This is why I have been paying for my own health insurance

[question everything]

There is a strong thread http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132x2198093 about the "60 minutes" segment about employers fire employees who smoke on their own time. And while this one corporation was highlighted, I have heard about this with others. The reason, supposedly, is that smokers cost a lot of money for health care and health insurance.

The reality is that employers pay for health insurance and, supposedly, can do what they want. As do insurers who underwrite policies.

And I don't know that universal insurance will solve this specific problem - a separate topic.

Like most, our family was always covered by our employers and being young and healthy we've never worried about this.

About 10 years ago one of us worked for a small company - only 5 employees. And the owner/boss would always give us a copy of a report that he received from the insurance company - detailing the health provider that we saw, the cost and how much the insurance paid and what was our share (but not the nature of the visit).

And this was the first time that I thought: hey, this is no one's business. I even wrote to someone in the state government and the reply was that each employer has his own contract with an insurance company.

And even then I though: what if, as in so many places, there is only one gynecologist who performs abortions and his/her name is well known - with all the protesters and the constant need for body guards. And what if a female member of the family visited this doctor - for whatever reason. Would the employer than conclude that that patient terminated her pregnancy? Would he feel that strongly about this topic that he will terminate the employee?

Several years later, during a job change when the new employer would not cover us for several months, and when I saw how expensive COBRA was, I decided to pay for my own.

We've both been employed by several employers that did offer coverage for both of us, but I have stuck with my own. And, yes, I was lucky to get cover while younger and healthier.

But I have always thought how better it would be for employers to pay us whatever they pay on our behalf and let us go and find the best insurance for us.

I do believe in market forces. I have no doubt that if all million of us who are now covered through our employers will have to purchase our own individual policies, or form our own "groups," that the market will come with policies to meet our needs. Let's face it - the one offered from work is expensive. After all, we do not always need maternity and pediatrics coverage, and we do not always need geriatric coverage, either.

And, yes, perhaps we will decide on our own the deductibility and co-pay, the same way that we do for our home and cars insurance. Many employers now want employees to be more conscious about how much they spend on health care.

My spouse comment after that segment was over (at least, when we stitched to the West Wing) was: the American workers have turned their back on collective bargaining and business have seized the opportunity.

I am not sure about that; one major difference in today work environment is that many of us are employed by small - less than 50 employees - companies. The other is that we are more mobile and I think that the nature of union is pretty stable work environment, but perhaps I am wrong.

Mostly, as I commented on the first thread, above, this is an issue of privacy. A right to smoke, to eat a lot of fat, to gamble, to terminate a pregnancy, and to attend a place of worship, a political rally or send our kids to school of our choice.

[SheilaT]

1. What I want to know is

how much you pay for your health insurance and just what it covers.

[CountAllVotes]

5. yeah I'd like to know that too

I suspect this person never considered what it might be like to be uninsurable like the poster below that had breast cancer.

No one will sell you any type of insurance if you have a problem that may lead to something expensive.

:kick:

[question everything]

22. It is now $270 a month with $1500 deductible

for the year. It would be $250 if I chose $2000 and I may just do this next year since I have not generated even $1500 (so far). It does goes up every year and, hey, I am not getting any younger and I am sure that the age makes a difference.

As I said, I am healthy, just go for the yearly physical, more or less so I went to look at my contract with the BlueCross BlueShield of MN and it pretty much covers whatever other plans cover.

As with every plan, one should visit physicians that are in the network and so far all are within the network. (Another problem with employer coverage - they change carrier and all of a sudden your favorite physician is out of network).

Sooo

- Ambulance 80% after deductible
- Child care - preventive, developmental assessments, lab works, immunization and number of visits per year - 100%
- Chiropractic care - 80% after deductible
- Dental - 80% after deductible mostly surgical treatments, not regular cleaning and filling and stuff
- Emergency, including inpatient and outpatient and doctors - 80% after deductible
Home Health Care - 80% after deductible for a max of $25K a year
- Infertility treatment - prescription drugs up to 6-cycles lifetime limit
- Impatient hospital - 80% after deductible
- Mental Health - 80% after deductible
- Transplant - 100%

And so it goes. Yes, a lot of limitations and exclusions, and I hope not to be in a position to find out..

