April 2, 2008 – USA Health Insurance (Rant)

Once in a while, I gotta rant. This time, it’s about how fouled up the health insurance situation is in the states.

Most places that I have worked touted themselves as being on the cutting edge of health insurance reform (I’d say health insurance gimmicks). Most of these changes resulted in the employee paying part of the premium.

When we first heard about this, it was called “Flexible benefits” because you got to choose your health plan, and balance that choice against how much more you would pay each month. This soon became the norm.

Another place I worked pushed even more. At first, they provided you a way to measure your health via a questionnaire. You could do this or not – it was supposedly anonymous (but we suspicious types never really believe that). The next year, you got a discount on your premium if you completed the health questionnaire. The next step was this – if your health measurement indicated you had a problem or a health risk, you got a discount if you did something about it. For example, if you smoked, you got a discount if you joined a stop-smoking program – the discount applied even if the program didn’t work, and you still smoked. Likewise for a weight-loss program. The final step (although there is probably still something that can be squeezed out), was that you only got the discount if the problem got better – you stopped smoking, lost weight, etc. Written this way, you could argue that your health is important to them, and that they are providing incentives for you to get healthier. Cynics would say something a bit different.

If you tie in the insurance changes with the cultural effects of professional life in the Silicon Valley, you get a potent mixture. Life revolves around work. Stress builds up. Health suffers. The attitude is “Oh you’re sick? Did you get that report done?” You see co-workers coming to work with fevers, still working outrageous hours, because they have deadlines and expectations. You get a culture clash when you find out that people in other parts of the company go to their child’s soccer game in the middle of the afternoon (Don’t these people have any sense of priorities!?!?). THEN you find out that you’re expected to join programs to reduce the health problems largely caused by spending so much time at work. And just when are you supposed to go to these programs? So you end up resenting the system and paying more for your health insurance. And you aren’t any healthier…

So, this was just a low-level irritation for me for decades until I asked my health insurer about gastric bypass surgery. Then the irony hit full force. You have health insurance, which you pay more for because of a weight problem. Certainly, you do things like diet and exercise to help it. But there is no way you are going to go to a doctor multiple times per month for three (3) years for a medically supervised program – how can you do this when you don’t even have enough time in the day to get a full night’s sleep? Since retiring, I now had the time and the insurance (18 months of COBRA) to really do something about it. But the insurance won’t cover the surgery unless I have proof of a medically supervised weight-loss program lasting 3 years. This is not what I call encouraging better health. This is more like looking like we care while not paying for surgery.

If you read this, you know that I went ahead with the surgery. I had it done in Costa Rica. It cost about a third of what it would have cost in the states. It cost me about double what I would have paid out of pocket if insurance had kicked in. It didn't - I'm healthier without the insurance.

I realize that my situation is *nothing* compared to so many others. I don’t have cancer, I don’t need a transplant, I don’t need anything experimental. But this is just one more item showing how manipulated we are.