Today I went online to pay for COBRA, the program that will extend my health insurance from my last job for a monthly fee. That fee is $743.97
At my last job as a resident in a New York City hospital, my insurance came with the job, I had good coverage, and I didn’t have to worry about it, or even think about it.
Now because I’m a consultant, my job doesn’t pay for my health insurance. To keep the same insurance coverage I had before, the out of pocket insurance cost is, after I pay taxes, almost 20% of my income. Even if I never see a doctor. Even if I never fill a prescription.
Let’s start here. I am 31, with no major medical problems. I take one medication, the pill, and I take it like you’re supposed to – I’ve never been pregnant.
My BMI is 18.5. My blood pressure is typically 100/60 and my resting heart rate is 60. By every basic metric that we in medicine track to be sure you are doing ok, I am beyond ok.
And that doesn’t even get into my blood work, which so far has been perfect. My HDL is twice as high as my LDL and my total cholesterol is at the very low end of normal. (Normal by the way, is warped in our society – our “normal” ranges are based on a very overfed group of people. No one checked your LDL in the year 1600… our norms have become exaggerated based on very recent steady states that in reality aren’t so steady.)
In addition to all of that, I am vegetarian, and I don’t eat fast foot or junk food or even processed food. I spend $150 or more a month on yoga classes – if you look at my bank statements, you see that I keep paying Kula Yoga Project, Strala Yoga, and Vira Yoga money, so I must be using them. I also do some sort of cardio every couple of weeks, and would join a gym, but between the yoga, and how much I dislike the gym vibe, it doesn’t make sense financially.
Yes I should pay something for health insurance. I should pay for catastrophic coverage in case an accident should happen or a prolonged hospitalization should be required. I should pay something for prescription drugs. Drugs for high cholesterol, a preventable disease, should I need them, should be covered, but covered less than drugs for say, Cystic Fibrosis, which is genetically inherited.
I should pay something for the ability to go to the doctor’s office for a reasonable co-pay if I need to, and something so that if I need a procedure of some kind that is covered in some part too.
Insurance should be what it’s meant to be. A shared cost in society. A benefit to me in that it creates a collective bargaining power amongst all of us who put into the pool. Yes I should pay up something in advance, so I can get a life saving procedure I could never afford otherwise.
But I should also be rewarded for how I live. For the chronic diseases I will never get that are upwards of 90% of our health care burden. I should not pay 20% of my salary for services I will never use.
And while the example I cite, COBRA, is not the cheapest out there, it, or something just as expensive, is the only way I can continue to see the doctors I have been seeing for the past year — the ones who know me, the ones with whom I have a relationship.
Trust me, as a doctor, when you know your patient, when they are NOT a stranger showing up out of the blue whose history, context, and personality are foreign entities and therefore important but unknown variables that will influence their care and their outcomes, you do your job so much better. You are happier, your patient is happier, and the process is infinitely less wasteful.
I don’t have all the answers. I do think people should be rewarded for good behavior. I do think what I pay to Kula Yoga should be deducted from my health insurance costs because yoga keeps me both fit, and sane. And the absence of any fast food on my credit card statement should factor in, too.
So should my stats, ie the basic metrics by which we judge anyone’s baseline health in medicine – BMI, heart rate, blood pressure, and fasting blood sugar.
I believe when we start taking people seriously who take their health seriously, our overall health care costs will be lower, and we will stop the insane waste that is me paying 20% of my salary to an administrative system I don’t use, for care I generally never need.
Food for thought,
Robin Friedlander MD