Why is using American health insurance such a farce? We can begin with the preposterous process of personally procuring it.
As the end of 2015 appeared, I received missives in the mail from Assurant Health, my health insurer, that I would be delisted at the end of the year. I had used them for only over a year, mostly because they provided a “better deal” operating through the Aetna network I had reliably used for many years. I don’t use health insurance much. In terms of personal health I have so far been exceptionally fortunate, and have tried to combine physical, mental, social and spiritual health practices to give me the best shot of staying that way. My blood pressure and heart rate are both low, my last total cholesterol was 125 (no statins) and I have, very gratefully, experienced no major illnesses. The only medication I take is aspirin, more to prevent cancer than cardiovascular disease. Though I am in my early sixties, I should be a pretty good candidate for a health insurer.
Most of the Obamacare options were out – fortunately, I have a good paying job. The other options came down to three – two HMOs, and a high priced PPO through United Health.
Ah, United. Many physicians dislike the company, which has generally paid far below Medicare rates. My beef with the company was different. Over three years before, I had closed out a Wells Fargo Bank business account, foolishly thinking that a closed account was indeed closed. Then for the next three months this closed accounted paid for three months of United Health insurance. To whom? How? This was clear fraud.
Who had signed up? No answer. Wells Fargo said it was all United’s fault. United’s response was – silence. Silence following silence.
If someone had bought a television set or an expensive watch on my credit card, I would possess redress. The only redress I had, according to the reaction of both Wells Fargo and United, was to sue – which would cost more than my closed bank account had already shelled out. Heads you lose, tails I win.
So on December 7th (remember Pearl Harbor) I bought into my Aetna HMO, which only requires about $13,000 a year before my deductible comes through. I paid for this new insurance through a credit card.
Or at least I thought I paid.
Aetna admitted I had paid, but could not provide an account number, or an insurance card. That was being “processed,” and would take “some weeks.”
What if something happened to me on January 1st, or after? Good thing I did not need to find out. After many efforts and calls, my insurance card arrived in the mail – two months after my payment.
But during those months government websites and others noted my “lack” of insurance. Day after day I received notices that I would be without insurance if not signed up by the 15th of the month. I also got emails from the health insurance broker who had sold me the Assurant policy, promising “other options” for health insurance. Strangely, these “opportunities” never emerged.
As the weeks progressed, the notices became more insistent. Somehow the emergency deadline of December 31st passed, but not the opportunity for yet another “last chance” to sign up. As January progressed, I received increasingly strident and frequent “reminders” eventually increasing in incidence to every few hours, pointing out the disasters awaiting me.
But in early February following, many, many calls I became officially insured by Aetna. In the future, as long as I don’t get sick, things might work out rather well.
My webmaster was not quite so lucky. Carefully researching her options, she took up with the very few HMOs offered and checked out a group of internists who as primary care physicians would determine pretty much everything that happened to her – PCPs have great sway in HMOs. Signing up, she was told she could get a “new patient visit” with the primary care physician she had researched by calling on April 1st. In other words, three months after “becoming” insured, she could “call” to make an appointment – and then wait weeks or months further.
What if something went wrong before that? Well, at least emergencies might be covered – one hopes.
Except she next received a note that the internist’s practice was too full. Her new PCP could not see her – though she might eventually see someone new to his practice.
Sensibly she began looking elsewhere. However, there was another problem – “shifting” her PCP was forbidden until a waiting period of 30 days. That meant at least a month without anything but emergency care.
No exceptions, she was told. But it’s not my fault, she rightly answered. Too bad, came the response. Repeatedly.
The Age of Anxiety
Ours is a time of tension and stress. Listen to media pundits and the sky is falling every hour. The end is nigh – except it isn’t.
Yet to keep populations healthy people need a sense of security. Though health is often about how you live and regenerate yourself, individual sickness has a lot to do with luck.
Most developed nations know that. They recognize that organized, rationalized national health systems save them a great deal of money: a healthy populace is necessary to a healthy economy, and a politically secure nation.
Yet if the basics of health care cannot be obtained by healthy, working people – what about the tens of millions without insurance? Or those who get ill and find their “required” treatment requires “preauthorization” that is nearly impossible to obtain. The anxiety of arbitrarily available and arbitrarily applied health insurance leads to insecurity for individuals, families and communities, while making us a more unhealthy nation.
That’s not just bad for business. It’s bad for us all.