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Health insurance — do you have it?

Health insurance — do you have it?

Do you have health insurance right now? If so, who pays for it and how much does it cost you? If not, why not?

Health care and insurance is a mess here in the U.S. So while I normally avoid politics like the plague here, I’m interested in what might change in the U.S. healthcare-wise depending on who gets elected. It directly affects my pocketbook. But before we can talk about what might change, I wonder what things are like now for people. (If you’re outside the U.S., I’m interested in your experiences too.)

Over the years I’ve had no coverage, minimal coverage (student health center only), full coverage, catastrophic coverage, and now I’m back to full coverage. I’ve had HMOs, PPOs, and done private pay. I’ve had my doctors assigned to me, and I’ve gotten to choose my doctors. (While paying extra for the privilege.) I’ve had doctors who got me in the same day (sometimes the same hour) and doctors that I had to wait months to see. I’ve had claims pre-approved and then denied despite pre-approval. I’ve had to argue with insurance companies to get payment. I’ve had providers who told me, hey, pay whatever you can afford and we’ll accept that as payment in full, because it doesn’t look like the insurance is ever going to pay. I’ve had doctors say that they could no longer see me unless I wanted to do private pay because they no longer took my insurance (or because I lost coverage.)

The one thing all the policies that I’ve had have in common is that they’ve all been expensive and full of exclusions. They’ve been expensive up front, and then even more expensive if I actually had to use them. Still, they were all a lot better than nothing. I discovered that having ANY insurance at all gets you a discount from medical providers, while having no insurance means you pay full price.

So what about the future?

If Obama wins and gets his policies enacted, it sounds as though things will pretty much continue as-is, with the exception that people without coverage now will be eligible for the same insurance that federal employees are. What do federal employees pay for their insurance, does anyone know? As-is is not the greatest, but at least additional people could be covered, which is an improvement. But what about the people who can’t afford whatever federal employees pay?

If McCain wins and gets his policies enacted, it sounds as though there will be some major changes. People with employer-provided health insurance will be taxed on it as income. Right now I pay $80 per month for my share of my employer-provided health insurance. I’m going to guess wildly and say that that’s probably 1/3 of the actual cost of my plan. (And I have a high-deductible plan.) So say $240 per month just for my own coverage. That’ll bump my taxable income up by $2880. Well if just my insurance alone is $2880, what about my husband’s and my son’s coverage? What about families of more than 3? There is the $5000 credit per family or $2500 for individuals, which I am completely and utterly confused about. Here is what the McCain site says about it: “While still having the option of employer-based coverage, every family will receive a direct refundable tax credit – effectively cash – of $2,500 for individuals and $5,000 for families to offset the cost of insurance. Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider.” It then goes on to link to something even more confusing. I can’t tell what they’re proposing. But I do wonder how a tax credit will help people that can’t afford health insurance now. They have to come up with the money FIRST. That’s how credits work. First you pay, then you get it back.

What do you think?

View Comments (24)
  • This is such a hot topic for me.

    McCain’s plan will SCREW many people. Especially those who have existing medical conditions.

    My youngest was born with heart defects. She has had three heart surgeries and requires ongoing checkups with cardiologists. How in the world could I afford to buy insurance for her on $5000 / year?

    We’re currently covered under my work plan. I have a high deductible HSA plan. I pay $65 biweekly for my share. I have a $4000 deductible for the family. After that it’s an additional $1K (80% paid by insurance, we pay 20%) for a max of $5000 out of pocket per year. For choosing this plan my company contributes $1500 every year to my HSA account. This has worked out well for us as we utilize our HSA account to pay for our deductibles. I max out the contributions I can put into our HSA account and that money can roll over from year to year (unlike an FSA where it’s use it or lose it).

    When we looked at the traditional HMO “copay” plan and compared it to this plan, we would have paid out a ridiculous amount MORE had we gone the “copay” route. Plus the bi-weekly contribution would be $165.

    I am praying Obama gets into office. And if McCain does win (God forbid!!!), this healthcare plan doesn’t make it into reality.

  • We’ve had group health insurance for the last 20+ years. In the last 4 years we’ve had to actually use it and it has been pure misery. Sure, everything is covered when you buy the policy but things change when you start using it.

