When Obama was first elected, I opined that the first thing the Democrats should do is pass a simple measure requiring pay stubs to show the real cost of people’s health cover. This would make a person’s salary package far more transparent (e.g. all the raises people got from 2001-2008 pretty much went to their healthcare; it would be nice if people realized this).
E.g. I pay something like $500 per month for my health insurance — until the Affordable Health Care Act (“Obamacare”), I had no idea of what the insurance actually cost or how it compared to the health package offered by any other employer. When one employer says “we have great benefits” it’s completely unclear what that means. You don’t generally start drilling down into pharmaceutical and ER copays during a salary negotiation (well, I don’t). As soon as thehealthsherpa.com came out (healthcare.gov being a fiasco, albeit one that actually works now), I was able to look at how my plan looked compared to the various grades of cover offered under Affordable Health Care, and it turns out that it’s about equivalent to a Platinum plan, and for our family the cost of such a plan on a health exchange would be around $1600/month. This means my employer could be paying something like $1200/month for me — an important fact that is not easily discerned — that’s certainly more than it’s contributing to my retirement.
Despite the existence of the Affordable Heath Care Act, there still seems no provision for classifying employer-provided health cover in some kind of transparent way, so that (for example) when you’re deciding whether or not to change jobs, or which spouse’s health cover would work best for the family, or figure out the pros and cons of double coverage — you’re basically in the dark.
This affects me personally. Rosanna (my brilliant wife) recently took a job at UT Dallas. It includes, we were told, excellent health benefits via Blue Cross Blue Shield of Texas. BCBS, as it’s known, is probably the biggest brand in health cover in the US. My plan (which is via my employer, who is based in Washington State) is a variation of BCBS as well, and Rosanna’s previous cover (through the Federal government) was another variant of BCBS. BCBS is usually at or near the top of any list of coverage accepted by a healthcare provider. I should note that both of us have always had PPO (vs. HMO) plans, which are more expensive and offer wider choice.
For most of our time together, we’ve had “double coverage” — i.e. each of us has gotten the other covered through an employer-provided health insurance plan. Until June this year, Rosanna’s primary cover was her Federal plan, widely considered to be awesome. She frequently was denied prescribed medications (even generics), had to jump through hoops and waste immense time and effort—including unnecessary and expensive visits to specialists to rubber stamp prescriptions—to be allowed to receive needed medications (in many cases we simply aren’t allowed to pay cash for prescriptions). Then there was a two month period during which she was between jobs, and her Federal health cover expired. Everything got easier and cheaper. As secondary on my insurance (also BCBS, remember) the only time she was denied a prescription was when my insurer suggested a slightly cheaper but similar alternative drug—which turned out to be more effective—at least be tried first before the first drug would be allowed. She grudgingly switched to the suggested alternative and preferred it. Copays dropped from, sometimes, over $100 for a single scrip, to $40.
So, when Rosanna went through benefits election during the spinup of her new job (she’s an Associate Professor) she had some hesitation in getting her own coverage again (which cost her, just covering the two of us, about $250 per month; again we have no idea what the university pays). The benefits person convinced her that she could only benefit — in some cases her copays would disappear (which had been our experience with double coverage up until around 2012 when we moved to the Washington DC area where many doctors simply won’t handle insurance at all and expect customers to pay cash and get reimbursed themselves). So we agreed to try the plan as an experiment, and it is a nightmare. So far, by getting BCBS of Texas through UT Dallas in addition to my plan, we have lost money, time, and wellbeing.
To begin with, the immediate effect of my wife getting her own new health cover was that she simply couldn’t fill any prescriptions at all. My BCBS detected that she now had her own BCBS of Texas and —perfectly reasonably—refused being billed as primary. But BCBS of Texas prints insurance cards with no relevant information (needed by pharmacists) on them, and when the clerk tried to get the information from them he had to wait on hold for ten minutes and answer the same questions over and over (in the US no enterprise is able to ask a question once, so this is hardly unique to BCBS of Texas) only to be told to call a different number. The first clerk gave up at that point. Eventually, I found a sympathetic clerk who spent half an hour sorting it out and voila, we were able to fill prescriptions, but all her copays increased (from $40 to $120 in one instance), and for whatever reason our “double coverage” doesn’t do us any damn good.
Bear in mind that pharmacists, in the US, are harried people buried in tedious makework—filling the simplest prescription involves asking your surname (and trying to remember how it’s spelled) and birthday, often your address (for verification), fighting with a computer terminal, a cash register, a card swipe, some kind of nutty signature system that acknowledges you’ve received a drug or know about its side effects, a stapler, and a half-dozen pieces of paper — beyond their proper job which would be finding the right pills, counting them (three or four times in the case of pain killers), sticking them in a jar, and applying a label. In the US, the people qualified to do this crap have to get a PhD (which is ridiculous, but degree inflation in the US is rampant — optometrists also have PhDs) so their time is presumably not exactly cheap, and how a health insurance company can reasonably expect one of these people to waste 30 minutes to bill a single prescription baffles me; surely this is some kind of breach of contract or bad faith. Remember — every other insurer prints the required information on the card.
By the way, if you’re wondering about the rising cost of healthcare, maybe requiring someone who can look stuff up in a database, counts pills, stick labels on a jar, and operate a stapler to pay $120,000 in college tuition might have something to do with it. (In Australia, pharmacists have a slightly specialized bachelors degree — as do lawyers, doctors, and optometrists — and I don’t think society has collapsed.)
My twins are going through a horrible bout of gastroenteritis and were prescribed zofran, a decent anti-nausea medication. We got it through my insurance (thankfully, my insurance covers the girls) and it cost whatever our usual copay is (I simply don’t remember how much I paid, so it was probably $20 or so).
Rosanna has nausea issues and—on the same day—was also prescribed zofran. BCBS of Texas denied her the medication. So she got her doctor to prescribe her fennigan instead. They also rejected this prescription. (The pharmacy, after trying to reason with the insurer, pointed out that the cash cost of the drug is $10, so we simply paid for it ourselves.)
Note that without insurance, a generic version of Zofran costs $17.14 at Walmart.
So BCBS of Texas basically charges us money to screw us and, the way health insurance works in the US, we can only change her benefit election once per year (i.e. a year from now) or if there’s a life-changing event (like a birth, death, marriage, or divorce). We joked tonight that it would probably be better to get a quick $500 divorce, elect to drop the “insurance”, and then remarry than continue to receive this “coverage”. Seriously, it’s that bad.
When the Ebola came to Texas, one of our neighbors went a bit nuts and started waving down fellow parents at the local elementary school, trying to get us to sign a petition to close down the school (because you can’t just keep your own kids home without dealing with truant officers or whatever). I tried to reason with him and he eventually went off on a Republican talking points rant about how he’s been screwed by “Obamacare”. I told him that he was either being screwed by his employer or his insurer — they were just using Obamacare as an excuse. (Incidentally, my health premiums and copays went up this year, and the benefits people ascribed this to “Obamacare” as well.)
Here’s the point — it doesn’t do you any good to do good if the people you do good for can’t tell. If Obama and the Democrats had started 2009 by making healthcare costs transparent, they’d be in much better shape today.