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Rambling about Gambling. - Blather. Rants. Repeat.
A Møøse once bit my sister ...
Rambling about Gambling.
Not the lottery or sports-betting kinds- I singularly fail at those. No, it's time again to place my annual wager in the You Bet Your Life- Literally!- game known as the selection of health insurance.

For me, at least, Obamacare was not the train wreck that the Rightpublicans have made it out (and largely helped it) to be. My local Chamber of Commerce sifted the alternatives and gave us a bunch to choose from with varying levels of cost and risk. Alas, I will no longer be a Redshirt, since Independent Health has pulled its sole-proprietor plans completely. But two other companies do offer them, from the Platinum level closest to what I now have (and which would cost about $1,000 a year more than I now pay for single coverage), to a Bronze level that mostly matches what I could get through my part-time office (which would cost $2,000 a year less but would have much higher deductibles and out-of-pocket maximum amounts).

So instead I'm choosing between the two medals in the middle which come closest to my current cost (and are both less than what I pay now).  Gold is essentially what Eleanor has- a modest annual deductible (this one's $600) but no health savings account eligibility- while silver has a higher but still non-astronomical one of $2,000, which is high enough to allow HSA contributions. The only other major difference between the two is the co-pay for inpatient hospitalization: it's $1,000 in the gold plan and $1,500 in silver.

The deductible difference is $1,400 for 2014, and the lower premium for the silver plan cancels out over $1,000 of that difference. So basically, you're asked to gamble roughly $900 of potential exposure to costs ($400 in net deductible difference plus $500 for the higher hospitalization hit) if it's a high-use year including hospitalization, versus being able to deduct both the premiums and over $4,000 of additional health care expenses from our income taxes and save that money for the future, or apply it to other health care costs such as dental, if I wind up not having a high-cost year.

This leads to two questions.

First, of course, is "who knows?"  I'm likely to end 2013 with exactly one doctor visit (and that only because they won't allow renewal of my blood pressure medication without being seen annually), a year's supply of two regular meds, and a one-time renewal of an occasional-conditional one.  Had I made the bet on the higher-deductible plan last December, I'd be thousands ahead now.  On the other hand, in 2012, I had the Dread Kidney Stone kerfuffle, with multiple visits to doctor and radiology, an aborted dye test and ultimately a CT-scan. All of that would have pushed right up to the maximum out-of-pocket for that year, which is more than you're allowed to contribute to an HSA.  Going the silver route that year would have been disastrous.

The even better question is, "why are we forced to gamble about this?"  It's just another unintended consequence of tying health care so stupidly into the employment-and-taxation scheme of this nation's economy, instead of treating it, and paying for it, as a basic entitlement all in the first world should have.  That's how employers got into the medical lives of their employees in the first place- as a loophole. World War II was on, and the gummint had imposed strict wage and price controls on the economy, so employers started offering health care as a benefit to get around the limits. Maintaining its tax-free status required Congress to cost-benefit any change in the whole system, and that's how we've wound up with this total goat rodeo of rules about eligibility and deductibility that has become a giant gambling game.

It's also largely based on a pile of false premises. HSA's are a vestige of the George W. Bush approach to health care reform (in fact, probably the entirety of his approach to it). The idea was, if we let people pre-save for their health care expenses, they'll shop around for the best price and that will drive prices down. Bullshit. I've yet to walk into ANY medical office, or see ANY medical website, that has their fees for services posted like the menu at Mickey D's.  Nobody wants to shop on price when their life and/or death could be on the line. We want the best; we've been told all our lives (and see on the tv) that we're entitled to the best; and by golly we're not going to settle for Dr. Meineke's Discount Mammography even if it leaves a few extra bucks in our account unless we have to.

So sometime today, I will scratch the check and ticky either the gold or (more likely) the silver box on this form, and I will live to fight another year. Nobody knows what this will all look like come this time next year, when I may be choosing between bronze and styrofoam if the pricing goes as badly as cynics suspect.  Still, I'm happy to shoulder some of the pain if it helps get this nation on the right road to fixing one of its biggest, and longest-ignored, societal problems.  And the surgery for the shoulder pain will be covered, even though it could arguably be a pre-existing conditon;)

ETA. Silver it is, but no thanks to the brilliant minds in whom I was encouraged to place my trust. Before heading over with formage and checkage, I called- just to be sure that the Chamber agreed with me that I'd be able to use an HSA to pay for the extra deductible expenses.  The return call came from the Head Honcho Herself, who opined that, no, none of the Blue Cross plans had this thing associated with them.

Funny, that. Because the two times we have had HSAs, we were sent off into the wilderness to open such accounts ourselves. So I quoted the appropriate regs to C, who said she'd get back to me. Which she did: yes, silver does fall into the HSA guidelines, but no, Blue Cross never bothered to mention that in their state filings, so they're amending them and they should be okay. (By my reading of the Internal Revenue Code and our own past experience, it doesn't matter whether the state "approves" the HSA deduction or not. If the numbers fit the law, it does. So there.)

The sadder thing, in my mind, is that such a business-friendly organization didn't have as clear an understanding of the law as I did- and how many of their members may have looked at just the raw premium/deductible/out-of-pocket numbers and not realized that there was a major benefit to paying a little less and deducting a lot more from your income.  But then, Chambers of Commerce (at least the US-level one) have been among the biggest opponents of Obamacare, so I probably shouldn't be the least bit surprised.

This entry was originally posted at http://captainsblog.dreamwidth.org/175479.html. Please comment here, or there using OpenID.
1 comment or Leave a comment
glenmarshall From: glenmarshall Date: December 10th, 2013 02:43 am (UTC) (Link)
One problem with US health care is that it's expensive, in all aspects. We Americans doth protest too much when we are put in the presence of this unpleasant reality. Denial is sooo much more comfy.
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