Health Insurance in America: Legalized Extortion

 

Audio Link to Health Insurance in America: Legalized Extortion

 

Included in yesterday's mail were two ominous envelopes, one addressed to me, the other to my wife.  They were from our health insurance company.  Being that this is mid-May, I knew what the contents of the envelopes would be: one-page letters informing us what our insurance premiums are going to run in the coming year.  With sweaty palms and racing heart, I began operating on the envelopes, terrified by the news that would be contained therein. Last year at this time, our premiums rose 14.6%; the year before that slightly under 13%; the year before that 15.8%.  Envelopes open, I gingerly removed the one-page form letters addressed to "Dear Member."  Reading the twin missives of doom took less than 30 seconds.  My worst fears had actually been bested by the reality of it all; beginning July 1st, our premiums would be going up an additional 25% . . . 25% . . . 25%! 

Yes indeed; as of July 1st, we will be paying the princely sum of $34,934.88 for a year's worth of "coverage" that includes neither dental nor vision nor podiatry, carries a $10,000 deductible, and is regularly refused by many doctors because the company doles out payment with a costive eyedropper.  And, to add mortal insult to lethal injury, this outrage comes fast on the heels of my wife being denied -- once again -- coverage for a crucial pain-reducing procedure because, in the opinion of some company stooge she ". . . does not present sufficient pain to warrant said procedure."   And just last month, they denied my doctor's order for an MRI because, once again, they deemed it "unnecessary."

Now mind you, my wife and I are both reasonably health-conscious people.  We don't smoke or drink, stick to healthy diets (keeping kosher in a largely non-kosher world forces one to eat lot of salad, fruit and fish) and get a reasonable amount of exercise. (I for one am a long-time inveterate gym rat.) We are healthy people who live active lives despite having conditions that might lay others low. In other words, we do everything in our power to be as healthy as is humanly possible.  And yet, we are about to begin paying nearly $35,000.00 for a year's worth of what is truly substandard health insurance coverage.

To put the rate of increase into perspective, two years ago, my wife's monthly take home pay from her part time position as an instructor at a local community college covered our monthly premium.  With this newest spike (and a concomitant cutback in her teaching hours), it now will take nearly 3 month's take home pay to cover but a single month's premium. Our annual insurance premium will be about 50% more than what we pay for the mortgage on our home and a rental property.  

So why not just change carriers? Because the last time we tried, we were turned down flat because of pre-existing conditions. (Starting next year, under terms of the Affordable Care Act, this will be illegal.) Moreover, we had to report the insurance agents (who all but guaranteed us "better coverage for less") to the state attorney general's Office of Investigations; they had signed us up (and were already billing us) for a couple of "savers' club" groups without our knowledge or consent.  

Now mind you, I am not in any way kvetching about the quality of medical care we receive.  Our doctors at Cleveland Clinic Florida are first-rate; indeed, some are galaxy-class. The problem is, that in order for these first-rate and galaxy-class physicians to provide us care, it costs an arm, a leg and a pancreas gland . . . and starting in July a clavicle and a hyoid bone. 

So what can be done?  Next to nothing, I am afraid to say.  Oh sure, we could simply drop our healthy insurance and pray that we remain healthy until age 65 and can begin being covered by Medicare . . . provided that Paul Ryan and the GOP don't have their way and voucherize it before then.  Then too, perhaps we could sit down with a supervisor or representative of the company that so willingly takes in our dollars and try to work something out.  No dice.  From prior painful experience, when given the choice between compromising and simply losing us as paying customers, they simply respond "Well, that would have to be your choice . . . to drop coverage." Even waiting for the rest of the Affordable Care Act to take effect won't do any good; while carriers may be debarred from denying coverage due to pre-existing conditions, there is nothing that says they have to make it affordable.  You see, the affordable care act isn't about health care; it's about health insurance.  Far from being "socialized medicine" as so many argue, it is a gigantic beribboned gift to the health insurance industry which, if properly and rigorously monitored, could eventually slow down the unconscionable increases in all aspects of health care.   Don't get me wrong. I have no problem with corporations making a profit; that's why they're in business.  What I do have a huge problem with -- and here I know I'm not alone -- is facing the prospect of going broke just to be covered by a company that loves saying "REFUSED!" 

