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Inadequate Health Care
Good Shopping Skills Don't Apply
A good consumer shops around. In a competitive market, there are often many options to choose from. If the prices are too high, the smart shopper researches until she finds a deal that will suit her pocketbook. In the world of health care, however, good shopping skills don’t apply if you already have a health problem. A pre-existing condition eliminates your options when you go to look for a better deal in insurance coverage. You have no choice but to stay with your current insurer and downgrade options within your policy in order to get affordable coverage.
Take John. He is 48 and has long been self–employed, first as an owner of a printing company and now as a rehabber of old houses. He is also studying part-time for a master’s degree in social work. He says that his health insurance plan had been affordable until the last five years or so. Now, however, his premiums have shot up to $490.00 per month. Moreover, his insurer will only pay half after he reaches his $1500 limit. Only when he spends an additional $2,000 will his insurer foot the entire bill.
John doesn’t have the option to shop around for a better policy as he has a pre-existing condition: a slightly slipped disc. If he wanted to change insurers, they wouldn’t cover anything to do with his neck. So he keeps his insurance affordable by eliminating doctor visits and prescription drug coverage from his plan. Thus, if needed, he must take those costs on himself.
John feels that it is unfair that the people who need health insurance the most are denied it. “They only want to give you insurance if there is nothing wrong with you.” He thinks health insurance should be about sharing risk, not leaving people high and dry.
He also feels that insurance companies ask invasive questions. When John decided to quit drinking ten years ago he attended Alcoholics Anonymous (AA) meetings. His was a private decision and did not involve legal trouble such as alcohol related tickets (DUIs) or treatment at a rehabilitation center. On the application, his insurance company asked if he had ever attended an AA meeting. The organization is, as its name states, an anonymous one and he could not see how that was any of the company’s business. John said he could better understand if there were questions about alcohol- related hospitalization or legal trouble, areas where insurance is involved. But no such questions were asked. In this light, the reason for the question about AA is unclear and disconcerting.
Health insurance in the U.S. today is rather oxymoronic: it’s something you know you want to have but at the same time hope not to use. If you do indeed need to use it, you are in danger of losing some of the coverage. It’s hard to think of another business where long term customers, such as John, are penalized rather than rewarded. John has acted responsibly over the years in maintaining health coverage for himself but now he has to accept minimized coverage due to skyrocketing premiums. In addition, his pre-existing condition means he is stuck with a company he doesn’t completely trust. When it comes to health care in our free market economy, the option to get the best deal by shopping around doesn’t really exist.
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