    In-network / Out-of-Network, bills from assistants I didn’t know about, undefined costs, sheesh, seems like you don’t stand a chance. If something is out-of-network then standard/customary doesn’t apply so everyone can try and get you for everything they can. WHAT A MESS!

    I pay nearly $6,000, and growing, in premiums every year. We’ve had 2 out-patient surgeries in our family in the last two years, and have maxed out the rest of our insurance requirements but still paid more than $5,000 out of pocket.

    The basic math says we paid more than $11,000 each year for health coverage protection. Initially, you would think the insurance company took a hit on us because of our expenses but since they only pay the medical community a reduced amount called “Usual and Customary”, I am sure they still made a considerable profit at everyone else’s expense.

    So, why do I have insurance?

  • There isn’t a single person in the US today that is turned away for care if they go get it. Glad you Brits enjoy your system, but most of us here are completely happy with ours, thank you.

    What’s your tax rate in the UK today? The reason why the US has led the world for over two centuries is because of the opportunity that people have to succeed or fail in our system. People like myself work our tails off to get ahead and accomplish our goals and dreams. Levy confiscatory taxes and you destroy ambition. There are definitely some in our country that can’t care for themselves and need support, but many have chosen to spend their money on new cars, flat screen TVs, cell phones, etc instead of on their own healthcare and the necessities of life.

    Currently I’m white collar professional, deliver pizza several nights a week, and run a couple of companies on the side. It’s taken me 13+ years to build up a business (after lots of failure thru trial and error) so that I can work for myself and no one else. I won’t take this step, though, until I can afford to support my family properly (to include health insurance). I don’t begrudge this fact as God gave ME the responsibility to care for my family and no one else.

  • As with many here, we’ve had various plans. Originally had an HMO and the company (a somewhat large one) paid everything but like $50 every two weeks. The cost for HMOs rose drastically and right before I left the company was moving to a PPO plan. However, since I left before that I was able to continue the HMO through COBRA. That cost was $550 per month.

    We were on that for about 8mos. Swithced companies again and participated in an HMO for a couple of years. However, that cost rose to about $1600 a month and our portion was going to be about $750. We still had $20 co-pays for visits and medicine. We switched to a PPO thinking we would save money. It didn’t. It was a nightmare. However, not once did I think someone else should be taxed to reduce my bills.

    We finally moved to an HSA. Current deductuble is $3600 and our cost is about the same in premiums. So we pay about $7200 for medical coverage. The HSA has been the best plan yet.

    I hear people complaining that they only make this and make that. I’m with PizzaForADream. I’ve worked two jobs most of my life and my wife even does some day care. If you don’t make enought money, find a 2nd job or do something to earn more funds. It isn’t my job or PFAD’s to be taxed to help pay your health care. I don’t think Health Care is a right. We’ve had our share of medical problems and emergencies. We have always had to work with the hospitals and insurance companies to get them paid. In the USA, you have the right to pursue happiness, not to it.

    As to McCain Vs. Obama. I heard in the debate that the credit was to the person, not the company. I’ll have to go read the text. But again, I’m not in favor of that anyway. I think the biggest difference between them is one (Obama) believes they know better how to spend your money (higher taxes). The other (McCain) believes you should make your own decisions (lower taxes). I will say I believe the whole party system should be scrapped. Most of us tend to vote our party instead of who is the best candidate. The party system also generally only leaves us with two viable candidates. I would certainly love to pick from a bigger field.

  • For the Pizzadude and those of like-mind, the bootstraps theory is a lovely thing. However, it’s important to keep in mind that your personal experience does not equate universal truth. (Say that over and over, like a mantra. It actually can create a greater capacity for tolerance.) Yes, even if you’ve managed to travel a lot with your job. It’s a big, diverse world with many different paths. Your path is not one that is appropriate or applicable to anyone but yourself.

    This issue troubles me greatly when I see the general populace discuss it. Screaming about “socialism!” and the like just makes me cringe. Successful, stable, post-consumer industrialized nations have complimentary aspects of differing economic models in place to best care for their citizens. But for some reason, citizens of the United States seem to respond with alarmist, knee-jerk rhetoric to paradigms deemed unfit during the Cold War. Times have changed. Integrated systems work in multiple countries. Yet we are still screaming about “socialism!” and “privitization!” Sometimes I think our current mess of a health care system has more to do with mass stupidity than corporate corruption.

