From the end of 1997 to mid-2005, I was uninsured. After I moved from Massachusetts to California, I took advantage of the lower rates out here to get a catastrophic health plan. It was catastrophic all right. It paid for virtually nothing. Once I had to get an X-ray; I checked the web site, and it said that X-rays were covered. I got the X-ray. When my claim was rejected, I called to ask what was up. I was told that because this was a catastrophic plan, what that line meant was that X-rays done in the course of emergency care were covered. "So I should have gone to the emergency room?" I asked. Long pause. Well, no, the insurance rep said — if I could actually choose to go in and get an X-ray, that wasn't enough of a catastrophe.
This was representative. I've had various minor health issues over the years, for which by far the most common reduction of my bill has been zero. Once I had some very minor surgery done on my hand, just a few hundred bucks; the insurance did cover $38.50 of that. I think it also knocked a prescription down from $120 to $105 once. Aside from that, it was "Paid Amount: $0.00" after "Paid Amount: $0.00". I was very much looking forward to signing up for a better plan when the open enrollment period started in October. Then of course there was the infamous "troubled rollout". My issue turned out to be that the Covered California web site couldn't handle people with irregular incomes like mine. "How much money did you make this month?" Well, zero. Wait, don't put me in Medicaid. Here's a month when I made eleventy-five gazillion dollars! Wait, don't make my premium eleventy-four gazillion dollars. I wound up waiting until I'd done my taxes for 2013, then going to one of those "navigators" with my latest return and a bunch of old ones, to get my information into the system that way. Here was the result:
The last time I had blood drawn, under my old plan, it cost me $884.94 (not a typo). Under the new plan: $3.
My old plan knocked about 20% off the price of a prescription. Under the new plan: every prescription is $3. I've recently been prescribed about ten different things, so this has saved me gobs of money already.
My insurance kicked in March 1st and within two weeks I actually had a bit of a medical emergency. (It was the kidney thing again.) In the past I've had to weigh the pros and cons of seeking treatment, one of the main cons being the $613 bill that would show up later. This time I couldn't just make an appointment at my usual doctor's office — the receptionist put on his best regretful voice and said that the place doesn't take my particular ACA plan — but it was probably a bit urgent for that anyway. I found another provider through the web site and went there posthaste. I saw the fee schedule there — pretty eye-popping. My cost? All together now: $3. "But you couldn't keep your doctor!", opponents might object. Well, sure I could have, if I'd paid out of pocket, and since my old plan didn't actually cover anything, it would have cost the same as usual. What I couldn't do is keep my doctor and get the mega-discount. Sticking to a junk policy that doesn't offer a mega-discount anywhere is not much of a solution.
But what about the premiums? Couldn't you apply what I just said about doctors to insurance plans? I could always have gotten a plan with better benefits if I'd just paid more! Doesn't this law just force people to do that instead of letting them make their own choices like grownups? …Yeah, not so much. Compare:
Old plan: $113/month
New plan: $45.59/month
That's right: the new plan is less than half the cost of the crappy one. Now, if I secure another windfall, then yes, I will have to pay quite a bit more. But I will be able to do that because, y'know, I'll have the windfall! What strikes me as interesting about this concern is that it inverts the basic idea behind insurance, which is: I'm doing okay now, but I'll sacrifice a little now so that if my fortunes take a turn for the worse, I can't fall too fast. Worrying about paying back subsidies due to unexpectedly high income is essentially a matter of grumbling, grr, this may be a pure benefit at the moment, but if my fortunes take a turn for the better, I'll rise a little slower! It's bad enough to complain about the proverbial "good problem to have"; worse still is to complain about a good problem to have when you don't even have it yet.
A while back I overheard a couple of neo-hippies at the farmers' market proudly declaring to each other that they didn't vote, because it just meant endorsing what I guess we are now calling the "evil corporatist oligarchy" or something like that. The thing is, I too am way the fuck left of the Democratic Party. I believe in social democracy and long for the demise of the sadistic plutocratic class that is destroying the world. I'm not an incrementalist by nature, and the ACA fell far short of what I would have liked to see in the way of health care reform. But this business of nobly refusing to back the lesser of two evils is bullshit. A few days ago I was in physical pain, direct suffering that doesn't yield to argument, and now I'm not, and the reason I'm not is that the Democrats swept the 2008 elections and enacted this incrementalist half-measure. So if you're here to ask your blogger whether incrementalist half-measures are right for you, I can tell you that so far I give this one a thumbs up.
(Addendum: I posted this over at the Daily Kos and someone pointed out that I hadn't mentioned the deductible on this plan. Good catch! The deductible is zero.)
Update 2014.0415: Speaking of half-measures! About a month after I posted the above, I got a bill for my trip to the urgent care center. Apparently the $3 I paid up front wasn't the end of it after all — they want another $57.69. This is still a significant improvement over the insurance I had before: under my old plan, my bill would have been $230. But it also shows that we still have some distance to cover before we can match those countries where you pay your premiums (or just your taxes) and actually receiving medical services comes a nominal cost or no additional cost at all.