Health insurance is wasted on the young

There has never been a time in my life when I’ve owed a lot of money. That certainly has changed this past two years as my husband and myself find ourselves with medical debt that we may never pay off . As you can guess, we have no health insurance — we can’t afford it and even if we did have an extra $650 a month we couldn’t obtain it due to our pre-existing conditions.

Briefly, I had emergency surgery to remove a cyst on my ovary in 2010, a diagnosis of an autoimmune disease in 2011 and two bladder cancer surgeries in 2012. My husband has had high blood pressure for over 25 years due to a heart defect discovered in his 30s.

My husband and I live very simple lives and have little debt. For the past 18 years we’ve been self-employed, owning a retail music store, and for many of those years I worked for other companies. Some offered medical coverage, some did not. And for some of those years I was able to offer medical coverage for our few employees which also covered my husband and myself. The group coverage was minimal and started out being affordable but with increases it was impossible to afford for long. I tried catastrophic coverage but that was almost as expensive as regular coverage but with a higher deductible. Of course, neither my husband nor I needed the coverage when we had it. They say youth is wasted on the young. I say health insurance is wasted on the young.

The medical community has been great. From the cashiers who expect payment for services rendered that day to the lawyers who try to collect for the hospital system. They all understand and have spoken with many people who can not pay the high cost of medical services. I continue to be touched by the expressions of concern and their desire to help.

In October I had to visit my OB/GYN after not seeing her since 2010. As I explained all the medical woes I’ve experienced since our last visit we talked of the uninsured people who work but don‘t have insurance. She surprised me at the end of the exam by not charging me. To say that it was a relief not to incur yet another bill is an understatement. I was brought to tears.

Last week I had my first mammogram in three years and I expect the bill to be over $300. The last time I had a mammogram it was around $100. The technician encouraged me to have one next year but then understood my reluctance due to the cost so she gave me contact info for the Susan G. Komen Foundation. So I will use that resource next year thanks to her kindness. And I don’t have words for the services from the free clinic. They are the only reason I can get a 3 month checkup for the bladder cancer. It’s over $800 for a check up at the urologist office.

Preventive care is a luxury for all the people I know who own small businesses. Very few I know of have health coverage. Mammograms? Colonoscopies? Annual checkups? We have to see blood before going to the doctor. It’s a given that minor ills like the flu, ear ache, aching joints, and unfamiliar pains don’t warrant doctor visits. Much less a trip to the hospital’s emergency room services where a visit costs several thousand dollars. While my husband and I waited for admittance into the hospital through the emergency room for the cyst surgery we overheard a woman asking to be seen for carpel tunnel syndrome. She’d evidently had been there before too. Carpel tunnel syndrome is an emergency?

So my husband and I find ourselves in our mid to late 50s in the terrible position of trying to find doctors that will see us without insurance, trying to explain to bill collectors that we must pay in (very) small installments and trying not to be too embarrassed about our situation. And it is embarrassing. Owing $20,000 is like having a weight on your shoulders and it’s very worrisome. You can image what the cost was before the hospital system gave us a charity case discount.

I still consider my husband and myself young and in good health. We do all the rights things about taking care of ourselves and expect many more wonderful years together. But we’re really looking forward to age 65 when we’re eligible for Medicare.

Kelly Wooten is a patient.

Health insurance is wasted on the young

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American healthcare delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

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  • Guest

    You and your husband have saved yourselves WELL over $20,000 by not having paid for health insurance for the past 35 years. So in reality, you’re still coming out ahead.

    I’m not sure what the point is here. Is it that you were waiting for the government to FORCE you to buy health insurance, so Yay Obamacare? Or that you thought someone ELSE should have been buying it for you? (Who? The “evil rich”?) Or that you think it’s A Good Thing that starting in a few months, people can wait until they have an expensive medical problem and THEN go ahead and buy their health insurance, like waiting to buy car insurance until AFTER their car is totaled or stolen? Or that Obamacare is bad, because it’s going to make even young healthy people who don’t “need” insurance (like you were once), buy it anyway, to subsidize the older folks who didn’t bother to buy in until they were older and more expensive?

