So, at the new job, I’ve been suffering through all of the orientation stuff, and what I’ve noticed, regarding healthcare, is that the ACA (Obamacare) notwithstanding, I’m still facing the same idiocy I did seven years ago when I switched jobs. At the new job, I can choose among 23 different healthcare plans.
Yes, twenty-three. Sure, they can be grouped into some broad classes: catastrophic insurance only, fee-for-service/PPO (high-end), and HMO-like plans. But within each of these categories, some of the plans have to be worse than others. Worse, since I can’t determine ahead of time what my medical needs will be (hopefully, minimal), I have no idea which plans’ specialists are the ones I might need. It sort of defeats the concept of pooled insurance.
I watched a room full of smart people, many with advanced degrees, get frustrated as we all realized we would waste a lot of time trying to pick the ‘best’ plan–with no idea if or how we’ll succeed or fail.
This is something I discussed seven years ago and it’s still a problem:
….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.
This isn’t ‘choice’, but an overwhelming amount of information that will result in some (or many) people getting screwed. Hard to believe that’s efficient.
We could have done much better.
Added: After writing this post, I stumbled across this by Dr. Michael Gorback (boldface mine):
The point of this exercise is not that there were cheaper drugs available that had the same pharmacologic action (a topic for another day) but that my insurer could change the rules without my knowledge or approval.
As it turns out, when you purchase a health insurance policy, you only think you know what you’re buying. You know parameters such as the deductible, coinsurance, premium, maximum out of pocket, and so on. You know whether or not you have maternity coverage, psychiatry coverage, a lifetime cap – and all sorts of nonspecific things.
But the devil doesn’t lurk in nonspecific things, does he? Your policy documents don’t specifically say that certain drugs aren’t covered, or that you might have to try one or more other drugs before they will cover it, or they might refuse to cover it because your condition is not listed as an FDA-approved use for the drug.
One of my colleagues relates an amusing story about this hypocritical farce. He prescribed pregabalin for a patient. The insurer denied it. He spoke with a doctor at the insurance company, who said they wouldn’t cover pregabalin because it wasn’t FDA-approved for that condition. He said they would cover a very similar drug called gabapentin. Gabapentin is cheaper than pregabalin. My colleague then observed that gabapentin wasn’t FDA-approved for that condition either. Upon which the insurance company authorized pregabalin. Or was it pre-authorized?
When it comes to hospital services you might know that they will pay for 60% of charges after the deductible is met, but what you don’t know is what rates they have contracted with providers of healthcare services. Suppose your insurer has negotiated a price of $1,000 for your surgery with the XYZ hospital chain. Another company might have negotiated $800….
There is no way you can know any of this when you sign your contract. Even if you could, they can change it whenever they feel like it, just like they did to me. One year they might pay for a certain treatment, the next year they might decide there’s not enough evidence and your coverage is gone.
You have to use your policy if you want to find out what’s in it.