Debbie Knight

The cost of health insurance?

In observation on December 14, 2011 at 1:21 pm

Thankfully I don’t have to resort to being a research experiment in order to afford health care like the rat in the above cartoon.

Working at a university (especially one with a medical center) definitely has it perks — one of which is good health insurance. Of course, the rates will be going up next month, but you won’t find me complaining about it.

There are plenty of people out there who can’t afford it. And one of those people is my sister.

She works at a small daycare that does not offer a health care plan. She simply cannot afford individual health care insurance on her part-time paycheck.

Last month, she felt the costly effects of not having health insurance.

She had a sharp pain on her right side. She suffered until the pain became intense enough to seek medical attention. She went to a fast clinic located inside a grocery store. The nurse practitioner suspected she had gallstones, but the clinic lacked the ability to accurately diagnose this condition and suggested she go to the emergency room.

That gave my sister pause – that would be really expensive. Was her medical condition serious enough to warrant going to the hospital?

Her pain persisted and she eventually decided to go to a nearby hospital.

After an x-ray and blood work, they determined she had pneumonia in the lower right lobe of her lung which was causing the pain.

However, one of her blood tests came back a little “off” which lead the ER doctor to order a $2,500 CT scan to look for possible blood clots – which, thankfully, there were none.

While she was lucky it wasn’t anything more serious (say something that required surgery), she now owes the hospital well over $5,000 (and the bills are still rolling in). Somehow she will have to pay these bills, possibly arranging payments she can afford each month.

Could she have avoided this much out-of-pocket expense by having health insurance? Definitely.

Could she have avoided the emergency room if she had a regular physician? The answer is a resolute “yes.”

But will she do either of these things (buy health insurance and have a regular physician)? The answer is most likely “no” – she simply cannot afford it (especially now that she owes the hospital so much money).

So you might say she’s in a catch 22 situation. And I’m sure she’s not alone.

If she had a regular physician, the doctor could have ordered the x-rays and determined she had pneumonia. But because she was in the ER, the ER doctor had to in good conscience rule out the blood clot. Was this “defensive medicine” on the behalf of the ER doctor? Or simply standard medical practice?

Defensive medicine. Covering one’s medical practicing butt to deflect the slightest whiff of malpractice. Could this be one factor in rising health costs? Is defensive medicine being driven by the medical institution or by the consumer? Do we as Americans expect this privilege? Do we demand the thorough workups, demand the prescription drugs, demand good health care? Do medical professionals rely too heavily on expensive diagnostic tests to make diagnoses? These are tough questions to answer.

I will say that I never appreciated just how expensive health insurance can be until I asked another sister how much she pays for her insurance. She somehow manages to cover the cost of her individual health insurance. It runs her $456 a month at the moment (those rates will be increasing early next year) and she has a $1,000 deductible. She also works at the same day care, but swings the high cost of insurance by picking up babysitting jobs to supplement her income and by living very frugally.

Is it worth her paying $5,472 a year? It could very well be, especially in light of our sister’s recent hospital bills.

My mom, like many retirees, is now on Medicare. And with the changes in coverage, she now faces the decision which prescriptions drugs she can afford to continue taking and which ones she will have to let lapse. I find this unsettling.

Again, I’m grateful that I only pay a small portion of what she pays for health insurance. And I’m grateful that I have really good health care coverage.

I’m not sure what can be done to “fix” the health care system, but I do know that it needs some help.

I had high hopes the health care changes proposed by President Obama and modified extensively by Congress would help people like my sisters – those who make too much money to qualify for Medicaid benefits – but alas, I fear the reform did not go far enough to be effectual. My sisters could really use the help, as well as countless Americans out there.

My sister’s recent experience with the health care system really brings the issue home for me. And I find it both eye-opening and frightening.

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