Thanks to MichelleS – Guest Blogger. An insightful and informative article based on personal experience.
What is the most dreaded time of the year? If you ask that question most people will tell you tax time. For me however, the most dreaded time of the year is open enrollment. For those of you who work in the corporate world you know exactly what I am talking about. It’s the short little time period the insurance companies give employers to allow employees to change their benefits. Every year I have grudgingly, look through the information until my eye glaze over and then by default just accept it for what it is and sign up for the same old coverage. But every year I tell myself, there has to be a cheaper way, but the task seems so overwhelming and the system so riddled with regulations, I dismiss it as just the way it is.
This year however it was a little different. Our open enrollment was last month and last year was a pretty average year for us as far as visits to the doctor. We just barely met our deductible, so I pulled out the checkbook to find out how much we paid verse how much the insurance company paid. This task did require duct tape. Our health insurance premium is $3500/yr for a PPO, now remember we are fortunate to be an average healthy family we also paid another $1000 on top of this that included co-pays, deductible, and prescriptions. Would you like to know how much the insurance company paid, after adjusting the doctor price from the “excess of the allowed expense for a participating provider “ $498.00. This was the part where I needed the duct tape. What in the world are we paying for?? Now I know that some people have legitimate health concerns that make their premiums higher and I am not trying to belittle the fact that a health crisis can cause financial havoc for a family. My point is the average healthy family of 4 is really paying to much for health insurance.
It’s not just costing money either, it’s costing time. Just recently, my daughter smashed her finger and it swelled up and turned black and blue. So, as any good parent would, off to the urgent care to have it x-rayed. Good news it was not broken, bad news we got a bill for 389.00. WHAT?? HHHMMM. Luckily I got my “Explanation of Benefit’s” the same day, because the bill from the urgent care was not itemized (a regulation of HIPPA), but the EOB was itemized. The urgent care charged my insurance for surgery, well the insurance did not know we DID NOT have surgery. The insurance company would have paid it but we had not met our deductible. So after 30 minutes on the phone and a call back promised within two weeks, which never came, and a follow up call the bill was cleared.
I’ve had to deal with similar situation over the years, when the bill was not correct and it took me several attempts to clear it up. I wonder how often the insurance companies are over billed and it’s never corrected, or how often a bill is paid by the patient, because they don’t want to bother with the insurance company? The thought came to me, how much time and money would we (patients and the doctors) have saved if we could have just paid out right at the time of service. We don’t go to the doctor every month, the money we’ve been paying to the health insurance could be set aside in savings for when it’s needed. Sounds simple, makes sense, so why is can’t we do it that way? There are many questions I have and I am sure you have, I hope to answers some in the next couple of days.
The questions I brought up in Part 1 have been nagging at me for a long time. So, I decided to look into the history of how HMO’s and “employer provided” health insurance evolved. First, I must admit I am extremely embarrassed about how easy this information was to find. A simple google search got me started.
Here is what I found out. “Universal Health care” has been a battle in congress pretty much since 1942, this is when congress legislated that *only* employers could make tax deductions for health insurance premiums. So individuals had no incentive to obtain individual coverage. This would be the first step in our slippery slope. The next attempt was in 1943 with the Wagner-Murray-Dingell bill, this was an attempt to add heath insurance to the social security system, as well as other provisions, including nationalization of unemployment compensation. This bill was supported by organized labor and farm organizations and opposed by organized physicians. The bill met with strong opposition, including organized doctors vowing not to serve patients under the plan, but referring them to the politician who they paid. It never came to a vote in congress. However, in 1945 the bill was revised when President Truman sent a message asking congress to address specific areas. When the “new” bill was introduce later in 1945, it sparked a nation wide discussion. People became aware and nonprofessional groups took time to “dispel false notions and groundless fears”. The bill was never passed.
Two decades of debate continued, during which time commercial health insurance companies started seeing more interest and enrollment grew. The Social Security Administration also, continued perusing the idea of offering health insurance as a benefit to recipients, and in July 1965, another progressive move toward socialized medicine, Medicare and Medicaid were signed into law. President Truman was the first person enrolled and it was done ceremonially at the signing
The latest step and the one that has brought us to the system that is in place today is the HMO Act of 1973, signed into law by President Nixon. This act provide funds, tax payer money, to start or expand an HMO with a list of mandates and bypassing state restrictions. The HMO had 3 basic requirements, to provide a specific list of benefits, charge the same price to everyone and be structured as a non-profit.
Well, I don’t know about you but I was just a kid in the 70’s. I never realized that HMO’s were basically started by the federal government. It never occurred to me that they were anything but well meaning non profit organizations trying to provide better health care. I bet the general public does not know that HMO’s were started by the federal government. That HMO’s probably violate the 10th amendment to the constitution and HMO’s very likely were a trial run for the government provided health insurance, but they put it in the hands of non profit, so when it did not work the federal government could rush, and I do mean rush, in to fix the problem.
So there you go, a brief history of insurance legislation and the progressive movement to socialize health insurance. And believe me this is just the highlights I think the point I want everyone to take away, is this has been going on for a long time. We need to not only stop this legislation, but kill it for good. I hope you learned something you did not know from this article and are encouraged to so some googling on you own. Just make sure you have your duct tape handy.