For everyone complaining about the high cost of health insurance

**pflyers85** · 10-12-2017, 07:49 AM

I totally agree. To me it is ridiculous to have a system in place where people are using insurance to cover basic medical treatments that 95+% percent of people have to undergo. The whole moniker of "health insurance" is really a misnomer when you think about it. The product known as health insurance really isn't an insurance product but a pre-paid health coverage plan. Insurance traditionally is a product purchased to hedge against an otherwise rare event that incurs catastrophic loss. This over utilization of insurance to cover basic care has allowed costs to skyrocket because the only prices most consumers look at is their monthly premium and the copay.

**disneysteve** · 10-13-2017, 06:45 AM

I completely agree but I also recognize that the issue is far more complex.

You say you shouldn't be able to buy insurance after you're already sick. Does that mean you are in favor of re-instating pre-existing clause policies? If so, what is someone supposed to do when they get sick and can no longer get coverage? Oh yes, they go bankrupt. Medical bills are the #1 cause of personal bankruptcy. Even folks with insurance go bankrupt due to medical bills because plans don't cover 100% of costs.

There is definitely a problem with the disconnect between the patient and the cost of care.
Patient: "I want an MRI because I jammed my thumb this morning."
Doctor: "You don't need an MRI for that. Do you have any idea how much an MRI costs?"
Patient: "My insurance covers it so that's what I want."
I can't tell you how many times I've had a conversation that went pretty much like that.

There needs to be more transparency in pricing for sure. Even transparency, however, won't change much unless the way health insurance works also changes, as you mentioned. If I have a $50 copay, why should I care if the real cost of the test is $500 or $5,000?

I have often said that health insurance should be more like auto insurance. It should cover me if my car is wrecked or stolen or destroyed by a fire but it shouldn't cover oil changes, new tires, or replacing the windshield wiper blades. In the same way, health insurance should cover me if I need surgery or dialysis or cancer treatment but it shouldn't cover minor stuff like strep throat or a common cold.

There's a HUGE problem with that, though. It incentivizes people for not getting medical care. "Why should I go for an annual physical if I feel okay?" Give people insurance that covers that annual check up and they flock to the doctors' offices. That's how a high percentage of "silent" diseases like high blood pressure and diabetes are caught. It's far cheaper to identify those problems early and get them controlled than it is to wait until the later stages of disease when treatment is far more expensive and less beneficial.

You mention no limit on claims. How would that work exactly? With your auto insurance, the coverage is limited to the value of the car which is a known number. How do you assign a value to one's life? "Sorry, you've maxed out on your coverage. You'll just have to die now."

I am absolutely not suggesting that care should be free, but even having a copay is a barrier to treatment in many cases. When I hurt my shoulder and had to go for physical therapy, I had a $30 copay. I had to go 3 times a week. That's $360/month. How many average people can afford that? I often have patients forgo therapy for that reason. The result? They don't get better and sometimes end up needing more costly treatment down the road, even surgery, that could have been avoided.

We need universal coverage. People shouldn't be walking around with no insurance. People shouldn't be trapped in crappy jobs just for the medical benefits. People shouldn't be stuck on Medicaid because if they get a job, they lose health coverage for themselves and their families. The whole system is broken.

**LivingAlmostLarge** · 10-13-2017, 09:49 AM

everything steve says and then some. I know right now two families going broke who have jobs and health insurance and cancer. No income = no money. No money to pay the mortgage, to cover the % not covered by the insurance the spouse has to cover the non-working spouse who is sick. But the money goes to medical, mortgage, and rest goes on cards. They can't cover the 20% when the 20% is six figures. I can't say I don't feel sorry they did everything they were supposed to except have 6 figures already saved.

And it adds up. Not working and the disability doesn't cover what they made. It doesn't cover all the regular bills let alone now the medical bills rolling in. The cost of surgery and hospital stay and chemo and everything else.

We're not just talking cancer, but any sort of long term medical problem. Or having a child with special needs. I recall my delivery was $30k for my DK1 and then another $100k for her week in the NICU. Not to mention all the medical problems we had for the first two years. I mean other families without our coverage which we paid $250 for our entire delivery for me and $250 for her week hospital stay. Yes that's what we paid. I paid $10 copay for the ortho specialist for her hip dysplasia. She had ENT do ear tubes and do antibiotics and she was allergic to a couple different types. Her cardiologist for heart murmur. She had a gastro enterologist for her reflux she was on medication for 2 years rotating and changing. She had allergist for allergies. This all happened in the first year alone.

So tell me how the hell am I am supposed to buy insurance for her? Tell me how she's born deserves the blame for all her conditions because everyone says people bring it on themselves. That luckily for her we have great insurance and money.

I'm just pointing out that she didn't smoke, drink, do drugs and neither did i, but we're not exactly idea insurance risks now. Not to mention the inherited condition from DH? We're uninsurable period. Don't lie to me and say we can be insured. Any regular insurance company will likely not cover anything and basically make the premium so expensive even for catastrophic.

It's lip service people give about insurance companies until they get something then when they join the uninsurables they change their tune.

For everyone complaining about the high cost of health insurance