According to a recent poll from the Kaiser Family Foundation, 42% of the American public don't know or aren't sure whether the Affordable Care Act is the Law of the Land.  It is.  How do I know?  Well, just yesterday, the House of Representatives tried to kill it . . . for the 37th time in two years.  Even the House wouldn't be so dense as to try destroying something that does not exist. (Oops . . . I take that back, maybe they are that dense!) And yet, because they are forever railing against Obamacare, forever trying to scare people with talk of "death squads," loss of liberty and the looming communist/socialist/fascist takeover of America, lots of Americans are against it . . . or are they?  When queried, people who say they wanted Obamacare repealed, still say they like aspects of it . . . like keeping children on their parents' policies until age 26; like not being denied coverage due to pre-existing conditions; like no lifetime caps on coverage.  And yet, they are against it.  

Despite the fact that the Affordable Care Act likely won't affect our personal situation, I am all for it -- until we get smart and one day enact universal coverage.  Likely the only way that will ever be accomplished is if enough people find themselves in our position -- of being priced out of health insurance coverage because it costs more than two mortgages and two car payments combined -- and demanding change; real, tangible, intelligent change.

Anybody out there know of a company that can provide us coverage without resorting to extortion?  Any suggestions?

Please? 

©2013 Kurt F. Stone

Comments

[Alan Weiss]

Dear friend,

I am so sorry that you have to endure this terrible treatment. How dare them! Greed has gone too far. It was the plan of the insurance companies since the early sixties. Just give the doctors and the hospitals more money. Give them more money. They have brought it to fruition and now hold the country by the gonads! They will continue I am sorry to say.

[Hope]

I have been complaining of the same thing for 3 years. As an employer, I offer my employees healthcare, We have an HMO (80/20) with a high deductable. This payment is higher then any other bill we pay including our rent.

As a healthcare provider, you know that I have a contract with your insurance company. You are correct, they are the worst company to deal with. It takes months, sometimes years to get reimbursed, always with an ongoing battle.

You may or may not know that Aetna has purchased your insurance company as of May 7th. I'm sure your premiums will not be affected but hopefully once the take over is i place, Aetna won't be so stingy with their authorizations.

My advice, switch to Medicare when possible. I wish I didn't have to wait another 9 years!

[Andy]

Very sorry to hear of your difficulties with health insurance. Have you tried Aetna thru AARP?

[Roberta]

The answer is to stay healthy.

[Bob]

Seek help from the State Commissioner of Insurance. We have used them for past health insurance issues. It is worth a try.

[Roz]

Voted for the wrong party...

[KFS to Stanley]

We do have some of the best medical care in the world . . . its the delivery system that stinks, which means that there are tens upon tens of millions of people who cannot take advantage of it.​

[Stanley]

According to the people who want to repeal Obamacare we're supposed to have the best medical care on earth.

I forgot! There's always the hospital emergency room!! Oy!

[Stephen K.]

Good post.

I joined the local chamber of commerce, solely so I could buy their insurance program. My monthly premium, for myself (with pre-existing glaucoma), my two sons, a $3,500 deductible each and $5,000 overall, is $1,450.

The chamber dues are another $350 a year.

Of course, this still means health insurance costs me $20k a year before taxes, but it's better than your deal.

Maybe your local chamber has a similar offering.

Stay healthy, man.

[Dr. Dana]

Kurt, I'd just like to share the early part of my health insurance experience as a physician, who started practice in the fall of 1964. At that time there was no insurance and my charge for a visit was $5 either paid in cash or forgiven if the patient was either poor, another physician or his family, or any member of the clergy or their family. The reciprocal care or year end gift made it work out alright. About 5 years later a physician I had trained in a nearby small town told me he now takes health insurance and was paid $25. for the same work that I was receiving $5 and I should look into it. So I did, and sure enough, my payments from insurance progressively rose during this period of client development by the insurers. Also during that period, insurance allowances continued to rise whether we even asked or not. Unlike you, Rabbi, my wife and I pay about $10,000 a year and we also have Medicare.

There are many abuses of health care and its reimbursement strategies. It is complex, but the broken parts are definitely discoverable and the future will very slowly improve and make sense once all the corruption is discovered and professionalism and honesty becomes the dominate modus vivendi and modus operandi.

[The Midnight Owl]

horrible, extortive situation, made only worse by unscrupulous doctors and hospitals who over bill, rules regulations and paperwork, that force doctors to spend too much money to handle it, and lawyers who are easy to litigate, forcing large premiums for insurance on doctors. Medicare and AARP will eventually take care of it for you, I suggest the "F" plan in AARP. In the meantime, call as many insurance companies as possible, you may find a more pocket friendly one if you exhaust yourself--- I had the same situation with my oceanfront condo insurance, and happened on a company that would cover us, at far less than the state's Citizens-----------and stay healthy

[Baila]

Come to Canada . . . we will show you how it works.

[Andy]

Very sorry to hear of your difficulties with health insurance. Have you tried Aetna thru AARP?