Wednesday, July 11, 2012

Some (personal) Medical Insurance Facts

While the country is swirling with monumental discussion, facts, statistics, opinions, lies and myths about the medical care and medical insurance issues, I thought I would share some of my personal facts regarding my wife’s and my medical coverage; anecdotal though it may be.

Medical Insurance:
When we retired in 2006, our group (state public employee) medical insurance premium for our joint coverage began billing us $893.76 per month. Prior to retiring our employer paid for this coverage. Today our premium is $1,157.46 – a 29.5% increase in premium costs over 6 years. The current rate of inflation is 2%.

Last year our monthly health care premium actually went down from $1,159.52, to $1,157.45 this year – a $2.07 per-month decrease. However, the plan has changed whereby we now must pay $500 out-of-pocket before anything is covered. So essentially, our medical costs have actually increased 3.5% over last year.

This year, our insurance provider is requiring all customers to participate in a mandatory “Health Engagement Model (HEM) program”. A surcharge (penalty) of $17.50 per person will be added to our monthly premium if we do not comply with the HEM requirements, which consists of watching online training videos. Between my wife and me, we have spent six hours on this process. Emphasis for those of you who decry government interference regarding your health care, note that these are private company hoops we are having to jump through – not government.

Over these six years, our group coverage has forced us to change insurance companies four times. As a result, we have had to change from medical providers and facilities with whom we have established doctor-patient relationships over years. Emphasis again, for those of you who decry government making decisions about your health care, note that these are private companies, making choices for us who we will be allowed to see – not government.

One prescription my wife takes cost $543.78 for a 3-month supply in 2007. This same prescription charges the insurance company $912.58 today. This is a 68% increase in the cost of this drug over five years. Our co-pay for this prescription was $15, it is now $75.
… researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion. [1]
Dental insurance:
We discontinued dental insurance as the premium amount plus the out-of-pocket costs for non-covered expenses was more than simply paying for services directly.

Final thoughts:
Our medical insurance premium, deductibles and co-pays consume one-third of our disposable income. I often wonder how many Conservative local business owners would much rather I spend that $19,800 a year in their local restaurants and businesses than send this money to out-of-town insurance companies? Multiply my $19,800 by the thousands of people like me – this amounts to millions of dollars denied the local economy.

Consider that for every car you buy, every bag of groceries, every movie ticket, every magazine, every gallon of gasoline… the cost of employee medical care premiums is factored into the price of what we pay for those goods and services. Why wouldn’t Conservatives rather want to either A) reduce the cost of their goods by that factor and increase sales, or B) pocket the additional profit from the reduced overhead, by having their employee insurance costs picked up by a single payer government plan? A single-payer plan seems like a win-win for every business in the county except medical insurance companies. Our business leaders must be the laughing stock of the remainder of the developed industrial world.

My final thought on the ACA (aka: ObamaCare)
It appears to focus of this law is directed entirely on insurance coverage but little on containing the rise in medical costs and the demise of medical outcomes. But hey… it’s a start.

1. Big Pharma Spends More On Advertising Than ResearchAnd Development, Study Finds,, January 5, 2008.


TravelBug-Susan said...

Holy smokes, Batman, that's a lotta dough.

At this point we have opted not to carry medical insurance because it's just too expensive. We will deal with any payment for medical issues as we need to. We not, however, appreciate anyone telling us we HAVE to HAVE medical insurance.

TravelBug-Susan said...

correction: ** We do not, however...**

Robert the Skeptic said...

TravelBug Last year my "surprise" heart infection and surgery cost $250,000. Insurance paid for most of it.

In most states, drivers are required by law to have car insurance. You may be a good driver, but what about the uninsured guy who runs the red light an crashes into you?

Personally, I am not thrilled about the "mandate" either; I had actually hoped that aspect of the ACA would have been declared unconstitutional by the Supreme Court. I don't like the idea of mandating I have to pay a private entity for anything!

Medical coverage should be a government benefit just like roads, bridges, schools, police/fire... long list - just like ALL the other 'civilized' countries do.

Beach Bum said...

Emphasis for those of you who decry government interference regarding your health care, note that these are private company hoops we are having to jump through – not government.

Nothing makes me want to go postal on conservatives than when they whine about some sinister government agency out to death panel grandma but ignore corporate bean counters who do it now.

Robert the Skeptic said...

BeachBum I agree with you. I'm really tired of this constant "our Government is Bad" mantra. Really, it's that bad here? Like compared to Syria, Somalia, even European countries where there NOTHING like the 1st Amendment, or anything like it, exists?