    Or is it that even without government coercion, when someone like you who doesn’t have health (car, home) insurance, comes up against large health (car, home) expenses, charity-minded folks voluntarily step up and help you out, so isn’t that nice?

    I don’t know.

    • Noni

      I think this is a yay ACA, as she made this point:

      “As you can guess, we have no health insurance — we can’t afford it and even if we did have an extra $650 a month we couldn’t obtain it due to our pre-existing conditions.”

      I know several people who COULD afford insurance but could not get it due to pre-existing conditions (one of which was acne).

      There are many things I loathe about the ACA, but eliminating insurance denial for pre-existing conditions is one element I like.

      • Guest

        It will be fine as long as EVERYONE doesn’t get the idea that, “Hey, I can skip paying $650/month for insurance for 35 years, that’s $7,800 a year in my pocket or $273,000 — a new house! — over 35 years, and then when I actually NEED expensive medical care, THEN I’ll go ahead and buy in.”

        Because if very many people do that, we’re stuffed.

        • Pookie

          I don’t think they actually had a savings of $273,000. They paid insurance premiums for years. They stopped paying when the premiums got to $650, meaning they were cheaper. I am not saying that they did not save money, I just believe it was a lot less than what you say it was.

          • Guest

            Were they somehow not aware of the fact that if you stop paying health insurance premiums, and THEN you get sick, you have to pay for your own medical care? And that once you ARE sick, you’re a very bad risk for any insurer to pick up?

            Like if I stopped paying my house insurance premiums, and then my house got severely damaged in a hurricane, I couldn’t expect insurers to buy me a new one, and I also probably couldn’t expect anyone to write a new policy on my badly-damaged home?

          • Pookie1990

            If you know how to solve health care, please share it. These people went without insurance out of financial necessity. There was not enough money. Comprende?

    • Pookie

      We don’t know how much they actually paid for medical services. They said they had $20,000 in debt. They may have paid much more than this already.
      Thanks to “cost shifting” these people are charged the most possible for medical services because they don’t have insurance and they don’t have the leverage to negotiate with the hospital.

  • Anthony D

    The
    Obama administration is particularly focused on getting younger,
    healthier Americans to enroll, since they will help lower premium costs.

    This is code for: If you’re old, congrats, you just got a break in
    premium thanks to the young and healthy being forced into insurance.

    • Suzi Q 38

      Is it possible that the young will just pay the fine and not have insurance?

      • Matt

        The smart ones will! If the choice is paying $7,800 a year for health insurance you don’t need, or a $500 to $1000 fine, why not pay the fine, and put the other $7,000 in your pocket! If you ever get sick, THEN you can fork out for health insurance, since they can’t turn you away for “pre existing conditions” now.

        All the feckless Boomers who wrote this bill, think it’s grand that THEY got away with not paying for health insurance when they were young, and now they don’t want to give US, the same privilege?

        • lissmth

          The “fine” can be so easily gamed it hardly exists.

    • Matt

      Too right! Today’s version of the author and her husband, won’t have the OPTION, to save alot of money by not paying for health insurance when they’re young. They are gonna get socked, to pay for the irresponsible boomers who spent their lives gaming the system.

  • Ron Smith

    I found my parents old bill for my delivery in 1958. The cost of the vaginal birth, the physician, and the hospital stay which was brief was about $160.

    My parents paid it off in about three days in installments.

    When I look at the things that have changed since then I think about the higher quality of care, the higher tech of today’s care, and the higher number of medical support personnel we have.

    The higher quality of care I think has been pushed by the demand for the HIGHEST quality of care. Americans feel entitled to this highest quality of care. Just look at the increase in medical lawsuits. People are willing to try to sue doctors in a heartbeat it seems. And the bottom line is their perception of quality of care. ‘Poor care?…you’re entitled to better. Call me and the law offices of Dingbat, Dingybat, and Dongbat! We’ll get you the money you deserve!”

