Tuesday, August 25, 2009

Politics: What Health Care Do You Want?

TORONTO, ONTARIO - There is a sizable contingent of people in the United States that claim to be satisfied with their health care plans, if we believe the polls. I simply don't understand that. Have they not noticed the decrease in the quality of their medical plans (or increase in cost) in the past decade?

The last time that I was actually satisfied with my health care plan prior to moving to Canada was in 1998. I was still in college and underage, so I was covered by a parental health care plan. As I was living outside of my parents' home state, an inter-HMO agreement for students was invoked and I found myself covered by Blue Cross Blue Shield of Massachusetts. One form submitted set up this coverage. I then received a welcome package in the mail, and with one phone call selected a primary care physician. I only visited that doctor once in a year (I think related to an upcoming foreign trip), and that visit cost me $5 in co-payments. My parents probably didn't get their money's worth for covering me that year, but had anything serious happened, co-payments would have been minimal and I'm certain the medical system around Boston would have treated me well.

In the private sector, I never had a decent health care plan. I never paid very much for myself (most of the time, I paid nothing, and I think not more than $120 a month at my last job in the US in 2005), but that was not true of my peers with larger family. A peer at my last job was paying nearly $1200 a month to cover a family of four. Compare that with a maximum charge (for people making more than $200,000 a year) in the province of Ontario of $900 per person per year; most people pay about half of that.

Far more galling than the cost was decreasing amount of benefits. Well removed from the $5 co-payments of my youth, my last health care plan had a $5000 annual deductible that had to be met before it would pay anything. Prescription drugs, of course, were on a separate deductible of similar magnitude (I don't remember the exact number). Basically, unless I was hospitalized at some point during the year, the plan wasn't going to pay anything. It amounted to catastrophic health insurance (and, in fact, it wasn't really that, as I believe it had a $100,000 cap over which it paid nothing).

I thought this plan was pretty awful. However, when I talked to a nurse during a physical in 2005, I found out that she had a $1000 annual deductible. My plan may have been with a Paid Provider Organization instead of the Health Maintenance Organization (HMO) that had run the 1998 plan that I liked, but HMO benefits had declined, perhaps not quite as dramatically, based on conversations I've had with friends and family, even those who are public employees.

Does anybody remember what health care plans were like as late as the 1990's? Perhaps a few people working for large businesses still have such plans, but certainly not the 84% of insured people who claimed to be satisfied with their plans in a recent poll, never mind the 18% of those under 65 who don't have any health insurance at all. Have people lost their minds, or have their expectations been so lowered that they are happy to have any insurance at all? I don't understand.

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