First of all, thank you to everyone who commented on my post about COBRA. One of the odd things about the situation was that I was screwed by the calendar: had I switched jobs during a calendar month, I wouldn’t have to have picked up my own health insurance. This doesn’t alleviate other inefficiencies, such as everyone wasting their time (and salary money) re-registering me for the exact same health insurance. Which brings me to a point that needs to be raised, even if it is obvious:
There is a difference between health insurance and healthcare.
Granted, even Yogi Berra probably wouldn’t have said something this obvious. What led me to blunder into the obvious was having to decide which health insurance plan to choose at my new job. I had a total of seven different health insurance plans to choose from, three of which were HMOs. The HMOs were the most interesting: the most expensive was $173/month (for an individual), and the least was $118/month. As far as I could tell based on the benefits package, the $118/month was the ‘you are legally required in Massachusetts to have health insurance, but if anything happens other than an annual checkup, you’re hosed’ plan. But I could be wrong: maybe someone paying $173 per month is just wasting his or her money. Or maybe we’re both screwed if something bad happens.
The problem is that I have no way to evaluate how good any of these plan are at keeping me healthy, which is what I care about–hence, the above distinction between health insurance and healthcare. It would be nice to see these plans broken down by healthcare outcomes (and death too…) as well as patient satisfaction (granted, these data would have to be subdivided–a twenty-five year old woman isn’t the same as a sixty-five man).
This is one more reason why consumer choice healthcare is a bad idea: we’re essentially gambling with our health. I use the word gambling because none of us have any way to evaluate if the insurance we have picked will provide the healthcare we need if something disastrous (or even mildly annoying) strikes. I have no idea if something bad happens (and there are many kinds of ‘somethings bad’) whether my plan will provide the healthcare I need. Would I have access to the specialists I might require? Which treatments would be covered, and for how long?
Realistically, I can’t determine that. That’s not a choice, it’s Russian Roulette.
Related post: Paul Krugman has another reason why ‘choice-based’ healthcare fails: the big ticket items (e.g., cardiac surgery) aren’t driven by choice, but by necessity.