    The higher tech of today’s medicine isn’t all about EMRs. Its about perception. Sure I’ve got a fantastic EMR that I custom built and it shines like a new nickel when patients see it work. Kinda like seeing a ‘New iPhone’ get released. But what patients really want is a doctor who’s relational. The picture I see in my mind is of two young people texting…while standing almost nose to nose, but buried in the latest, greatest device. Where is patient and physician humanity in all this?

    Hospitals, vocational-technical schools, and nursing programs everywhere advertise constantly. ‘Get a high paying job working in the field of medicine. Join us and we’ll train you for that [nursing, laboratory technician, medical coder...insert your own ever] job. Raise your lifestyle and your income!’ We’ve painted ourselves in the corner. The most significant part of health care costs is ancillary staff salaries. They directly affect the bottom line of a hospital. But the hospitals have proliferated so much that there is so much competition for the limited supply of ancillary medical talent, that they have to pay top dollar.

    We are on a deadly spiral of health care costs. Like Obamacare or not, we are nailing the coffin shut from the inside.

    We need to come back down to earth to understand what is a reasonable expectation of reasonably priced healthcare.

    My wife and I shopped around for her hysterectomy hospital. I wanted to try offer to pay cash. One hospital in the Fayetteville, Georgia area, finally told me that they could only do her surgery for $25,000. Cash. Not including the physicians fees. In Macon, Georgia, we paid cash, and the total for physician and hospital services was about $9,000 as best I can recall. We had reasonable expectations, reasonable service offerings from the hospital, and reasonable provider care. We didn’t have the attitude that we had to have some ‘best’ hospital or provider. We know things can go wrong and we didn’t go into that with some kind of ‘best if used by’ label on it all.

    Obamacare is not going to fix this. Probably any plan devised by anyone is not going to fix this. The problem I think is us the consumers. Trading fairness in a younger public group for ‘fairness’ in an older group is fair in neither case.

    Just my 2 cents.

    Ron Smith, MD
    www (dot) ronsmithmd (dot) com

    • Suzi Q 38

      Good points.

      I have done the same for my MRI’s. The prices range from $5K for all three sections of the spine, to $30K. I could not believe it.

  • Cleo1117

    I am not impressed by your story in the least. You two are a perfect example of why the health care system and insurance companies must over charge the rest of us. My husband was self employed and I worked as a teacher just so we could purchase health insurance. We payed a monthly premium that was still very high in relation to our incomes but it was and still is the responsible thing to do. I am not alone when I say, I AM TIRED OF PAYING FOR PEOPLE LIKE YOU TWO TO HAVE MEDICAL CARE, get off the gravy train and take on some real responsibility for yourselves.

    • Noni

      She says in the FIRST PARAGRAPH that they could not obtain health insurance due to pre-existing conditions. The country may have some moochers but there are plenty of folks that could afford health insurance and were denied coverage – at any price. So, reread the post and then save your judgment for those who actually deserve your scorn.

      • Tim

        So what did they do with the money that the rest of us schmucks have been stupidly paying our health insurance premiums with? What did they think would HAPPEN if they needed medical care and hadn’t bought insurance, if I couldnt get insurance I’d at least put away the equivalent of a premium every month to use in case I ever got sick!

        THIS IS WHY HEALTHCARE IS SO EXPENSIVE FOR EVERYONE ELSE.

        • Guest

          I don’t know. Why don’t people save up for college? Why don’t people contribute to their retirement? Why don’t people have savings accounts? I honestly believe some people cannot afford them.

          I know there are loads of lazy scammers out there; I work with many of them. That said, I also know there are people out there working hard and trying to get by and are not actively trying to dump on you and I for their healthcare needs.

          These are working people, the exact people who can benefit from the ACA (whose heart is in the right place but in my opinion is a disastrous plan). I’m not sure why you’d vilify people who work, support themselves and do not rely on the government but also could not get health insurance.

