Even after Obamacare—the core provisions of which are possibly about to be ruled unconstitutional by the Supreme Court—the U.S. health care system is based on the premise that open-market competition is the best way to deliver health care. It’s been pointed out elsewhere that this is both theoretically absurd (one doesn’t buy health care at one’s leisure, like choosing a toaster) and factually inaccurate (the U.S. system is only very partially an open market, but because we’re pretending it is, the non-market components of the system are haphazard and inefficient). I’m not out to draft a complete thesis on the failures of the American health care system, just to illustrate them with my own recent experience.
I’m 36 years old, and in good health. For now, at least, I have the luxury of rarely requiring health care—which is a good thing, since my job does not provide it for me. I went completely without health insurance for my first couple of years in this job, because I could get away with it: I knew that if something dire happened to me, Hennepin County Medical Center would take me in and stick the taxpayers with my expenses. (This being the free market and all.) But eventually I decided to do the prudent thing and buy health insurance—thinking that, well, if my appendix suddenly ruptures, it would be convenient not to have to declare bankruptcy.
So where do you go to buy health insurance? They don’t sell it at Target (I don’t think). I asked around, and was pointed to Assurant. After asking me a long series of questions about my physical fitness—this was circa 2009 in Minnesota, when it would still have been perfectly legal to leave me in the lurch if I had any potentially expensive condition—Assurant agreed to hook me up with coverage. For $88.97 a month, I’d have a $5,000 deductible.
I did the math, and that actually seemed fair. If I stay basically healthy and then, like most Americans, die around age 70 in a fantastically expensive manner, Assurant will probably about break even. I have to say that it’s been a little troubling that my premium has since risen at a rate that, if it continues, will make my monthly premium over $4,000 a month by the time I’m 55—but we’ll cross that bridge when we come to it. I did contact Assurant last year to inquire about raising my premium to reduce my deductible, and was told that so few people requested those plans, they’d been discontinued.
Well, there’s the free market for you: unless I find a job that provides health care, I have little choice but to pay out of pocket for anything short of a major medical procedure. Obviously this reduces my incentive to go in for check-ups or preventative care, but what the hell. Who has time for that stuff anyway? I figured I’d deal with any troubling health incidents if and when they occurred.
When turned out to be last fall. I woke up one night with a pounding heart and a strangely tight chest, which seemed very strange since I knew I was in good shape and don’t have a family history of early heart disease. Still, enough of the Google results told me that I was in mortal danger that I went in to the doctor. By “the doctor,” I mean my childhood doctor—or at least to the clinic I’d used as a child, which turned out to still have the records of all the physicals and vaccinations I’d enjoyed back when I was on my parents’ health insurance.
Where else was I supposed to go? I needed an appointment on the quick, and not only was it impractical to compare and contrast prices and services, it might have been impossible. Here’s the conversation I had with the scheduling nurse when making my appointment:
“How much will this cost?”
“You have insurance, right? It will go on your insurance.”
“Yes, but I have a high deductible, so I’m expecting to essentially be paying cash for this.”
“Your insurance will bill you.”
“Right, but how much will they bill me? How much does a physical cost?”
“Oh, God, I have no idea. You’re paying for the whole thing? I mean, maybe several hundred dollars? I really don’t know.”
Okay then. Well, I had to get checked out, so I went in. The doctor sent me for an EKG, gave me a clean bill of health, and told me to drink less coffee and alcohol. At no point was I told how much anything would cost, or asked whether I wanted to pay. They just did what they did, and I went along via not wanting to die or whatever. I actually went in once more, to urgent care, about a month later after being freaked out by some tingling in my fingers. The bottom line basically seemed to be that it was the effects of anxiety—which I do have a family history of—probably coupled with some overdoing it in the booze ‘n’ caffeine departments. Good to know: I’m not dying, and I’ve been fine ever since. Now, back to our story.
It was December, I’d been to the doctor twice in the last month, and I hadn’t been billed one single penny. They just knew where I lived—and who my health insurance provider was. How much health care had I just purchased? I had absolutely zero idea other than the very rough estimate the nurse had given me on the phone. I tucked a thousand dollars away in savings—fortunately, I was in a position to do so—and braced myself for the bills to come.