The joys of having health insurance

  
The title to this post might seem a bit snarky.  But it's actually serious.  Health insurance (and its close cousins, vision and dental insurance) are great things to have.

And I'm about to lose mine -- yet another of the perks of being unemployed.

Take what happened to me two weeks ago: I was flossing my teeth and minding my own business when I felt something grind at the base of one of my molars. Then, to my dismay, a large filling popped out in my hand.  After a few hours of panic, I found a local dentist who kindly fit me in her schedule and filled the tooth for me without incident (Thanks Dr. Johnson). I am currently covered by a basic dental plan that only covers the cost of preventative care, but also ensures that I only get charged the insurance company's negotiated price for a filling instead of the list price. The upshot for my wallet was that I spent $89 instead of $129 on a filling -- a cool 31 percent discount-- because large insurance companies have bargaining power that individuals do not.

The same goes for the prices for other health care services as well. Obviously, the larger the insurance company, often the better the price, which is why Medicare and the Veterans'  Health Administration (VA) tend to negotiate much better prices for services than private insurance companies.

Having insurance generally  means that you get a better rate, but more importantly it generally means that you get reimbursed for large medical expenses. If you suddenly have a heart attack, contract TB, get cancer, or get turned into a hood ornament by an SUV driver who thinks stop signs are optional, insurance picks up most of the costs by drawing on the premiums paid by healthy people around you. Hey -- you'd do the same for them; in fact you do all the time.

I'm still covered through my university health insurance for the summer  because I taught both terms last year (Thanks again Graduate Employees' Organization). That's about to run out. I'll be eligible to continue coverage through the Consolidated Omnibus Reconciliation Act of 1986 (COBRA). I'll have to pay the full cost of the premium, but that will be much cheaper than going on the individual market, where insurance companies will look at my history of asthma and depression and jack my rates up accordingly -- if they'd cover me at all.

Now, I'll eventually be covered under my spouse's plan, but her insurance won't cover me until we get hitched. So COBRA it is. It's a heck of a lot better than nothing, but the $250 I'll be shelling out every month come at a time when money is, shall we say, tighter than it has been.

The reason I'm in this state, along with many other problems that plagues civilization, is crappy public policy. Follow me below the jump for more details...




Unlike almost every other industrialized democracy, the United States has traditionally provided the bulk of its insurance through employers. To put it mildly, this system is insane. Many of the people who most desperately need health care are the least likely to be employed. We've worked around this a bit by covering everyone over 65 with Medicare, some extremely poor people through Medicaid and children through Medicaid and SCHIP.  But most able-bodied adults don't qualify for Medicaid unless they have children and/or are completely destitute. This is especially true in more conservative states, like my current home, which set eligibility rates as low as they possibly can. The result is that unless you have kids, are pregnant, are completely destitute, or some combination of the above, most unemployed (and increasingly many employed) have to go without health insurance -- about 48 million last year in the United States.  For these people, bankruptcy from health expenses is a very real threat that their counterparts in Europe, Japan or Canada don't face.

The inanity of this system is about to change considerably thanks to improvements through the Affordable Care Act, AKA "Obamacare."  It expands Medicaid (though again some states like Texas have decided its a better idea to let their poor people go without insurance. I firmly believe that the politicians running these states are going to Hell.) and mandates middle-income people without insurance enter into state-level exchanges, which are essentially large risk pools that keep costs manageable. Subsidies also ease the burden on monthly premiums, as illustrated by the invaluable Kaiser Family Foundation.

But for now, I'm stuck.

This fact was driven home to me when I first arrived in Houston. We were driving down Main Street and I saw the Texas Medical Center for the first time-- 15 hospitals, three medical schools and multiple attached specialty centers. The cluster of gleaming glass skyscrapers seems to ooze scientific competence and screams promise for any sick person who needs help. 

My fiance pointed out Ben Taub Hospital to me, and told me it was the county hospital that took all the uninsured patients. My heart fell -- because it underlined starkly just how much my world would close without health insurance. Almost all of those hospitals, and doctors, and specialists who could save my life would be off limits. That world isn't quite real for me yet, but it is uncomfortably close. And 6.3 million of my fellow Texans live that nightmare every day.