Oh, what I should have mentioned in my original post was that we should be able to deduct our premium payments, starting at a lower limit. Right now one has, first, to itemize the deductions and, two, can deduct only the medical expenses, including health insurance premium, that exceed 7.5% of adjusted gross income. This, I once read, is because "most people are covered by their employers."

[SheilaT]

31. Thank you.

A long time ago (maybe thirty plus years ago) a lot of health plans looked a lot more like that -- a somewhat large deductible, after which decent coverage kicked in. Unfortunately, considering the cost of inpatient care, even a simple surgery could set you back many thousands of dollars.

But given that the yearly deductible works out to a little over $120 per month, it's possible to budget for that amount. The point being, if anything major happens you have a degree of coverage which isn't that far away from what's offered by many employee-based health plans.

I once made the mistake of reading through the health plan we have through my husband's employment, and was somewhat horrified to learn all that it excluded. None of which I can recall off the top of my head, which means I should probably reread the thing.

[question everything]

32. Medical insurance started as "major medical"

For hospitalization and surgeries and such. Not for office visits and shots. Again, I think that if we'd have to pay for our medications the drug companies would not be able to get away with the exorbitant prices, justified by the fact that most do have prescription coverage. Even the new Medicare bill does not force the drug companies to lower their prices, it just send more tax money to pay for them.

I once administered the health insurance of my employer. One manager, making real good money and with a working spouse was complaining that the office co-pay was $10 which did not help the spouse with the weekly allergy shots that cost... $8. This was a couple with a six figure income back in the mid 90s.

If such a couple were to make the decision, they could decide for themselves whether they wanted higher premium that would cover everything, or lower one and pay the $208 shots for the year.

[proud2BlibKansan]

2. Your spouse is right

We no longer have unions to protect us.

[MrModerate]

3. I've worked for a big company for awhile . . .

And I don't doubt they get similar reports to what you described -- but don't seem to care. If you work under a "right to work" arrangement (which means, of course your employer has the right to fire you whenever they care to), you'll find that they can do all sorts of things that impinge on your privacy. Drug testing, restricting the nature of health care they will allow you to select under company auspices, etc., etc.

But the bottom line is that there are two things hugely wrong with the American health-care system: insurance companies and drug companies. Insurance companies suck up most of the dollars and produce no medically useful result, and drug companies have written the laws in such a way that they are completely unrestrained by market or other forces when it comes to setting prices or even which drugs they will produce.

Fix those two problems, and health care will be so cheap that everyone lucky enough to have a job will be able to afford the level of care -- with privacy -- that they want.

[walldude]

18. Amen... everyone is getting screwed here,

Doctors, paitents, employers, while the health industry get's rich. It's sickening.

[question everything]

25. True. But I think that one reason is that we are not good consumers

We complained about car safety, about safety of toys, of flammable clothes, of accuracy of labels and the manufacturers are forced to change them.

But we do not purchase our insurance, we do not select our network of doctors, we do not even shop around for doctors and hospitals. We have to do what the insurance company allows and, in most cases, we do not even see the invoice. They go directly to the insurance company and if you even do look at the report from the insurance company, I, at least, am embarrassed about how they cut the fees to the doctors.

And this is a third problem with our health care system: insurance company that are traded on the stock market and hence see their responsibility to their shareholders, not to doctors and patients; CEOs that make millions while doctors leave the field because they cannot make a decent living. Yes, I know that there are some plastic surgeons who make millions. They, and others who refuse to accept a third party payment. Even some country general physicians. I don't remember where I've read the story: you see the doctor, you pay, what $25 or $30 office fee - I don't recall exactly - and that's it. Such physician save a lot of money by eliminating the convoluting paper work.

