Let’s talk about health care – Part Two: More concerns, especially for the ladies, working or living life laid off

By Mariam Williams

“If a man will not work, he shall not have adequate health care.”  2 Thessalonians 3:10, NOECV (New Ongoing Economic Crisis Version)

I’m concerned about our attachment to employer-sponsored health care and the resulting fears and bad habits.  The above verse really says, “If a man will not work, he shall not eat,” but we behave as if health insurance as a standard benefit of regular, full-time employment were mandated by God.  We can’t imagine it being any other way, unless we are extremely poor or extremely old, in which case we already live with state and/or federally funded alternatives.

Yet, we don’t see how it traps us.  I know a brilliant entrepreneur who has often chosen to be someone else’s employee while running his own businesses just for the benefit of group insurance. I applaud a recent post on “Please Feed the Animals” for asking just how many other would-be entrepreneurs exist who desperately want to boost our economy and enjoy more time with their families but are afraid of losing their health insurance?

It’s a perk that I kind of miss for reasons you’ll see later, but the dependence on employer-sponsored health care coverage might be one reason the health of so many people in our nation is so bad.  It hit me just recently that employer-sponsored health insurance removes some of the individual responsibility to take care of yourself.  Do you smoke?  Are you overweight or obese?  A binge drinker?  Do you just like to see doctors a lot?  Are you into bungee jumping or sky diving?  Searching for health insurance on your own, every factor that you can control matters, as do many that you can’t control.  Smokers, the obese and the adventure-seekers pay more for individual health insurance.  If an employer handles it, the employer’s co-sponsorship portion goes up, but unless the company is forced to drastically cut costs, the employees never see the effects of their own behavior.  You can do as much damage as you please while someone else fits the bill, never fully understanding how much you’re costing everyone.

I discovered this about one month before I was laid off, when every employee at my former place of employment was required to re-enroll in or reject the company group insurance plan.  The plan had increased about $30 a month over the previous year.  I wasn’t happy about the cost increase, so I shopped around for alternatives.  A former health insurance agent advised me to go ask the human resources department just how much the company’s portion of the monthly premium is and to then compare the plan they offered to an individual plan with similar coverage.  He said I might be surprised at just how much the company was paying for each of us.  He went on to explain that along with all those factors we can control, participants in a group coverage plan also pay for other factors, like every coworker over the age of 45, every one with a pre-existing condition, all female coworkers still in their child-bearing years and all coworkers with children under 23.  The insurance company calculates the risk and, in my former employer’s case, a separate benefits company then negotiated a rate the employer felt was fair.

The HR manager wouldn’t tell me what that rate was, but I found out about a month and a half later when my COBRA letter arrived, informing me that I could keep the same coverage I was unhappy with for the low monthly premium of nearly $400.

You see, with COBRA, you continue with the group insurance plan.  You get your low deductible (although this particular plan’s out-of-pocket limit was still well into the thousands), $35 co-pays for office visits, free labs and your $15 prescription drug benefit. Your pre-existing conditions are covered.  You don’t have to get a physical.  You don’t have to sit on the phone for an hour with an underwriter who grills you about the medical records he has open right in front of him.  You don’t have to sign anything giving that underwriter permission to contact your doctors and find out if you left out anything.  If you’re pregnant, you’re still covered.  And for those conveniences, you pay what you didn’t know your employer was paying every month.

I, a healthy woman in her late twenties, had the option of paying a premium of $400 a month. And if I had had a serious pre-existing condition or if I had been pregnant, there wouldn’t have been many other options for me.  There’s just something wrong with that.

Even when the HR manager declined to reveal how much the company was paying, I had a feeling it was something ridiculous like that, and I started to get pissed off about it.  I was angry that I was in my late twenties, exercised daily, was petite, childless, ate right, rarely watched television, had never ever smoked anything, did nothing adventurous, and I was paying for everyone who wasn’t any of those things.  I think there’s something wrong with that too, and I’m concerned that a nation that doesn’t know about this stuff will continue to contribute to the astronomical cost of health care with its bad habits.

As a country, we have another bad habit that shows up more quietly in our health care system than it does in our economy, but affects health care just the same: we spend a lot of money on things we don’t need.  How much would each household save if they only bought the health coverage they really needed?  In my research on the group plan, I found the only prescription drug I used at the time for $9 at one pharmacy, and a prescription drug I had used in the past for $4 at another.  I didn’t need a prescription drug benefit.  I’ve shared my thoughts on children on this blog before; I obviously wasn’t trying to have any, so I saw the prenatal care and maternity coverage as being only for a shocking and nearly impossible accident.  I had no reason to see a doctor or a specialist several times a year, so although I appreciated the idea of a low co-pay just in case there came a time when I did need to see a doctor often, it frustrated me then.  I only opted in to the group health plan because the premium was pre-tax, and I would actually take home more money with the coverage.  The unemployed don’t have the pre-tax option.

As I end this venting session, I leave you with one more concern: adequate and equal health care for women.  When I met with the former insurance agent, I learned that my gender would complicate my search for individual coverage.  Did you know health insurance companies charge women more money just because we go to the doctor more instead of waiting until we’re near death like men do?  Did you know that birth control is never covered under an individual health care plan because (as an underwriter once explained to me) it’s seen as something for a lifestyle choice, not for a medical condition?  Did you know that’s bull, because some birth control does treat certain medical conditions?  Did you know that Viagra is covered under individual health insurance plans?  Do you know how difficult it is to find an individual plan that will cover prenatal care, labor, and the first seven days of an infant’s life?  Do you know of an individual plan that will pay for an abortion?

Did you know that the bill going through the House right now mandates that women can’t be charged more for their health insurance than men?

Do you trust the very insurance companies that treat women unfairly to be honest without a public option, or without any reform at all?

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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