For the past several years, I’ve purchased an individual health insurance policy through the ACA Marketplace. (Actually, in December of 2013 I bought directly from an insurance company because the ACA website failed, but the policy was the same.) My husband Tom is already on Medicare for medical insurance and prescriptions. He also has a supplementary policy to pick up costs not covered by Medicare. Tom’s premiums for these policies are so reasonable they make me laugh.
My individual policies, in contrast, have had high premiums, high deductibles, lots of co-pays, and big co-insurance. Apparently I got spoiled during all the decades that our insurance through Tom’s employer covered us. We got the care we needed at prices we could afford. True, the costs rose most years, but only annoyingly, not rapaciously. Not so with my individual policies, which are blindingly expensive.
Under the Affordable Care Act, many people with low incomes receive significant government subsidies. This makes sense, and I personally know people who would have no health insurance without those subsidies. In my own case, I don’t qualify for a subsidy, which of course means that Tom and I are not even close to impoverished, for which I am grateful.
Nonetheless, during each of the four ACA open-enrollment periods, I’ve been shocked and discouraged by the steep and steeply increasing policy prices. The high premiums are a monthly hit, but the worst element is the annual deductible of multiple thousands of dollars. Because I have pre-existing conditions and a propensity for certain illnesses and injuries, I can’t forego medical care and remain healthy and functional. So I go to doctors. I pay the full costs of all visits, tests, and prescriptions, till the deductible is met, which usually happens around May. After that, everything is “free,” so I try to postpone the more expensive services till later in the year.
Now it’s 2017. I have the highest premiums and deductible and co-pays and co-insurance ever. But in three months, when I start Medicare, costs will plummet and I can unshackle myself from my exorbitantly priced ACA policy.
So what to do till then? I’ve decided to avoid all non-essential medical care till April 1. Yes, if I acquire a bacterial infection I’ll go to the urgent-care nurse and get antibiotics. If I get hit by a truck I’ll ride the ambulance to the ER. But I won’t go to the orthopedic doctor to find out why my ankle seems to be degenerating. I won’t visit a wholistic medical practice that might help me control my GERD with dietary changes. I won’t seek a replacement for my osteopenia med, which causes additional reflux and bone pain and which I have simply quit taking. These things will have to wait.
Of course I realize that people with no medical insurance don’t seek such services anyway. They do without diagnoses and treatments nearly all the time. They remain sick or injured longer than I do. I know this. The one advantage of declining to use my medical insurance for the next three months – except for emergencies – is that I may gain a tiny bit of insight into what it’s like not to have insurance. That’s probably worth my walking around on a chronically unstable ankle for awhile.
Not all countries have this problem. The U.S., contrary to popular belief, does not have the best health-care system on earth, nor the least expensive. Most European countries, several Middle Eastern countries, Japan, and other nations rank higher. Here are links to three fairly-short, recent articles comparing health systems in a variety of countries. Recognizing that many of them have smaller populations than the U.S., or a narrower range of income levels, there may still be lessons to learn from how they manage the care of their people:
To be sure, I am thankful to have health insurance at all. I can get routine care, specialist care, urgent care, emergency care, tests, prescriptions. I’ve visited places in the world where a single aspirin is a luxury, where sick people sit beside dirt roads staring at nothing, where parents fail to treat their child’s bleeding head wound because they don’t realize they can help. My situation is the opposite of that, and in comparison my gripes seem silly.
But I live where I live, and I believe that in a nation as rich and resourceful as the U.S. our health insurance should be better. I hope as the new Congress debates the ACA and possible changes or replacements, they will try to learn from other countries and not think they have all the answers. Everyone in the United States should have health insurance, and everyone should be able to afford it.