#consumer driven

Let’s say you have a good job (even one with a health insurance company) that offers full benefits such as health care. You are so screwed by the way they stack the deck against you.

You pick your plan with the government set maximum out of pocket $12,800 and you pay them thousands of dollars in premiums year in and year out. You’re protected right? Most you will have to shell out in a year no matter what happens is that $12,800 right? Bad but you can plan for that, save using the HSA, etc.

Nope. Let’s say you get in a car wreak and are unconscious. Paramedics take you to the nearest ER, like they should. But that ER isn’t in network. Now you’re out of pocket max is $25,600 and you peg that. Not your choice, you didn’t pick where to get injured and couldn’t possibly say where to go. Doesn’t matter you owe DOUBLE.

And it gets even better if you are a good insured person and you go to your regular in network doctor because that is a completely separate bucket. You could end up owing TRIPLE: the out of network $25,600 + the in network $12,800 for a financial life ruining $38,400 PER YEAR. That is 74% of the median income in the US before taxes and you know food, etc.

I get that the insurance companies want to encourage you to use their network since it saves them money (and should keep your premiums down a tiny bit). That’s cool. But out of network should only apply to optional care! Urgent or emergency care should count as your basic coverage. Injured or seriously ill people do not have the ability to check every single provider to see if they are in network or not. And they sure as hell do not have the ability to choose a different provider. It’s not like they get handed a menu and can pick or choose.

The concept of consumer driven health care was to get patients to make informed decisions about health care and its costs. And from a market point of view it makes some sense. But health care is NOT a normal market. When you break a bone, get an appendix that’s about to burst or pass out you have absolutely no choice.