Clyde: The most wonderful time of the year
November 4, 2016
Now that Halloween is out of the picture, we are into that special time of year. It's the most festive, wonderful time there is. Nothing warms the heart like the annual "Open Enrollment Period" for health insurance plans. If you are lucky enough to have health insurance through your job, the company HR person will do the shopping for you. You'll get an announcement in January that your share of the cost is going up, the deductible is going up, and the coverage is going down. But at least you didn't have to do the shopping for it.
If you are on your own, either because you are self-employed or work for a company that doesn't provide health insurance, you get to do the shopping yourself. We all have the expertise necessary to analyze these complicated and completely one-sided contracts, and to decide which plan meets the unique needs of each household. Right?
The shopping is made easier because there basically are no choices. Unlike car insurance, where that obnoxious woman from Progressive Insurance is in your face every 5 minutes on TV, only to be upstaged by the GEICO gecko, there really isn't competition in the health insurance market. Once you get on Medicare, there is competition to sell the policies that fill the gap. Those are good business because the Feds pick up the bulk of the expense. But for full line health insurance, in Utah we have a duopoly.
There is Select-Health, which is part of the IHC mafia, and the University of Utah Health plans run by the Illuminati. Their prices are suspiciously similar. It used to be that the health insurance company was separate from the hospitals and clinics, so there was an independent party in the middle trying to negotiate lower prices for care. Not anymore. At least in Utah, the hospital owns the insurance company, or the insurance company owns the hospital. Somehow, you have to wonder if they have the patients' best interests in mind. Most of their plans limit access to their captive clinics and hospitals, so if you wanted to shop around for that knee replacement, go right ahead. But you're not covered if you go to the wrong place.
I’m not complaining that I haven’t hit my (now $6,000) deductible
—ever. Insurance is the only bet you make that you really hope to lose.
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After several years of modest premium increases, the cost of health insurance in the individual market has soared this year. My premiums are up 18 percent and the deductible is up by 27 percent. Health insurance is now the biggest item in my household budget. And there's very little actual benefit. Now I'm not complaining that I haven't hit my (now $6,000) deductible—ever. Insurance is the only bet you make that you really hope to lose. I'd much rather be healthy than have the pirates at the health insurance company actually have to pay a claim. Spending $7,000 a year in premiums and getting nothing back kind of sucks, but beats a heart attack. And I did get a "free" flu shot out of them.
The theory behind Obamacare was that everybody would buy health insurance, and with a big enough pool of people sharing the risk, including young healthy people who don't have heart attacks or knee replacements, there would be enough money in the system to make it work. The flaw is that the penalty for ignoring the "personal mandate" is considerably less than the cost of insurance. So the healthy young people aren't buying health insurance. Without that high level of participation, the system gets over-weighted with over-weight old people, and the costs soar. That, and the idea that if you go to the doctor for an ingrown toenail they want to do an MRI because they bought the machine and need to pay for it.
The Republicans have voted 60 times to repeal Obamacare. In nearly 8 years, they have yet to propose any alternative. Their "plan" seems to be returning to the old system, where we had to rely on the tender mercies of insurance companies that would refuse to insure you at all if you had a pre-existing condition like a sinus infection 30 years ago. Trump promises to repeal it and replace it with "something terrific!" Just how terrific remains murky. Maybe the Mexicans will pay for it when they get through building the wall.
In the meantime, the system needs some patching, and Congress remains on strike. Congress couldn't decide to leave a burning building, let alone find a fix for the health care system. Single payer is one option, Medicare for everybody. If we decide to stay on a system of private insurance companies, a little competition would be a good thing.
But somehow, it's hard to feel good about a system where the hospitals and doctors are working for the insurance company.
Tom Clyde practiced law in Park City for many years. He lives on a working ranch in Woodland and has been writing this column since 1986.