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Taking Care of Our Health and Our Healthcare

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The headline in today's Los Angeles Times caught my eye: "Healthcare insurers get upper hand." The article is written by Tom Hamburger and Kim Geiger. You don't have to read the paper every day to know that the healthcare system in the United States is a mess. We're all living it every time we go to see a doctor or fill a prescription. We can't keep going the way we've been going, there has to be some sort of a change. Unfortunately, the kinds of changes that the insurance companies are proposing just might make things worse instead of better. Linda Blumberg, a health policy analyst at the nonpartisan Urban Institute says that the insurance companies are going to have a very stable pool of customers, "...people getting subsidies to help them buy coverage and... they [insurance companies] will be paid the full costs of the benefits that they provide - plus their administrative costs."

Einstein famously said that a problem can't be solved at the same level at which it was created. What created this healthcare crisis was greed. The greed of both the insurance companies and the pharmaceutical companies.

How much of our insurance dollar actually goes towards insurance? That's got to be a well-kept secret. I haven't heard anyone talk about this yet. About 10% of every monthly premium goes to the agent who sold you the policy. And then another chunk, probably 20%, goes to the "general agent" or broker who the first agent has to go through to get to the insurance company. Before we even get to the entity that is providing the coverage we have to go through two middle-men. And these agents are doing quite well, indeed. Then the insurance company itself has tons of costs it has to build into our premiums, including all the paperwork and brochures they send us, and all the advertising they do to convince us that they are a reputable company. And of course, there's the $35 million dollars that the health service and HMO sector spent in the first half of 2009 lobbying Congress, the White House, and federal healthcare offices. This figure came from the Center for Responsive Politics; I didn't make it up!

Before my divorce, I had health insurance through my ex-husband's company. I was able to keep the same policy for a little while through a plan they have called COBRA. But then I had to get my own policy, and I contacted an agent. My husband and I met with him one time, for about 20 minutes, to basically sign some papers and write a check. We kept the same policy for many years, even though the premiums went up every year. Every single month this agent of ours was making money off of us. For years we never saw him, or heard from him. Then when our premium went up another huge percentage, I called him to ask what our options were. He told me to look online, and gave me the insurance company's website.

Now the insurance companies have all of their policies posted online so anyone can shop and compare for themselves. I figured out just how we could switch to a different plan and save some money, and called the insurance company direct. They told me I just had to write them a letter and they would take care of it. I didn't need the agent to be involved. Then I pointed out that we had clearly eliminated the need for an agent, and hence, the need to continue to pay his monthly commission. I asked if I could have that commission discounted from my monthly premiums, they told me no, it doesn't work that way. Isn't this crazy? Even when the two middle-men do no work at all, they still make money every month! It doesn't work that way for car insurance, or home-owner's insurance, so why should this be the case for health insurance?

As intelligent people, we know that we are responsible for our own health. We strive to take care of ourselves, eating right, working out, keeping fit. But it seems that the health insurance companies are working against us. Most preventative care, like chiropractic, acupuncture, and massage, are not covered. Many times mental health care is not covered, or covered only up to a certain amount. Doesn't it make more sense to do what we can to stay healthy, rather than spending tons of money trying to get our health back when we get stressed out and sick? And think of the money lost when we have to take sick days and miss work.

But then, people being sick benefits the pharmaceutical companies. They have all kinds of medications for all kinds of illnesses that are covered by the insurance companies. And just when we think we're doing well, along comes a vaccine they promote that they insist we need to keep us from getting something else.

Doctors have sky high rates because they are forced to make deals with the insurance companies where they are paid a percentage of their fees. When you look at your "explanation of benefit" statement that comes in the mail from the insurance company, you'll see what part of the charges are "allowed" and "not allowed" and what part goes toward your deductible. I don't know how doctors can make much money when all is said and done. Many doctors now have set up "concierge" service, which means that you pay a monthly fee to be their patient. It's a kind of secondary insurance. But do we really need that extra expense? Not me!

Obama has an uphill climb when it comes to healthcare reform. He's the David and the insurance companies are the Goliath in this scenario. Gerald Shea of the AFL-CIO is hoping for a change, but knows that the insurance companies will fight every step of the way, with all of their power and all of their money. "They have us beaten six ways to Sunday. Any time we want to make a small change to provide cost relief, they find a way to make it more profitable."

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