Who’s Scamming Who? Pretty much everybody except the vast majority of end customers.
Cases in point:
1. I recently found out the projected copay for a medication I need to treat my psoriatic arthritis. It’s $750 a month. And that’s after insurance. Note that said medicine is advertised to the point where it’s become a household word, yet the percentage of the population who truly needs it or should take it despite its laundry list of potentially deadly side effects is rather low. Although patient support programs offer help with this steep cost, I don’t meet the financial criteria for any of them (I’m just ever so slightly not poor enough, apparently).
2. The Commonwealth of Kentucky has a legal requirement that means my auto insurance company must send me, via US mail, a cancellation notice each month. That’s right – since I pay monthly rather than six months at a go, I get a letter each month that says I’m in danger of having my policy canceled. The first time this happened, I freaked out! But customer service calmly explained that they were simply acting according to state law, and I had nothing to fear. I wonder just how much money could be saved by simply removing this archaic law – or even allowing it to be done electronically, via email or text. Think of all those pieces of paper, the crunch time and system resources devoted to processing the production and tracking of the notices….oh and postage of course. For one person it isn’t much, but for an entire state of the insurance company’s customer base? Significant – and for a ‘warning’ that is largely unnecessary and/or unheeded. If you’re going to let your car insurance lapse, a warning isn’t going to sway you because you’re either reckless, broke, or both. I smell pork barrels!
3. My health insurance (Medicare supplement, that is) sends me oodles of email and snail mail to promote ‘special’ patient education and incentive programs, many of which have absolutely nothing to do with me or my health condition. I actually called someone there once and tried explaining that I have no interest in getting ‘points’ for colon screening, and little incentive to tune in to a webinar regarding nutrition, having taken nutrition courses in college. Even less likely am I to adhere to a rewards program for senior preventative health (I’m 43 and disabled, not 65+). Unfortunately I’m going to keep getting their near-spam (I am trademarking that word, hence near-spam(tm)). And we wonder why our trees are disappearing, the information superhighway clogged, and our hard fought cash depleted by insurance premiums. All so Jack can earn points towards that $3 duffel bag with the tacky insurance logo on it.
4. Some states require that an individual carry medical coverage for themselves in their auto policies. That’s right. You may have medical insurance, but that doesn’t mean you won’t automatically be charged a fair chunk of your car insurance premium for “medical costs that are not covered by health insurance” because you’ve incurred more than your allotted maximum. I ask, if I’m hospitalized after a car accident and incur over $100,000 in medical expenses, is it really going to ease my mind that a couple percent of that would be paid by my car insurer? Definitely not worth the cost in my ever so humble opinion.
7. Our health ends in our mouths. Why is dental insurance so much harder for the average Joe to get, and why on earth are we treated by insurance companies as though an infected tooth is something we can choose to ignore? I remember back before mental health coverage became mandatory for health insurance, and I applauded the recognition that our psyches and brains are indeed part of our total health and wellness. Yet any dental procedures are treated as separate and it’s assumed they are voluntary. Did you know that Medicare only covers tooth extraction if a person’s having an organ transplant or is in end stage renal disease? It’s true, even if you have dental problems as a direct result of a medical disease or drugs you must take to treat it. If chiropractors are (rightly) recognized as doctors by most insurers, why aren’t dentists and oral surgeons? My mouth looks attached to the rest of my body. Am I missing something?
6. Ever wonder why a medication might cost you a $30 copay at one pharmacy, and $80 at another? It’s no secret that insurance companies collectively bargain with hospitals, physicians, pharmacies, and other medical providers. We’re more or less led to believe that this saves us money – after all, that example would mean a $50 savings at drugstore A. But take a deeper look. If insurance companies are able to get their ‘network’ providers to slash fees, then either the fees themselves are woefully inflated to begin with or the savings for plan members is being sloughed off onto other customers. There aren’t even any winners here because all this bargaining doesn’t save anybody much in the long run; it’s just a numbers game, one that causes undue stress to direct providers, and you are just a (policy) number, in the bottom line.
“All right,” you say, “I get it. There’s way too much waste and game playing within the insurance realm, so what? It’s business after all.”
