The story I have heard is that the non-profit insurers (eg blue cross) were the primary insurers until the early 60’s. They didn’t shut out pre-existing conditions, the rates were similar for all people, boy scouts used to do campaigns trying to sign people up because the more people who were in the insurance pool the better it worked. Then the for-profit insurers were allowed (state regulations which had prevented for profit health insurance were removed). They began offering reduced rates to healthier people, and not covering unhealthy people, including the elderly, etc. Cherry picking the profitable customers. The non-profits business model no longer worked with the for-profits taking the healthy customers and they declined. Medicare was soon created to pay for healthcare for the elderly and some unhealthy people, medicaid to pay for healthcare for low income families. By now most of the former non-profits that still exist have converted to profit insurance companies.
Obamacare in some ways turns this clock back. No more pre-existing conditions, more uniform rates for statistically healthy and unhealthy groups, a PR drive to get people into the system.
Like the author of the article I too have health insurance which is very similar in its co-pays and deductibles. I, however, have had health issues in back to back years which meant deductibles, catastrophic annual limits each and every year. This adds up. Because one health issue (12cm of tumor blocking my windpipe) took priority, I moved from Stage 1 to Stage 2 in another area before I could follow through on the health care. As the health problems have escalated I have experienced another blow that the insured soon discover–Paperwork errors. A January surgery was paid and a my catastrophic limit was soon reached so that by my second surgery, I had 100% coverage. I breathed a sigh of relief because now that I met the cap, I could have the delayed procedures. I based my next decision on the idea I wouldn’t have to worry because I could take some time to pay off everything without worrying about adding to our already high debt load from 2 consecutive years of deductible and catastrophic limits. A third surgery revealed progression of the disease and a fourth surgery was done to extensively removed the problem and surrounding tissue. It was so extensive and seemed so successful that my oncologist released to my regular specialist care with 3 month checks. Meanwhile all the paperwork was being processed and REVIEWED. HOWEVER, what happened next is beyond my levels of tolerance. A review revealed the insurance company had paid the wrong amount on the first surgery. Insurance whiddled down the cost of the Jan surgery and I no longer met the catastrophic level. I still had more to pay on surgery 1 and now Surgery 3 and 4 were subject to the catastrophic limits and I had to pay large chunks of Surgeries 3 and 4, deductible put %. First off, I wouldn’t have had surgery 3 and 4 so soon after surgery 1 and 2 because we couldn’t afford more bills from 3 and 4 so soon. I would have waited several months instead, but had them nearer the end of the fiscal year. Second, why does it matter? It’s all a sum total that I owe. Because with every surgery come 10-15 odd bills, whether for the tests, prep, surgery, or follow-up. So while I could and did handle all the small associated costs of surgeries 1 and 2, I still had sizable monthly bills for hospital surgery 1 which are short term, high cost pay off. (They hand you over to collection if you don’t pay in well under a year.) When Surgeries 3 and 4 occurred, another 25+ bills arrived. As a rule of thumb:Bills under $100 are expected to be paid within 30 days. Between $101 and $250 they usually allow 90 days to pay. Then the whopping hospital bills arrived. So I’m stuck paying off more small bills which add up very quickly. Worst, I can’t do anything but pay up or go into collection and we have depleted everything fighting illness for several years now. I still have to go in every three months for checks and I can tell you now, it’s back. I’ve got the same problems and symptoms. Next time it could be stage 3 and our resources are gone. Insurance or no, you get screwed. To those who complain about Obamacare, shut up. It doesn’t go far enough.
I’m always mystified by the “free market” b.s. in these discussions, for what seems like a really simple reason: If I want a new TV, I can shop around until I decide what I want and what I want to pay. I can’t do that if I have a sucking chest wound.
I had a recent cancer scare, and when I expressed both my health and financial fears to a family member, she said, “Why are you worried? You have insurance.” My response was, “Yes, I do. That doesn’t mean I won’t go bankrupt anyway.”
Man, I love living in Canada. Nothing like a little US healthcare absurdity to boost my flagging patriotism. Our far right-wing government doesn’t dare touch our health care, though they would surely love to. Their heads would be on pikes within a week.
