In which I have no idea what I'm talking about

[summercomfort]

It's the middle of the night and I find myself pondering health insurance.

First, a confession:
I am deathly afraid of insurance companies and the bureaucracy involved. To me, the costs of health care doesn't make sense. I pay $100/mo for some bare-bones health care that doesn't even cover doctor's visits? But I have to have the health insurance because if I spend too long without any, then it's supposedly harder to get onto new ones later? Teeth cleaning costing $300? An ophthalmologist doing the same thing as an optometrist and costing $800? How much of it is covered? Is this thing they sent me a bill or not?

So, when given the choice of taking some over-the-counter drugs and hoping things heal themselves or (1) figuring out if it's covered (2) finding a doctor who'll accept the insurance (3) scheduling an appointment when I can't really take time off work, etc etc, I do the former.

As a result, I have very little knowledge of how the current insurance system works, except that it's BIG and SCARY and INEFFECTIVE. I've been on my mom's insurance, which was super-awesome but still full of forms and complexities. Then I was on my school's insurance, which was not only complicated but also covered very little. Now I'm on some sort of bare-bones insurance with a $2000 deductible which I didn't want to look at too closely.

I think a part of me just wants to pay directly for the quality of care. For example, I choose to get $15 haircuts instead of $75 haircuts. It's a conscious choice I make in terms of quality of service and quality of environment. I'd opt to go to a Chinese medicine doctor who'd give me a diagnosis and a week's worth of medicine for $50 instead of making an appointment for 2 weeks from now to see a doctor who'd charge me $25 copay and then refer me to another doctor, BECAUSE I KNOW WHAT I'M GETTING. For an x-ray, diagnosis, cast, and month of meds for a sprained ankle, I'm willing to pay up to $200. The problem, however, is that I'm not willing to pay $300 for teeth cleaning. That seems to be a $50 value, especially if we cut out the needless "let's x-ray your face again because then we can get more from the insurance company" part.

Ideally, for me, there'd be 2 health systems.

Type 1 is "Basic Stuff"
I'm talking about yearly check-ups of vision, health, dental, etc. I'd also include in here an annual psych check-in. I'd like this either to be

(a) like getting haircuts -- you see the price, you evaluate the worth, you pay for it. Let competition keep the costs low. I don't have vision insurance anymore because it's cheaper at Walmart/Costco. But it's hard to find those sorts of dentists.

(b) covered automatically by the government as a government service, like policemen. We're not talking about the fancy Dr. House MRI stuff here. Just yearly checkups and such. Maybe also life cycle stuff like birth?

Or some combination thereof. Like if I can hop on down to the local police station and get a checkup, some bloodwork, teeth cleaning, and an eye-check. Then they'd tell me I need to have 2 teeth filled in and a new pair of glasses and I need to exercise at least 20 minutes a day. So I go to Walmart and get glasses, and go to some dentist who got good reviews on Yelp for my teeth filling, and then go for a swim. Voila!


Type 2 is the "Big Stuff"
I'm talking about accidents, long-term illnesses, etc. The emergency, unexpected stuff. Unpreventable care.

This I'm willing to pay health insurance for. As a young person, sure I don't worry about cancer so much, but I do worry about getting hit by a car, falling from a cliff while hiking, etc. Plus in case I or my child needs depression or asthma meds. And I'm willing to pay into it now for the possible future of arthritis, diabetes, cancer, etc etc.

But at least this way I'll get to choose my insurance and deductible without cutting myself out of the basic care stuff.

Comments

[illuminatedwax.livejournal.com]

First, I don't think lowering what the doctors get paid is a good idea. Some work should be done to figure out what the profit margins are, but I know here in private mental health, we ride the very edge of making and losing money. There are set fees for different kinds of therapy, and insurance companies (and Medicaid) pay us even less than those, so there's not a whole lot of room for overhead. Plus, I think doctors should get paid well.

Second, the problem with health insurance now is that for a lot of the Big Stuff, like chronic conditions, if you switch insurance companies, you will get denied for having a "pre-existing condition."

There's no way the health care that will be passed will be "single payer" -- it's going to be a public option mixed with reform of insurance companies. At least that's what I've gleaned so far from the news. The media is really failing the country on this issue.

[summercomfort]

I agree that doctors should get paid well. But is there a way of lowering costs such that uninsured people can afford to go see the doctor, too?

Maybe we can parcel out some of the doctor's work. I mean, we already do some of that in terms of nurses (who get paid ~100k) and pharmacists (who get paid ~130k), whose work requires less schooling and therefore we can pay them less. When I went to the doctors' for a checkup, I saw 4 nurses before spending 5 minutes with a doctor before being sent to the bloodwork people, who I think are ... lab technicians? So in the end, what is the doctor being paid for? The quality diagnosis that couldn't be done by a nurse. The authority to make decisions and recommendations about my health. But I bet that's not the only things that the doctor studied, even though that's the main thing that the do.

So I'm all for having a new sort of basic care doctor who specializes in diagnosis and preventive care. Someone who can tell you with certainty whether what you have is the flu or something worse. I guess the HMO doctors already kind of do that, but ... more. A kid from Chinese School DIED because the doctor said it was "just a flu". When they took him in after another week, it suddenly became "it's too late". Maybe some of this comes from the paranoia at least among the Chinese immigrant community for western doctors and their lack of diagnosis skill. The saying is "Go to a Chinese doctor for the diagnosis and a Western doctor for the surgery".

