I know that I should be blogging about art but there are social issues that are near and dear to me. One of the most important is health insurance. Twenty years ago, all that I needed was a "bare bones" policy that insured me in the event of an emergency. That meant if I walked into an emergency room, everything after the deductible (which was something low, like $50) would be taken care of by the insurance company. No bills, no percentage, no "reasonable and fair costs" - 100% hospitalization. As time went on, and health costs increased, I was insured by the traditional 80/20 plan. At that time, HMOs and managed care were pretty lousy. The cost of seeing the doctor was only $50, and the dentist took whatever the insurance paid. Eventually, in the early 90's, health costs increased and I opted for a managed care plan. I was lucky enough to be living in a town with a medical school, and two very large hospitals within a few miles of me. I was also lucky enough to get a doctor that was just finishing her PhD, having finished her MD years before in Germany. I still have that doctor. She provides very good medical care. When I first went to her office, they had Saturday hours, Urgent care appointments, and students who accompanied the supervising physician during the school year. They even had people training as Nurse Practitioners and Physicians Assistants on rounds. My insurance premium was paid for by my employer - 100% of it. I only had a $50 lifetime deductible for dental. I had to pay a nominal amount for long-term disability insurance.
By 1999, I was paying $256 per month for a PPO insurance for my family. That was because the managed care plan my new employer offered was obscure and one of the few plans that my doctor did not accept. But at least the employer offered three different types of medical insurance (80/20; managed care; PPO) and I had an option. Several years later, when I was laid off, I found out the insurance cost over $500 per month. This included deductibles that had gone from $100 to $300 per person.
I was lucky enough to be employed and covered under a NJ State plan that offered several options, and was 100% paid for by the employer. This was 2002 and the cost for just having health insurance for myself was over $7000 per year. I didn't even run up that much in doctor bills. I did have appendix removed in 2002 and it cost over $25,000. My insurance took care of everything, my bills were paid, I only paid the $25 emergency room fee. Again, when I was laid off, the health insurance - for just myself - was costing $550 per month. The co-pays were nominal but instead of insuring a family, I was the only one insured.
Now I am employed full-time. Since 2005, my employer has gone from 100% hospitalization coverage to 90%. I still pay a percentage of the premiums, I have a high deductible, and I am in a managed care plan that fewer and fewer doctors are accepting because of the difficulty with the insurance company. My doctor only works 2 days a week seeing patients, the associates she works with are on call, but they are "appointment only". If I have an urgent care visit, I see a medical student who is being monitored by closed-circuit camera by the supervising physician at a desk, like a security guard who watches monitors. In fact, I even received a bill from a doctor who I never saw, who never saw me, for an additional co-pay because the "he" was a specialist. My co-pays are high, my deductible even higher, and I live with the knowledge that if there is a serious problem, that requires hospitalization, I will probably go bankrupt or rely on charity care. My local hospital is not even within the Provider Network of my insurance company.
In the meantime, my mother probably had $250,000 worth of surgery and medical treatments and will probably not pay more than $250 for all of it. She is retired, on Medicare and has additional medical insurance because she worked in the public sector.
I shudder to think what would happen if she did not have Medicare and additional health insurance to pay for everything. She would lose everything that she worked hard for, just so she could stay alive but under much more stressful and unhappier circumstances.
So the question remains, what do we do about this? I do not have a choice in my current medical coverage, so if the government chooses for me, I lose nothing. If there is no option for small businesses, does that mean big businesses are the only ones who can offer any medical coverage? Is a public option better, since most of our veterans and armed forces do not receive adequate health care? If we settle for less, we will only get less.
