Health Insurance Deductibles – An Extortion of Patients

On top of navigating the maze that is Obamacare, after you’ve found your plan that includes all of the doctors you want, and an in-network hospital with an Emergency Room is within 10 miles of your house (and making sure to save a breath and tell your ambulance driver before losing consciousness), making sure the hospital in which your children’s pediatrician has staff privileges is in-network and hoping that all of the ‘in-network’ locations are reasonably close to your home so it doesn’t take all day to sort out doctor’s appointments, you come to the next thing on the list, and that is when and how do you want to spend your money. Do you want to spend it all now or save your money now and spend it later?

Insurance premiums and deductibles have an inverse relationship, the higher the monthly premium, the lower the deductible, the lower the monthly premium the higher the deductible. And before I go further, let me explain what a deductible is – and that is basically insurance company’s way of bleeding you dry before they’ll step in and do what you pay them to do and that’s to cover your fucking medical bills. So on top of paying x-hundreds of dollars a month in insurance premiums, should I or God forbid my children ever need a hospital stay, I’ve got to shell out extra x-thousands of dollars before the insurance company will pay one dime. As far as how many thousands of dollars will I need to shell out depends on how much I want to pay every month. If I want to be economical and wishful that my children will not need major medical services, I will stick with the low monthly premium and high annual deductible plan. Because come November or December, after I’ve plowed $800 a month for health insurance, but all we ever used was the preventative care, which is covered anyways without subject to deductible, I would have just wasted thousands of dollars for nothing. But if God forbid someone needed a hospital stay, and I had the low monthly premium plan we would be forced to pay $4000 at the very least before the insurance company lifts one finger. Before I go further, it’s worth noting that deductibles renew every year, unlike unused cellphone minutes, they do not roll over to the next calendar year. So, come December 31st of every year – if you have unused deductible, come January 1st, it will expired and you start over again. So, potentially, anyone, on any given year or even consecutive years running, can access just under the amount of deductibles of medical services and basically be paying for all their own healthcare whilst being ‘fully covered’.

This is one area Obamacare didn’t address at all. They pretended to address it by putting artificial ‘caps’ on the wrong things. They put artificial caps on doctor’s salaries – which is the least of the problems in this equation. Doctor’s are not the people raising the cost of healthcare, it’s the health equipment manufactures and providers, pharmaceuticals and the fuzzy and grey R&D where untold billions are spent on ‘research for new drugs’ without ever needing to account for what the money being spent on or if the money spent is even effective towards the research. The effect of that is reflected in every medical bill you get.  I’ve heard anecdotally from people I speak to, that after doing the math, it wasn’t worth it for some people to attend medical school rack up hundreds of thousands of student loans and become doctors, especially if it’s like ER doctors or General Practitioner because of the salary caps. It makes more sense to be a physician’s assistant or nurse practitioner. How does artificially capping the doctor’s salary help bring down the cost of healthcare? It just discourages people from becoming doctors as it’s very expensive to go through medical school and do all the necessary training only to have a lifetime salary cap of x-dollars especially for those doctors who are not going into the more lucrative fields like anesthesiology or radiology. Obamacare mandated that 80% of premium payments must go towards healthcare and health services and any amount not used must to be refunded to policy holders at the end of every year. While it’s nice to receive a small check from your insurance provider, it still doesn’t go towards solving the real problem, which is lowering the cost of healthcare. To start off, the whole system of deductibles in health insurance should be abolished all together. While it makes sense to institute a deductible in other forms of insurance such as property insurance or car insurance – those premiums are substantially lower than health insurance; people normally access their health insurance not because they want to but they need to. To add such a prohibitive cost on top of a health emergency and the patient already pays monthly premiums is the equivalent of extortion.

In this whole debate about the cost of healthcare, as usual, is riddled with red herrings and false alarms. Doctors are not the main reason why healthcare cost is out of control. Doctors are essential in a well functioning healthcare system, yet the insurance industry are putting the blame on error prone doctors for their continuing increase in premiums and deductibles. The high cost of malpractice insurance and doctors passing on that cost to patients is a symptom of a larger problem. The problem is our overly litigious environment. Ambulance chasing attorneys are a dime a dozen and when they smell a whiff of blood in the water, they convince the patient to sue doctors and hospitals and they take their 33% - it’s an easy paycheck. Doctors and hospitals, to counteract this, begin practicing defensive medicine, ordering every test, every scan, regardless if necessary or not just so in the event they get sued – they are covered at least in the negligence department. Putting caps on malpractice suits again is just another artificial fix to a deeper problem, what’s more, it robs patients who suffer from true medical malpractice to be shortchanged in their compensation.

