Who’s Getting Trampled? Patients
Patients
We’re all patients at one time or another. Yet insurance companies and their boosters would rather we think of ourselves as “consumers” – as if getting health care were like buying a refrigerator or a television. It cannot.
Health care is much more complicated than deciding what size TV screen you want, and the consequences of a bad decision are much more dire. Worst of all, the current system demands we be at our most astute when we are actually at our most vulnerable. Search for a specialist who will accept your insurance when you have just been diagnosed with breast cancer? Compare prices when you are in severe pain and need surgery? Fight with your health insurance company when it refuses to cover the prescribed treatment you need urgently? That is truly being kicked when you are down by the very system that is supposed to help you get back up!
The Sales Brochure You’ll Never See
Some features of the insurance industry’s “products”:
- Insecurity. An all too familiar scenario: Start healthy. Get sick. Lose your job. Lose your insurance. Try to apply on your own, and get rejected. Manage to keep your coverage and it still may not be enough. With the health insurance industry, there are no guarantees.
—“Illness and Injury as Contributors to Bankruptcy,” by Himmelstein, Health Affairs Web Exclusive, February 2, 2005 - Rising costs. Everyone is feeling the health care pinch. Employers are passing on more of the pain to their employees by making them pay more of the premium and/or buying plans that have higher out-of-pocket costs. That leads many people with health insurance to still not be able to afford needed health care.
—“2007 Health Tracking Household Survey,” Center for Studying Health System Change, June 2008 - Diminishing benefits. Feel like your health insurance covers less and less each year? Almost half of insured workers say that’s exactly what’s been happening. Employees are so worried about their plans’ security, that a majority of those polled would prefer no pay increase in order to keep their current health insurance benefits.
—“Health Care Poll,” Wall Street Journal Online/Harris Interactive, October 22, 2003 - Denials of care. Think that your insurance company’s going to approve the treatment your doctor recommends? The fine print in your policy gives your insurer lots of ammunition for stamping “denied” on your claim. Even the health insurance industry lobby admits that 1 in 7 claims is rejected!
—“Results from an HIAA Survey on Claims Payment Processes,” Health Insurance Association of America, March 2003 - No meaningful choice. Most people have little or no choice in their health insurance coverage. Those who do have a choice have no meaningful way to compare plans. Ever try to choose from lots of health insurance “products”? It feels like they’re all part of the insurance industry’s game. They are – designed to protect insurance companies’ bottom line and not your health and financial security. Much of the information people should have when making these choices is not available. How does the plan decide if a particular treatment is medically necessary and thus covered? What percentage of claims does the plan reject? How many members appeal coverage denials? How many win an appeal?
—“Health Insurance Coverage of Working-Age Adults,” Commonwealth Fund
Learn how our market-driven health care system affects:
LATEST SCORECARD
Fifty-eight percent of primary care doctors in the U.S. report their patients often have difficulty paying for medications and care, and half of U.S. doctors spend substantial time dealing with restrictions insurance companies place on their patients’ care, according to the 2009 Commonwealth Fund International Health Policy Survey.
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Families saw their premiums for job-based health insurance rise to an average of $13,375 annually in 2009, with workers paying an average share of $3,515 and employers paying $9,860.
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