“In
many ways, buying health insurance is similar to buying a lottery
ticket. We hope for the best when time comes for the drawing, knowing
that the odds of winning are against us.”

Like many Iowans on an individual health insurance policy, we received our premium change notice from Wellmark Blue Cross Blue Shield of Iowa this week. The premium is increasing by 18% effective April 1. With the increase, it is still 31% less expensive than the COBRA coverage premium we had been paying after my retirement, so I am not complaining. The trouble with health insurance is not the premium; it is the uncertainty about what we are buying for the premium.

The biggest worry is that the coverage will be canceled if we get sick, or that the coverage won’t adequately cover a potential illness. Being self employed, and with Wellmark being the dominant health insurance provider in the state, there are not many other options if the coverage is canceled. I understand that experimental procedures are not covered. I understand that pre-existing conditions are not covered. I understand that there is a complex process of who pays for what and that initiation of coverage also began a dialectic between my doctor's office and Wellmark. Emblematic of this dialectic is that the doctor's office just last week reconciled the charges with Wellmark for the annual physical I took in July. Someone is making money on the cash float on this modest fee. It is neither the doctor's office nor us.

We make an assumption when we purchase health insurance. The assumption is that if we get sick, there will be coverage. At the same time, it is difficult to understand the provisions of the Wellmark contract. One of the terms on the application was that Wellmark reserved the right to refund all of my premiums and cancel the policy if something came up. In many ways, buying health insurance is similar to buying a lottery ticket. We hope for the best when time comes for the drawing, knowing that the odds of winning are against us.

Our health care system is flawed, on that, everyone agrees. What is less discussed is how the health insurance system in the United States is one more contributor to the transformation of society in the post Ronald Reagan era. In a dog eat dog world, we ask ourselves, “how can we protect our family?” The answer, at least partly, is don't expect others to take care of us. Certainly, don't expect this of insurance companies. Expect to be on our own.

We don't want government involved in our lives, but eventually we will have to rely on Medicare to protect us. We have been paying into this system for decades, so we hope it will be solvent when the time comes for enrollment. There are no guarantees.

We can accept that health insurance companies must manage their risks and in doing so, better manage their profitability. The service insurance companies provide must serve their profitability. If we want to participate in the process, that is our decision. What is hard to take is that the rules are often unclear. We feel like a pawn in their game, waiting for their next move. In the post Reagan era, that is about all we can expect.

~Paul Deaton is a native Iowan living in rural Johnson County.  Check
out his blog, Big Grove Garden.
   E-mail Paul Deaton

Watch for Dr. Alta Price's Health Care Reform Update every Tuesday here on Blog for Iowa.