What Good Are Health Insurance Companies?

Like many Americans, we've been through some health insurance woes. And for every bad experience we've had, we've probably heard another 10 horror stories from friends and family. Its a mess. I've never claimed to be an insurance expert. But who is? I always thought that having insurance meant that they'd pay for your claims, or at least a portion. I don't know why I thought that. Doesn't other insurance work that way?

Then I saw this while filling out some insurance info on my employer's website:

Who's Really Footing the Bill?
Think the insurance company picks up the tab for your health care claims? Think again.
You and XYZ Corp pay directly for your healthcare. Both your premiums and XYZ Corp's contributions pay for XYZ Corp's claim expenses. Our healthcare plan partners provide discounted provider networks and process our claims.
That means you can positively impact your pocketbook and the company's financial strength simply by carefully watching how you spend your healthcare dollars.So when you need healthcare services, think before you spend. Buy only what you really need. Make decisions like it's your money. After all, it really is!

Huh?!? I know that I'm on one of these "consumer driven" health plans (as if I have a choice), but this sounds like the insurer is just some middle-man between the health care provider and the insured who really doesn't do much of anything. For my family and I, we are paying $340 per month for health care. That comes out to $4080 per year. Mind you, we're all in great health, non-smoking, with no major pre-existing conditions. Also, I work for a very large employer - if they can't get good coverage, then I don't know who can, short of a labor union. My health insurance covers all preventative care, and the first $1600 of everything else. Then I have the next $1400 out of pocket. Then there is an 80/20 split between my employer and I with a cap at $2000 out of pocket for me. Then and only then does 100% coverage begin, maybe. So worst case, I could be paying $7480 in one year ($4080+1400+2000). The $1400 and $2000 would be direct billed from the provider. But my $4080 was pulled out of my check to the pockets of my employer? Or the insurer? Either way, someone has a lot of my money, and they haven't done much to earn it. I can get $1600 out of that$4080, leaving $2440 floating out there until I get into the 80/20 split. If I don't get there, then tough - that money is gone. I only break even with the deal once I've spent another $610 out of pocket. ONLY THEN will I have gotten my pre-tax money out of my health plan just to have my employer start footing the bill. This assumes no 'preventative care' (100% covered). So I'm sure they want me to spend those health care dollars carefully. Otherwise someone misses out on some fat profits for doing very little. What a mess. Just look at what this has evolved into.

One take on this problem can be seen through the (sometimes slanted) view of filmmaker Michael Moore. Watching his film SiCKO really opens your eyes to the core of this problem. They have no interest in you being healthy, only in charging you more for not being healthy. It is truly maddening that our government allows these companies to abuse customers this way. I don't know what kind of tax increase a universal health plan would entail, but I kinda doubt that I would be paying more than $7480 per year.

Something has to change. Who is going to do it? And when will it happen? I'm one of the lucky ones. What about those not blessed with good health?


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