It was a shallow fly ball that was going to drop behind shortstop. I took off full speed from right center field knowing the only way I corral it was to go full out. Then, as it descended, I knew I’d have to slide to catch it inches from the ground. So I did. The way I always do, on my right leg/hip. The ground was hard, I bounced a little—upsetting my timing and missing the ball by inches. I tumbled. Hard. It was a meaningless hit the fourth inning of a game with no runners on base. But that’s how I roll. I continued to play the rest of the game, and ran fine. We won the game. Back at home I started to feel tightness in my right knee. The next day I couldn’t walk. After months of getting opinions on what was wrong, an MRI finally revealed a torn meniscus that required surgery. I’ve never been inured before so this is new. I am scheduled for surgery June. It’s a minor procedure so it’s cool. I’ll be back to running the outfield soon enough. 

But this post isn’t about softball or a torn meniscus. It’s about American health insurance. Because after having researched costs for this thing, I can’t believe this is how it works. 

We pay $6,000/year for health insurance. It’s not a massive amount, but 6K could do a LOT more things than provide the “privilege” of health insurance. We haven’t even used our health insurance beyond having to pay the office visit fee at doctor’s offices. I guess the annual physical is free IF you don’t talk to your doctor about anything other than what’s on her checklist for a “physical.” If you do, it’s a different rate based on the agreement the insurance company has with the medical practice. Anyway, over 10 years that’s $60,000. Sixty fucking thousand dollars for “peace of mind” in case anything really, really, really bad happens. At which point I guess insurance begins to pay for stuff. Some stuff. Because they’re definitely not paying for everything. 

After I discovered how much we had to pay for my knee surgery, I scheduled thumb surgery for later in the summer. I’ve needed it years, but managed the pain with injections (that the insurance company doesn’t cover and that don’t go toward my annual deductible) to avoid paying more than necessary with a surgery. Plus, I always figured I’d get the thumb done when I needed something else. Well now I do. 

After calling the business office of the surgeons for the two procedures, I discerned the overall cost for surgery. But then I had to contact the surgery center to get their costs. Then the anesthesiologist office for that cost. (I had no idea this was the process for the patient.) Anyway, my costs come to, let’s call it, $15,000. Which includes the $1700 MRI. Yes, $1700. 

  • My personal annual deductible is $4500
  • $15,000 total costs
  • – $4,500 I have to pay 
  • = 10,500 left over

So now with this $10,500, health insurance finally begins to kick in. But not so fast. They’ll only pay 70% of this number. Which means I owe another $3150. 

So now I’m up to $7650 out-of-pocket for the two minor surgeries. 

The health insurance company ends up paying $7350. Or LESS than what I, the annual subscriber who pays them $6,000 a year to even HAVE insurance, pays. And you can bet your ass that there’s no WAY the insurance company is actually paying the providers this amount since they have all this inside baseball going on with them regarding fees and tradeoffs and whatnot. 

I understand that once my out-of-pocket reaches $8000, my insurance company will begin to pay 100%. But I’m still $650 short of reaching that threshold. So I am going to have one OTHER surgery that I need later this year—just to make them pay. And yes, because it’s inevitable, but I may have lived with it for another decade the way it is. Anyway, not now. Now I have to do it this year. It doesn’t make financial sense not to. (I haven’t crunched the numbers for the third surgery yet, as it’s early in the process.)

So for these two procedures plus our annual cost just to HAVE health insurance, we will be paying $13,650. (This doesn’t count our medications, doctors visits, etc.)

BUT, when you take what the insurance company “owes” for my two procedures ($7350) less the $6000 we pay them to simply have a policy, they’ll “owe” $1350. lol

Why is it like this? 

Greed, lawyers, and politicians. But mostly greed. Oh, and data analysts. Because the fact that I lose and the insurance company wins in this is no accident. Insurance companies know exactly how much the average American uses and why. They are brilliant at this. And we are their bitch. 

Our health insurance company for the last couple years is United Healthcare. Their CEO makes 19,000,000 annually. Guessing a $4500 personal annual deductible isn’t a big deal for him. And yet some folks will still be all like but he EARNS that money! No. He doesn’t. He and his cronies throughout the industry swindle it from regular Americans under the guise of “peace of mind.” But aren’t doctors and surgery centers and all the other things within the “health” industry making dime? Sure. Yes. Massive dime. Because we as a society have somehow allowed our freaking health to become a core tenet of capitalism. Something too big and complex to even rethink. Or even talk about rethinking.

Humans are fallible beasts. The American healthcare system capitalizes on this. Hard. And we take it. Because it’s too complex to fix, and all this nonsense about fixing it so that our fallibilities are not profitable, is somehow socialism. Which is the same word as communism to too many people. And insurance companies know this too.

In the movie It’s a Wonderful Life, Jimmy Stewart’s character, a banker, has an epiphany that the idea of a bank isn’t to make a profit, but help people reach their American dreams. (Don’t get me going about the banking industry.) Perhaps it’s time for a It’s a Wonderful Life reboot–except about ensuring that people who fall ill don’t go bankrupt. 

Jim

The Firebrand
Fatherhood

Jim Mitchem

Writer. Father to daughters. Husband. Ad man. Raised by wolves. @jmitchem on twitter. First novel, Minor King, out now.

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