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One of the biggest fictions of our health care system is the idea that everyone has a right to choose their health insurance plan, or even none, if they prefer. It’s the other way around. Plans choose people based on ability to pay, or not.
Policies determine how much benefit someone can buy while they’re healthy and/or employable. Invariably, plan premiums start around $250 per month with a $5,000 deductible moving to $500 per month with a $1,000 deductible. The premium is your monthly fee and the deductible is the amount you pay out of pocket up front for non-covered medical services (which is pretty much everything when there’s a problem) before your 70/30 or 60/40 insurance copay kicks in. This is partly where insurance companies make a profit margin.
Most people opt for the smaller premium hoping the larger deductible will never have to be met, which is no kind of long-term plan. Case in point is the little girl with the toy up her nose.
In last Saturday’s News & Observer, the Extra Nation section featured an article entitled, “Bill to pluck doll’s shoe out of child’s nostril: $2,659.” The story stated that the in-network facility did not have the correct tweezers to extract the toy, so the couple was referred inadvertently to an out-of-network provider who did. Because the insurer did not have a contractual agreement with the second facility, the couple had to pay thousands out of pocket to meet their deductible, which, by the way, is always higher out of network.
Some right, huh?
Either way, most people are out of pocket several grand a year. Employer-sponsored health insurance is cheaper, but the transition of jobs from manufacturing toward the service sector means most people are without those plans, and hourly wages make health insurance completely unaffordable. Even employers are trying to revamp or scale back benefits because of the monumental headache in administration and cost.
And on top of Republicans tearing Obamacare, or the Affordable Care Act, apart with lies about individual choice in plans and physicians, their pièce des résistance is they want everyone to shop for the best price heart surgery, orthopedic surgery, MRIs, X-rays, etc., to get the best deal. Capitalism in its purest form. For shame.
No one really chooses, because health care isn’t a choice; it’s always a necessity. Ask the parents of the little girl with a toy up her nose. Profit-less single-payer universal health insurance is a better way.
Deborah A. Baro