I really think that if we were more active consumers who would check the invoices, health care costs would not rise so much faster than the rate of inflation. Right now the buyers of health care are our employers, not us, the patients.

About 10 years ago, when both of us lost our jobs, we went on a bike ride and I fell and broke my ankle in two places, plus the tibia. Had a surgery to insert screws in my ankle. Even the 20% that I had to pay was a lot. So, both the surgeon and the hospital cut their fees because we were unemployed (the surgeon) and with the hospital because I sent the check immediately.

I had a podiatrist who would accept the insurance company payment and would forgive me my share. This was how I found that one can "haggle" with health care providers. It helped that in most cases we did have the means to pay and generally with stable employment - more or less. Of course, this was 10 years ago in California. Things may have changed.

[Child_Of_Isis]

4. Employment now depends on health and age.

I am 46, and a breast cancer survivor. I am unemployed. Everytime I have applied for employment, a medical release is provided. As soon as I sign it, I know that I am doomed.

[CountAllVotes]

6. that sucks

It is also discrimination but being that is overlooked and try to prove it, try to find an attorney to represent you ... you find yourself screwed as you have no money.

So what do you do if you need medical care? Just go to a doctor and hope it is not cancer I guess eh?

:hug: I am sorry for you. This is not right!

:kick:

[Child_Of_Isis]

9. The point is...

companies no longer just look at employment qualifications when hiring. And most are aware that medical problems start to show at 40 and on. I know a woman who was asked to step down due to cancer. They blamed it on "incompetence" but I worked closely with her and there wasn't any incompetence going on. In a private meeting concerning her step down vote, her "illness" was brought up and I replied "that's illegal you know". Of course I was considered incompetent before the week was up. So, there is major discrimination going on concerning health. Proving it is not going to happen.

[serryjw]

8. Do you Know you have lost a job because of the B/C?

13 year survivor and I don't think I have. The country is getting older and many people have heart disease and diabetes.I choose to be self employed due to the illness and inability to work full time. BTW I'm 55!

[Child_Of_Isis]

11. No, it is just preventing me from getting a decent job.

Decent jobs, in my area, that pay well, usually contain a medical release form. It clearly states that if the form is not signed, consideration for employment is not possible. I have signed several in these last few years ;-). I haven't tried McDonald's or Wal-mart yet.

[serryjw]

15. I'm sorry

the whole thing sucks...take care of health is most important....with or w/o insurance.Is there a county hospital you can go to?

[Child_Of_Isis]

16. There isn't any cancer now.

As far as I know, it is gone... and they don't really expect it back.

[serryjw]

17. How many years are you a survivor

What kinda treatment did you have? How are you doing your follow up treatment?

[Child_Of_Isis]

20. It's been two years.

I had a mastectomy. Mine was phyllodes. It is not like normal cancer, we don't get chemo. It was at one time considered very rare but cases are popping up pretty quickly...so they say. I did follow ups for a year then stopped. I don't trust the medical profession. Mastectomies have replaced hysterectomies in my opinion. Most likely the same effect could have been had by just removing the knot. In my case, anyway.

[serryjw]

23. Was your tumor

malignant phyllodes tumors? If so I think you made the right decision.

[Child_Of_Isis]

27. Malignant, on the chest wall. eom

[question everything]

26. You mean, you have to disclose your medical history

before you even interview?

I wonder whether this is something that you can raise on your own and whether you can find state sources to cover only this aspect of your health..

I wonder whether you can ask your state agency about this practice. After all, the state - one would hope - should have an interest in more working people who can pay taxes..

I am really very sorry to hear this. This is the best reason for a universal health care.

[Child_Of_Isis]

28. Yeah, the medical release is signed

right with the application. I am allowed to work and pay taxes of course, providing I work at low wage. I was offered a job at 7.00 an hour (capped) without any health questions involved. With that 7.00 an hour, I was to provide a vehicle and insurance, and gas. It required a lot of driving. :-)

[question everything]

29. I just wonder whether this is legal

whether employers are trying to get away with it, knowing that no one would challenge them.

