Health insurance system is broken

COMMENTARY

BY PETER "FISH" CASE This is not new information, nor will I tell you anything you probably don't already know, but health insurance in this country is truly the pits. I say this as someone who has health coverage through my employer: it ain't the best, it ain't the worst. But when I'm trying to juggle in-network, out-of-network doctors, what constitutes a visit that needs a referral versus one that doesn't and the differences in copays and limits, I mean, honestly, how are you supposed to keep it all straight? Answer, you can't, and they probably don't want you to.

I recently went to see a doctor that was out of network. I went to see this doctor because I like him and he seems competent; for this I get to pay double my co-pay ($80 as opposed to $40), but for me it's worth it. But what about that person who's running close to the edge, that person that would find the $40 to be a burden and $80 would force them not to take the appointment and live with the pain? Does that sound like a system that's working to you? To me, it does not, it sounds like a resounding failure. I will never understand how the United States hasn't figured this one out; we're one of the richest nations in the world and we can't figure out how to provide affordable health care to our citizens.

While I'm on it, let's talk about preventive vs. diagnostic. We are mired in a diagnostic system with the minimum preventive measures put into place. Let's face it, insurance companies don't want to cover every preventive test, they'd rather roll the dice with your life.

I've used this example before, but it bears mentioning again. When I was 39, something from my annual physical showed something my doctor didn't like and as a result ordered that I get a PSA blood test. Every-thing was fine, but because I was 39 my insurance company wouldn't pay for it.

So, I had to pay something like $300. Years later I found out the lab only charges like $20 for it. So yeah, our health care is truly broken in this country.

I don't blame those administering the health care: doctors, medical centers, hospitals. These people have to navigate this stuff at levels you and I can't even begin to fathom. Seriously, if you know anyone in the billing department at your local hospital or doctor's office, ask them what they have to go through to get paid from insurance companies.

Ask them why costs for simple things seem to be so expensive and they tell you they have to play this ridiculous game just to meet costs. It doesn't have to be this way, but it's profitable for them (the insurance companies) to play these games. The average single coverage plan is just shy of $8,000 a year, $666 a month (I'm sure that number is merely a coincidence, but it seems extremely fitting) and if your employer covers any of this (as mine does), be grateful. The average for a family, just over $22,000.

With those numbers in mind, does it sound like you should have to take anything out of your own pocket? You shouldn't, I shouldn't, but we do. I understand that insurance coverages can vary and if we're getting insurance through an employer the cost is lower on average, but it's still a healthy car payment for a vehicle that doesn't run.

Health coverage is a basic human right as I see it. Our right to get sick and not be financially burdened over it should be an amendment in the constitution as far as I'm concerned. But there are too many people making too much money with the current system to let it change now. We all saw what happened when President Obama tried to do it; it got torn down and I fear that's as close as we'll ever get to anyone trying again - leaving us with a national policy of, "don't get sick."

Peter "Fish" Case is a man with an opinion. He offers up a weekly podcast discussion that can be heard at www.theearspoon.com, and also serves as a member of the Brattleboro Select Board. Questions, compliments and complaints can be sent to him at [email protected].

The opinions expressed by columnists do not necessarily reflect the views of Vermont News & Media.