Capping the pay of doctors and providers on its own is not problematic if all the other cost related issues are addressed at the same time, especially the shadowy R&D and ‘marketing’. The billions spent on marketing and ‘research’ gets passed down the chain of medical services. For a routine hospital stay, they charge you $15 for an aspirin. We all know aspirin doesn’t cost anywhere near as much. A routine surgery can cost anywhere from $30,000-$40,000 for less than half a days use of the operating room and staff. A bag of IV doesn’t cost $200, an overnight stay at a regular room easily runs over $10,000 – cost of an all inclusive 5-star hotel. Every single one of these items, hospitals are padding their costs in the event they get sued. The fear of being sued is a doctor and hospital’s greatest fear. It can put a small practice out of business and a major PR headache for a big reputable hospital. Doctors, like teachers, are having their voice stripped away. Like teachers, big moneyed interest groups are telling doctors what they are doing wrong and how they should be doing their job. A doctor, who holds a medical degree, who is licensed to practice medicine and dispense medical advice and treatment, yet they are being dictated by insurance companies, big Pharma and other interest groups on how to do their jobs. And while they are at it, they line their pockets whilst cutting the pay of doctors – the people who actually do the life saving.

While Obamacare addressed the problems on a surface level and provided artificial band aid fixes, he never attempted to reign in unaccountable spending at big Pharma and medical equipment companies. Does a MRI of your right thumb really cost $1200? Speaking of scans, because of improvements and breakthroughs in breast cancer screening, the cost now is so low that it’s included in preventative screening coverage. If GlaxoSmithKline or Eli Lilly says they spent $500 million researching a new cancer treatment protocol hence treatment for cancer will cost over $100,000 over the treatment period of a few months – they should be made to prove that they did indeed spend this money on research and not research and marketing. No one denies research is important, not just with new drugs and treatment protocols but medical equipment and streamlining technology etc, but since these big firms will pass that cost onto the medical provider and the provider onto the patient when their research is finally done and their final ‘product’ is on the market, the public has a right to know exactly what research was done. You often see television commercials of big pharma saying they spent $200 million researching this drug or that drug, thereby justifying their patent and charging a premium while they own their patent, but the public never gets to see the proof of how that $200 million was spent.

While on the topic of research spending for new drugs, big Pharma do not spend their research dollars based on what medicines are most needed, they spend their money on what will be the most profitable. The most classic example of this are the erectile dysfunction drugs Viagra and Cialis, hundreds of millions was spent to ‘research’ and ‘market’ these drugs to a bunch of horny old men who want a second or third hurrah in the bedroom and they’ve made a killing on these drugs. In fact, it’s even been approved to be covered by Medicare under the Plan D in some states. While Viagra and Cialis is celebrated by society as a step forward in treating erectile dysfunction, the female contraceptive pill is facing tougher and tougher restriction for coverage. You have Catholic organizations refusing to cover it for their employees – even if it’s at no additional cost to them and they need not even know about it – but, based on principle, they can’t knowingly allow it. There’s Rush Limbaugh demanding a sex tape for every woman who demands to have her birth control pills fully covered by Obamacare but the elite (who mostly consist of horny old men anyways) have no moral qualms about having their erectile dysfunction medicine be covered by Plan D of Medicare.

A packet of lifesaving Tamiflu should not cost $100 to buy for those without insurance or those with insurance but haven’t met their Rx deductible yet. I was struck down with a really bad flu once, and my college health clinic was able to let me buy Tamiflu at a student discount, by the time I was on my third day of taking Tamiflu, I was never so grateful. Research money should be poured into lifesaving drugs for dangerous medical conditions and illnesses. There’s nothing wrong with wanting to treat erectile dysfunction or getting rid of your toe nail fungus, but research money should first be allocated to serious diseases which have no known cure.

The soaring cost of medical care, the big moneyed interest group, as usual blame it on everything but themselves. They blame it on doctors making too many errors, doctors constantly demanding more reimbursement, ambulance chaser attorneys, obesity, smoking, poor diet, the aging baby boomers, people living longer. While all of these things play a part in the rising cost of healthcare and need to be addressed, why does the for-profit insurance companies, big pharma and medical equipment corporations get to keeping lining their pockets? And why are the patients made to bear this cost? Especially when they are at their most vulnerable?

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