A View From the Losing Side of Health Care


For the last three hours I’ve been crunching numbers, trying to figure out how not to pay $600 to $800 a month for a health insurance policy that won’t cover any medical expenses until I’ve paid anywhere from $7000 to $9000 in deductibles. Then, even if the deductible is met, I’d only get partial benefits until I pay an out of pocket maximum ranging from $11,000 to $14,000. I’d reach these totals only from a catastrophic health event – a hospitalization, emergency room visit, or devastating diagnosis.

I finally conclude that I have no choice. I’ll be paying for the promise of a service that I’m not likely to use in 2016. I’ll be responsible for all of physician visits, medications, labs and most tests. I’m in this position because I’m one of the 200,000 people who lost coverage when Health Republic Insurance was forced to close its doors this month.

I’ve been looking at the silver plans, but out of curiosity I pull up the pricing for the platinum–the best coverage money can buy. I’m almost embarrassed to look at these plans. I know they’re not for me, a lowly middle class freelancer. The premiums range from $1200 a month to $1900 without the government subsidy. Even with my subsidy, most of these plans would cost me roughly the same amount as my monthly mortgage. For that price, I don’t have to meet a deductible, but I’d still have to cover copayments ranging from $15 to $600 until I reach an out of pocket maximum of $4000.

It doesn’t seem so bad, but then I think about that $1500 and how hard it will be to pay each and every month. My income fluctuates. I lose clients, get new ones, lose them again. There were some months this past year that it was hard for me to pay for my $660 premium with the now defunct Health Republic Insurance. I had the platinum plan with them and it was actually affordable, except my therapist dropped out of the plan in March and my primary care physician dropped out in July. So, I didn’t even use the benefits much.

I close my eyes and imagine not worrying about the cost of a doctor’s visit or a prescription. It’s not that hard to visualize this because I’m able to do it for my children. They are both covered for $30 per month under Child Health Plus, a NY State subsidized health insurance plan available for all children 19 and under. For $30, all their health needs are met with no copayments, coinsurance or deductibles. No surprises.

But this luxury is not in the cards for me. My husband and I are perpetually, perennially destined to be under insured. Before the Exchange, I purchased plans through local business organizations and watched helplessly as my family’s deductible climbed higher and higher each year. It was $9000 the year before I switched my children to Child Health Plus, the same year my daughter , then 11, was diagnosed with cancer. In the span of three months, I was responsible for over $20,000 in out of pocket medical costs.

Some months, after I pay my insurance premium, I don’t have more than a few hundred dollars in the bank. Okay, it’s most months. That’s what kept me from going to the dentist when my jaw started to ache and my tooth started to throb. I’d just paid out of pocket for my regular cleaning and check up and I’d had no cavities. I didn’t want to pay another $150 and I figured the pain would pass. I was wrong. My top left molar had cracked from clenching my jaw in my sleep, something I’d started doing since my daughter’s diagnosis. I could’ve gotten a night guard a few months earlier, but it was $500 and I put it off.

I had an abscess. The dentist recommended I have a root canal at a cost of $2400. He printed out a payment plan for me. I left his office crying and had my tooth pulled by an oral surgeon for $375 instead.

I wonder why dental isn’t a part of most of these plans. Who made that rule? Aren’t teeth a part of your body? I wonder what happens when a health insurance CEO has a toothache. I look up the CEO of my chosen plan, Empire Blue Cross, and try to find his salary online. I discover that Empire is owned by another company called Anthem. The CEO of Anthem, Joseph R. Swedish, was paid a salary of 13.5 million last year, so I guess he’s not worried about getting a toothache.

I make the mistake of looking up Anthem’s profits. According to their web site, they have 70 billion in revenue. What does that mean? Is that one year’s worth of revenue? They insure over 38 million people. That’s so many of us.

I feel, not for the first time, like I’m being harvested for my premium payments, culled like wheat in a field. I do the math. If 38 million people all pay $800 a month, that’s 30.4 billion dollars. What if we all stopped paying our premiums all at once? What if we just…stopped and instead created a big fund to breathe life into the healthcare co-ops that are shutting down, leaving people like me with few to no options. Do I sound like a socialist? I don’t care.

I hate insurance companies. I loathe their existence. They serve no purpose other than to make their shareholders happy and their executives rich. They are the reason that healthcare is a losing battle in this country. They’re the reason we don’t have a public option. They were the cause of the massive rise in uninsured people to begin with. From industry insider Wendell Potter’s book, Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans:

“There is a practice known in the industry as purging. The purging of less profitable accounts through intentional rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61% in 1993 to 38% in 2009.”

I lost a second tooth three months after the first, another victim of night time grinding. I finally spent $500 on a mouth guard and was prepared to get an implant so that I would eventually be able to chew on the left side of my mouth again.

Except there was a complication and it turns out that I need a bone graft before I can even consider an implant at a cost of about $2400 (ironically, the same amount as the root canal would’ve cost me).

I’m still not chewing on the left side of my mouth.

My first three months of insurance premiums for 2016 will cover the cost of the bone graft I need. But now, by law, I have to buy insurance, so no tooth for me. Ironically, the money I’m paying for a service I’m not receiving is preventing me from getting the treatment I need. But I have no choice. I am afraid. I’ve see how much it costs to get really, really sick. The bill for my daughter’s first forty day hospital stay was $600,000.

Insurance companies are banking on my fears. They are banking on yours. What must it be like, working in an industry that thrives on fear? In America, health insurance = life. And that’s why Anthem will undoubtedly have another banner year of unprecedented growth in 2016.