By Augie Lindmark
KevinMD blog, Oct. 5, 2015
I cracked a Budweiser and flipped on Spotify radio for what I was told would be a challenge. On my computer screen, Minnesota’s health insurance exchange website waited expectantly, to which I submitted the Holy Trinity of health information — age, date of birth, and tobacco usage — and waited. The next page loaded slowly, evidence of the voluminous information that would soon surface. I had hoped for simplicity, instead, I qualified for 38 different health plans from which to choose.
The timing of this health insurance search was important because I would soon celebrate my 26th birthday — the threshold age under the Affordable Care Act that initiates millennials into health insurance independence — and with that, an expulsion from my parents’ health insurance plan.
As a medical student, I’m surrounded by practicing physicians who forewarn me about the pitfalls of shoddy health insurance. Buried in those 38 plans lurked high deductibles, unknown health provider networks, and procedural coverage that acted more like a sieve than a blanket.
I experienced what some economists and physicians refer to as information asymmetry — the situation where a patient is inherently disadvantaged because the knowledge needed to make decisions is siphoned to those who approve claims, set prices, and charge bills.
Health insurance has too many options. And the wrong choice has serious consequences.
While I attempted to purchase health insurance for the first time in my life, I could see why over 600,000 Americans are annually bankrupted by medical bills. But the holes in our health system are underscored by the percentage of those cases covered by insurance. The answer is a lot. Of medically related bankruptcies in this country, almost two-thirds involve patients with some form of health insurance. American health insurance, when stripped down to its core, is a ruse.
Consider the recent example of Susan Rosalsky and Michael Trost. After chest pains led to an Emergency Room visit, an out-of-network charge meant a surprise $32,845 medical bill from a cardiologist not covered by their insurance. The majority of their bill was covered, but with a minor — albeit very expensive — exception. Regrettably, their story isn’t unique: Nearly one-third of patients covered by private insurance experience some level of surprise medical bill, according to a 2015 survey conducted by the Consumer Reports National Research Center.
When I scrolled through my online health insurance options, plan #35 cost $150 a month, a monthly premium that fit into my budget. But I would need to pay $6,300 out of pocket before I saw in-network charges covered, and only 60 percent coverage on out-of-network bills. And I had little knowledge of what procedures were included in the plan.
To assist confused customers like myself, state exchanges employed armies of health care navigators (assistants trained to help with purchasing coverage). When I spoke with a navigator, he could explain deductibles and define co-pays, but neither of us could decode the future implications of a high or low coverage, expensive or cheap, transparent or confusing health plan.
We both navigated alright. Except we didn’t know which way to go.
If you’re an uninsured millennial, you pose problems to health insurers
Two years ago the Obama administration made its push to encourage the millennial generation to sign up for health insurance. The success of the Affordable Care Act hinged on the turnout of the “Young Invincibles” and their willingness to get coverage. Big insurance corporations like UnitedHealthcare and Aetna watched with keen interest.
If Millennials didn’t flock to the insurance market, the insurance companies would be left with older, sicker patients. Younger people bring less risk to insurance pools; we tend to be healthier. In the eyes of insurance companies, you’re a good patient if you never step foot into a hospital, or need an emergency appendectomy, or get cancer, because that money can be moved away from health care and allocated to shareholders and beer cup advertising at major sporting events.
As you may remember, the push to get millennials signed up for health insurance employed numerous media mediums which included President Obama’s awkward, viral interview withZach Galifianakis on Between Two Ferns. A millennial generation focused news outlet, Mic News, held a competition to gather ideas of how to enroll 18 to 35-year-olds: They sent the top three voted proposals to the White House, including my submission, to get feedback. But perhaps the best — and most unbelievable attempt — were the Brosurance ads, first aired in Colorado, which utilized the alluring power of keg beer to sign up for health insurance. Had the state’s marijuana legalization preceded the Affordable Care Act, different tactics might have been used.
Marketing aside, at a legislative level, the fear of insurance companies would need to be assuaged. Two key components allowed the hefty insurance players to buy into the plan. The first was the individual mandate — the requirement for individuals to purchase health insurance or face a penalty. The second was expanding coverage to millennials under their parents’ insurance plans.
That is, until we turned 26.
Private health insurance makes cents, not sense
Unfortunately for Americans, millennial or otherwise, health care has evolved such that financial stability designates how we partake in, and access, health care. Our patchwork system treats medicine as a good that can be bargained and bought, similar to that of fresh produce or potato chips. Of industrialized nations, we’re the only one without some sort of universal health coverage. Unsurprisingly, we place dead last in preventable death.
My health insurance, for now, is a student health plan offered to medical students. The details of coverage are hazy, but it has a low deductible and reasonable premiums.
Years ago I welcomed my birthday by counting the years successfully completed as a human on my fingers: five and ten, one hand and two, were prominent milestones. I confess I still complete this action every morning of September 29, though, it’s more compulsion than proclamation.
This year, I counted four hands plus six for 26 years. When I finished my tally, I crossed my fingers in hope — for luck, for health coverage, but above all, for an inexpensive 26th year.
Augie Lindmark is a medical student. He can be reached on Twitter @AugieLindmark.