          I’m amazed how hospitals and insurance companies have managed to get people to hate each other and doctors but seem to have no problem with the hospitals charging whatever they feel and CEOs earning millions of dollars for denying care.

          • lissmth

            There are plenty of shiny new cars out there on the highway, too. Maybe health insurance would have been a better choice than a new car?

          • Pookie1990

            Lissmith, it must be really hard for you to go for a drive “knowing” that all the “shiny new cars out there on the highway” belong to people who have shirked their health insurance obligation.

    • adh1729

      “You two are a perfect example of why the health care system and insurance companies must over charge the rest of us.” No, no, and no.
      Who was forcing you to do commerce with the insurance companies? The middle man is the reason that medical costs went out of control. Down with the middle man (i.e. the insurance companies, Medicare, Medicaid, etc.)
      You are a perfect example of socialistic thinking. Socialism has never worked and will never work.

      • Pookie

        Take the profit motive out of healthcare. The middlemen are just part of the problem. Medical services are not billed at what they cost. Some people get them for less and some get them for more. It is the fault of the insurance companies and the medical providers, who charge nonsensical, arbitrarily high prices.
        Medical providers have to charge what their services cost, not what they can get out of people. The government has not done enough to intervene.

        • John G.

          You think the government should intervene MORE?

          Healthcare costs only started to spiral out of control after the government STARTED intervening, in the 60s starting with Medicare and Medicaid.

          • Pookie

            Yes I do. Sometimes fairness has to be legislated.

          • Disqus_37216b4O

            “Sometimes fairness has to be legislated.”

            So you’re kind of a “From each according to his ability, to each according to his need” kind of gal.

            Karl Marx would be proud of you!

        • lissmth

          “Profit” creates incentives, provides a return on investment to public retirement systems, IRAs, and 401Ks; and results in the best innovation and technology the world had ever seen.

          Prior to this Obamacare mess, insurance companies earned a 3 – 4 percent profit. Contrast that with Microsoft’s 42%. You want to socialize Microsoft too? How about Apple? Don’t they make to much money?

          • Pookie1990

            How many people can afford the best innovation and technology the world has ever seen? If medical care is priced out of most people’s reach, it may as well not exist. What is the point in that?
            By the way… you do know it’s not “to much” but “too much” don’t you?

    • Pookie

      Cleo 1117 your comment doesn’t make sense. Thanks to cost shifting, hospitals and doctors charge a different price to everyone. You are not just paying for these people, you are also paying for people on public insurance, private insurance and whoever else happens to get a better back door deal than you did. This lady and her husband were charged top dollar because they were uninsured. You get a negotiated rate because you have insurance.

      If you go to the same hospital as these people do, they would be paying for your medical care because the hospital would shift your costs to them.

  • Mengles

    “As you can guess, we have no health insurance — we can’t afford it and even if we did have an extra $650 a month we couldn’t obtain it due to our pre-existing conditions.”
    Which are only considered pre-existing bc you chose not to have health insurance. Actions have consequences.

    • Guest

      Or, they had health insurance, lost it, and then were marked with pre-existing conditions.

      Most people have health insurance as children but are not always able to get coverage once they are adults.

      Health care in the US may be bad. Insurance companies may be bad. Hospital administrators may be bad. Your fellow human beings are not bad. Stop blaming them for the broken health care system.

      • Tim

        Well, whatever the case for them not having insurance, if they had set aside the thousands upon thousands of dollars they were saving by not paying for health insurance, THEN, when they DID need medical care, they would have had a huge savings account to draw from. $20,000 would have been a drop in the bucket, given all the money they saved by not paying premiums.

        Should people have any responsibility AT ALL for planning for their own needs?

        • Guest

          Of course they should! Teenagers should wait until marriage to have sex or always use birth control, people should only have kids when they can afford them, parents should have 529s for their kids and 401ks for their future, they should live within their means, they should work and not rely on gov’t services and they should have health care.

