December 05, 2001
From the desk of Jane Galt:Health Care Hysteria The New
Health Care Hysteria
The New York Times has this article on the new "Cat Cap" coverage, a sort of institutionalized MSA plan, that's going to be offered by some insurance plans next year. Typical Times, the headline is "A New Health Plan May Raise Expenses for Sickest Workers". Equally true: "A New Health Plan May Lower Expenses for Young, Uninsured Workers and Finally Allow them to Get Coverage". Don't look for that headline any time soon.
The basic premise of Cat Cap insurance is that you have an MSA -- a medical savings account, contributions to which are tax free (just like health insurance benefits) -- coupled with high-deductible insurance that ensures that if you are in an auto accident or have some other catastrophic illness, you are still covered. Anything minor or routine, you pay for either from your MSA, or after that is deducted, your pocket.
The coverage in the Times is unsurprisingly hysterical, and larded with spurious examples of the disaster waiting to befall unsuspecting families. One example with which I am extremely familiar is Serevent, the steroid inhaler for asthma. The Times points out that a family which now has a contribution of ca. $130/year for the drug would pay as much as $800/year under the new system. What they of course do NOT mention is that in order for the family asthmatic to get asthma medication probably worth between $900-$1200 a year, plus a couple of doctor's visits which we may value (since I've paid for them out of pocket) at $300 a year, they will pay $3500 a year for insurance. You have to be the kind of asthmatic who shows up at the emergency room 6-10 times a year (believe me, I've done the math) for the health insurance bill to even start working out in your favor. The vast majority of asthmatics do not fall into this category; I who have 40% loss of lung function (and 80% loss in my bronchiae), have been to the emergency room for asthma twice in my life, both of them the result of a hysterical insurance company nurse afraid of being sued, rather than my own judgement about what was medically required. (Do not forget your inhaler when you go skiing. Never.) The Times leaves the cost of insurance out of the equation because employer's pay it. But employers do not do this out of the goodness of their heart -- surely Pravda-on-the-Hudson does not believe that employers do anything out of the goodness of their heart. They buy you health insurance in lieu of paying you wages that you could use to buy your own health insurance -- or anything else your heart desired -- if tax incentives had not essentially destroyed the private market for insurance. The Times also conveniently factors this out when they are discussing the deductible, leaving the impression that employers and insurance companies are atttempting to pull a fast one in order to line their own pockets, rather than offer a new type of insurance that consumers might want.
As it happens, high deductible insurance is exactly what this consumer wants -- and what I am not allowed to get due to New York State's byzantine health insurance regulations. Instead, I must pay $350/month for a horrible HMO that I don't want and which will come nowhere near to paying for itself. While the New York Times no doubt politely applauds the state for protecting the sick, I have to live at home because half my take home must go to insurance and student loans -- insurance, by the way, that won't cover my pulmonologist or any of the services I actually want, like decent physical therapy.
The other thing left out of the equation is service. For years, my HMO doctor made me wait from 1/2 to 1 1/2 hours to see her, perched on the examining table in a gown, then whizzed in and out within ten minutes when I finally did see her, shoving some inhalers my way whenever she got tired of hearing me complain. My asthma got steadily worse. The pulmonologist I paid for out of pocket, on the other hand, spent over an hour having a technician run me through tests -- then sat down and spent an hour talking with me about my lifestyle, reasonable limitations, how I felt, and explaining his diagnosis. He prescribed an intervention that halted the progression of my asthma and got me back into the gym within a month, after I'd spent several months lying down every chance I got because of the wheezing.
The Times complains about the deeply sick, wanting the rest of us to pay for it. In some categories I agree -- children stricken with leukemia shouldn't be denied care because they had the misfortune to be born to restaurant workers instead of lawyers. But what about the guy who's been overeating for the last thirty years, and is now a diabetic heart patient (EXTREMELY expensive diseases to treat). Suddenly, the injustice argument seems a little thin, especially when you think that maybe if this guy had to pay for his treatment along the way, he would have been a little more careful with his weight. Which group is a larger percentage of those suffering high medical bills I have no idea. But I bet the Times reporter doesn't either.
Posted by Jane Galt at December 5, 2001 08:41 AM | TrackBack | Technorati inbound links