The young guy was pacing the waiting room hoping for good news. The news wasn’t good. The initial diagnosis was that his eight year old Nissan truck needed a new battery. He agreed to the estimate - $264 for parts and labor. Was that a good price? Before either of us had much time to ponder the question, the repair shop’s manager returned with new and even worse information.
“We tried to jump your truck. It won’t turn over. It looks like you need a new starter.”
A new starter? What happened to the battery?
“A failing starter can weaken the battery. The starter will be $614. We may not get it done till Monday. The starter isn’t easy to access on your truck.”
It may have appeared that the young guy had to make a decision, but that really wasn’t the case. He had had a choice, where to receive (car) care. His truck was having difficulty starting and he picked this particular shop. He either trusted them or he didn’t. And if he didn’t, it was too late. His truck was on the rack.
The manager came out and mentioned that the back brakes didn’t need immediate attention, but would soon. The total cost, battery, starter, brakes, etc… was $1,544. Shocked, but now empowered with a choice, the young guy agreed to the starter and battery.
There is an illusion of choice, a fantasy of control, in health care that is no different than what the young guy experienced at the repair shop. Can we really turn down one more blood test? Is this CT Scan really necessary? Do we really need another pill? Who are we to question our doctors’ recommendations?
Some of our friends on the Right never miss the opportunity to cite what they call President Obama’s biggest lie, “If you like your doctor, you can keep your doctor”. It wasn’t a lie. It was a mistake. As many in Greater Cleveland learned this last year, your insurer can add or subtract doctors at will. You don’t have any control over the network associated with your policy. At best, you might be able to purchase a different policy that will grant you access to the hospital of your choice.
The Patient Protection and Affordable Care Act (Obamacare) was a poorly crafted law that had/has more than a few flaws, but it does contain many important consumer guarantees. The PPACA codified both guaranteed issue and the ten Essential Health Benefits. That insurance card in your wallet is your ticket into a hospital, a doctor’s office, and the maternity ward. This is particularly important when your employer, not you, gets to decide your insurer and coverage.
Those guarantees are about to be dismantled. The administration is promoting the creation of association policies. This blog, consumer groups, insurance commissioners, and almost every organization that places the importance of access to health care above the politics of health care, have noted the risks of association policies. Our concerns have fallen on deaf ears.
The American Cancer Society’s Cancer Action Network was one of the first to sound the alarm:
ACS CAN opposes any policy changes that exempt Association Health Plans from federal protections that are critical to cancer patients including prohibitions on pre-existing condition exclusions, Essential Health Benefit coverage standards, maximum out-of-pocket limits, and prohibitions on annual and lifetime limits. ACS CAN also opposes removing Association Health Plans from state regulatory authority which could severely disrupt the insurance market.Will your employer’s new group policy cover your preexisting condition or your wife’s pregnancy? My personal claims exceeded $600,000 in 2016. Are we about to return to group health policies that max out at $250,000 or only $50,000? This is not an exaggeration. This is not fearmongering. Those policies existed just a few short years ago. The PPACA ended all of those concerns. Association plans will return us to those days.
When will you find out that you’re not really insured? When will you realize that you have coverage in name only?
The young man called his wife for a ride to work. I was at the repair shop for an oil change (preventive care). As the clerk handed me my keys, he mentioned that my tires were OK, currently at 9’s. I reminded him that I just purchased them from him last month.
Photo – Still Tired – David L Cunix