Well, it’s a really complicated issue. 

Unlike most of the world, the United States doesn’t have free nor universal healthcare. And we won’t even touch that subject here. We’ll just see what it means to have health insurance and what it means to not have it. Okay, maybe we’ll touch that subject just a little bit. But first, we’ll share the stories of 3 families with children, all of whom have health plans through their jobs, meaning they pay part of the health plan premium, and part of it is paid by their employer.

Photo: Pexels 

Family number 1.

A family of 2 parents and 2 children, where both the parents are working and both are insured through their job. The mother is paying about 150$ a month only for her insurance and the father is paying about 600$ in order to get insurance for him and the two kids. So, about 750$ a month for the whole family.

This is their story.

Their 3 year old falls and hurts her leg while playing. She appears to not be able to step on her feet and at the same time, being just 2, couldn’t explain what exactly happened, where specifically she feels pain or anything like that. She is just crying.

So, the parents drive her to the emergency room, check her in, sit for an hour with a crying child in the waiting room, then finally a doctor is able to see her, she gets an X-Ray, they see that nothing is broken, so they send the family home. But, before they do, they charge them 400$ for the visit to the ER, since that’s the price on their health plan for an ER visit and tell them – that’s not everything that will be charged for the visit. But whatever else there might be, it will go through the health insurance. 

“We were curious and asked what we would’ve been charged if we didn’t have health insurance. They told us that whatever the bill might be, they usually give a 65% discount”, says the father.

Photo: Pexels

After a month of the visit, they get a letter in the mail from their health insurance with Explanation of benefits, telling them that the hospital is asking for about 1900$ in total for the visit and demanding an explanation as to why the hospital wants that amount.

“We sent them the report from the visit, and we still don’t know if they’ll accept it or we have to pay some part or the whole bill. And that’s after those 750$ we pay for health insurance every month. If we make a simple calculation and take 65% out of 1900$, we would have paid 665$ for the whole visit without any insurance. We already paid 400$ and if our health insurance asks for any more money, I don’t really see the point of having it – if it’s the same either way. Actually, when you take the premiums into the calculation, it’s a lot cheaper to just stay uninsured”, says the father. 

Until now, the insurance hasn’t asked for any additional money for that visit.

Of course, that doesn’t mean it won’t happen.

Family number 2.

A family of 2 parents and 1 child, where only the father is working and the whole family is insured through his job. He pays just south of $1000.

This is their story.

They go for a routine check up with their primary doctor for their child. The doctor sends them to occupational therapy for an evaluation. It turns out the child will have to go there twice a month. 

And the price?

Simple! $135 without insurance or $75 with insurance. 

Or in other words – $135*2=$270 monthly without insurance or $75*2+$1000=$1,150 monthly with insurance for the visits and the premium for the insurance.

They don’t have any other health issues or visits to the doctor, no one in the family takes any medication… so, those almost $12,000 in the year for the premiums are money sent to the insurance just in case something extremely bad happens. Of course, $12,000 without the contribution from the employer. When we add that, it’s a lot more for the insurance.

Photo: Pexels

Family number 3.

Another family of 2 adults and 2 children where only one of the parents work and the whole family is insured through that job. The monthly premium for the insurance is $850.

The mother in the story has a sudden rash and trying to figure out if it’s an allergy of some sort, goes to an urgent care center, known as a minute clinic, because that’s the fastest and most convenient way for her, not having to wait for an appointment from her PCP.

A doctor is able to see her immediately and gives her treatment. She gets the payment information at the front desk. She is told – $100 without insurance or $70 if she uses the insurance.

Afraid that the insurance will charge her for something extra in the coming weeks, she decides to put that insurance card back in her wallet and gives her credit card only. It’s a one time charge of $100.

Photo: Pexels

Bottom line (or a conclusion)

Well… there’s really not much of a line here. It’s pretty simple. Health insurance is freaking crazy (and) expensive. And sometimes there’s no point in paying for it. Especially if you can get the same service for the same (or similar) money if uninsured.

People are paying thousands of dollars a year for something they pray they’ll never need. And when they finally need it, they are expected to pay some extra money… and only then to learn that they would have paid the same minus the expensive monthly premiums…

And here comes the thing we mentioned at the beginning of this article – the lack of free or universal healthcare in the US. That’s something that is pretty universal to the US and US only. Okay, I mean there are some other countries in the world without it, for sure. But, when we are talking about the developed world, the US is on the top of the mountain. We are talking about a lonely, ill and expensive mountain top here.

It doesn’t have to be this way, you know…

There are so many other options. And it doesn’t even have to be completely covered by the federal or state or whatever else level there is… even paying for healthcare insurance that can cover anything and everything without any copays would be a lot better than the current system of paying and paying on top of those payment and then some more payments and then a surprise medical bill in your mail that you forgot about that went to collections and then on your credit report for some 7 year…

But let’s not stress about that. It’s bad for your health. And the healthcare system won’t help you for free…

Written by: Jovan Postoloski

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