Merriam-Webster defines health insurance as “insurance providing compensation for medical expenses.” OK, that’s pretty generic. Most people have their medical insurance through their employer. 49% are covered through their employer, 36% are covered through Medicare or Medicaid, 9% are uninsured and 6% are covered through an individual or family plan. If you’re 65 years or older you’re covered by Medicare, or as I call it “socialized health care,” I’m paying for your benefit. If that ain’t the definition of “socialism,” I don’t know what is. Just think, you’re the Ven-ez-u-ela of America. Suck on that, Sean Hannity!
Let’s break down the annual medical costs for the typical family. Most of us pay medical insurance premiums of around $500 per month ($6,000 annual) for the privilege of having medical coverage for the family. We also have the co-pays every time we go see a doctor or pharmacy, which are typically around $15-$20 per visit. Then we have the annual deductibles of anywhere from $1,000 to $10,000 per year. My former Fortune 500 employer had a $6,000 annual deductible. My wife and I have had three surgeries over the past three years, so we paid out of pocket over $12,000 each of these three years ($6,000 annual insurance premiums plus $6,000 deductibles).
Half of our daily mail is medical bills.
Now before the Berniecrats starts yelling “Medicare For All!” and the Fox News crowd starts yelling “Socialized Health Care!” (even though it’s good enough for them — see above), you have to tell me how we’re gonna pay for it. I need more than a campaign slogan. Keep in mind that former Gov. Jerry Brown took one look at former SB-529 (California Medicare for all) and said,” There’s no funding mechanism for this. The state will go broke.”
If beer was free, would you drink more or less? As someone who has worked many bars over the years, if it’s a No Host Bar (you pay) the average person will have one, maybe two drinks. If it’s an Open Bar (someone else is paying) the average person will have four to six drinks. It’s human nature. If medical care was free, would you go to the doctor more or less?
Which brings me to my next point. The New York Times reported recently (“Study Finds ‘Eye-Opening’ Gap in Hospital Bills,” New York Times, May 9, Page A18) that many hospitals charge private insurance companies up to 10 times what Medicare pays. Medicare is the floor or “lowest reimbursement rate” for hospitals and medical providers.
I shattered my elbow in a 2017 bicycle accident (don’t hit a tree root protruding through the cement going through Sequoia Park!) and “local hospital” billed me $68,993 for my surgery. The bill was adjusted down by $43,198. So I called “local hospital” and asked them why they billed me $68,993 when the insurance company only allowed $25,795? Their answer: (I’m paraphrasing here) “We throw spaghetti at the wall to see what they might pay?” Are you freakin’ kidding me!? The insurance company sliced your bill by 63% and you didn’t know what they would pay?
What we need is standardized medical pricing throughout California, if not the nation. Give you an example. My wife had a knee problem a few years ago and needed a MRI pre-surgery. She called “local hospital” and they quoted $3,700. We then called back our insurance company to make sure everything was copacetic. The insurance company laughed at us and asked where we live. “The going rate for an MRI is $500. There are three medical imaging places in Redding and four in Santa Rosa that charge $500.” So I called “local hospital” back to see if they would match the going market rate and they said “No.” Since this was a deductible coming out of our pocket, take a wild guess what we did? Yup, we drove down to Santa Rosa early Friday morning and paid $500. We then spent the rest of the day along with Saturday wine tasting. Even after the hotel, gas and food, we saved over $3,000.
Matthew Owen resides in Eureka.