From the Blog

Fun With Self Employed Health Insurance Part Two

Yesterday I talked about worrying about not getting health insurance. Despite the fact that I’m a little nutty, it is a legitimate thing to be anxious about.

Thankfully, in our case, we did get coverage from an independent plan. We used a broker, and he recommended a provider and a plan, and I filled out the application, I answered their questions about my medical history, and I gnawed down my fingernails until I ruined my dinner.

We applied for a high deductible HSA plan. HSA = Health Savings Account. Basically, an HSA is like a tax sheltered retirement account, except you can make withdrawals for medical costs. I was actually able to take some money out of a 401k to fund it. If we don’t use the money in the HSA, then it’s just like any other retirement account.

The whole idea behind a high deductible plan (with or without HSAs) is that it will encourage people to not go to the doctor. That’s what it boils down to. Advocates of this plan call it “consumer driven,” or they call it “having skin in the game.” What it means is that because you are spending a lot of your own money first, you will think twice about having that strange mole looked at. Or maybe that deep cut will heal without stitches. Or maybe it’s cool that your knee bends the wrong way with that torn ACL. Maybe you can just learn to live with chronic debilitating migraines. You can just tape up a broken toe to your non-broken toes, right?

The idea is that spending your own money means you will make more responsible choices. So if you don’t have the money, or if you don’t want to spend the money, you don’t go to the doctor. You live with your ailments, chronic or not. Life threatening or not. Emergency or not. This is called “being responsible.”

But here’s the thing. Being irresponsible is buying a new BMW when you have the budget for a used Tercel. You can’t shop around and look for better deals when it comes to healthcare. There are no better deals. You don’t “shop” for healthcare, insurance companies shop for you. You better be bright and shiny, you better be in good working order, you better not have too many miles, otherwise insurance companies are currently well within their rights to withhold their products from you.

This is not “shopping.” People who need health insurance are not “consumers.” If you have a pre-existing condition, you don’t “take your business elsewhere,” when you are turned down. There is no consumer empowerment if you need the product in order to stay healthy and you know, “alive.”

We are among the “lucky ones” because I happened to have a 401k that I could use to fund an HSA (you can do this one time in your life without penalty). We took a plan that had a $5000 deductible each. Our savings won’t completely cover us both ($10,000), but we’d have a head start. Since we have this money in the bank, it could be said that we are among the “responsible” ones. But if we broke an arm, one arm, one time, it would wipe out years’ worth of savings in one fell swoop.

Healthcare is prohibitively expensive for pretty much everyone. And you know what? Needing healthcare is the great equalizer. It doesn’t matter if you are poor or super rich. At one point or another, you are going to need to go to the doctor. And even if you’re really healthy, and you consider yourself “responsible,” you’re going to get older and your shit is going to start breaking down. It’s the universal condition. Let’s stop pretending that going to the doctor is disdainful or irresponsible. And let’s stop pretending that if you are poor, that access to healthcare shouldn’t exist for you, because you can’t afford it. Healthcare is not a commodity.

Okay, so there’s that rant. And I still haven’t even gotten to the part about our health insurance that is making me think about all this. Maybe I’ll be able to get to it tomorrow, before I get all ranty and my head explodes.




  1. So, wait – how is that insurance? Isn’t it basically just you putting money in an account to pay for yourself should something happen? Couldn’t you just put it in the bank? Does it earn interest? Or am I missing something and insurance applies in such instances – like you broke your arm and it cost $10k but you only paid $5k deductible?

    • Our deductible is $5000 each (we thought, that story tomorrow). The HSA is just a tax-sheltered savings account you can get only if you have a high-deductible plan. It does earn interest, but not much right now. We will use the HSA to cover the deductible if we ever have an emergency. After we pay the deductible, the plan starts paying, just like any other insurance.

  2. Barbara Holmes says

    Sucks don’t it…

  3. So to cut costs Washington state notified folks on medicaid that they will pay for 3 non-emercency visits to an emergency room. That’s fine, a small percentage of folks use the ER as their primary care. But, some of the things they won’t cover are chest pain (unless you are diagnosed with chest pain of cardiac origin), difficulty breathing, having a miscarrage, etc. There are 700 diagnoses they won’t pay for. They will pay for visits to an urgent care clinic. You just know eventually someone will die because they used up their 3 non-emergency visits and the 4th time they had chest pain it really was a heart attack; but they did not seek care due to cost. I work in an ER, few patients have medical degrees and are unlikely to be able to differentiate chest pain from indigestion v. chest pain 2/2 having a heart attack. Also hospitals must provide care to anyone who presents to the ER. Anyone who thinks the USA does not need healthcare reform is sadly uninformed; it is broken on so many levels.

  4. This is one of the BEST blog posts, editorials, whatever, I have ever read. It’s so damn true, and so damn sad. We also have a high-deductible (“catastrophic”) plan; in our case, $8500 for each of us, and we live in Latin America. We are not covered in the USA because that would have tripled our premiums. Yes, I said tripled. This is seriously screwed up. I hope Washington will one day get their heads out of you-know-where and fix this calamity.

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