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Saturday, June 20, 2009

Just One Little Piece Of The Problem

by digby

There is a health insurance problem I rarely see anyone discuss, so maybe it's rare. But it happens to be something I've confronted personally so I know a little bit about it. This is from a commenter at Shakespeare's Sister:

I always roll my eyes when it comes to the threat of "wait times."

Right now I have been avoiding going to the doctor for the past three years because I'm afraid of having another "pre-existing condition" added to the list and I can't guarantee I'll be in this state a year from now. When you are self- insured, your insurance ends when you move out of state, and you have to start over again from scratch. Keeping your slate as "clean" as you can makes a huge difference in the premiums. (And yes, I know this is f*ed up. As someone who strongly believes in regular, preventative checkups, I find the situation appalling if inevitable.)

So, right now, my "wait time" is going on four years. If I knew I had stable insurance, I'd be signing up for a doctor's checkup right now!

How many people out there are petrified of going to the doctor because they have individual insurance and don't want a "pre-existing condition" on their medical record? I think there are plenty. The inevitable increase in premiums (if you can get insurance at all) if you switch plans or move out of range of your insurance company factors hugely into your decision to go to the doctor or treat something you know will affect your coverage.

I know that most people are covered under their employers, so this doesn't affect them. But there is a sizable population of freelancers, students and self-employed people who are reliant on the individual market. (And the Republicans want to put all of you in it!) We are pretty much slaves to our insurance. We can't even contemplate moving to a new state without taking into account whether or not we will be able to get a new policy. We hate the idea of going to a doctor because it will put a pre-existing condition on the record, thereby making it even more difficult to ever switch. Certainly if we are over 50 or have had an illness, we are pretty much stuck with what we have, taking whatever the insurance companies dish out without any hope of getting an affordable policy elsewhere. (That's assuming they don't issues a rescission and deny us coverage anyway.)

You cannot have a dynamic, growing economy when people are not able to take risks for fear that they will lose everything they have, even their lives. If you can't change jobs or start a business or move to a place where there are more opportunities for fear of being without health insurance, the whole system slows down. If you try to "fix" the system without a serious program to contain costs, then American businesses will remain at a disadvantage as well. And, needless to say, making American citizens dictate all of their important life decisions on the basis of whether or not some insurance company bureaucrat might decide that the dental work they had seven years ago disqualifies them for health insurance is a recipe for economic stagnation. (True story...)

The incentives in our system are completely nuts on every level and that's not going to change by tweaking a little bit around the edges.

Update: Reader Steve T writes in with this humdinger ...

Here's a prime example of the American health care system. Last week I mentioned that my co-pay for a prescription drug had doubled in January. I called to ask about it, and the person I reached suggested I should enroll in one of Kaiser's cheaper plans which still offered the lower co-pay. That sounded sensible to me, so I applied online for a plan that would cost me $300/month (down from $343) and $30 for my blood pressure drug rather than $60.

Yesterday I got an e-mail saying my application had been denied. Why? Because my medical history (in their own medical system!) showed that I'd been treated for high blood pressure within the past five years.

So I can continue paying the higher monthly premiums and co-pays to Kaiser, or I can complain further and risk them telling me that I'm too big a risk and they don't want me as a member at all.

Is that a Catch-22 or what?