December 19, 2013

My wife and I were triply-screwed by health care insurance . . .

We’re older Americans, late 50s, so before the ACA took effect, we were at that stage when insurance companies saw us as a bad risk -- too old to expect we’d just pay premiums without incurring costs, too young to be shuffled off onto Medicare should we get sick.

And we have pre-existing conditions. In my wife’s case, it’s a reality; in mine, non-existent. My wife has RA, so insurance sees her as a drain on profit. For myself, a false positive on an in-office prick test for diabetes consigned me to seven years of ever-increasing premiums. No other test ever showed me to have even a “pre-diabetic” condition (in fact, every test showed the opposite), yet my insurance company insisted I’m diabetic. And my attorney (my brother) told me there was little hope of ever convincing them otherwise, since they could use it to justify increasing my premiums without fear they’d have to payout.

And our third strike? We chose to pursue an American dream: We started our own business twenty-some years ago.

Because we were not in some arbitrary corporation’s risk pool, we were charged more for insurance. So on top of the other acts which should be criminal, add that insurance companies subjectively classified people based on nothing more concrete than the size of the check cut for the group’s coverage. And those not covered by a relatively large check got charged on average an exorbitantly larger amount. Considerably more than was justified to cover administrative processing costs. Certainly, “economy of scale” dictated lesser rates for greater numbers, and the threat of moving a large account brought extraordinary concessions, but does any of that morally justify charging multiple-times-over to those less connected?

In the 20 years since we chose this independent path, our insurance premiums rose each year by 7 to 40%, depending on the level of criminal greed rampant within our insurance carrier that year. Uncontested, our 2014 premium was set to rise to $2,884 a month in January. It was an unsustainable burden that presented us with an intractable choice: pay the ransom to receive the medical security we need and save little for retirement, or opt for lesser coverage that may likely leave us physically incapable of enjoying whatever retirement we may find.

Given the shortcomings and latent criminality of all for-profit medical insurance, ours was a good policy; not great, but passable. We chose our own doctors (important for my wife), and enjoyed some amenities. It came with a high deductible, however, and no guarantee we wouldn’t lose it should we have need to use it. In short, it was something we needed to keep but in truth couldn’t see how.

That was our condition -- our medical insurance condition -- on September 30.

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It was our good fortune to be Californian when the ACA rolled out. The Covered California website was flawless. We accessed it at our leisure, debated the merits of each plan offered, and were able to sign up with little trouble. All told, it took about two hours on the web, less time than I’ve ever spent negotiating for insurance of any sort.

The insurance policy we selected is every bit as good as the one we had before. We can continue to use every doctor we presently have, our selection of hospitals includes all those from before plus some more (including the finest hospital in the region), our deductible is no greater and there’s no cap on payments. And best of all, should I ever use it I won’t lose it, and the limits protect me from some forms of bankruptcy.

The cost? $1,181 a month for the both of us. A 60% savings over our cost on the “free market.”

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I can’t remember when we knew health care reform was one of the most critical issues facing the nation. Undoubtedly, the relentless litany of horror stories of those caught without insurance, or forced into bankruptcy despite having it, deeply influenced our belief. On a personal level, we saw the potential for disaster the time I changed jobs and only a fluke saved me from being without insurance when an unexpected hospitalization almost wiped us out right when our first child was born. And our attitude definitely solidified after the birth of that child, when our insurance carrier denied her needed surgery because a congenital defect was deemed a “preexisting condition.”

So we knew the transformation of healthcare had to be fundamental. The problems were endemic to the for-profit, corporate model of health care insurance, and the only viable solution in our opinion was to dismantle the entire rotten structure. Decisions about health care -- indeed, the very idea of health care -- have to be wrested from corporate bean counters and stock option influence and invested instead in the very people who depend on this timely care -- care too often denied them for lack of money or so faceless investors can make another dime.

We wanted single payer. We wanted universal coverage. And we had been agitating for it since well before Barack Obama entered the national scene. So when he took up the cause, we supported him in every way we could.

We didn’t get what we wanted. But then, we never expected it. After all that’s transpired, we find it best for our health to content ourselves with the belief it was enough for the process to move forward. Necessary, but incremental changes have been made, changes that may one day lead to the type of care this nation requires. I believe it will be in place by the time my grandchildren enter their majority. Which is good, as two of them are with us today.