THE MIRAGE OF HEALTH CARE COVERAGE: HIGH INSURANCE DEDUCTIBLES

To get a better picture of how gruesome American healthcare is, we need to combine the numbers for uninsured with high deductible policies.

The average Obamacare bronze plan has a deductible of $4,500 for singles and $12,700 for a family of four. About 18% of Obamacare sign ups are in these. These policies can be like no insurance at all if they can’t pay the money up front even if expenses go beyond the deductible.  Other plans have lower deductibles, but higher premiums. For more detail: click here

A chronic high cost illness can go on for years and go through the deductible every year. So policy holders have to pay the deductible all over again the next year and each year after that. There is the option to move up to a silver, gold or platinum, but these have higher premiums.

The 18% of the 7 million who signed up for Obamacare  bronze plans can barely be classified as insured. They may not be able to use the policies, but have to pay for them anyway and the government will borrow more money to pay for the subsidy.

Employer provided health insurance is moving toward higher deductibles and copays as well. This is unlikely to stop given the way the U.S. healthcare system is run and our population ages.

Compared to the more advanced single payer healthcare nations, the U.S. has the highest out of pocket expenses. The following charts give a glimpse of the situation. These are for pre-Obamacare 2013. With 14% still uninsured, copays and all the high deductible plans, any future updates will probably be for the worse.

Out of pocket

Problems paying bills

In this environment, there are a number of things you can do.

1.There is a special deal for qualified lower income people for Silver plans called “cost sharing reduction subsidies” that lower deductibles and copays. In the future, you may want to check this out.

2. You can shop around for services. There should be a market effect lowering prices as providers compete with each other for desperate high deductible policy holders. However, many hospital chains hold area or regional monopolies so there may be no price competition. That’s one reason they form chains.

Your highest prices will probably be for things done in hospitals compared to other facilities that might do the same thing.

Hospitals have higher overhead because federal law requires them to take in anyone who goes to an Emergency Room. People with no insurance or near no insurance with high deductibles use ER’s and don’t or can’t pay. So hospitals have to make up for it somehow.

You can be a little safer with them. If something goes wrong during a procedure, you don’t have to be rushed to a hospital. You are already there.

You have to be careful shopping around. Be sure to get prices for everything involved in writing. For example, a colonoscopy will have a charge from the doctor. Then there is a facility fee where it is done. Add on the cost of anesthesia and the anesthesiologist. Be sure to cover it all. They may not give you it all if you don’t ask.

Hospital prices can vary wildly between hospitals in the same city and hospitals in different parts of the country. The variance can be in the tens of thousands of dollars for the same procedure (to be covered in future blogs).

So shop around.

2. You should also question whether a procedure is needed at all or if there is a lower priced alternative. Getting a second opinion is important although doctors with the same training, prejudices and monetary incentives may not give a true second opinion.

A good example of this is a stent for heart disease. Dr. Michael Ozner, Dr. Dean Ornish and many others state that most of these are not necessary if you are not having a heart attack or unstable angina. They can cost about $40,000 and can require costly follow up over the years, which will put policy holders through the deductible year after year.

There are drug and lifestyle changes (diet and physical activity) that can reverse heart disease.

In 2001, I was told to have a stent and refused. I wasn’t having any chest pains at all, but they said one artery was significantly blocked. I followed Dr. Dean Ornish in a general way. I exercised and cut down on bad fats. I suspect they may have overdone the blockage diagnosis. I’m still here.

In this area alone we could cut down on waste in the American healthcare system that probably is close to $100 billion a year on these procedures and follow up for them. It might also be pointed out that these procedures don’t cure anything. If diet and physical activity remain bad, having to do additional stents and bypass operations is common.

Former President Bill Clinton went through the money driven healthcare mill with a stent and bypass operation. He changed his diet drastically to vegan. He did this not because of a deductible. He saw what these ineffective treatments were doing to him. He found a cheaper better way to health. He is setting a good example.

3. Prevention of illness is a great way to avoid deductibles. Bill Clinton is doing that with diet and lifestyle changes. Most illnesses have causes. They can be avoided by minimizing the causes. They can often be reversed by eliminating causes (Bill Clinton). Our money driven sick-care system thrives on doctoring illnesses with expensive treatments that rarely cure anything except with properly used antibiotics. There are better ways.

Prevention will be covered deeper in future blogs and pages. Briefly, lack of physical movement or a sedentary lifestyle contributes to arthritis, heart disease, diabetes, Alzheimer’s and cancer. It also contributes to obesity which significantly raises the risks of these diseases.

Any kind of sweets (including artificial sweeteners) except a little high cacao chocolate that are not fruits should be minimized or eliminated. The same goes for refined carbohydrates like white bread, pretzels, donuts, cakes, and cookies. Fast foods and processed meats also contribute to ill health. This sounds like a life not worth living, but it isn’t. There are nice things to eat and you will look and feel better.

Hopefully, the coming higher premiums, copays and deductibles will inspire all of us to follow in Bill Clinton’s footsteps in our own way and live a preventive lifestyle. You and the rest of the country will benefit from it.

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