Monday, July 27, 2009

Are people really satisfied with the health insurance they have?

‘How’s your wife?”

“Compared to what?”

H. Youngman

We keep hearing that people are “satisfied” with the health insurance they have. I have to ask, compared to what?

We live our lives comparatively. When we judge our wealth and income, our success in life, even our health by comparing it to others. Just look at your true feelings as you attend school reunions. There is fellowship, pleasure, … and comparisons.

Why would anyone be “satisfied” with their current health insurance? It is very expensive, unduly restrictive, uninformative and mysterious

I can only think, compared to not having insurance. OK, that makes sense. Or, compared to being on Medicaid, or having to go to a clinic. Or, compared to having to pay for the whole thing yourself and not be helped by an employer. Or, finally, compared to what might be coming down the pike and you might have to change to something new that you haven’t tried before, because we fear change. We do think comparatively.

Years ago we had a young new employee from a labor union family when single payer came up on the California ballot. Of course, this would have benefited her a great deal. But she was against it. We asked her why. She said that it would probably all be just like Medicaid, and she wanted "private insurance." Was that comparative thinking? I thought maybe it was.

I have to agree that I think similarly.

But if we compare our insurance to the way it used to be, don't we get another picture? Price has risen astronomically. Is it not significant that health insurance costs twice what it did ten years ago, on average? In many cases (Bayside Medical Group, our practice, for instance), only double would be a blessing. Difficulties with accessing care has risen. Providers drop out of networks and leave patients with more to pay, or needing to change providers. Provisions within policies have become more company-friendly rather than patient friendly. The insured have become progressively under-insured. We are the proverbial frogs in the slowly warming water that will parboil us if we don't do something, but we don't know quite what to do.

We can also compare our insurance to that of other countries, but that gets shot down too quick - Canada, the UK, they certainly have their problems. Sweden has too different a culture. France is too French. It is tough for people to imagine difference.

But in sum, I think all this public obeisance to “you can keep the insurance you currently have” is just for political sales; necessary, but destined to be transitory. The point is, break the logjam, get reform started, get some people on new insurance, and most will say, “remember that old insurance that we liked? It stank!”

Budd Shenkin

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