Friday, July 31, 2009

What Happened to Health Benefits?

Yes, I said benefits.

Raise your hand if you remember when you had medical insurance coverage as a benefit from your employer, that didn’t require a monthly contribution from you… and it covered your entire family at no extra cost… and it covered dental… and eye care… and you could get prescriptions filled at a local drugstore.

I remember having a health benefits plan where insurance covered 80% and I paid 20% after an annual deductible. I went to whatever doctor I chose to see and paid my share. There were annual limits so the cost of a catastrophic illness was contained. Yeah, I complained about having to fill out a form to get that 80% sent from the insurance company to the doctor, but in retrospect the plan was, well – sensible.

Put your hand down if you now have to contribute an increasingly large portion of your hard-earned salary every year for medical insurance… or if your contribution goes up per person covered… or if you have to get a referral to see a specialist… or if you have to get your prescriptions filled through the mail.

Unless you work for the government, chances are there are no hands in the air.

Now, don’t get me wrong. I’m not blaming the corporations for the excruciatingly high cost of medical insurance coverage. That one is on the insurance companies, the drug companies, and the HMOs.

But, I do believe the corporations started to abdicate their responsibility to their employees when they accepted, heck maybe even endorsed, HMOs as a way to keep their cost per employee low. Employees chose these plans initially on the promise of better preventive care, better overall coverage, and lower out of pocket costs.

Hmmm… that didn’t quite turn out the way anyone expected, did it…

And at the bottom of the slippery slope (or at least I sure hope it’s the bottom) we see enormous administrative costs, huge gaps in coverage, and plans so complex to decipher that they make your head spin. Coverage levels, deductibles, pre-existing conditions, COBRA, primary care physicians, referrals, qualified status changes, coverage gaps… well, let’s just say that the only thing I can think of that is more complex than medical insurance coverage is taxes.

Let’s get real -- the problem is not about coverage -- it’s about cost.

That form I had to fill out in the old days may have been annoying, but it served a purpose – I actually knew how much that doctor visit cost. That 20% I had to pay out of pocket also had a purpose – I made a cost-based decision about what I needed.

So the answer to this problem must be adding the bureaucracy of government health care, right? Oh, and maybe we could fund that with taxpayer dollars. Or wait… maybe we could make the employees pay taxes on the medical benefits they get from their employers, in addition to paying the sky-rocketing premiums they already pay.

I think I’m getting a migraine. Oops -- better hold off on that -- my prescription refill hasn’t arrived in the mail yet.

What do you think? Comment here….


Anonymous said...

Love the post - it's all about cost. With reasonable medical costs, we don't have to universally cover everyone --- everyone can afford basic medical treatment. There are encouraging things going on in retail medicine (Minute Clinics, etc.) where you can get routine prescriptions, vaccinations, etc for often what is less than a copay. No need for insurance.

And cost has to be addressed just to keep Medicare / Medicaid afloat. We can't even sustain the people we have convered in this program today, let alone cover more in a gov't system. THe CBO esimtates that we'll be 20-50 trillion (yep, with a T) in the red in the next 30-40 years simply due to population demographics and cost increases in medical services.

The real issue is what is driving these costs increases and how do we address it? If we do that, we sort of get universal coverage (even with a private system) as a nice by-product.

Firefly said...

Anon -- I agree. The Minute Clinics you mention sound like a great idea. If only we could think of medical care like a business....