Obamacare isn’t the solution, it is a compromise. Sadly, it doesn’t bring US healthcare up to the level of the rest of the developed world, but it does still have a lot of improvements, including the pre-existing condition coverage, limits to expenses, and the required insurance company investment in healthcare vs. profits.
Thank you for some nuance. Too many Americans (of differing ideologies) go to extremes when they talk about Obamacare. Obamacare will saves some lives, but not nearly enough as we’d see with a true single payer system for health care:
I think the first step we can do as Americans is educate one another on the facts. If you haven’t already, please review this FAQ link above by the Physicians for a National Health Program. And, please spread it everywhere. It answers many of the questions people have who’ve been duped by industry to be afraid of a single payer system in the USA and/or misconstrue it with Obamacare.
Also, this interview with one of the former heads of CIGNA insurance is amazing and shows how all sides of our American government have been corrupted with money and lies. He was in charge of lying to the American public by industry and his conscience couldn’t take it anymore and he became a whistleblower. I wish his whistleblowing got just a fraction of the attention Snowden did considering the tens of thousands of deaths, countless suffering and job lock he could save Americans from if we’d just listen to him.
The US healthcare system is the product of government intervention and not (as many on the left and right like to claim) free markets.
The funny thing is the only people that believe that are on the outside. It’s not only “government intervention” at play. There’s much more to it than that Libertarian think tank (a.k.a. industry) talking point implies.
This is straight from the horse’s mouth from CIGNA (view this interview to see just where these talking points come from). As he explains from his extreme position of authority, industry has entire departments dedicated to lying to both U.S. government lawmakers and the Americans public to keep the system the way it is and thwart a true single payer system for health care. As a matter of fact, he was in charge of it. It would behoove you to listen to what he exposes.
Surely there must be a better way than both of these?
The best system we flawed humans can muster thus far is a single payer system. This FAQ goes into implicit detail on how an American single payer system can be different and better than the way other countries implement it.
There is no perfect system, but as you probably agree, America’s system is currently draconian, deadly and overly expensive no matter who you specifically blame for it.
While you are sick trying to regain health and everything that requires, you also still have a life and everything that requires, and now add on 20+ hours a week calling insurers, creditors, pharmacies, etc etc. The system is fucked. Good luck to you!
Pretty soon you guys’ll start telling us that an average MRI machine is less complicated and uses less expensive parts than your average car plus your average computer. . .
Or that some people who would happily be doctors and take are of people don’t because of the insane cost and debt to become one. . .
Or that the quality of our medical equipment is lower than that of our average consumer gadgets. . .
Or that there’s something fundamentally flawed our pharmaceutical patenting and testing processes. . .
Or that market forces don’t work when the consumer’s primary thought is ‘my arm just came off’ . . .
I mean, the rabbit hole of stupid goes on quite a while, doesn’t it?
You can’t even do it if you have a recommended but not urgent surgery planned. My efforts to find out “exactly how much am I going to be on the hook for when I have this surgery that my doctor feels I need, in case I need to postpone it for a few months and save up?” amounted to nothing but hours of frustration and eventual rage. I got answers like “well it depends on which anesthesiologist is on duty that day and whether they’re in or out of network” and “it depends on whether your surgeon decides to bundle in the charges for extra fluids if you need them” and “since you’re spending a night in the hospital afterwards, it depends on whether they record you as actually admitted or not, and therefore whether it’s billed as in-patient or out-patient.” So apparently, the answer to “how can I be an informed consumer of my health care and plan ahead for medical expenses?” is “hahahahaha, fuck you.”
True enough. Or, if you buy their explanation, it’s because we’re lazy, uneducated consumers who aren’t being “active participants” in our health care and go to the doctor because we’re frivolous and wasteful. If I have to go to another meeting with HR about why, yet again, we’re getting our health benefits cut back and/or at extra cost to us so as to encourage us to “participate in smart health care spending,” I’m gonna punch someone in the nose. Luckily, that HR person will be an educated consumer and will get the best deal on his or her subsequent medical care, I’m sure.
Instead it has a health insurance system. For no good reason. Purely historical accident.
We eventually gave up fire-department-by-subscription. Time, and past time, to treat health as a basic component of maintaining a society worth living in.