True enough. But I would argue that the type of insurance (for simplicity sake let’s stick with health versus auto insurance) can and should affect just how much the numbers game is played with our own money. It goes something like this: If you can afford a car, choose to own one, and choose to drive, there is every reason to expect that you take responsibility for this privilege and insure yourself appropriately. While my earlier examples indicate that you might be paying more than necessary, it’s still true that one can always buy a cheaper car, choose to take public transportation, bum rides, walk, etc. The fact that you exist does not mean you will ever automatically need car insurance, or a car at all.
If, on the other hand, one were to try and avoid needing medical attention, well, that’s not exactly something we can control. It’s safe to say that simply being born—even conceived—most likely means you will receive care from a health professional of some sort. And the cost of that care (plus the ensuing medical care you are almost certainly likely to require during the remainder of your life) has to be paid. Rightly so—we live in a society in which people are expected to earn their keep and to be compensated for their efforts.
Most Americans aren’t prosperous enough to pay for medical costs directly, unless they are extremely lucky, so we rely on health insurance. Here’s the thing though; health insurance is too expensive for a disturbingly large number of us. Not only that – once you have insurance, there’s no guarantee it’s going to make your medical needs affordable anyway. You technically have a choice, to get coverage or not, but you can’t choose to not need medicine. Even if you’re in peak health, you could fall and break a leg, get hit by a drunk driver, contract a rare tropical disease at that elite resort…the list goes on. Getting medical care is a basic human need, not a luxury, and the sooner the powers that be realize it, the sooner we can start reigning in the high costs associated with it, from provider, pharmaceutical company and insurance to life saving medicines.
One reason I’m writing this is to illustrate just how much medication cost inflation and insurance shell-gaming has affected me personally. Remember my first point? About the high cost of the medicine I need? Well, I was told by my rheumatologist over ten years ago that I needed it. It was really the only chance I had at avoiding eventual disability, he said. I had health insurance through my employer (ironically it’s the same company I now have via Medicare, in an odd circle of events). “Yes, of course we’ll cover this drug!” they said. There was just one catch. They’d cover it at 100% for part of the year – that is, after I’d already paid out of pocket $8500 or so. Before that $8500 mark, they would cover the drug at 30%. Well…thirty percent of the cost at that time turned out to be roughly $1500 a month, which was about half my take-home pay. My doctor appealed, my doctor wrote the pharmaceutical company’s assistance program (I had insurance so wasn’t eligible), my doctor appealed again, and in the end, I wound up having to quit work. I’ve not been able to afford this medicine since, and it doesn’t look like I ever will.
I know that there are exorbitant research and development investments that need to be recouped, but one can’t help but wonder how much cheaper the meds could be if they were advertised on television, say, once a day versus twenty-five. I also can’t help but wonder how many prosperous but misinformed patients see the advertising, demand the medicine, pay out of pocket for it, and either don’t really need it, can’t benefit from it, or develop the aforementioned deadly side effects. All of the above hint that the drive for revenue outweighs the needs of the patient, and I’m a living statistic in the proof.
True, I can’t say that lack of access to the drug caused my disability. There is no way to know whether or not it would have been effective for me. But I would have liked the chance to find out. And I would certainly rather be a contributing member of the American work force than someone who still contributes to society but in a far less tangible way (or not at all, if you ask certain closed-minded individuals). So the Industry won, but I lost, my employer lost me, and now I depend on a beast equally intimidating: my private disability insurance payments. I’m thankful I was lucky enough to be covered by my company, and glad I had paid a good sum into my Social Security fund when I was working… but I could devote another column entirely to life on benefits and how the shell games just keep on being played.
Stay healthy, if you can, and hold your policymakers accountable for your policies.
For the record, I do actively advocate for reforms in areas that concern me, including many addressed by this post, and I recommend that any citizen keep informed and keep in touch with lawmakers, business representatives, and concerned parties when it comes to any law or business practice that needs to be changed. I won’t tell you how to feel – just to be sure and express those opinions; it’s a huge part of how democracy works. One tool you may want to explore is the White House’s petition web site, where anyone can create or sign a petition regarding US policy.
(This document created from 100% post consumer recycled words and phrases.)
Echad Woundwort 