Saving A Bundle on Your Health Care, Part 3

Click here for the Health Tip link.

Let’s say that you’re among the numerous unemployed whose COBRA benefits are expiring. Or you’re among the under-employed who aren’t eligible for your employer’s health insurance. For the first time in your life, you realize you don’t have health insurance. Maybe you lie awake at night wondering what you’ll do if you or a family member gets sick.

People without health insurance can be divided into two broad groups: those that are healthy and those with chronic health problems. This health tip will focus on the first, the “worried well.” In an upcoming tip we’ll discuss the second group.

If you’re healthy, the odds are very much in your favor that you’ll stay that way. You’ll likely live a nice long life and, if you play your cards right, you can do so without doctors, prescription drugs, lab tests, hospitals, and all the other trappings of my profession.

But you do need to cover yourself in the unlikely event that a health catastrophe occurs. Essentially, this means covering potential hospitalization costs, which can quickly eviscerate your savings, your dwindled 401K, your condo, and everything else you own. For this, I recommend you buy what’s called “traditional health insurance”–the coverage people had pre-1975, before the health insurance industry became the cash-cow darling of Wall Street.

To determine your coverage needs, begin by looking at your bank account balance. Ask yourself, “What’s the largest amount that I could afford to spend in the very unlikely event that I need to be hospitalized?” That number is your deductible. You’d also be responsible for a certain percent of charges (usually 20%) up to a certain maximum (usually $1,000 to $5,000). This is called the co-pay. The larger the number you agree in advance to pay out-of-pocket, the lower the cost of your health insurance, or your premium. The “I want everything covered” policies are very expensive.

You can find a quote on traditional health insurance here:

This link is to Blue Cross Blue/Shield of Illinois. Understand I have no great love for any health insurance company, including BC/BS. But Blue Cross being a not-for-profit means they don’t have a passel of shareholders willing to vote for anything reprehensible in the name of corporate profit-taking.

When you enter your personal data and click “Find a Quote,” skip the “Top Three Bestsellers” (the ones they want you to buy) and go to “Compare all Eleven Plans.” Not surprisingly, the one at the very bottom of the list is traditional health insurance and it’s not insanely expensive (about the same as auto insurance, actually). The health insurance industry doesn’t make much money on traditional policies.

Do realize, though, that traditional health insurance is not going to pay for your sore throat, minor aches, pains, mammogram, or Pap smear. You won’t be able to get an annual check-up with all the tests for a $20 co-pay like you did when your employer provided more expensive insurance. For routine office visits, you’ll pay out-of-pocket. Your policy also won’t cover prescription drugs, which you probably don’t need anyway. But think about it. You don’t buy auto insurance to cover your car’s oil changes or the mechanic’s diagnosis every time your engine makes a funny noise.

Also, it’s possible learning to live with less coverage might help you learn something about yourself and your body. For example, you might discover that most symptoms and illnesses go away by themselves. The old saying “doctors exist to entertain patients while nature takes its course” is true. Your strained back, cold, or upset stomach will last maybe two weeks with or without a doctor. If things get worse rather than better, you can always go to your primary care doctor (or one of the mini-clinics at Walgreen’s or CVS) and get a generic prescription drug.

Even most longstanding symptoms aren’t signs of lurking disease. They’re usually the everyday discomforts of having a body, messages from within, letting you know you’re behaving in a way your body doesn’t like. Most headaches are caused by stress. Heartburn (re-named the more expensive-sounding reflux esophagitis) doesn’t need a gastroenterologist, gastroscopy, and Nexium at $120 a month. It’s usually just your body pleading for you to stop overeating late at night.

Symptoms of actual significant illness are different. These get progressively worse in a relatively brief period of time (weeks rather than months). Symptoms like this do need attention. But bear in mind that when you think you need a doctor, your primary care doctor is much less expensive than a specialist. Emergency rooms are the most expensive of all. If your health insurance company decides to deny your emergency room visit as medically unnecessary, you may find you owe $5,000 for the visit.

Not only can you learn to live without doctors checking you for every symptom that pops up, you certainly can do without most prescription drugs. Natural products can be used for many common symptoms and when you do need a prescription drug, you can get a generic version of just about anything at Costco for pennies.

To gain some perspective on our current situation, let’s go back to pre-1975, and find out what people did before the current healthcare crisis. How did your parents or grandparents handle health care costs? Likely…
1. They bought their own Blue Cross hospitalization insurance. The for-profit insurance companies simply didn’t exist as a significant industry before 1975.
2. They didn’t seek medical attention for every symptom.
3. They virtually never saw a specialist unless referred by their family doctor who, to the embarrassment of today’s doctors, could handle lots of procedures (from minor surgery to delivering babies) on his or her own.
4. They rarely saw the family doctor and when they did, they paid in cash. Can you imagine never having to call and fight with an insurance company? They never did.
5. They rarely took prescription drugs.
6. They used the neighborhood pharmacist as an adjunct health care provider (“What should I take for my…?”).
7. They certainly weren’t exposed to as much health news as we are today. There were no headline-grabbing “news” stories on TV, no physician-as-nanny personalities badgering them about how to behave, and definitely no commercials for prescription drugs. Plus, physician advertising was illegal (really!).

Despite this, people were reasonably healthy until their 70s, when various chronic illnesses started to appear (hastened along because many smoked, didn’t exercise, and ate too much, but you know better. OK, some health badgering does pay off).

So what I’m trying to say is this: faced with the specter of “no health insurance,” take a deep breath. You need some cheap traditional coverage for the unexpected hospitalization and a major attitude shift. You’ve made it this far and you’re still alive. Take good care of yourself–your body is good at self-healing.

Be well,
David Edelberg, MD