    On a less judgemental note, McCain’s plan worries me because group protections could be eliminated, making coverage extremely expensive and/or unavailable to many people, particularly those with existing health conditions. Obama’s plan would provide care for the uncovered. As someone who works for a health-related non-profit, I’m encouraged by this. We provide protection where the government falls short, particularly for those who are denied care at traditional medical facilities (again, sorry Pizzadude–most of my family is involved in the medical industry throughout the country and have been told to turn people away who come in for care. Mandantory care is only provided in emergency situations. As a result, non-profit groups have to take up the slack, if they are able).

  • I’m glad Obama won. I hope his administration leads to the change that he campaigned about. We shall see if universal health insurance will pan out. It will be hard to implement.

  • Actually our U.S. system discourages small business and entrepreneurship and innovation/risk-taking. Due to the fact that adequate healthcare is tied to your job, many people I know are unable or afraid to take the leap into small biz.

    It’s unfortunate that most americans buy into the ‘big government’ would ruin the current (bad) system. Most people would benefit, even successful entrepreneur-types.

    Unfortunately many people like pizzaforadream won’t understand unless he personally suffers a catastrophic or chronic illness that would make him uninsurable.

  • @PizzaForADream: But the wonderful quality of life enjoyed by US citizens is what makes the state of the country’s healthcare system so shocking, surely? It’s out of sync. The USA is the only wealthy, industrialised nation in the world without universal healthcare. How has this enabled the USA to have “led the world for two centuries”?

    Tax in the UK, btw, is 20% on earnings up to £34,800 ($60,000). Earnings over £34,800 are taxed at 40%; around 7% of the population is taxed at the higher rate.

    Every year, £81.5 billion of our tax revenues go towards healthcare (UK billion = 1,000 million). This works out at just over £1,350 ($2,338) per year for every man, woman and child.

  • As a fellow Brit, I’m with Plonkee! For us, healthcare is “free at the point of need” – and it’s a right, rather than a privilege. You could be run over by a bus tomorrow – but if it happens here, you’ll get good medical care regardless of your place in life and you can concentrate on getting better, rather than having to worry about how you’re ever going to pay back the medical bills.

    @PizzaForADream: When I read views like yours, I am stunned that people can actually think like this. The USA’s maternal mortality rate is twice that of the UK’s. An estimated 40 percent of those deaths are preventable, and are attributed to poor quality of care. Black women are three times more likely to die in childbirth than white women. That’s not “opportunity”. That’s disgusting.

  • You are missing one point with the McCain plan. Yes your taxable income will go up $2880, but you will get a credit for $5000. So you take your increase in taxable income times your tax rate, I’ll assume 25% for simpler math (2880 x .25=720). Your tax liability goes up $720 but you get $5000 refundable credit. So assuming that $720 is your only tax liability, you will receive a refund of $4280. When looking at this plan you need to remember to multiply the cost of your insurance by your ta rate before comparing it to the $5000 refundable credit.

  • won’t the tax credit go to the insurers, though, rather than directly to the individual tax-payer? that’s my understanding from reading mccain’s site.

  • Pizza, people are not turned away for care if they are dying RIGHT NOW, but otherwise people who cannot afford it are turned away every day. This means that people sometimes die from ridiculous things like a toothache. Try going to a doctor for a pain and telling them that you don’t have insurance and can’t pay, and see what they do.

    I know many people who are very unhappy with our current health care system.

    What upsets me about both of the proposals is that neither of them address how to help people who cannot afford coverage. I guess that’s what Medicaid is supposed to be for, but there are lots of people who do not qualify for that and cannot afford health insurance otherwise. You wouldn’t believe what I had to go through to qualify for disability insurance — insurance that I was willing and able to pay for.

  • Go into the ER’s in any hospital and Texas and tell me that people are turned away. In fact, down here hospitals are failing and going out of business because they are REQUIRED to provide care. Even for those here illegally are given care. No system is PERFECT when humans are involved.

