Insurance and Ignorance in America

I have this sense of foreboding this morning. It actually started last night, really. I'm not sure what started it, but I haven't been able to shake it. It's not that I don't have some cause to worry--there is a possibility that Mr. PolarBabe may be laid off in the very near future. While the financial implications are obvious, the biggest worry is over our health insurance. COBRA for 5 people would be a fortune. Dr. Tween is an out of network doctor, so I pay out of pocket for her services already, and she isn't cheap. I need a good team behind me and she is so good, she is worth the expense. I can't bear the thought of having to see someone else. I finally got my medications through our prescription program with her (Dr. Bombay refused to prescribe them through the service) and I now have no co-pay for those meds, and get them 3 months at a time. To have that go away--when just two of my medications would cost a combined total of $500 a month...what the hell would we do?

That's just me. My kids come first. Fortunately, we are blessed with three very healthy children. They are almost never sick, even with colds. Fevers are very rare. I mean, I really have never even had to clean up vomit. What mom can say that? There will come a day though, when one falls, maybe splits something open and needs stitches, or breaks an arm or leg or any of the myriad injuries children get. Maybe one does get some terrible illness, God forbid. It's a terrible position to be in.

I'm not going to make this a political rant about Obama's current health care bill. I do sit and wonder though about the talking heads who get up there, with their main point being that 80% of all Americans being satisfied with their current insurance plan. I'm one of them, by and large. That really isn't the point of the plan though, is it? It's more toward those without insurance. How does that fall by the wayside in all their arguments? How many people are in the same situation I am afraid that we may find ourselves in?

I'll be honest, I'm not informed enough to know if this is the perfect solution. Having spent the entirety of my career in the insurance industry, in a claims environment no less, I do know about the administration of benefits vs. profit margins and the mentality of a claims adjuster. I will tell you--insurance companies get away with a lot. Whether by design or by error, procedures and benefits are denied. Then, the person who either doesn't know they can appeal or doesn't have the fortitude to go through the process, will just go away. This is only a small example, a simple illustration. It gets far more complex than that.

I have yet to hear someone say they LOVE insurance companies. Even people who say they are 'happy' with their insurance company is usually satisfied because they had a really bad experience with a different insurance company, or they haven't had much need for medical treatment beyond their annual physical. I've worked for a number of insurance companies in my career, and there really isn't much difference between them. They are all looking to improve their bottom line, increase their client/subscriber base and control costs (translation: reduce payout). It's important to understand that controlling costs does not simply mean lowering overhead. They employ staff to review medical procedures. It's typically a medical professional who looks at what your doctor is recommending and then decides whether it's necessary or not. In some cases, a 'medical case manager' (usually an R.N.) makes the decision. Do you really want a nurse to decide whether or not your doctor can perform a test or surgery? There is another process called a "peer review" where a doctor reviews the recommendation and then makes the decision. Either way, we are talking about medical professionals who are not currently in practice, and who are not intimately familiar with your current situation. This is just some of what is involved in the authorization processes to determine what is medically necessary that the general public just doesn't know. That's actually the good part. The less complex stuff is simply reviewed by the claims adjuster who has anywhere from a high school diploma to a bachelor's degree. Health claims adjusters aren't paid much compared to other adjusters (such as general liability), by the way. Don't believe me? Yahoo has a salary tool--look up the salary for health care claims adjuster for your local area, then compare it to a liability or Workers' Compensation adjuster.

Anyway, point is the Insurance Companies don't care if everyone is insured. They just want to make sure their bottom lines aren't affected. If 80% are satisfied, they'll stay where they are like I probably will. Most people don't like change. It should be noted that free care isn't always what everyone wants, so there is still a market for insurance companies in many countries with a NHS (think France. I also have a friend in Canada who has private insurance). Maybe--just maybe--what insurance companies really fear is that a social plan might be better and more honestly administered. That would be real competition. People would really want that.

So, I guess I went on a rant anyway. I'm still not saying this is the perfect solution. I just think everyone should have available medical care. Insurance companies shouldn't stand in the way of it for the sake of their already plush bottom lines. (Those operating in the red...well we know how they got there). They can all still compete with each other. They aren't competing for the uninsured business, as it is. Why would they worry about them now?