I wanted to write a really short blog post about a phenomenon I've been noticing more and more in my work: the rise of high-deductible insurance plans. (If you're bored by this topic, may I suggest my last blog post).
What is a high-deductible insurance plan?
Essentially it's this: you don't actually get any health insurance until you meet deductible of several thousand dollars first. For most of us under 50, that means we are essentially getting no insurance even though we often pay a high monthly premium.
How does this work? Let's say you go to a doctor for a bad back, for an annual physical and because you get pneumonia in a given year. And let's say all those doctor's visits total up to $2000. But unfortunately, because you have an ACA plan (otherwise known as Obamacare), your deductible is $3000. And that means you are fitting the bill for all those visits, despite paying a premium monthly of $250 or more a month. That's right, your insurance doesn't pay a thing. Quite frankly it's a joke.
So Why Does This Exist?
The simple answer is profit. A more complicated answer is something like this. After the ACA passed in 2010, many particularly odious and evil insurance practices such as pre-existing conditions and lifetime caps on spending were eliminated. This was a gigantic victory as health insurance companies regularly used to let people die because of a preexisting condition and lifetime caps because it hurt their profit margins.
But those clever, profit-driven insurance companies were not going to take the drop in their profit margin lying down, so they created something new: the high-deductible plan. Outwardly their reason was that a high-deductible plan would motivate people to practice healthier habits and use the doctor less. But in reality, it meant that health insurance companies were trying to pass the costs on to us, the consumers.
This has disastrous consequences for many. For example, if you're a family of four, living pay to paycheck, paying a premium of $300-400 a month but also responsible for the high deductible, the decisions often become about whether you get to eat or get that medication that your partner really needs. These are not choices anyone should have to make.
What happens is that even though the number of people being insured has increased, many more of us are underinsured now, meaning we will use the doctor only we absolutely have to because we can't afford to go. And that means things like mental health or chronic physical ailments very easily go untreated.
In a word, it is inhumane and wrong. We're the only civilized country in the world without a single-payer plan (maybe we aren't actually all that civilized).
There are a few politicians fighting for the people. Elizabeth Warren just today introduced the bill, which will greatly help the ACA. But nothing will change unless there is an actual movement. I'm skeptical. The insurance lobby is incredibly strong. But younger people are pushing more and more left these days. Maybe there is some hope there, just as there is some hope now against the gun lobby.