    In my 13 years in the Air Force, I travelled all over the world and it was “USA appreciation day” every time I was gone. There is NOWHERE in the world like here. Unfortunately, most American’s are so spoiled that all they can do is complain. Spend a day on the streets of Nairobi, Kenya or on the streets in Saudi Arabia or in many parts of Europe and your perspective completely changes. A simple think like having ice in your drink (which we all take for granted) is a LUXURY in 95%+ of the rest of the world.

  • I live in Canada, which offers universal healthcare. I love it. I’m not saying it’s perfect, because nothing is. I completely admit that our system has problems, but I think the benefits far outweigh the detriment. I’m young (under 30), and thus far healthy (thankfully), which means that ostensibly the money I’m paying in now through taxes is funding other people’s healthcare. I’m okay with that; I don’t need that money, and since it’s taken out of my pay before I receive it, I frankly don’t notice it being gone. I also recognize the worth of social health; a healthier population is beneficial to my personal health. Why should my higher income give me more of a right to treatment than someone with a lower income? There are so many ways in which society gives us (the comparatively wealthy) have great advantages over the poor. I don’t think access to healthcare should be one of them.

  • I believe that this credit is sent to the taxpayer with your normal tax refund. I think the McCain site is trying to say that you can go out and find insurance and pay for it yourself rather than having your employer do it. The wording is confusing. I have been discussing this in a graduate Tax Policy class, and this is the way all the professors have interpreted it as well. The challenges of lining up each taxpayer with the insurance company that they have would be a great burden, and nearly impossible to do on a national level.

  • I don’t believe folks really think life under Obama will be better. Can you say SOCIALISM?!! He, Pelosi, and Reed, et al are lining up all the legislation you can imagine to seize control of every aspect of our lives and “entrust” it with the government. With no filibuster ability in the senate (potentially) and therefore no checks and balances, the next 4 years will be the end of our dominance in the world and our way of life. Don’t know about you guys, but I’ve never seen a government bureaucracy that wasn’t fraught with waste (spend 13 years in the AF)! What makes you think this is going to “magically” change?!!!

    Our country was founded on the right to “PURSUE happiness,” not to have everything given to us! I apologize for those of you that have health challenges or excessive medical bills, but God didn’t make the world “fair” and we will each have our own battles to fight in our lives. As I grow older in life, I won’t expect each of you to share my medical burden and don’t care to share yours either.

    We live in the greatest country in the world with the most opportunity in the world. Go out and create a future for yourself!! If you don’t like the money you make or the situation you’re in-change it!!! Start a business, develop the next BIG IDEA. Get out of your rut and pursue your dreams!

  • @Mike — you’re mistaken. McCain’s $5000 credit goes directly to the insurer, not the insured (you and me).

    To answer the question: I have employer-provided health insurance. It covers me and my two children. My husband is 73 so he’s covered by Medicare and a Medicare-supplement program.

    Our current situation: my employer (a small corporation with two full-time employees — me and my husband) pays approximately $1,300 per month (!) for our PPO insurance coverage (medical, dental, and a completely useless vision plan). Our deductible is $1,000 and our co-pays are $25 for an office visit, $50 for a specialist, and $75 for emergency care.

    Our future situation: my husband plans to retire. When we dissolve the corporation, our access to group insurance plans will dissolve too. We’ll be faced with paying for our own insurance — a thought that absolutely terrifies me. I have all sorts of preconditions plus I’m pre-menopausal. I know from experience that if I can even get insurance (no guarantee), it will exclude all of my pre-existing conditions plus they’ll exclude all of my female risk factors. My daughter is healthy (though accident-prone). My son, however, probably has Asperger’s — an issue only barely covered by our current insurance and certainly excluded in future private insurance coverage.

    I had a friend trying to get insurance. She was in excellent health with no pre-existing conditions and the only company that would even cover her wanted to exclude coverage on her breasts, her ovaries, her cervix, etc. All of the typical cancer risk factors for a middle-aged woman. Her premiums would have been about $1,200 a month and they wouldn’t have covered any of the health issues that she might need coverage for.

