I don’t know whether to bless it or curse it.  I bless it when I need it and it covers a medical/dental procedure.  I curse it when it doesn’t and when I pay my monthly premium.  Now, what am I getting, exactly, for this big chunk of change?  Sometimes I think I would be better off to buy disaster insurance and take my chances.  Because that’s what the insurance game is all about: taking chances.  It’s legalized gambling.  What I’m gambling on, though, is my and my family’s health.

I’m not a gambler; have no interest in Las Vegas, casino boats, and the like.  I work too hard for my money to see gambling as a form of entertainment.  I have no problem with other people gambling.  It’s just not for me.

I suppose, then, it should come as no surprise to me, that I gamble very conservatively with my health.  I assume that at some point in the year I or one of my family members will need the E.R., an ambulance, an unexpected trip to the doctor, etc.  What if it’s more serious, though?  Am I willing to have disaster insurance that will pay everything after $100,000?  Nope.  That’s too much for me to risk.  So I gripe and complain every month as I pay my ridiculous premium.

As I see my Explanation of Benefits (EOB) statements come back I wonder, what exactly am I getting for this ridiculous premium?  My insurance doesn’t cover X, Y, and Z and I have a deductible that would feed a small country for a day.  Hmmm.

Insurance companies are in the gambling business too.  They are gambling that they will have to pay out less money than they take in via premiums. Sometimes they win, sometimes they lose (usually they win).  I understand that the stakes are high.  If they don’t take in enough and they pay out too much, they will go out of business.  I get that.  But the stakes are high for us too, as consumers.  If we are under- or over-insured, we feel it in the pocketbook, big time!

And who is caught in the middle?  Healthcare providers.  Doctors, dentists, hospitals, clinics, etc. are caught between people and their insurance companies.  We went into this business to help people (99% of us did, anyway).  Because of the culture of insurance, however, people have to choose between their health and their pocketbooks.

I blame insurance for the skyrocketing cost of healthcare.  I realize that insurance companies blame providers, and I admit that there are some providers who share the blame.  Nonetheless, it is insurance companies who force healthcare providers into contracts that barely cover the cost of overhead in a private practice.  Just say “NO,” you say.  We have found the hard way that doing that slashes the patient base.  Most patients just can’t afford healthcare without their insurance.  In that respect, healthcare providers are forced to dance to the tune of insurance companies and work for the pittance they pay.  That type of system forces healthcare providers to cut staff and/or cut patient time in order to meet overhead expenses, to keep the lights on.

I don’t deny that there are healthcare providers and healthcare facilities that are making money hand-over-fist.  They have somehow figured out how to work the system to increase their profit.  Good for them!  I ask myself, though, how important is patient care to them?  Please don’t misunderstand me.  I am not saying that highly profitable healthcare providers do not prioritize patient care.  I am just saying that it makes me wonder.

Where will this end?  Where are we headed if we keep going in this direction?  I cannot see the future, but this one is easy to see.  If we continue on the path we are moving on, small, private practitioners will be squeezed out to make room for corporate healthcare facilities and providers who can maximize the insurance dollar.  And isn’t that what we want?  Don’t we want healthcare to be as efficient and cost effective as possible?  As a business owner, I say Yes!  As a compassionate person and a sometimes-patient, I say, Hold on there!

When efficiency and cost-effectiveness come at the expense of healthcare providers spending less and less time with each patient; of patients only being able to schedule with assistants and not the doctor/dentist; of appointment times that are fewer and farther between and patients have to wait 5 months to get in; of treatment that is downgraded to a lesser-quality procedure because the insurance said-so; then I have to object.  It is unconscionable to offer that kind of healthcare to our citizens.  I believe that is called a two-tiered (or three-tiered, etc.) healthcare system.

What can we do about it?

  1. Don’t get upset with your healthcare provider when your insurance doesn’t cover something.  It is YOUR contract, not your healthcare provider’s.  You should be upset with your insurance company.
  2. Get angry enough to contact your state and local representatives.  Congress is famous for inaction, but if there is enough of a swell of upset, media will cover it, they will feel the pressure, and they will take action.
  3. Shop around!  I realize that it isn’t as easy to change health insurance companies as it is to change grocery stores, but that doesn’t mean it isn’t possible.  If we write to our health insurance companies’ CEO’s about the lack of coverage of procedures, the low reimbursement rate, the lack of in-network doctors/dentists, and the high premiums, and enough of us do that, they will begin to notice.  Remember, they are in the business to make a profit.  If people are angry and taking their dollars elsewhere, they will listen.

I haven’t answered my original question: Is health insurance a bane or a blessing?  For me, it depends on the day.  I guess it is both.