By leigh | August 21, 2009
if you look up “uninsured” on google, you will get more than 9 million results; in google-news alone, more than 14 thousand; in google-shopping (?!), more than 93 thousand results… clearly it’s a hot topic.
sample headlines this summer, from the internets:
The immensity of the problem of the uninsured
Uninsured toll worse than you think
Uninsured ‘worse than epidemic’
The citizenship of the uninsured
The plight of the young, uninsured American
The sick and uninsured
What to do with the uninsured
i am uninsured. i don’t much like being a hot topic.
Who are the uninsured?
What do we know about the uninsured?
How much do the uninsured cost the insured?
Should the rich pay for the uninsured?
did you do a double-take? or just patiently wait for the punchline? because… how could a doctor be uninsured?
Many uninsured are hardworking
Not all uninsured are poor
Eligible but uninsured
Uninsured crisis wildly overestimated
Trying to cover the unenthusiastic uninsured
i remember being on food stamps during the reagan years, and being a single mother during the clinton years. i didn’t much like being a hot topic then, either. there was a lot of concern, many furrowed brows, on the subjects of welfare and unwed motherhood. much of this concern was actually… hostility.
this hostility is what i see – i’m sensitive! – today, in some vocal parts of the public debate about “the uninsured.” sometimes the hostility takes the form of denial (they’re not really uninsured; being uninsured is not really that bad, etc.), but the underlying tone remains: “they’re” not like “us”… “we” are not like “them”… “they” have strange ways.
“43 percent of Americans in the 18-64 year-old age group have incomes at least 2.5 times the poverty level and are ‘voluntarily’ uninsured.”
“The majority of the uninsured are either illegal immigrants (as many as 12 million), or earn between $50,000 and $75,000 annually (8.3 million), or earn more than $75,000 a year (8.74 million) and elect not to purchase health insurance.”
“They borrow leftover prescription drugs from friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones.”
“I’ve heard illegal immigrants say that they find ways to receive free or inexpensive treatment for themselves and their children. In general, I’ve read (though I can’t find the source) that the uninsured receive about half the amount of money per capita to pay for medical treatment that the insured receive.”
as “the uninsured,” such talk causes me shame, frustration, and anger.
as a primary-care doctor, on the other hand, it is just very weird to me how strongly set the notion is – as demonstrated by these kinds of arguments – that being insured would mean not getting sick… or that getting sick would fade in significance… would mean no longer going without care… would mean being cared-for and well.
and we have the companion notion, that not having insurance poses a terrible risk: the risk of getting sick or injured, and not being cared for, and not being safe. but, as a primary-care physician, i’ve said it before, and i’ll say it again: health insurance is not health care, nor is it health. nor safety.
(we probably should not even use the term “health plan,” except where we refer to the strategy we’ve figured out – maybe with a doctor’s help – to preserve our physical and/or mental well-being. and for heaven’s sake, we should stop calling insurance companies “health providers,” no matter how much they want us to.)
i don’t have a health insurance policy (though i certainly have a “health plan”!), because, as a small business owner, i can’t find one that would provide any reasonable degree of health care. i have looked at around 125 different local health insurance policies online, thanks to the many search engines available online (110 policies on one search engine alone!). here are 5 representative policy quotes, for myself and my husband. (my 20-year-old will have to fend for herself, unfortunately, since adding her makes any package even worse.)
~insurance benefits start after we spend a $20,000 yearly deductible* out-of-pocket
~office visits cost 40% of doctor’s fee, after deductible
~prescription medicine costs 50% of store price, after separate (additional) deductible
~insurance benefits start after we spend $10,000 yearly deductible
~all visits cost 50% of fee after deductible
~drug benefits not mentioned online
~insurance benefits start after we spend $15,000 yearly deductible
~office visits with primary physician in-network** cost $20, deductible waived for preventive visits once a year
~office visits elsewhere, 30% of fee, after deductible
~prescription medicine costs 50% of store price
~annual preventive office visits with primary physician in-network cost $20, out-of-network cost 50% of fee, yearly deductible waived for both
~other insurance benefits start after we spend $1,500 yearly deductible – other doctor visits 30-50% of fee, after deductible
~prescription medicine costs 50% of store price, no deductible, they choose your pharmacy (mail order contract)
~$800/month (total with copays and meds, roughly ten thousand dollars a year)
~no deductible; benefits start immediately (not including preexisting-condition coverage)
~office visits cost $25 for in-network docs only
~for out-of-network doctor, we pay $12,000 yearly deductible, then pay 100% of out-of-network fees [misprint?]