    This year alone, we’ve had three visits to the ER/Urgent Care for my daughter. My son had to be evaluated for liver disease, needed a series of blood tests, and most recently broke his collarbone (Monday will be our 5th $50 co-pay for that event alone not to mention the ER costs, ambulance costs, etc). Plus he needs a full-panel neuro-psych evaluation that the insurance company doesn’t want to cover because they don’t have a single qualified in-network provider in our entire state. And 4 weeks ago I had surgery and an overnight stay in the hospital. If not for insurance, we might be in danger of losing our house because of the huge medical bills.

    You can see why I’m terrified to lose our employer-provided group insurance coverage. My only consolation is that my husband (twice a cancer survivor, battling cancer for a third time, high-blood pressure and pre-diabetic) has Medicare and won’t be facing the pre-existing-condition monster that I face.

    As for my medical insurance history, like you I’ve had it all — from nothing, to student coverage, to major medical, to full coverage.

    For those with the funds, I don’t believe you can beat the quality of care available in this country. And I don’t believe any government can offer a socialized medicine plan that could compete with the quality of care provided under a good insurance plan. But the fact that huge numbers of citizens (esp. children) have no insurance and don’t have access to adequate medical care and the fact that families lose everything they have when a medical crisis hits — there’s something deeply wrong with that scenario.

    Although I have fears about Obama’s plan (which, btw, is NOT socialized medicine), I think it’s vastly superior to McCain’s plan.

  • Ooo, ooo, I can help with this! I am a government employee, so I’m giving you all the link to our health insurance (dental and vision insurance is on another website, and I’m assuming not a part of Obama’s plan). What you pay depends on the plans you choose, and obviously what I pay is not the full cost of the insurance–the gov’t chips in for the rest.

    Right now, I’m on a regional HMO plan that costs me $45.52 every two weeks. My catastrophic limit (max copays) for the year are $1,000 and I don’t have a deductible. Copays of $10 to $20 for doctor’s visits (primary vs. specialist) and $10 to $20 copay for meds (generic vs. brand name). The same plan is $125.89 every two weeks for family coverage. Monthly, this would be $98.62 and $272.77.

    It’s a pretty cheap plan, but it covers the things I care about and I can switch every year or (I think) when there is a life qualifying event. All in all, it is what works best for me right now.

    Play around with it, see what sort of coverage you’d get under Obama’s plan if you qualified for it.

  • Mike, I thought the $5000 tax credit was only for people who DON’T have employer-sponsored health plans…

  • The U.S. private system does NOT work, period. The insurers are trying to make a profit and one of the best ways for them to profit is to take your payments (or your employer’s payments) and then NOT pay when you actually need it. I have been fully insured through work most of my adult life but I still have had to fight for coverage time and time again. I’ve always won because I learned how to fight them but it shouldn’t be this way. I can’t imagine having to fight if I ever got really sick. I also know many people that have fought against denied claims. Not everyone has the time, energy or smarts to fight insurers and they know it.

    We should put the Healthcare system on the same footing as police and fire department – these are essentials, not something that would be nice to have.

  • I live in the UK. I’ve never had to worry about paying for healthcare at home and I will vote to maintain this system. One of the downsides is that Brits often don’t think to buy travel insurance when they go abroad (which is often) and since most people don’t have health insurance at all (since it’s free at home) you can see where that goes wrong.

    When I was a student, I spent 3 months living in the States on a J1 visa and had travel insurance arranged by the people that organised the visa. One of the other British girls I was with needed to go to the doctors and get a prescription for something that wasn’t covered by the insurance (it was essentially catastrophic cover). In the UK this would have cost her £0 for he doctor’s appointment, and up to £6 (at the time) for the prescription, or you can actually pay about £20 to get it over the counter at full price. In the beach resort we were living in, her doctor’s appointment was $70 (they gave her a discount) and the cost of the drug was $30. Our take home pay was around the $185 a week mark.

    I’m not a fan of the current American system at all.

  • It sickens me that for such a ‘prosperous nation’ we fall short so evidently in regards to our healthcare. It’s sad for many people.

  • Thanks, Mike & CH. I have edited my post to reflect that. (I was originally going off what I thought I heard McCain say in the debate. His web site does say the same thing as the article cited, which is that the tax credit would apply to everyone.)

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