And even the uninsured, who really get nailed by hospitals have to support the health care benefits for those lucky enough to have it through their employers. Health Insurance benefits are not taxed to the employer or employee. In essence, unlike many other types of ‘perks’, it’s tax free to the beneficiary (employee). And those without these programs have to bear the full cost (often more expensive than work programs) after tax. If you want to see some screaming, read the comments of those that have employee healthcare when presented with the idea that it should be taxed as income (as it really should).
Probably that is true on an individual level - the article was discussing it at a macro level. I am going to once again see if I can find this post because it was great.
You can’t even do it if you just want routine care. Just try getting a price list from ANY health care facility for even very standard procedures. If you have a powerful insurance company they MAY have negotiated a special rate- if you’re an individual, or have a high deductible, the facility will stick you with ridiculously inflated charges that have no relation to their actual costs. I’ve come to feel that to a great extent it’s the facilities- the medical-industrial complex- that are the main villains here. No other consumer service or product has this kind of power and information asymmetry.
I’m with Group Health Cooperative in Washington- supposedly a “good” provider- yet I can get zero information about charges. Their customer service flat refuses to discuss or disclose pricing information and can’t even tell me what precisely I have been billed for. Since we are on a catastrophic plan with about $5,000 annual deductible (for which we pay $823.00/ month as healthy non-smoking 60 year olds), we would be the ideal test case for market choice- but you don’t have a market when you can’t get information. Since in this situation GHC is both the insurer and the provider, negotiation is moot- my experience is that the system sticks those who pay (who are not indigent, who care about their good credit) with the maximum charges possible.
Computerized medical records have been a boon to the facilities, because they can bill for every last nitpicking detail. It used to be a 15 minute Dr. appointment was one price- no longer. When you are reminded of some tests you should get in the near future- ca-ching! the register rings, and it’s another visit charge. So what used to be a simple visit is run up to several hundred dollars- often without the Dr. being aware of what happens on the billing end- after all, most people just pay a flat copay. Every note is another charge, once the record gets to billing.
Medical care in the US is a situation where the power and the information are entirely on one side, and the consumer is just a pawn.
What a perfect system for the insurance companies. They get to take the young and healthy people, then drop them as soon as they start costing money. They don’t mind the government covering low-income people since those people don’t have the money to extract. And they really don’t mind the government covering the elderly since they both cost by far the most and often don’t have a lot of money to extract. Certainly not enough to pay for their end-of-life care at the rates insurance companies want. Meanwhile all the bullshit the insurance companies do to maximize profits drives up the cost of health care so the government pays more to cover just a small portion of the population than single-payer countries do to cover everyone.
And the government goes
Here’s where the system is incredibly fucked up. My parents have been on vacation for the last couple weeks. They drove from Ontario to Newfoundland and have been driving all around there. Health care in Canada is by province, but if they got into an accident or something, Ontario would still cover them there. They had been considering driving back through the northeast US, but decided against it because of health insurance. It would have cost quite a bit just for a few days insurance and they definitely couldn’t take the risk of some medical emergency bankrupting them. Imagine if the US was on a single-payer system and got costs down to a similar level as Canadian provinces. Then the provinces wouldn’t mind covering health care in the US in a similar way that a province covers you in another province. Imagine the increase in tourism.
Yes, I spent two years out of the last 10 uninsured, so tell me about it. “How much will it cost if I come in for a visit?” “Well, that depends…”
And my favorite: “How much will this medication you’re prescribing me cost?” “I don’t know…” “Is there a less expensive option?” “I don’t know.” I had one prince of a doctor, an old-school OB-GYN whose practice also unofficially did primary care because most of his patients were low-income and didn’t have another doctor, who actually tried to keep up on such matters and once told me “this is the cheapest antibiotic I can prescribe that will treat your infection. I think Walgreens carries it at the lowest price but if you find out different, let me know and I’ll call it in somewhere else.”
This was at a visit for an ear infection one week before a planned trip to the UK. The visit cost me $95 and the antibiotic cost me about $20. Fast forward 2 weeks, and I was in the A&E at 3 in the morning in London for a UTI. Visit cost me $0*, identical antibiotic cost me $14. The cab there and back cost me more than the visit. I came home full of rage at anyone who talks about how terrible “socialized medicine” is.
*I was in the country for 2 weeks so the staff at reception declared me a “temporary resident.”
