September 24, 2009

Health Care

So, in the states, there has been a lot of talk about health insurance and all of the possible health care plans. I’m afraid I’ve not kept up with them hardly at all, nor do I have any expert knowledge in the subject. I do, however, have a few thoughts and reflections based off of our recent experience that I think our applicable. No answers, I’m afraid, but some points for discussion.

First, I should share some of our experiences. I finished my Master’s degree this past May, and we had student health insurance during this time. It was great. The challenge came when it expired mid-August, and my new job’s insurance didn’t start until after I was employed for a month, at the end of October. Hence, we’d have a month and a half without insurance: a situation I wanted to avoid if at all possible. Comprehensive coverage didn’t matter, all I wanted was some sort of catastrophic major medical insurance.

This was surprisingly hard to find, especially since I was looking at rather the last minute. (I was hired at the beginning of August, after all.) It turned out that trying to find insurance while we were in Ithaca presented us with only two options. Two? One would expect that, like car insurance, one could choose from a variety of providers. But we could only choose from two. The situation is even worse here in North Dakota: Blue Cross Blue Shield provides somewhere around 90% of health insurance in the state.

To compound the issue, Rita’s diabetes disqualified her from many plans. Even though she keeps awful good care of herself, the insurance companies view it as equivalent to something like HIV. To some degree, I understand: diabetic supplies are a constant expense. But I’m okay paying for constant expenses, it’s the unexpected gargantuan expenses that I want insurance to cover me for.

Nonetheless, I attempted in mid-August to apply for a month and a half of health insurance while we were in Ithaca. I had three options:

1. GHI sold a catastrophic-style plan, but only had plans that began on the first of the month. That wasn’t helpful when we were looking for coverage nearly immediately. Besides, we particularly wanted coverage while we were traveling.
2. Blue Cross/Excellus had a plan, but insisted on getting the paperwork done via snail mail. Again, the time frame just wasn’t going to work out.
3. HealthNY is a state-sponsored program for low-income folks, but would not cover out-of-state services and, again, wouldn’t start until the beginning of the month. Not only that, but, being a able-bodied individual, I’d rather save tax dollars for those who actually have a real need. Why should I take from the poor?

I didn’t think this would be difficult! And it took many, many hours on the phone and researching trying to figure this out.

In the end, we were able to apply with Blue Cross Blue Shield in North Dakota. We thought everything went swimmingly. Until, last week, I received the cards indicating my acceptance…but nothing for Rita.

What happened?

I called, and found out that, indeed, she was rejected for medical reasons. Our only recourse was to apply for a state-sponsored plan. We’re still waiting to find out if that works—and, frankly, seeing as my work insurance starts in a week, I don’t care much any more.

This system is definitely broken.

I have a few thoughts about what could improve.

1. Why isn’t this just insurance? Health insurance is an odd beast. It has come to function much less as insurance—i.e. financial help in times of extreme need—and much more of a discount plan, with copays and the like. This functions not only to complicate the insurance, but also to make qualifying that much more difficult.
2. Denied? I suppose one could be rejected for car insurance, but it certainly doesn’t happen often. Why? High-risk applicants are simply charged more. I don’t see why this would be a bad model for health insurance.
3. Complications. I have a Master’s degree in engineering, for crying out loud. I’m not the sharpest knife in the drawer, but I can usually figure most things out eventually. But health insurance? I spent on the order of two full days trying to find out what options we have. That’s completely crazy, and was only possible because I was unemployed at the time.
4. Competition. I add this with a bit of hesitation. I certainly think that given more companies offering insurance in either New York or North Dakota, we would have had a simpler time. I realize that competition isn’t a panacea to all problems, but different companies focusing on different markets would have been very valuable in this instance.

Those of you paying attention to the current health-care discussions in the United States right now notice one thing that I didn’t put on the list: universal health care. I have what I think is a good reason for that, though it’s perhaps not what you expect.

I should be forthright: I do tend to favor as little government as possible. But that’s honestly not my primary concern.

My concern is one for the character of people. One thesaurus lists synonyms such as integrity, honor, moral strength, uprightness, fortitude, strength, backbone, and resolve. In my mind, these are some of the most important qualities to nurture in people. (Perhaps the most important qualities, if you attempt to be a secular society.) Character, however, is built not out of having others take care of you, but rather learning how to take care of you and yours through sometimes difficult situations. It isn’t easy, but—as with many difficult things—it is worth it in the end.

Thus, it seems to me that having equal health care available to all demotes rather than promotes the character of our people.

Don’t hear what I’m not saying. I want health care to be cheaper—definitely. I want it to be more available to more people. I don’t want to worry about health care any more than you do. But I want to have a good character—and want people around me to have a good character—even more. And I believe that a strong sense of personal responsibility and a minimized reliance on “someone else” to take care of us is vital for this.

I think this is what I would propose, in addition to the points I raised before:

Despite my dislike of government intervention, why don’t we simply have the government pay for the large capital costs of health care, such as hospitals and equipment and research. This could be completely government sponsored, similar to our roads. Then, paying for doctor’s visits and other care could be done directly out-of-pocket at a much reduced cost. Is it enough? I have no idea. But it preserves the mental model of “I am responsible of providing for me and mine; I need to be a mature person of character.” rather than “Why doesn’t the world take care of me?”

Responsibility. Character. Integrity. A nation built on these will assuredly outlast a physically healthy nation who is morally bereft.

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