          Unfortunately, that is not reality. What if you became ill and lost your job? That could happen to me or my husband or both and we’d be screwed. It shouldn’t be that way.

  • querywoman

    I find it strange that doctors won’t see them without health insurance. Lots of docs are glad for cash only patients.

    • Guest

      I’ve found doctors who wouldn’t see patients without health insurance. They’re afraid they’re gonna get stuck with the bill.

    • BudgetDoc.com

      Indeed. They’re out there. You just got to know where to look.

      • querywoman

        Yeah. Plenty of cash only doctors work for more than insurance pays, and still manage to get the patients.

  • Guest

    Baby boomers seem to be especially slow learners.

    If you don’t bother to get home & contents insurance, and then your house burns down, (A) No insurance company in its right mind is going to insure you for that house and those contents AFTER they’re ruined, just in time for you to make a huge claim, and (B) Some people will be sympathetic to your plight, and some (especially those who have scrimped and saved and done without in order to pay the home insurance premiums YOU weren’t paying) won’t.

  • Dorothygreen

    There are valid and invalid arguments here. The author talks like she has no knowledge of the ACA: that the “pre-existing issue is a none issue. Nor, does one know if the author and her husband have pre- existing issues that are “preventable” by diet and exercise – this puts the biggest strain on income tax and premium payers. Nor, do we know how they spend their money or what their income is, It just seems that their income is low. And, as such they may well afford health care come Oct 1.

    But even with all this the cost of insurance will continue to be unaffordable for many because we have no health care system as long as all the players can dictate and raise their prices independently. No other country does this and we don’t need so called socialized medicine to accomplish it.

  • DQUser

    The American health care nightmare is a creature of the insurance, pharmaceutical industries and the AMA. Other western industrialized democracies have better healthcare outcomes at a lower cost than the US. So why doesn’t America just copy the best one? Answer: The insurance industries, pharmaceutical industries and the AMA.

    • lissmth

      Actually, America has far better cancer survival rates than socialized system in UK and Canada; better than Germany and Norway. [references available] About those “outcomes” you speak of, how do you know that?

      • DQUser

        According to the WHO, by the usual measures, longevity, live births per 10,000 deliveries, hospitalizations due to infectious diseases, deaths from medical errors etc etc America is only 39th in efficacy.

        There’s a link on the website which take you to it: mayovictim.DOTcom (change the letter DOT to a period.

        • Disqus_37216b4O

          Those WHO numbers are a joke. Most of the countries they’re comparing us to don’t count infant mortality/live births the same way we do.

          • DQUser

            Re mortality/live births? Are you sure? The number of still borns, which ever way you count them, are still dead.

          • Disqus_37216b4O

            In many countries, a baby is not counted as having been born alive until it has managed to live a day or more. Thus, American babies who are born extremely prematurely at 22 or 23 weeks and only live a few minutes, are counted as a mortality. That bends our “longevity” and “infant mortality” curve way down. In most other countries, those babies would not have been counted as live births to begin with. And, having never been counted as “alive”, their deaths don’t count either. It’s just as though they never even existed. Ghost babies.

            This is from Dr Linda Haldeman, “Infant Mortality Comparisons a Statistical Miscarriage”:
            ~ ~ ~
            “Low birth weight infants are not counted against the “live birth” statistics for many countries reporting low infant mortality rates.

            According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.

            But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies – considered "unsalvageable" outside of the U.S. and therefore never alive – is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.

            [...]

            Some of the countries reporting infant mortality rates lower than the U.S. classify babies as "stillborn" if they survive less than 24 hours whether or not such babies breathe, move, or have a beating heart at birth.

            Forty percent of all infant deaths occur in the first 24 hours of life.

            In the United States, all infants who show signs of life at birth (take a breath, move voluntarily, have a heartbeat) are considered alive.

