Good health buys insurance.
Money only pays for the premiums.

According to a 1999 study from the Henry J. Kaiser Family Foundation, available at http://www.pbs.org/newshour/health/uninsured/#, 44 million of the current 300 million American did not then have any health insurance for many different reasons, the primary one being that middle class, employed people simply could no longer afford it. The must-read, sobering book Uninsured in America by Susan Starr Sered and Rushika Fernandopulle describes in chilling details the consequences for the world’s richest country of such a disgraceful situation (excerpt available at http://www.ucpress.edu/books/pages/10379/10379.intro.html.) By 2006, the number of the uninsured had reached 46 million and it is increasing daily.

Being French, I grew up in a system described as “socialized medicine” (whatever that means), in which health insurance premiums are commensurate with one’s income while providing the same amount of benefits to everyone: everyone is charged the same fixed percentage for health insurance premiums instead of an all-across-the-board flat amount. Of note, most of the other deductions taken out of the employed American’s salary follow the percentage system: FICA, Social Security, taxes, etc., and everyone seems in agreement with its fairness. Somehow, however, any suggestion that it would make sense to apply it to health insurance is met with loud and angry protest, Gods knows why. I, personally, don’t get it. To me, that would be more equitable than the current system. Fortunately, I was fully employed while bringing up my daughter, and the bulk of my monthly premium was paid by my employer. However, I was still responsible for a portion of it and, let’s face it, a by-weekly deduction of $67 from a $700 paycheck represents an amount much more considerable than when deducted from a $2,500 paycheck. Like everyone around me though, I bit the bullet and did what needed to be done to see my wages increase regularly. Nevertheless, what needed to be done was not always what I liked to do or believed was right. Eventually, the trade off (my soul for a regular paycheck) became too high for me and I decided to become self-employed so that I wouldn’t have to sell my soul any longer. As of today, I haven’t had any health insurance for almost two years and, quite frankly, I am not concerned about it. And to be honest, my daughter and I hardly ever used the twenty-years I paid into health insurance. Common sense tells me that, with such a poor return and so little to show for it, the wisdom of the investment was questionable at best.

I will say, however, that one of the reasons I am not concerned is that I don’t expect to become ill and to need insurance anytime soon. I am way too interested in holding on to my health to waste my time and energy in worrying about disease. Besides, I have much better plans for my money than pay for an insurance premium I know I will never use and, to me, insurance is tantamount to throwing money out the window. In addition, health insurance is one link in a seemingly well-orchestrated system in which I simply do not believe: it covers us only for certain approved amounts spent for only certain approved treatments (medical, pharmaceutical or surgical) provided by only certain approved caregivers (physicians and medical professionals recognized as such by certain agencies) often under circumstances that I view as the systematic abdication of our individual responsibility and control over our own body, i.e., only when we agree to hand over our body to the medical system and giving it free reins with it. I probably would be in favor of those treatments if they proved to heal or prevent disease but, so far and based on my observations, it really isn’t the case. “The great secret of doctors, known only to their wives, but still hidden from the public, is that most things get better by themselves; most things, in fact, are better in the morning.” Dr. Lewis Thomas, M.D.

I did say “seemingly” well-orchestrated for a good reason: even though our system is less than a century old, it is on the brink of a collapse, according to the March 1, 2006 , issue of the Journal of the American Medical Association http://jama.ama-assn.org/ and a December 2006 study by the American College of Physicians http://www.acponline.org/hpp/statehc06_1.pdf

I will also say that the more I study a book I consider my instruction manual, the Bible, which I view as the most complete: “How to be a healthy, happy and creative human being” and the more I fail to see a justification for a great number of the western world’s inventions. Nowhere does it say: “Thou shall retire at age 65 and quit earning daily an income to support yourself”, or “Thou shall fear illness and the future and put today a lot of money into insurance just in case the Bible lied to you.” The way I see it is: we either believe it or we don’t. But the Bible has been here for over 2000 years and I haven’t heard of its impending collapse… Western Medicine can’t say the same.

So, how does health insurance work? Well, insurance is simply legalized and organized gambling: insurance companies, which are in the business of making money by collecting more premiums than they anticipate paying out for incurred medical expenses, bet with you, the insured, that based on existing statistics and on your current health, you will not need to use your policy this year and they will not have to make any payment on your behalf toward medical expenses. However, to assure that they will not lose money, should they have bet on a dead horse or should you suddenly come down with something they could not anticipate in view of your present, healthy condition, they calculate your premiums based on the cost associated with the sickest individuals in your specific age bracket. The older you get, the higher your premium, because the more likely you are to become sick and be the victim of a terminal or long lasting health problem. It doesn’t matter to them that you never once, in your life, set foot in a hospital. For them, the older you become and the more you become “a serious illness waiting to happen.” This is reflected in your premiums.