~prescription medicine has $100 yearly deductible, then costs 50% of store price
*to spend $20,000 on doctor visits in a year, my husband and i would each have to go to the doctor every week (50 visits apiece, assuming a $200 visit each time). of course, we could cut these costs in half by never going to the doctor at all, ha ha.
**in-network means you choose a doctor from a list provided by the insurance company. the doctors on that list agree to accept lower fees, and to never “give it away” for free.
what about COBRA? $1,100/month. that’s more than $250/week, folks. but i can’t pay even $700 per month, even for plan #4 above. (of course, #4 wouldn’t start paying bills until after we’d paid for 7.5 doctor visits, yearly.)
but… what if one of us gets hit by a car while riding a bike? what if i cut my hand washing dishes, and can’t sew myself up? what if this year’s flu… is Bad? what if Something Really Bad happens?
The 161 million Americans with employer-sponsored health insurance are facing substantial increases in out-of-pocket costs … In 2007, adults with employer coverage faced an average of $729 annually in out-of-pocket costs for medical services, including deductibles and other forms of cost sharing such as copayments and coinsurance. That represents a 34 percent increase from 2004.
The U.S. government predicts that consumer out-of-pocket health care expenses will reach an average of $3,301 a year for each household by 2014 from $2,500 in 2009. These costs are in addition to any health insurance premium.
A report issued by the Department of Health and Human Services indicates… 12.6 million non-elderly adults – 36 percent of those who tried to buy insurance on the private market – were deemed ineligible for coverage by insurance agencies.
… Insurance companies respond to an expensive condition such as cancer by initiating a thorough review of the patient’s health insurance application. If the insurer discovers that any medical condition, regardless of how minor, was not reported on the application, it could revoke coverage retroactively for the patient and possibly all members of the patient’s family, the report said… even if the condition found is not related to the expensive condition or if the person wasn’t aware of the condition at the time [...and even if the person was paying their inflated premiums faithfully and on-time].
…we all have these articles of faith: you’d better not lose your coverage!
you’d better not have any gaps in your coverage!
you’d better do whatever you have to do, to keep your coverage!
…but it looks a lot to me like, the way things now stand, especially since i can’t afford it anyway, having insurance covers very little, above and beyond an insurance company CEO’s salary.
am i the only uninsured doctor? (answer: no.)
eighteen months ago – before the economy really hit the wall – i wrote in to an internet mailing list for independent physicians, almost all of whom are primary-care small business owners – a very idealistic bunch. i asked how they pay for their own health insurance. here are some of the replies:
With I and my family being healthy, we get by with a $230/mo high-deductible policy, and I put $470/mo into an HSA [health savings account]. If we stay healthy, that money goes into the retirement fund. –JH
I pay $300/month basically to cover catastrophic care, then pay everything myself up to about $10,000/yr. –TM
We pay (arrg!), $1100/month for a Blue Cross Blue Shield premium, and there is a $3000 deductible in addition. Brutal. –TP
We have an individual policy through a major insurer for $311/month for our family of four… $10,000 family deductible… We don’t offer health insurance to our employees… We tell our employees how much it costs for group insurance vs individual insurance and encourage them to at least get catastrophic coverage. –KP
I have been fortunate to have health insurance through my husband’s pension; the only reason he was ‘allowed’ to retire. –KS
I get insurance through my wife’s job. –DC
My [physician spouse]… got a job working 2 days a week at the VA and gets full benefits. –KO
I get a better deal through the local Chamber [of Commerce] membership… Not sure how that works if one is a solo doc with no employees [note: group policies are available by law only to businesses that have employees]. –KL
My premiums have increased 20% since I opened 5 years ago and that is for a policy with fewer benefits… I fear what would happen to our premiums if someone in my family (or my nurse) gets sick. Interesting thought: I fear the losing the ability to access the health care system that I am fearful of entering in the first place. –JB
Some people on this list have told us, Leigh, that they have no health insurance. Some people on this list are way behind on pap smears and mammograms. Some of us pay through the nose… Your state medical association may offer a plan – mine does and it costs 20% more than buying on my own!!… You can join the chamber of commerce. You can buy the cheapest high-deductible plan you can and hope for the best… And always buy a box of tissues for the crying and anger that comes with the bills. –JA
of course, as physicians, my friends and i always have the option of getting high-paying jobs in fancy clinics, examining and treating 4 patients an hour. is it worth it, just to get low(er)-cost insurance? how many of us stick with jobs that are not good for us (or our families), just to get “coverage” which might not even “cover”?
what will i do? same thing i’ve advised my uninsured kids, my uninsured friends, and my uninsured patients to do: live clean, find a doctor like me (primary doc, affordable subscription fee, discount for full-pay), and watch out for good news in health-insurance reform.