            If a child in Hong Kong or Japan is born alive but dies within the first 24 hours of birth, he or she is reported as a “miscarriage” and does not affect the country’s reported infant mortality rates.

            [...]

            Too short to count?

            In Switzerland and other parts of Europe, a baby born who is less than 30 centimeters long is not counted as a live birth. Therefore, unlike in the U.S., such high-risk infants cannot affect Swiss infant mortality rates.

            Efforts to salvage these tiny babies reflect this classification. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States.

          • DQUser

            Thank you for that information, I appreciate it. I have also seen reports that say the poor US live births ratios reflect the lack of pre-natal care in the US, particularly among low income groups.

            Do you contest the other WHO figures for longevity, hospitalizations, incidences of infectious diseases etc?

  • Pookie

    Health insurance is wasted on those who are not sick.

    • Guest

      How expensive is health insurance going to be, though, if EVERYONE waits until they need it, to start paying for it?

      It’s like if Obama banned car insurance companies from offering policies based on risk. You wouldn’t have to buy car insurance until AFTER your car had been totaled.

      • Pookie

        Let’s wait and see how the Affordable Care Act plays out.

        • lissmth

          Has you head been under a rock? Are you not reading?

          • Pookie1990

            While the ACA has a lot of problems, your solution (cash pay everything except major medical) isn’t any better.

    • Guest

      “Car insurance is wasted on those whose cars have not been totalled yet.”

      “House insurance is wasted on those whose houses haven’t burned down yet.”

      “Funeral coverage is wasted on those who aren’t dead yet.”

      Do you have any idea what insurance actually IS?

      • Pookie

        I always assumed that insurance actually IS a contract between an individual and an insurance company in which the company indemnifies the individual against all, or part of a future loss.
        But does it really matter what insurance is?
        The better (and somewhat less condescending question) is whether private insurance is the best solution to protect individuals against healthcare expenses?
        Anther more pertinent question would be how do we contain spiraling healthcare expenses?
        Yet a third question: How do we streamline the medical billing system so that charges are fair and intuitive?

        • lissmth

          We get people paying cash for their own care until things reach a catastrophic level. Then, HSAs should kick in. Of course, that would involve transparent and fair prices. Studies show that those who do it that way spend 9% less than those who have insurance that pays for everything.

          • Pookie1990

            Your idea is great if you are healthy, or if you get a catastrophic illness. If you have a medical condition, or if you are already very poor, you may not have enough cash on hand to pay for medical services.

  • Pookie

    Exactly.

  • lissmth

    The problem with not having health insurance is that you pay nearly twice what an insured person pays. Doctors and hospitals have secret contracts to set prices which results in secret prices within their “networks.” Once your $300 mammogram is run through insurance, it will be less than $150. Even if you have very high deductible, you pay $150 instead of $300.

    The problem now is that Obamacare has pushed the cost of insurance to nearly, or totally, unachievable levels. In my area, the premium for a young man (high deductible) was $35 in 2019 (right after the bill passed) and will be about $200 under Obamacare. He now has to pay for maternity even though the risk is zero that he will have a child. That provision was all about gender equity and had nothing to do with actuarial risk.

  • lissmth

    1. Stop third party pay except for catastrophic events
    2. HSAs
    3. High-deductible, inexpensive insurance with an incentive for young people to buy.
    3. Cash until catastrophic event
    4. No secret contracts to fix prices.

    • Pookie1990

      While it may be unrealistic to expect healthy people to buy health insurance before they are sick, it is just as unrealistic to expect people to save enough cash to cover all their non catastrophic medical expenses (doctor’s appointments, prescriptions, medical equipment, physical therapy…etc.).

      • Disqus_37216b4O

        “it is just as unrealistic to expect people to save enough cash to cover all their non catastrophic medical expenses”

        Why?

  • heartdoc345

    wow, $100k in a year. Must have been a hell of a migraine. That smells of significant overcharging – or a lot of unnecessary tests (did they do a head CT and an LP with every ER visit “just in case ” it was a brain bleed?)