[theosakakoneko.livejournal.com]

I don't really like where the insurance talk is going (required for everyone except if you are low-income, which means it won't be universal, even though they're touting it as universal in order to gain public sympathy, and all it therefore really means is forcing people like me (except not insured - I am insured) to get insurance they don't want so they can pay for the medical costs of grandma over there who can't afford to pay as much as her medical costs cost the system. It's pretty much like social security in a way. But still, I understand you kinda need it to be that way for insurance to WORK. It's just that if you exclude the low-income people, they'll still be screwed. I don't like it.

But I'm not very knowledgeable on this topic, and I don't feel motivated to do the hours of research it takes to become knowledgeable. Basically all I know is that your crappy insurance with a huge deductible that doesn't seem to pay for shit but costs $100 a month (in my case, $160) is important to have, because if I *didn't* fork over that useless $160/month that's not currently doing me any good, if I *did* get hit by a car or get cancer (my mother got cancer only a couple years older than I am now, if that), if I didn't have insurance, I'd be bankrupt, and my parents would be selling their house to pay for whatever leftover medical fees my illness caused that I couldn't pay, because even though they aren't expected to anymore, they still care about me and would rather go bankrupt themselves than see me not get the treatment I need. I try to explain this to my really low income friends, but it's hard to convince someone working at Target for $8/hour that spending $50/month (you can get BCBS Young Adult plan for this - I wish I could opt for that, but alas, it's only available if your employer doesn't offer insurance) on something that doesn't cover anything in normal daily life is that important.

On another note, I don't have dental insurance, because I figured there's little chance any emergency could render me in this type of situation for dental work, not at age 27 anyway. However, I have come to the realization that one of my wisdom teeth is going to have to come out, and that sucks. It will probably cost a few hundred. But dental insurance is $520ish a year. So I *probably* still made the right decision, but it could come down either side of the wire, since I need a teeth cleaning too (but I won't pay $300 for that...I will shop around until I can get it for $100 or less. That's how much I paid the last 2 times, because my father called the family dentist and said "if you don't charge her what you charge the insurance when we come in, we won't go to you anymore" (and my parents both have large dental issues) (on another note, it sucks that doctors charge uninsured people more than insured people...another system failure that's understandable from the doctor's side but sucks from the individual's side)). Anyway, I would have gotten the dental insurance if I knew I'd need the wisdom tooth pulled, but my dentist told me 1, I only had 3 that would ever come in, 3 in my mouth at all, and 2, they were all coming in fine and wouldn't need to be pulled (my teeth are itty bitty tiny tiny way smaller than normal, and there's extra room even after I have 2 extra teeth than usual ANYWAY (as 2 of my babies never came out and the corresponding adults have come in) and those 3 have come in and are just fine, as they said). Alas, the 4th which they said didn't exist is coming in now, and badly, underneath another, so it'll have to go. Ugh. Can't trust dentists...but this doesn't surprise me since this was the same dentist who didn't realize until I was 22 that I had those 2 extra teeth either. XD

Wow....sorry for the novel!

[summercomfort]

SIGH.

Yeah, I have major dental problems. Like, I have 2 crowns already, and there's like 20 patches in my mouth from 5 different dentists. Of course, some of my dental problems comes from crappy dentists leaving holes in my mouth where they shouldn't have -- one guy left this weird hook thing between two of my back teeth that always gets food stuck in there. One guy read the x-ray wrong and drilled up the wrong tooth (and charged me for it!), and then a month later the filling fell out just at the beginning of my month-long road trip and I didn't have dental insurance, so my dad persuaded me to wait until I got back to China a month later and the dentist in China basically said, "it has to go". So yeah, dental care is important to me, but I don't have any right now. When I went in February to a dentist that took cash-only patients, she's like, "You need a lot of dental work done. I'll do the teeth cleaning. Then come back when you have insurance." So I'm basically waiting for September to roll around.

Anyway, I'm willing to pay insurance for the Big Things. I mean, this is the definition of insurance, right? Just like I pay car insurance. Of course, how much I decide to pay is a personal risk assessment. Is the guarantee against the risk of potential health bankruptcy worth the $100/month? Yes. Maybe the answer is no for people who'd have to choose between spending that $100 on food or on insurance.

But my problem is that I actually care more about the small things -- the preventive care stuff that will prevent/diminish the cost of long-term big things in the future. Yearly checkups that tell me my chance of getting diabetes or breast cancer or whatever. Pap smears. I haven't had my period for 9 months, and would have liked to visit a gynecologist around month 6 to do checkups and blood test.

[theosakakoneko.livejournal.com]

Um...hon! Really?? You need to go to a doctor if that's true! I get freaked out around month 3 and freaked out a LOT. And also, freaked out. ;) I'm not very good about my preventative stuff either but...you really should go to see a doctor if you haven't.....

[summercomfort]

Well, I will, once I (a) go back to the states, (b) get more better insurance, (c) find a doctor under said insurance, (d) make an appointment, (e) get referred to a gynecologist under said insurance.

Or maybe I should do it here.... hm...