Underinsured Is Unsustainable

by Julie at ProgressiveKid

Underinsured is an oxymoron. If you’re insured, you’re insured—right? Wrong. As legions of us know all too well, paying high insurance premiums faithfully for years guarantees nothing but regular dings to your bank account and possibly little to nothing in return. Given that many of us have numerous insurance premiums, the dings can feel more like brutal gut kicks.

Chances are if and when you need to make an insurance claim you will find (or already have found) that, like me, you are “underinsured,” meaning that you will not receive full coverage for needed services or you will receive no coverage at all because of exclusions you never knew existed. Your chance of coverage denial is greatest if you’re making a health insurance claim. A study in the June 2008 issue of Health Affairs reports that over 25 million of us are now underinsured for health coverage, a 60 percent rise among working adults in the last four years. Add that to the 50 million Americans who are uninsured for health care, and it represents nearly 30 percent of the U.S. population. In terms of expenditures, we underinsured Americans are paying 10 percent or more of our income on out-of-pocket medical expenses and 5 percent or more of our income on health insurance deductibles.

When my partner and I developed incapacitating illnesses at around the same time, we discovered quite disastrously that our supposedly high quality health insurance did very little for us. Our need for care, including so-called “alternative care” after traditional medicine failed us, led us into crushing debt that we are still struggling to overcome ten years later. Like many people in our situation, we now blow off regular check ups and often do not seek help for needed medical care. We’re in abundant company. Fifty-three percent of underinsured and 68 percent of uninsured people forgo needed medical care. We 75 million Americans are likely to skip recommended treatments and tests and leave prescriptions unfilled. As a result we are more likely to receive fatally late diagnoses of cancer and other life-threatening conditions, which for those of us with insurance ironically will cost our insurance providers far more money than if they had adequately covered preventative care. And because many of us do not have a regular doctor or nearby clinic, we often end up in costly emergency rooms, taxing the system even more. A July 17, 2008, story on NPR reported that about 50 percent of emergency room visits could be handled in doctor’s offices or clinics, but for many Americans a hospital ER is the only option. By contrast, in Holland 90 percent of the country has 24/7 access to primary healthcare, including house calls.

Insurance is on my mind these days because my 5-year-old daughter was recently denied coverage for an eye condition that can be serious if untreated but responds well to therapy. Our health insurance company denied our request for coverage, despite the fact that my daughter’s doctor recommended a course of eye therapy treatment to resolve the problem. When we contested the denial, backed up with extensive research about the benefits of eye therapy, our insurance provider acknowledged that the therapy would be beneficial but nevertheless denied coverage based on a technicality that such therapy was not listed among their covered services when we signed on. This begs the question, how is it reasonable to deny needed mainstream medical coverage that is deemed necessary by a doctor and that is in fact in this case a preventative measure against surgery?

The answer is that it is not reasonable. It is not reasonable for my family, or for society. Furthermore, and more importantly, it is not sustainable. For those of us who concern ourselves with issues of sustainability, as any thinking person must with 6.5 billion humans now on the planet, revising our health insurance system should be a top priority. Like Western medicine, American health insurance focuses almost pathologically on reactively treating acute illness rather than proactively supporting long-term wellness. My daughter’s eye condition fundamentally affects her physical, intellectual, and emotional development. Giving her the care she needs to overcome the problem now would help foster her lifelong good health. It is in the best interest of the insurance company and society at large, whose collective premiums pay for individual treatment, to provide for my daughter’s lifelong wellness so that she does not cost the system more money in the long-run on treatments for problems that could have been prevented.

As is the case in so many areas of contemporary American society, the kind of long-term big-picture thinking that creates sustainable systems (which one might call wisdom) is eclipsed by narrow, short-term agendas, sustainable or not. Our individualist-capitalist bias turns us against considerations of sustainability and the collective good in favor of pursuing individual gain, competition, and financial reward. This America-think has made us a nation of workers putting in the longest hours for the least amount of time off. It has made us the world’s greediest energy consumer, using 25 percent of world energy, and the biggest carbon emitter after China; yet in spite of—or because of—our increased consumption, as a nation we are less satisfied in the last few decades than ever before. These are not statistics to be happy about, especially when that insurance claim denial letter arrives in the mail.

Julie Hall is the author of the new book A Hot Planet Needs Cool Kids: Understanding Climate Change and What You Can Do About It and the founder of the green online store ProgressiveKid.

Image by Bernard Pollack, 2008, Creative Commons license.

©2008 ProgressiveKid

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