Oh, but we have to pay taxes... boo hoo, help help I'm being oppressed! You are right, Beach Bum, a totally blind eye and mute response from these cry babies when private corporations screw us all over.

TravelBug Here is another way to look at this issue - You don't want anyone telling you that you HAVE to have medical insurance. Fine for you, but what about me? I'm doing the responsible thing and paying for insurance... in fact, I am paying MORE because other people are shirking their responsibility.

If you end up going to the emergency room, or are hospitalized or receive other treatments, providers are required to provide enough care to stabilize you. They are NOT required to provide that care for FREE; if you don't pay, someone else does. That is not personal demonstrating responsibility.

If we all went out to dinner and you decided you didn't want to pay your share or couldn't afford it, how is that fair to foist the additional cost on to me? Like you, I don't want people telling me I have to pay MORE for health care coverage because others are shirking their responsibility and shifting the cost onto me. When you step out beyond the "how does this effect ME personally", there is a much bigger picture.

billy pilgrim said...

we have government health insurance that costs about $100 per month. some provinces charge and some don't. our government health insurance was initiated when health costs were dirt cheap compared to what they are now. i have no doubt that if we didn't have government provided health coverage right now there's no way we could initiate government coverage with the spiraling costs.

i've had to change family doctors twice in the past 2 years because we have a shortage of family doctors. walk in clinics are replacing family doctors.

Rubye Jack said...

I agree with your last comment, and your entire post. We all pay for the uninsured and to my mind it only seems right for everyone who can to take care of themselves so the taxpayer doesn't pay for the uninsured's visits to the ER. I really don't like forcing people to take care of themselves but if we don't force some people, then we end up paying for them. For those who have very little income, I would be happy to help them but for those with money -- no way.

Face it, insurance companies, banks, pharmaceutical companies, etc. control our lives, not our government. They also own the Republicans and most Democrats. Okay, probably all Democrats also.

Secret Agent Woman said...

People who have Medicare/Medicaid already have a government-sponsored insurance plan and I can't see any fair reason why it is not provided to every one. It burns me that I can't get adequate health care coverage because I am a small business operator and can only buy crappy high-deductible coverage. And it also burns me to have to help pay for the health care of others (those on Medicare/Medicaid AND the uninsured) when I can't get coverage for myself. We need a universal tax-paid health care system. It is the ONLY fair way.

Robert the Skeptic said...

Billy That is my fear in this country, that health care costs have risen to such significant levels, the pain and suffering to bring that under control will be more than the system can bear.

Rubye Basically the corporate Oligarchy has co-opted our republic; the corporate controlled media pumps out propaganda that motivated the public to make choices against their own self interest. I see little hope for our slide into world decline.

SecretAgent I agree, there is no reason why Medicare could not be expanded to all individuals. But remember we are Americans; if we haven't figured it out, it can't be done. Meantime, the rest of the developed world looks at us and scratches their head.

KleinsteMotte said...

Someone who needs to pay 1/3 of Their retirement income for health care while living iN the USA? That is really sad! What has made it all go so wrong???
Right now millions are spent on getting a party into power. What's the point? The nation is and will be run by a wealthy group who have no care for the common good of the people or their land. Profit is deemed to be above all.And soon all the drugs will not be able to fix anything anyway.
Even our oceans are turning acidic! Carbon dioxide is taking over!

Greed and need for speed is changing how the world will be. With our current rate of over producing offspring, over consumption of water and air the balance of oxygen and carbon dioxide is so out of whack it makes some horror stories seem tame.
There appear to be far more serious issues and we are all just sitting back wishing and dreaming. There will be no winners in the end.

joared said...

I agree about not liking the "mandate" but agree with the arguments you present here for requiring everyone to have insurance. Too many likely wouldn't get coverage which is also why auto ins. had to be mandatory. We must all be in this to make it work, and spread the cost which is what makes so much insurance work -- fire, flood, home, etc. Of course, until something is done about reining in the insurance and pharma companies cost controls will still be out of hand.

I work in health care and know only to well how unexpected events happen to ALL AGES that can turn an individual(s) and family's life upside down financially for the rest of their lives. Those that choose to not buy insurance may think they're gambling just with their own lives and resources -- are willing to take their chances. But, the reality is the rest of us -- health care providers, and citizens are stuck with either helping them out when all goes awry -- or should we become a society that says -- "Well, tough nuggies for you" which may be what these extremists on the right are advocating. They're beyond being what I consider conservatives -- not what that word used to symbolize.