The idiocy of private health "insurance"

Dear Kaitlyn,

I just found your blog via a comment you made in Pandagon. And I read this.

I doubt very much you are an idiot. I'd say you are way ahead of the curve.

I'm very different than you in lots of ways, but we've got a lot in common too. I'm a military brat to start with, and a feminist, and I owe some of my own mental liberation to having read MAD back in the day.

Anyway, you are not the problem here. The problem is, private insurace sucks the big one. It is the essence of the evils of capitalism, distilled.

I didn't realize this until 1989, when I was already 24. I'd just moved in with Natasha (you can probably find plenty to go on about who Natasha was if you go way down to the earliest entries in this blog) and she wanted to write a play about AIDS. So, she said, let's you and I go get tested for HIV, to research that experience. So we did.

In those days, it took days or weeks for the blood sample to get processed; you had to make an appointment to come get the results back. They set it up so that no one could find out which way it went until you were in a meeting with a trained counselor--a bit nerve-wracking but good policy I think.

Since Natasha was researching the play she asked what they'd have done if either of us had tested positive. While we were discussing the options HIV-positive folks had back then one thing the counselor said was, if you've got health insurance, keep it no matter what, 'cause once you get dropped from whatever plan you had, you are screwed. No one will insure you at any bearable price. You become a human hot potato.

Now I suppose to some people this seems only reasonable, but it got me thinking about the very nature of private, for-profit, health insurance. The idea is, you pay money now, and they are betting you will never get sick and they can pocket the money, because if you do get sick it is gonna cost them way more than any one client typically can pony up over a lifetime to cover good care. So--either the fine print lets them off the hook, letting them get away with promising way more than they plan to give sick clients, or the chances of your getting sick are quite low.
Since there are dozens of rival plans competing with each other, every one has an incentive to try to persuade young, healthy fools to part with their money, and get rid of the older, sicker, more savvy folks who might want some value for what they've paid.

It might seem OK if people were in fact able to select and keep a plan when they are young and healthy, and guarantee either that that plan continues all their lives, so the company that was happy to take their money when they were young has to take care of them when old. But in real life, only very rich people have that option.

Look at me for instance. I was able to stretch CHAMPUS eligibility until I was 22, because my Dad was still on active duty and I had not actually graduated from college yet, but once I got too old for that, I had zero coverage. Could I afford to run out and sign up for some plan that would cost me hundreds of dollars a month to keep up? HAH! Once I moved in with Natasha as her full-time, live-in care provider (Natasha was disabled, if you haven't glanced at my blog yet) I worked over 60 hours a week--but at minimum wage, and with zero benefits. I was barely able to pay minimal payments on my student loans.

In 2003, I became theoretically able to sign up for union-supported health plans, but that brings me to the worst part of the story of private health "insurance in the USA. The only way that the vast majority of Americans can possibly afford to buy in is via their workplace--and as we have all learned these past 25 years or so, there ain't no guarantee anyone can keep a particular job in this country, no matter how hard they work or how loyal they are. And if your insurance is tied to your current job, it disappears the day you are downsized, laid off, or just plain fired. And all the money you paid into it vanishes into thin air as far as you are concerned. Lord help you if you have acquired "pre-existing conditions" since you last "shopped" for insurance by shopping for a job--they may have been covered at bearable rates under your old plan, but you can't keep that plan, even out of pocket if you have savings--it was a specific contract involving both you and your boss, who just got rid of you.

Or sometimes, the job just vanishes. A long time ago Molly Ivins observed that Unemployment applications in Texas didn't have any checkmark for "employer went belly-up;" her newspaper had folded, gone bankrupt, but the forms pretend that bosses are infallible and immortal--if you are out of work it has to be your fault!

But Natasha Littletree, my personal boss, actually did die, in early October 2004. I can verify--California, like Texas, has overlooked the possibility that some jobs just disappear completely. So if I had ever jumped through all the hoops necessary to sign on with Kaiser that the Sonoma County IHSS Public Authority and SEIU 250 had set up, all the money I might have paid in would have been gone.

In my current job, I have a similar theoretical right to sign on to Kaiser benefits at a price I'm told is fantastically low. Except, I don't have the money. (And one can only join up in certain time windows in the year, when the contracts are renegotiated and the phase of the moon is just so...)

And I still think that giving my money to a bunch of professional crooks is a bad investment. It may be better than getting stuck with a hospital bill, since I have no savings to pay a medical bill out of pocket, but I'm on the Republican health plan--don't get sick. And if I'm getting sick I don't want to know.

The only sensible plan is to do what every other civilized and half-civilized nation in the world does--have the ultimate insurance plan, the whole nation is the clients, everyone pays, and everyone gets served alike. No bureacracy of competing insurance bean-counters for doctors to apply to in the hope of getting paid; no contracts renegotiated every year that raise rates while adding loopholes for avoiding service. It is a simple fact that universal plans like Medicare, when not screwed up by politicians trying to privatize them, spend just cents on the dollar in administration, whereas private insurace takes a good sixth or more of their income to feed the company itself.

If I ever get into a place where I can pay my insurace premium, at this late stage in my life I'm beaten down enough to buy in, but only because I have no prospect of saving much before I'm quite old, and because I have some hope that at long last, our country might wise up and introduce universal health care once and for all. If I had been able to afford private health insurance all these years, but instead had saved the money, I daresay I might have saved up enough to cover big medical bills out of pocket.

But working class people can't do that by definition--why is another rant. The only sane thing is to hit the rich up for the bills. After all, they have no chance to get rich if there aren't healthy working people who are not in a rebellious mood, have they.