Are there any advocacy groups for breast cancer, or other cancers, for that matter, in your area? Clearly this has to affect many people. You may not be able to fight this alone, but perhaps with other groups that know what can and cannot be done?

[Silverhair]

7. The problem with that is:

At one time I owned my own insurance agency, specializing in selling health insurance. I was an independent agent and carried several different companies.

The main problem with your solution is that your "group" will become a selective group, just like COBRA is.

The reason that employer supplied insurance is so good, is that the group is not assembled for the purpose of gaining insurance. It is assembled for a task. The insurance company is then able to use the standard morbitity tables to estimate the expenses for the group, and save some on processing costs. But when you assemble a group for the purpose of gaining insurance, then the standard morbidity tables are useless. People who are young & healthy will not feel the need for insurance so they won't be part of the group. People who are older & sicker will join the group, hoping for a bargain. Costs will go up. The only way the company has of controlling costs is by being selective on who they will cover, and by having the pre-existing conditions clause.

COBRA is ultra expensive because it is an insurer of last resort. They are forced to take a person. So an person turned down by all other companies goes to COBRA. He is expensive, and the money can't come out of thin air, so the rates are very high.

The problem is NOT that the insurance companies are evil. Too many people here are looking for villains whom they can blame. It is a form of magical thinking. If they can get rid of the "bad guys" then the world will be happy. But the real problem is the entire structure.

The only solution is universal health care.

[yvr girl]

10. Universal Health Care is such a blessing

I had no idea employers invaded their employees privacy so much in the USA. I've never heard of anyone in Canada needing to take any sort of medical exam for a job. (Except for jobs like airline pilot.)

Health care premiums are a fixed amount for each employee (one amount for a single person, another amount for a family.) Our basic premium is set by the government - the company is not going to be penalized if several employees get sick.

[Child_Of_Isis]

14. My daughter had to take a full medical exam

just to get into college.

[Tom Yossarian Joad]

12. K&R

[MarsThe Cat]

13. we used to have private insurance-

then i was diagnosed(at age 36) with a chronic, debilitating illness...after about a year, our due date kept changing...then we were one day late with a payment...and we were no longer insured.

now my wife works for a company with fantastic (PPO) insurance for us both- and i also have medicare, as the condition grew into complete disability by age 38...and i'm 44 now.

[1932]

19. Perhaps there should be a law that insurance is portable and goes with

the person and that employers are required to pay your carrier directly up to a fixed amount (but do nothing more), and if you want more coverage, you pay for it, but you get a tax deduction for it.

The problem is that that means that each employee would have to pick the best insurance for themselsves and you can bet that the power imbalance would mean that a lot of people would get screwed by manipulative insurance companies.

That's why EVERY profession should have a union, and it's why everyone should vote for Democrats.

[Cleita]

21. This is why we need a system like Canada's.

They can deliver health care for half the cost in enrollment than we do with private or employer backed insurance and everyone is covered not just the cherry picked non-smoking, skinny people. Not only that, when you start getting older, your premiums are going to start rising. The first time you get a costly disease, they will either dump you or charge you so much that you won't find it worthwhile to continue.

The basic fact is our privatized health system is for healthy, young people. Once you get old or sick, and really need health care, they have no interest in covering you anymore.

[Roland99]

24. Where I used to work, I paid $25/mo. for excellent coverage

The company had a fair amount of overhead and had fewer than 200 people.

Where I'm at now the company (about 60% of the size of the older company and a bit less overhead) offers to pay nothing of family insurance (meaning I'd have to pay $450/month and won't even be eligible for several more months. But, I'm making more money (but not enough to cover the difference but I enjoy the work I'm doing more....much more.

[bbgrunt]

30. it would seem that people who advocate a "culture of life"

should be leading the charge for universal health care.........

but most of them are so full of hubris they think their own fortune is entirely of their own making.