If you’re like me, you’ve been dealing with your company’s open medical enrollment during November. And, if you’re like me, you’re seeing costs go up, coverage go down, and lots of folks blaming it on Obamacare. So I’ve been thinking about our plan’s changes and wanting to write a post about it…. and what came to mind was the statement of Rabbi Hillel:
If I am not for myself, who will be for me? If I am only for myself, what am I? And if not now, when?
What this means is that while we have to have a reasonable amount of self-concern, we also have to be concerned for the community. We have to be concerned for the community, for if we don’t care about others, what does it say about us? Further, we can’t keep putting it off to tomorrow. We have to do it now.
What does this have to do with healthcare? Let me discuss the changes in my PPO plan, and perhaps you’ll see… and perhaps you’ll understand why Obamacare is so important, even if it means some of us pay more.
This year at the Ranch, we’re seeing some interesting changes in our health plan. These changes are partially due to the fact that what we had could have been considered a “cadillac” plan. A greater driver, however, was the fact that our plan is self-insured. The company wants to reduce their health care costs, and to do so they have to change behaviour.
They are doing this by tinkering with the plan. First, they are adding a $200 deductable for brand name drugs. This is to encourage people to use the less expensive generic drugs. Although some drugs do not have generics yet (many inhalers, for example), and others have different efficacy for name brands (depression and migraine drugs are common examples of this), for many people the generics will work just fine. Those of us who need the specific brands will end up paying more, but it is important to have this happen to make people aware of the costs of their medicines, and to push them to making the more cost effective choice. So some pay more in order to reduce overall health costs.
Another change they are making is to make the cost of off-network providers much more expensive. Again, this is to make people aware of the increased cost of using such providers. Even if those providers write-off the amount above reasonable and customary, so the patient doesn’t pay more, the company ends up paying much more. I know this change will push me to being much more proactive in ensuring I am using in-network providers.
They are also increasing the cost of using the emergency room, and decreasing the cost of using urgent care. Again, this is to push people into making the right decisions and reducing medical costs overall.
What is the net meaning of all of this? Some people are going to need to pay more so the overall system can become more healthy. Similarly, some healthy people will need to purchase health insurance — even though they will likely not use it — to spread the costs over the entire system and make insurance affordable for everyone. Employers may have to choose to raise prices very slightly in order to do the right thing and provide health coverage (or… god forfend… they may make slightly lower profits).
What Obamacare is about is very biblical. It is about realizing that society means more than just caring about yourself. It means caring about your community, because if you don’t do it, who will. Further, if we don’t do it now, we never will.
P.S.: As tomorrow is Thanksgiving, here is something else to think about: For those of us lucky enough to have jobs and other means of support: Let us be thankful for them, and thankful that (hopefully) we earn enough to be able to do something to help someone else. For those less fortunate: Let’s be thankful that you live in a society that doesn’t just think about itself, but cares for others.
