My husband and I are in extremely fortunate circumstances. We are both employed by large employers and have access to extremely good health insurance coverage that is affordable to us. I carry my husband on my insurance; he covers me. My insurance is a second/supplementary insurance for his care; his insurance is the supplemental for my care. When our children were young enough to be covered by us, we each covered them (for more money but still extremely reasonable). His employer provides dental insurance; my employer provides an account that will reimburse for some dental costs and also for eye glasses and contact lenses. Oh, and my husband has a medical savings account to pay for whatever insurance does not cover. I don't have one because it is usually not necessary. Our providers have our insurance information. We do pay out of pocket for eye exams and pay a portion for prescriptions, depending on what they are. The meds for rosacea are the most expensive but they last a long time.
What this has meant is that we see very little in the way of medical or dental bills. For the most part, we have been very healthy although each of us has had cancer which required major surgery but no chemo or radiation or other treatment beyond surgery. My husband has had a detached retina and cataract surgery as well. We've paid very, very little for this care aside from the insurance premiums. Each procedure cost us less than $500, which we could afford even if we didn't have the funds sitting in the health savings account. When our son was a college student (covered by our insurance but still in network for MY insurance; out of network for his father's insurance) he slipped on some ice and broke his ankle, which involved a trip to the ER, x-rays, casting, crutches. It cost us $25. Total. Yes: $25. No missing zeros. Not $250 or $2500 or even more. We paid about $1500 each for orthodontia for two of the kids, >10 years ago, with insurance picking up the rest. A real bargain although since they were in orthodontia at the same time, it was a hefty blow to our budget and at the time, I was working part time and had no insurance coverage except through my husband, so we were not earning as much money and had more bodies to provide for. Still, we were very, very, very lucky.
Everybody should be so fortunate. EVERYBODY. Every single person on the planet.
We are also fortunate to live within driving distance to a truly world class medical facility that I utilize and that I force my husband to utilize when there is anything serious going on because he still clings to the notion that local is more convenient for maintenance of the usual late middle aged condition of some (familial) high cholesterol and high blood pressure (also familial despite how difficult you might believe that it must be to live with me). But the cancer and another scare did convince him of the wisdom of going to the best possible place when facing something serious. The fancy place an hour away handled our surgeries and actually our diagnoses. EVERYBODY should have such good access to excellent health care. EVERYBODY.
The thing is, I know that the coordination of the insurance, multiple bills, statements, etc. are not free. It costs something to send out each statement, even electronically. That cost is rolled into the cost of whatever office visit, procedure or lab test ordered.
Many of my co-workers in my work unit are much younger than I am. I watch them go through a lot of mental gymnastics, trying to guess which of the three options (my employer provides 3 options for insurance! We can choose which we think suits our needs best, each at a different cost). I simply choose the most comprehensive with the smallest deductible because it is cheaper in the end for someone in our age group. Sure, most years, we don't use anything other than periodic check ups, eye and vision, dental, etc. My co-workers would say that we were 'wasting' money. I say: we're paying to be covered in case of an unexpected event, as with the cancer. Each of us was diagnosed unexpectedly--one of those: I don't think it's anything serious but I'd like to order the biopsy just in case situations. We are both alive because of that. My co-workers end up paying a lot more out of pocket than I do, even if I include the years when one of us had to have surgery.
The concerns I have about single payer were pointed out upthread by another poster who wrote about Medicare and Medicaid. The thing is, the dollar amount of reimbursement for medicaid patients has never fully covered the costs of treating those patients and now, the gap between what Medicare will pay and what the actual cost of services provided is growing larger and larger. Meaning those unpaid costs get built into the prices that everyone else pays. Also, some of the Medicare rules are byzantine, to say the least and are entirely predicated on the notion that providers are trying to cheat. Of course, some are and some do, and some patients are not honest, either.
My ONLY concern--let me repeat: my ONLY concern about single payer health coverage is that our 'fiscal conservative' legislators will try to be 'fiscally responsible' and short change providers on the actual cost of care, driving physicians out of the field and making everybody worse off.
I'm sorry: this is getting really long but I wanted to say that our current insurance situation is stellar. Truly stellar. But it wasn't always like that. When our first child was born (by c-section which is much more expensive), my health insurance refused to cover prenatal or delivery charges because my doctor determined the date of conception to fall outside of the 3 month waiting period for 'pre-existing conditions.' We were very poor then, although I was fully employed and my husband was a grad student. The doctor and hospital bills fell entirely upon our shoulders and totaled close to 33% of our gross income for the year. The pregnancy was not intended but although surprised, we were thrilled. Also extremely, extremely broke. Extremely. Years later, I realized we actually qualified for medical assistance but it never occurred to me at the time. Probably would have toughed it out without anyway.
Later, when the children were small, we were all insured through my husband's employer. The insurance coverage was pretty good (not as good as now but still good) but it kept changing every year (employer's choice, not ours and all cost driven) so that it was always a source of anxiety about whether or not we could keep our pediatricians, whom we liked very, very much and trusted. For myself and for my husband, as healthy young adults, we rarely saw a doctor so it was less problematic. For a year, we paid out of pocket for the well child visits and then we simply could not and had to change doctors. This was ok--although not ideal because the kids were all healthy and had no chronic or complicated conditions to be managed where continuity of care would be vital. Continuity of care is ideal for everyone; if you have a serious chronic condition, having to change doctors can be extremely costly in terms of dollars (to the insurers as well as the patients) and can cause delays, confusion and lack of continuity of care. This is very serious if you are talking about such common but chronic conditions as diabetes or asthma.
I understand how it is and why it is that there are 'networks' for insurance providers. But it's all nonsense and I believe should simply be illegal.
But really, the main benefit is simply my own complete comfort with getting advice and opinions - from people who know their stuff, at least in their specialty. Monday I have an appointment with Dr H, a local orthopedic surgeon. If the referral was an utter stranger I'd be a bit nervous about it. But he's a guy whose skills I've heard other docs gush over, speaking almost enviously, I know a bunch of his patients and have hung out with him a little at a party or two. I have no doubt that almost anyone else with Dr H's credentials would be just as competent, and maybe even more attentive if they were some young doc trying to gain reputation and all that. But I'd be nervous right now if I never heard of him and had an appointment on Monday - and I'm not.
