***Warning - extreme geekitude complete with numbers ahead*** 

I've been reading the stories here and elsewhere about people who don't have insurance, and are forced into bankruptcy by chronic illness, or just one bad accident, and getting sicker and sicker to my stomache, but now, I'm starting to realize that it's not just the uninsured and the underinsured in this country that are in danger.  In the last few years, insurance has gotten to the point where it’s no longer insuring anything.  One of the points behind having health insurance is that you pay into the system for a lifetime, knowing that if you do so, you will be covered if something catastrophic happens.  Now, with the coverage levels being lowered every year, and the premiums raising, any health crisis is going to send me (or anyone else who is middle class, let alone at the poverty level or below) into permanent debtedness or bankruptcy.

I am a fairly typical federal worker – don't you judge me!  Ok, go ahead and judge... but at any rate, I’ve been with the Government for 20 years, and part of the Federal Employee Health Benefit Plan or FEHB for all that time.  When I first started, my contribution was $19 every two weeks, which entitled me to consultation with my doctor at a copay of $5 per trip, prescription drug coverage at a reasonable copay of $5 for generics/$10 for brand name, and the knowledge that if I was hospitalized, I would have to pay a $50 per day fee, but that everything else was going to be covered, and I wasn’t going to have to worry. 

Life changes, and I got married, so I did switch over from single coverage to married coverage in 2001.  But even then, I was paying $80 every two weeks, my copay was either $5 or $10 (I can’t remember which, but it was one of the two), and while it had increased, it was still livable. 

Now, in 2009…  I’m paying $164 every two weeks (so my contribution has increased over 100% in the last 8 years), my copay has increased to $20 for an office visit, my prescription drug copay has changed to reflect that I pay a percentage of the drug cost (30% for brand name drugs, 20% for generic drugs), I have to buy my own vision and dental insurance separately, and if I’m hospitalized, I’m expected to cover 20% of the charges.  Oh, and there is a $300 per person deductible annually, just to add to the cost.

If I add together my bi-weekly premiums and my employer contribution (that’s another $352 every two weeks), my vision coverage ($10 every two weeks) and my dental coverage (another $35 every two weeks), it comes to just under 25% of my gross salary.  That’s just for premiums – that’s the cost to me before I even think about using the service.  One fourth of my total income is going out to an insurance company just to make sure that if I do get sick, I don’t go bankrupt – and that’s with the OPM, the nation’s largest employer and most powerful negotiating group, setting up the insurance, so it should be the best deal available.  It’s the deal that senators and congressmen get – I’m still amazed that none of them have looked at it and said “Wait a minute – I’m paying $14.5K a year just for health insurance premiums?”

Now, I do have some serious medical issues, so I may be a little more sensitive to the whole “health care cost” than most people.  I am an insulin-dependent diabetic with sleep apnea and lung issues, so I have to sleep with an oxygen concentrator, and I have several prescriptions.  To cover my share of the costs, and my deductible, and my copayments for doctors’ visits, I have set up a HSA for the year, which is why I know the amount I’ve spent (and conversely, that BC/BS has spent on me) for medical care this year.  So far, I’ve spent $1,973 on copayments/prescription costs/deductibles/medical equipment rental.  Figuring that $300 of that was a deductible leaves me with $1,673 – that’s 20% of the costs, so I’ve cost Blue Cross $6,692 (give or take a few bucks).  Assuming that spending continues the same, that makes it around $9K for the year.  I will have paid into the system $14.5K.  They’re making $5.5K just off me, and I’m a fairly high-cost average individual.  But again, I understand – we pay into the system, so that if something catastrophic happens, we’re covered. 

But are we?  Last week, something happened that brought home just how inadequate this coverage is.  I have a roommate who lives with my husband and me.  (He lives with us because $12 an hour doesn’t go as far as it used to, when an average one-bedroom apartment is $600, but that’s a rant for another day.)  He has also worked all his life, and he has similar insurance to mine through his work (a little bit higher deductible, but similar.)  Tuesday night, he started throwing up uncontrollably, to the point where we had to call an ambulance, and he was hospitalized.  They were never quite able to pinpoint the reason why he was vomiting, but they did manage to stabilize him, stop the vomiting and he was finally released Friday morning…  along with a bill for his 20% of the charges – around $1,200.  He knows that he’ll also be getting a bill for $500 to cover his deductible, and another $75 for the ambulance ride, plus he’s got 6 new medications that he’s supposed to be taking to try to lower his blood pressure (another $100 monthly there)…  He’s played by the rules all his life, paid into the system, and yet, one bout of the flu or food poisoning could put him into debt for years.  And then I hear that in the proposed bill, Congress is thinking about lowering the insurance company’s coverage from 75% to 65% (or possibly lower?) to try to "control costs". Why on earth would they do that?  As an inducement to not use frivolous medical services?  Do they honestly think that forcing my friend to pay $2000 dollars instead of $1200 is going to make him less likely to end up throwing up uncontrollably?  Or possibly they think that my friend is better able to pay the extra $800 than the insurance companies that have been posting record profits and paying their CEOs $11 million dollar yearly salaries? 

This is why we need a public option, not just to get insurance for the uninsured, but to protect those of us who are insured.  In the past few years, private insurance has gone from being adequate, to insanely expensive and ineffective.  We’re paying more and more for less and less…  from “Well, dental has gotten too expensive, so we’ll take it off the policy to keep premiums down, and you can cover it with a separate policy” to moving from 90% coverage at 80% coverage to 60% coverage, to eventually getting to the point where it’ll be cheaper to just go ahead and pay cash and pray we don’t get anything chronic and expensive.  We need another option to keep them honest – or at the very least, we need effective regulation of the health care industry.  Yes, some may call it socialism, but in this case, capitalism is clearly not working.  In order for the markets to work effectively, all parties need to be bargaining in good faith, and frankly, the insurance companies have not shown me any indication that they are anything but for-profit pirates, plundering our GDP to line their own pockets.