On the other hand, you, the insured, bet that you will become ill and that you will need to use your policy. In other words, you bet that, during your policy-year (year during which you pay your premiums), you are more likely than not to be seriously ill and require help with paying your medical bills. When you buy insurance, you have the mindset that sometime this year, you will become sick. You expect it; you anticipate it; you believe it will happen. It’s called fear. By buying insurance, you buy peace of mind. What you don’t buy, though, is health.

The system was designed to work to the advantage of the insurance company. So much so, in fact, that in order to protect themselves further from having to pay their insured’s medical bills, they pick and choose whom to accept as an insured. Hence the long questionnaire you need to fill out when applying for insurance. Sad as it may be, in today’s overall health climate, more and more American are being turned down for health insurance on the basis of their health history. Those unhealthy insured who are not turned down may end up paying exorbitant premiums and be imposed a six-month waiting period for pre-existing conditions (adverse health conditions which existed before you applied for insurance) or the health condition may simply be excluded once and for all on the policy, meaning that, for example, the $45,000 hospital bill for your heart attack will not be paid by your insurance because you have been under medical treatment for high blood pressure for three years. Anything else can be covered but think about it: if your blood pressure is 184/112, are you more likely to have cancer or a heart attack? What good is it to you, then, to be insured if the most probable illness is excluded?

HMO’s (and PPO’s), which made their apparition in the 70s and became almost the normal form of health insurance for corporate America ’s employees, function somewhat differently but with the same goal: make a profit. An approved primary care physician, usually a generalist or an internist, serves as the gate keeper for the insurance company. He provides the primary care and has the control over whether and when you will require the help of a specialist, in which case he will refer you to a list of those approved by the insurance provider. Pick one not the list and your treatment will not be covered. For those of you who worked a long time for the same company, you may have noticed that every two or three years, your employer would announce that he had contracted with another health insurer or HMO. As a result, you sometimes found yourself having to choose a new primary care provider and, when under the care of a specialist, a new one as well as yours are not on the approved list. Hard to develop a trusting relationship with a doctor when you change so often, isn’t it? Why the need for such a change? Money. “I’ve been rich and I’ve been poor; rich is better.” Sophie Tucker. That’s what businesses do: make money. Not spend it when they can prevent it.

Due to certain regulations, HMO’s are, by law, compelled to accept as an insured everyone in the same group, regardless of health (have you noticed that they never ask you question about your health?). To make it profitable for them, they must calculate their premiums based on the statistical medical costs of the older individuals in the insured group. As a result, 20-year old John who is never ill pays as much as 64-year old Paul who had a triple bypass five years ago and is currently undergoing chemotherapy for cancer or Susan, pregnant with twins. As employees become older, they become sick more often and more severely and they start costing more to the HMO, which is then left with two choices: increase the premiums of the entire group and write themselves out of the market by becoming no longer competitive or simply cancel coverage to the entire group altogether. (They are not allowed to cancel coverage for only a few individuals.) Large corporations, which pay the bulk of their employees’ premiums, do a good job of shopping around for the best insurance deals which is why, every so often, they change insurers without asking for your input, regardless whether the trusting relationship you have established with your doctors will come to an end as a result.

Obviously, there exist many variations of the above systems but you do get the idea of how insurance works.

Now, in the recent years, insurers have considerably increased their deductibles and their co-pay to offset their pay-out in order to remain in the business of writing policies. The deductible is the portion of medical bills which are not reimbursed because your policy covers you only after you have already incurred a certain amount of medical expenses. The deductible is something you absorb. Nowadays, deductibles can be anywhere from $500.00 to $10,000.00 per year. In addition, co-pays, which were $10.00 twenty-years ago, may now have increased to $20.00 or $30.00 a visit and/or a prescription.

When all is said and done, you may easily be paying thousands of dollars in premiums, deductibles and co-pays every year without ever receiving any benefit from being insured. Or, if you are declared uninsurable because already too sick to be attractive for an insurance carrier (and therefore the most in need of health insurance), you may be paying out-of-pocket for all of your medical expenses while waiting to come under Medicare, which won’t kick in until you reach 65.

Why did I get through the trouble of explaining the above? Well, for starters, most people have little understanding of how insurance works. Fewer even realize that insurance does not guarantee health. It only guarantees that you may get some financial help with your medical bills under certain circumstances when your health is failing. But until you decide that, to a large extent, you can control whether it will, indeed, fail, you may be in for spending outrageous amounts of money you will never get any return for.

So, instead of being reactive when you do become sick, wouldn’t it make a lot of sense to become proactive and assuring that you don’t so that, in addition to feeling physically well all the time, you no longer feel compelled to waste so much money? You already eat every day because you know that, without food, your body won’t survive. Most of you probably regularly purchase supplements such as vitamins and minerals (not covered by insurance…) Doesn’t it make sense to see whether a $350.00 DrNatura cleansing and detoxification could, in the long run, save you thousands of dollars in insurance premiums, deductibles and co-pays by restoring your health? Small investment compared to the savings.

Just a thought…

Christine
CBrightlife@aol.com