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ASSADI: Choice in healthcare coverage is illusory


Column: Dose of Reality

One day I was sitting in my Healthcare Systems course, and as the clock ticked to the first minute of lecture, my professor exclaimed, “Time to take a quiz”!

Murmurs in the room heightened as students wondered, will this be graded? What are we supposed to know? After all, we were in the finance portion of studying healthcare systems and she had prepared us for this subject with, “this will be the most difficult unit this semester."

To our relief, she said, “This is a quiz we will take all together, just to gauge what you all know about health insurance." A sigh of relief exhaled from the lecture hall, but then slight panic began to settle into the seats. We had no idea how insurance works. 

Then our professor displayed a survey with a multiple choice question along with the percentage of Americans that correctly answered that question. For half of the questions, approximately 50 to 60 percent of Americans got the right answer. 

These questions were mostly related to the definitions of “insurance premiums” (the monthly payment made to an insurance company to continue enrollment) and the definition of “deductibles” (the minimum paid out of pocket by the patient before insurance kicks in to pay). 

Unfortunately, the worst questions for Americans dealt with applications of these definitions. Only approximately 25 percent of Americans would correctly calculate the amount for which they would be responsible. For example, if they were to receive lab tests from an out-of-network lab.

Our class sat back in shock. We were relieved that this was not graded, but also that we were not in a hospital bed trying to budget our healthcare costs. The mathematics were not difficult, and most likely would be calculated on an insurance bill, but the problem had to do with seeing the potential bill ahead of time. 

The possibility of being in an in-network hospital (a hospital where one’s insurance will cover a portion of the bill), but an out-of-network radiology department or lab for blood tests is fairly common. This phenomenon is known as the “surprise bill”: A patient goes to an in-network hospital and receives services that, without their knowledge, were not covered by their insurance. 

This type of calculation felt like the responsibility of a professional. In other words, it sounded like someone else’s job. The job of someone responsible for presenting these future costs to the patient or the job of someone to communicate which services are in-network and covered by their insurance. Unfortunately, this question accurately represents the responsibility put on the patient to understand their healthcare plans. 

This puts the legwork on the individual and treats them as a consumer, even if they are not privy to the prices before they can access the “product”: surgeries, lab tests and an IV bag. Regarding private insurance as a “choice” is deceptive in my opinion. The consumers of the product do not see the listed prices, as only the insurers can do that. 

The hospital's prices are incredibly high, even if the costs do not match. Profits are being made without regard for the patient's ability to pay. Without insurance, the patient cannot act as a consumer.

This is especially true as wages are staying relatively stagnant while medical costs and deductibles skyrocket. Being uninsured is not an option. Since most insurance is tied to employment, the employees do not have a choice of which insurance company they are paying toward. As the point of insurance is to offset high medical costs, but deductibles and premiums combined exceed $20,000 each year on average, Americans are not receiving a great return on their investment. 

Since most Americans are insured by insurance plans from their employer, they do not have a choice of which insurance company or plan they and their families can use. Then the insurance companies make their own choices of which hospitals, physicians and services they want to cover, not the patient. And the products are not for leisure or convenience (they are not “wants” of a consumer with money to spend), they are necessary in many instances. 

And considering as many as 66.5 percent of bankruptcies are due to medical-related expenses in the United States, we need to rethink our illusion of “choice” when it comes to private insurance.

 Yara Assadi is a School of Arts and Sciences sophomore majoring in public health. Her column, “Dose of Reality,” runs on alternate Thursdays.

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