U.S. Health Insurance A Nightmare

Armen Hareyan's picture

On 1 August, the health insurance that covers my family for about seventeen years expires. So, I tried to keep the same health insurance provider Kaiser Permanente, but this time as a private individual. Until now, I had the chance to benefit from a "group coverage." While this is complicate, I will try to explain by the lens of my own experience how the U.S. health care system, to what extent and how quickly it can become frightening.

For years my health care expense were covered by Kaiser Permanente Insurance Company through a business for which my husband worked. Losing one day my medical insurance was not part of my concerns. Indeed, it is illegal for a health insurance company to reject a person whose "application" is submitted by an employer, regardless of health status and medical history. The reason why millions of Americans will choose one job over another is also, unfortunately, often linked to the type of health insurance offered by the company, not the merits of employment.

In the event of divorce or redundancy, you can keep the same health insurance for a period ranging between 18 and 36 months, through a health plan known as Cobra. This is, of course, if you can cover the entire monthly cost. The cost of Cobra health insurance is rather higher than a coverage provided by your employment.

In short, in August 2006, I found myself in the position to endorse Cobra. I was fortunate to have some savings and judging from the invoice things, for a woman with three children, looked like this: $531 dollars a month for the cost, add to that $15 per visit, $100 for a passage to emergencies, $10 per item, etc. At least I had the peace of mind that we had a health insurance coverage through Cobra and Kaiser could not get rd of us. But then, the compilations began.

The nightmare begins when trying to purchase an individual health insurance without the support of a company or a union.

It's been seventeen years that I am about insured by Kaiser Permanente, however, I had to fill out a lengthy questionnaire on the history of my health, as if Kaiser does not already know all the details. After a few pages I began to feel anger. The same questions come in different forms. The trick is known: they are made to mislead and incite you to answer something erroneously with the best intentions. If you are one day hit by a serious and expensively treated disease, your health insurance company may take your case, examine under the microscope and accuse you of lying. It has the perfect excuse to evict you.

Those cases are numerous. Let's say you forgot to declare candidiasis or a bad flue during your adolescence. You may be released from your coverage. Or, let's say you drink too much wine, have undergone surgery, have a little diabetes or cholesterol, forget the coverage. If you do not have a chance to have an employer, you might never again be covered. I know a man whose 19-year-old son has recently been made of something benign. He has just been informed that his son will never be covered by an individual health insurance.

Now turn let's turn to the premiums. They are scandalous. A few years ago, Kaiser was one of the latest HMO companies (Health Maintenance Organization) to provide roughly one health insurance option for all individuals. With a monthly, fee depending on the fluctuating number of members of your family, you were entitled to a very complete and satisfactory health coverage. It is no longer the case. Kaiser now offers dozen alternatives through which it is extremely difficult to navigate.

After having decided for the option at 616 dollars a month (at first sight the more interesting for my family), I finally realized that for this price, I had a $7000 dollar deductible. After that, the hospital would cost me $500 per day, drugs are not covered at all and that I should pay $50 per visit to the doctor. This means that unless there is a catastrophic event, the 616 dollars per month would be used strictly for nothing. I spent time looking at the details of the other health insurance plans. There is not one that is higher in terms of acceptability then the other.

In the United States, health problems have contributed to 62.1% of individual bankruptcy.

I came to the conclusion that it might be cheaper not to subscribe to health insurance, but it is still possible to have an accident and find myself completely in the hay. But again, be assured there is no guarantee. According to a recent article in the American Journal of Medicine in 2007, health problems have contributed to 62.1% of individual bankruptcy in USA. 77.9% of these victims were initially covered by health insurance. Insurers almost never cover the full costs of the care and in some cases even paying 10% of the cost of treatment can rush you into a financial abyss.

From all the HMOs that I have seen, Kaiser Permanente is by far the best. I never had to complain. That's why I wanted to keep it.

There are two health systems in the United States: the HMO and PPO (Preferred Provider Organization). With the first, you pay less, but your choice of a doctor is reduced. With the latter, it is more extensive: you see a doctor that you want, but your monthly bill is higher.

This is the health care and health insurance system that Obama wants to reform. The goal is that everyone, without exception, can receive health insurance coverage. Currently, nearly 48 million Americans are uninsured. However, the Republicans cry socialism. What horror! If the reform presented by Obama was enacted by Congress, we run the risk of being covered by the state, which would obviously be worse than not being covered at all, as everyone knows.

Republicans also argue that with a public health insurance system Americans would no longer be able to choose their doctors and their care, as if they had already! Moreover, the reform provides for the coexistence of two systems, public and private. However, since the private health insurance is more expensive, insurers are afraid to lose customers. They are losing anyway because fewer and fewer Americans find health insurance affordable. Others think that current system is useless.

Written by Armelle Vincent
Translated from Rue 89 (Rue89.com)

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