Health insurance is one of the big reasons I’m sticking with my less-than-satisfying corporate job, but also one the big sources of discontent and frustration there. I found an old orientation manual from the 80’s a few weeks ago and marveled at one of the benefits described: “your health insurance premium is paid entirely by the company”. Times sure have changed.
Now we’re faced with ever-escalating premiums and ever-diminishing benefits. What was once free is now costing me in excess of $500 a month to cover myself, my wife and my teenage son. I could save money by opting for the “value” option – sort of like the dollar menu of healthcare – but it’s advised that only the young and the single consider this, since they probably won’t need a doctor anyway.
We received an email from the president a few weeks ago promising “exciting new changes” we’d be hearing more about in the coming sign-up season. “Exciting”, “new” and “changes” are not words you want to hear describing how your health insurance is going to be affected. It’s never going to be better; it’s only going to be worse.
Rising costs are disguised by two buzzwords they must’ve paid a fortune to marketing geniuses for -- “choice” and “consumerism”. The choice basically comes down to how much you want to spend and how much of a gamble you want to take that this year you’ll be able to stay out of the hospital. The consumerist angle talks about patients taking an active part in the decision-making related to their healthcare. You’re supposed to shop around to find the best doctors and medicines like you were picking grapefruit at the grocery store, even when you find yourself in desperate need of said grapefruit because you have a hole in your leg the size of a tangerine. (Sorry about the citrus metaphor, but I’m writing this piece in my grocery store’s café).
“Ideally with this plan, you’ll take advantage of your annual physical to discuss all your concerns with your health-care provider,” advises the HR guy. “Then you can be set up for the year with the prescriptions you’ll need and be proactive about your wellness.” This is the same guy, incidentally, who is asked every year which option he finds right for his needs, and responds how he can’t really comment because everybody’s situation is different, but he gets his insurance through his wife’s work.
The free annual physical does have a catch, though. Any diagnostic procedure related to the physical is not necessary covered. My doctor advised me to have a colonoscopy when I entered my fifties, so one was scheduled with a nearby gastroenterologist and the local hospital. I talked to all parties concerned trying to get assurances that all costs would be paid, and felt like I had received these. The procedure was performed and shortly thereafter a bill for over $1,000 arrived. When I asked how this could be, I was told the procedure became curative rather than diagnostic when a small polyp was detected and removed. Had the examination and the snipping been done in two separate procedures, I could’ve had one of them covered. Or, I suppose I could’ve had the polyp reinstalled but this simply didn’t make sense.
Speaking of intrusive, the whole wellness thing had gotten increasingly in our face (again, not the best metaphor but I refuse to go lower) as the company tried to manage our medical needs. What started out as an opportunity to have our cholesterol and blood pressure checked in the breakroom by itinerant nurses progressed to quarterly phone calls to receive advice from the same call-center folks who care so much about our cell phone provider. It was bad enough having Joe from accounting hear about your LDL count while pondering his chip choice at the snack machine. But we had to opt for one of several preventive programs that required us to keep exercise logs, answer on-line screening questionnaires, and be scolded telephonically every three months to drink less Pepsi and more water.
Eventually even the corporate HR people realized this was becoming unmanageable when they saw how productivity fell the last day of each quarter as everyone scrambled to make up all the exercise they had done the preceding 90 days (“Hey, look at this– you can count yard work and house cleaning!”).
They eliminated these periodic inquisitions about the same time the next gimmick came along, the Health Savings Account, or HSA. Under this plan, you got a portion of your money back in the form of monthly funding that went into a special account to pay expenses not otherwise covered by insurance. Oddly, this struck me as something of a good idea the first year I tried it, when we got $1500 contributed annually by the company. When it dropped to $1300 the next year, I grumbled but decided to stick with it. At last year’s meeting, the overview went quickly past this part, mentioning that because the program had proven so popular, it was now down to $100. “You mean $100 a month, right?” I asked. “No, that’s for the whole year”. So my freedom of choice had come down to whether I did or did not want to get $1200 a year less. Not surprisingly, I opted out of the HSA for the more-expensive PPO offering, where you go online and hope that your doctor of 25 years is in fact a “preferred provider”.
I’m now reading over this year’s annual enrollment material, trying to prep myself for the potentially life-altering decisions I’m going to make for myself and my family. Hmm, guess I don’t want the HSA again, seeing as how the handy grid shows “who contributes to this account” appears to be “you only”. But there’s a new acronym this year – the HRA, or Health Reimbursement Account. I’ll have to hear more about that one, to see what loopholes are in there.
Regardless of my choice, I’m receiving assurance in the first paragraph of these medical options at a glance of a “unique promise” (uh-oh) the company is making to employees. “We promise to hold the line on employee contributions in 2010 for those who re-enroll in a comparable medical option” to what they sign up for in 2009. In other words, if you agree to pay what will definitely be more for benefits in 2009, you won’t have to pay even more still the next year, as long as you forego your freedom of choice.
Where do I sign up? (Probably in the breakroom).
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Your concept that you at one time had 'free' insurance is what has gotten you, and much of America, into this frenzy for Universal Health Care. No, it was not free, your employer paid for it. Regarding the HSA, YOU are allowed to contribute to the HSA and take a 100% tax deduction and then pay any qualified medical cost with dollars that were tax deductible and grew tax-free. Also, at your age (mine is 64) you should be putting every dollar you can into an HSA. At 55 you can even contribute 'catch-up' dollars. Then, when you are 65 you can use deffered reimbursements to have a tax-free income, pay any out-of-pocket costs with tax-free dollars and, most importantly, you can reimburse yourself for your part B Medicare premium! Take a look at any of the many sites that give a full explanation or visit www.HRAorHSA.com.
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