Monday, December 21, 2009

Us Versus Them

I left my full-time job a few years ago and for 18 months I sent in monthly checks to have my medical insurance continued under the COBRA plan. As I reached that time limit, I started to investigate individual medical insurance plans. Imagine my surprise - I found none at all! I found one provider that allowed me to fill in an application on-line - don't call us, we'll call you! Two years later, that application is still in process!

I wonder, if the new Federal reform of health insurance is enacted, is my situation going to improve at all? I gather that I will be required to make monthly payments again. Do I have any basis to hope to be better served?

I don't know what is in the bill that the House passed, or what the Senate is considering, nevermind what any joint committee is likely to come up with. I'm not encouraged by the snippets I hear on the radio and see on the internet. The main thing I hear is that insurance companies will stop rejecting people's claims because of prior conditions, if everyone, no matter how healthy, is required to enroll.

From an insurance perspective, this makes good sense. As the insurance companies point out, why should they be required to issue a fire insurance policy on a burning house? But somehow medical insurance is not fire insurance. A medical policy with a high deductible is much closer - a policy that would pay the typical holder only once in twenty years or thereabouts. I wonder how our system has evolved to its present state, with very low deductibles, so that insurance companies paying medical costs is common for many people. Most likely this is coupled to another peculiarity, that most medical policies are part of an employer's group plan, and largely paid for by the employer without being subject to income taxes.

From the snippets I've seen and heard, the focus of the proposed legislation is on the relationship between insurance companies and those they insure. Of course, every one of us is a potential customer of medical services. But the health care crisis is so much vaster than that one relationship.

Another crucial player is the physician, and in general the providers of medical services. This expands the network into a triangle. With the insurance company routinely managing all payments for services, the physician is stuck negotiating with the insurance company over which medical services are sufficiently cost-effective. This profoundly disempowers the patient.

Disempowerment of the patient - this may be at the core of the health care crisis. Of course, many of us find it convenient to disempower ourselves. It is easier to remain ignorant and to demand that somebody else take care of our problems, medical or otherwise. But an effective system will resist the temptation to prey on such weakness.

Behind the front line of physicians, nurses, etc., there is a whole army of suppliers, lead by the pharmaceutical industry. It is far more profitable to sell cures to the sick than to provide the simple tools necessary to maintain health. Of course, preventative medicine is not a 100% solution. But one major symptom of the present crisis is that even the most basic foundations of diet and exercise are much too seldom maintained.

That a healthy lifestyle seems so difficult to achieve - this opens up the pattern to the full world of our experience. Our culture has come to honor self-indulgence rather than self-discipline. We are surrounded by images, distortions held up as ideals. These distorted images include criminals held up as heroes, or exaggerated body proportions as healthy, or lavish living as smart economics.

Somehow it seems that many of the struggles around these issues present an illusion of a zero-sum game with distinct players - insurance companies versus policy holders, etc. But in the end we are just one society - one planet. A healthy system requires harmonious relationships among healthy components. Mutual exploitation, us versus them, is the path spiraling to collapse. Can we pull ourselves out of that pattern?


  1. We are a little better off in Massachusetts.
    Here, the state requires insurance companies to take individuals. The rates are similar to what you pay under COBRA. This is a recent development. Massachusetts is one of only a few states that do this.

    Have you looked at the plans offered by organizations like ACM and IEEE for self-employed professionals?

  2. Thanks for that tip, Paul. I remember seeing once that IEEE offers medical insurance. I need to go back and investigate that again. I let my ACM membership lapse quite a while ago, so I don't remember anything about what they might offer. Good suggestions, thanks!

  3. I'm confident that you qualify for membership in either organization.