Health Insurance, a Crapshoot

Nothing in life is certain, as the saying goes, except death and taxes. We live in a world of profound arbitrariness. No one has any control of where they’re going to be born, what kind of parents they’re going to have, and what economic and social status they’re going to born into. We don’t come into our lives with a warranty even if our parents are wealthy and live in the Hamptons. Life, in general, has an arbitrariness that few teleologists are comfortable with.

When it comes to Health Insurance in America, the crapshoot world of arbitrariness becomes even more transparent. If you just happen to be employed by an employer who pays 60% of your premiums, you’re one of the chosen. If your employer pays the deductible, then you’re one among the few. If you just happen to have a health-insurance policy that has dental, you are definitely in a minority, unless you’re willing and can afford to add dental to your basic coverage. And if you can afford a gold-plated policy with all of the medical amenities,including face-lifts, then you are, indeed, among the rich-and-famous.

Another if: What “if” your household income is smack-dab at the median level, which today, according to one Census Website, is a little over 50k, and the total amount of your health insurance premium is between 15k and 20k (A google search suggests that the average family health insurance premium is around 13k, a low figure in my judgment, especially if you want a more inclusive and comprehensive family policy).

Let’s just say your household income is 50k, a rounded off figure of what the official household income was in 2007. If your employer pays 60% of a $15,000 policy, that’s $9,000, leaving you to pick up the difference of $6,000. Now that’s for a $15,000 policy. For a $20,000 policy, your contribution would be $8,000, providing, of course, that your employer is willing to pay $12,000 (60%).

If you’re doing the math here, 6k is a little over 10% of a 50k household income; 8k is over 15%. Based on a 60% premium payment by your employer, that still leaves an average family household with a remaining 10% to 15% to pay for health insurance. Where in all the battles over privatized or “public option” issue is Congress even dealing with the basic math? Mathematics, as everyone knows, is supposed to be politically neutral.

There is a caveat here. Defining “family household” is tricky business. Those living in a household do not have to be biologically related and, therefore, not everyone in the household is a potential candidate for a family health insurance policy. If someone other than a biologically related family member is contributing to the household income, they have to find their own private, single health insurance policy, which, statistically, raises the total family household income paid out for premiums.

And there are other issues with the 10% to 15% employee contribution:

If the combined income of parents with children is below the median household income of 50k, the percentage cost of health insurance relative to income increases;

Your employer’s willingness to pick up major portion of the premiums—an increasingly risky possibility given the economic state of the times (GM CEOs consistently complained that their employees’ health benefits added a significant amount to the sticker price of GM vehicles);

The kind of job you have—if you’re employed by a small business, chances are your contribution to your health insurance policy is going to be bigger. If you are civil service, chances are the medical benefits are going to be more than adequate since a city, a county, a state, or the federal government is going to pick up the tab (are there any anti-socialists among this crowd?). Given the current economic crises of states and cities in the U.S., medical benefits are surely going to be placed on many a bargaining table come contract time.

Even many newly retired teachers are beginning to discover that their private-insurance medical benefits are not going with them. Boards of Education continue to negotiate them out of contracts, leaving retired teachers to pick up the total tab for their insurance while they wait until they’re eligible for Medicare, which does not cover drugs, unless you sign up for Part D. And Medicare Part D, of course, has a huge doughnut hole that requires a substantial contribution of the client after a certain yearly monetary ceiling (Try explaining this to Europeans or Canadians).

In general, the retirement picture for future workers in America is beginning to look grimmer and grimmer. With a strong potential of losing their post-retirement employer-sponsored medical benefits, a new government formula for Social Security eligibility, and IRA money lost in the stock market during the recent recession, more and more Americans are not quitting their jobs in their late fifties. Some of my friends are now talking about working well into their seventies.

Now what happens if you lose your job? A special program called COBRA will keep you going for about nine months. Whatever health insurance policy you had at the time will continue during that time, except you will have to pay around 30% of the premiums. By the end of the nine months, let’s hope you find a new job, a job that has medical benefits.

If you are self-employed, you will have to find a “group” that matches the kind of work you do (I’ve had friends, however, who have searched desperately to find some group—any group—to join to just to get a break on the premiums).

The sheer list of contingencies in this whole crapshoot game of Health Insurance in America can only leave one with a migraine. In its consistent arbitrariness, it is a train-wreck ready to happen.

When your job, your salary, the generosity of your employer, the state of the economy, and the financial status of the Health Insurance group you belong to are all put into the scary scenario of health insurance in America, it’s more than a roll-of-the-dice horror show, it’s medical-care Armageddon.

And no one, to my knowledge, has even broached the topic of bankruptcy in the Health Care industry. What happens if your Health Insurance company goes bankrupt? Who is legally responsible to pay your medical bills during and after the bankruptcy period? There is no FDIC program that will pay your bills, folks, unless the government bails out your Health Insurance company (now there’s something to add to your list of financial-insecurity fears).

To add more coals to the fire of my fear of a total breakdown of the Health Care system in America, the current private Health Insurance world is indeed a Joseph-coat-of-many-colors industry in terms of medical procedures covered-and-not-covered, specialist-referral requirements, choice of doctors, out-of-state coverage. Even doctors have become increasingly frantic at the sheer number of insurance forms they have to fill out for a vast array of different insurance companies.

Well folks, without a single-payer system, the greater burden is going to be placed on the individual employee in years to come. And the stats are currently in revealing that more and more Americans are paying more per-year for out-of-pocket (OOP) medical expenses—copays, deductibles, and/or coinsurance policies to pay for costs not covered.

The very, simple-to-understand concept of a single-payer system is that “collectively-as-a-nation” we can afford a health-care system where everyone pays into it through a moderate monthly paycheck deduction, or its equivalent, not to exceed a certain percentage of the median household or single person income (If your income is below the median, then you should be reimbursed, proportionately, at the end of the tax year with a “minimum” monthly financial contribution to the system. Those above the median could be charged a proportionate assessment maxing out at a dollar amount).

If I might use the private Health Insurance’s own philosophy that a “group” plan is certainly cheaper, then why not a national group Health Insurance plan? The Health Insurance industry has always pushed the idea of “group” plans, so let’s really go for it.

If more people contribute to the system, the financial resources are greater and can handle medical disasters without endangering the entire system (It is the same philosophy used in public pensions and annuities). As it is now, a series of medical disasters in a regional community could wipe out any regional group plan.

In the end, a Health Insurance Company bankruptcy, a loss of a job, a family medical catastrophe, the loss of post-retirement private health insurance benefits, and any lowering of an employer’s contribution are all the arbitrary and frightening possibilities in this current Kafkaesque Health Insurance world in America.

A single-payer system would annihilate those frightening possibilities with the clear aim of a Predator drone.

I don’t see any other alternative.

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2 Responses to Health Insurance, a Crapshoot

  • If i cease to comply both in the intended fashions of cooperating and dissenting then they cannot resist me. The grievous problem is whether i will let go of the myth that i must fit myself to them. I must, though, truly let go of myself. I am neither what I learned to expect nor nothing. I am like what a 2-dimensional being experiences when trying to deal with a 3-dimensional being. I don’t fit.

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