Health Insurance Is a Pain

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Bad Santa came to our office this morning.

Bad Santa is our insurance representative. He is actually a good guy, but he has a terrible task. He shops for health insurance for our 47 employees and their families. His December visit and his handout with its 8-percent cost increase and $1000 deductibles and ugly numbers brings home the abstractions of national health care in a way the nightly news simply can't.

I once had a summer job at a resort in Michigan where it was possible to have negative earnings after your room and board and withholding tax were taken out. We're not quite there yet but we're working on it.

"I only have one kid," protested a colleague who is the picture of perfect health and still looking at premiums of $7,000 to $10,000 a year.

Been there and done that. My two children are out of college and healthy but fall in the "young invincibles" cross-your-fingers category now that they are off my family plan.

Does it pay to stay healthy? Of course it does, in the sense that nobody wants to have an accident or get sick. But one of the problems with insurance coverage is that there is no payback or financial incentive for taking care of yourself and using as little medical services as possible.

Our agent and my boss looked high and low for the best coverage plans, including the big providers, self-insurance, and reinsurance for deductibles. They are numbers guys. They looked hard. The coverage for employees is very reasonable and excellent. It's families and uninsured spouses that get whacked. We have a "Cadillac" plan and a "Ford" plan. Suffice it to say, you could buy a car for what we pay in premiums and out-of-pockets.

A colleague suggested farming out one's small children to the carnival. Another suggested marrying a federal employee and going on their insurance plan. We're taking it under advisement.

"What about out-of-network?" asked another colleague. The answer: Don't do it.

"Price shopping?" Don't bother. The negotiations have already been done with the in-network providers.

"You have to be a bit of a manager," warned our agent, lest employees ignore their out-of-network specialists with their stealthy charges or the company reimbursement that kicks in after the $1000 deductible.

For the record, he's for national health care legislation. He blames tort lawyers and fraud for much of the cost inflation. And he says if you know a good doctor you better stay on good terms with him or her if you want an appointment on short notice, because business is about to boom.

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