrast with 37% of those with employer-based insurance. Billing problems affected 21% of Medicare enrollees, versus 39% of those with private and employer-provided insurance—almost double the rate. Further, only 13% of Medicare enrollees were unable to afford basic living expenses (food, rent, etc.), compared to 27% of those with employer-based insurance and 33% with private insurance.
The study goes even farther, breaking down disparities between those with Traditional Medicare (directly paid by the government), and those with Medicare Advantage (typically administered through an HMO or PPO). Only 6% of those with Traditional Medicare rated their insurance as “fair or poor”, compared to 15% of those with Medicare Advantage. The study did find that those enrolled in Medicare Advantage were less likely to spend 10% or more of their income on premiums and out-of-pocket costs (25% vs 36% with Traditional Medicare), but it also found that the old adage “you get what you pay for” definitely applied. Specifically, 32% of Medicare Advantage enrollees experienced at least one problem accessing care due to cost, compared to only 23% of Traditional Medicare enrollees. Also, 22% of Medicare Advantage Enrollees experienced a financial problem due to a medical bill (using up all savings, taking out a mortgage against the home, taking on credit card debt or declaring bankruptcy), compared to only 15% of those with Traditional Medicare.
Further, recent research has discovered that the deliberate complexities of insurance policies—which are created by the insurance companies themselves, not by laws or regulations by which they must abide—have created a 20% likelihood that people in the U.S. will get stuck with much more expensive out-of-network bills, even when they went to a hospital ER which was in-network. This is because, while the ER may indeed be in-network, the doctor who is treating them may be out-of-network—and those services are billed separately. Surprise!