Health insurance does not equal health care
Carrying a health insurance card does not guarantee quality healthcare. When you go to the traditional hospital or the clinic, the services provided are billed to your insurance company, and then they decide how much of the bill they will cover. Sometimes they cover all of it. An example might be preventative health interventions, such as a mammogram or an annual physical. Other times they cover none of it, in which case the bill goes toward your deductible. An example might be an urgent care visit. Your deductible comes out of your pocket, in addition to the premiums you pay regularly, either out of your paycheck or out of pocket.
When you carry a standard health insurance plan, often you are limited to certain health systems, while others are out of network. Someone, somewhere, is deciding what services are covered, and you might find yourself getting unexpected bills in the mail. What you thought was covered actually isn’t. Why am I paying this hefty premium out of my paycheck just to get more bills to pay on the back end?
A few decades ago, health insurance looked more like car insurance. You carried a deductible that applied to unexpected major events. The rest of your health care was paid out of pocket. Prices for care were more transparent and more affordable. Traditional health insurance costs have evolved for many reasons, not limited to:
Health care prices have risen
Our aging population has more chronic conditions which leads to more healthcare spending, and our entire population is arguably less healthy than in previous years
It is more expensive than ever to run a hospital or clinic. Lots more administrative spending, overhead costs, etc.
Prescription drugs are expensive
We’re seeing higher premiums and higher deductibles, and these increases are outpacing what people can afford. You may have heard the phrase “this year’s claims become next year’s premiums,” meaning the more we spend on healthcare now, the more expensive insurance will be in the future. How do we break the cycle?
If this message resonates with you, think about trying something different. Direct primary care offers price transparency. Know exactly what you’re getting for the membership price. Save your health insurance for the unexpected major expenses - the way it was originally meant to work.
