It’s Guessing Time!

November is the month when we have an opportunity to switch healthcare plans, increase life insurance coverage, sign up for longterm disability insurance, and make other changes to our employee benefits plans. Of if we do nothing during the annual enrollment period, our previous coverage will continue at the same levels until next November, when we get to try again. The trick is figuring out what each plan offers and whether the benefits will outweigh the costs. Of course, there is no real way to calculate how much coverage we might need, since it is impossible to know how many times we might go to the doctor, whether we will be involved in a catastrophic accident or have a stroke or collapse on the dance floor from some hidden malady.

By now we have received the glossy new brochure outlining the major changes for 2012 and informing us of new online tools that will supposedly make the whole process oh so much easier. It’s a given that whichever health plan we sign up for this year will cost more than last year and likely provide higher deductibles and lower benefits. At least, I assume that’s the case. I haven’t actually done the math. It’s hard to take the process completely seriously, though, when one of the plans is called MyChoice, and the other is called MyOptions. The last time I looked, “choice” and “options” meant the same thing. I did try to go online and check out the MyDecision tool that was supposed to help me decide which plan would best meet my needs, but all it did was pop up a video that started playing automatically and could not be stopped. One of my coworkers, who has apparently looked a little more closely at the two plans, says that the list of things not covered is actually quite entertaining. According to him, treatment for recovering from a religious cult is not covered, nor will our insurance cover the costs of special pajamas worn to the hospital.

I know I am lucky to have a job and health insurance these days, but still it irritates me that healthcare is so expensive and that for-profit insurance companies play such a large role in all medical decisions. And don’t even get me started on pharmaceutical companies. The process should not be this complicated. I consider myself fairly smart, but I am completely befuddled. While putting off making decisions about which healthcare program to sign up for this year and how much to put aside in my flexible spending account, I began to wonder what things were like in my parents’ and grandparents’ day. Did my grandparents have health insurance in the 1920s when they had their first child, or were they able to pay the doctor directly out of their savings? When my mother gave birth to me by Caeserean section in the 1950s and needed blood transfusions, who paid for that, and how much did it cost? And who received the money? I assume the payment went directly to the people who provided the services, namely the family doctor and the local hospital. If they needed medicine, they bought it from the local drug store. They banked at one of the two local banks in town, either Farmers or Merchants, and everyone knew each other personally.

The connections between doctor and patient were more clear. When mom needed blood transfusions, the students and faculty at the college where she taught went to the hospital and donated blood, knowing it would go directly to someone they knew and cared for. I think it’s the connections in general that are lacking these days. Everything has grown so complicated, so filled with middlemen standing between the providers and the ones who need their service.

I remember my father-in-law Bill telling a story about when he worked in the installment loan department at a small-town bank. The bank was about to close one evening when a man came in asking for a loan. Bill invited him in and chatted while they filled out the paperwork, trying to make the man feel comfortable, knowing that some people are embarrassed to have to borrow money. (What happened to those days?) He asked the man where he was from, who his family was, what he did for a living, and he wrote down the information on the loan application. Finally, he got to the point where he needed to know what the loan was for and was told that the man and his wife were expecting their first child. Bill congratulated him and asked when the baby was due (of course, they wouldn’t have known whether it was a boy or a girl until after the birth; there were no ultrasounds then). Imagine his surprise when the man gestured toward the window and replied, “Well, I’m not sure about that, but my wife is out in the car now, in right smart pain.” Bill said, “You’re telling me your wife is in labor now?” And the man said he guessed so. Bill stood up, took a roll of bills out of his pocket, handed $100 to the man, and told him to take his wife to the hospital straight away. He could finish filling out the loan application later. Now, you tell me whether you think any of that story could happen these days.

Well, this obviously isn’t helping me decide what coverage I need for next year. I’ll probably go with the MyChoice (or was that MyOptions?), and I’ll put enough money in my Flexible Spending account to cover the copays on my bee allergy shots, new lenses for my old glasses, and a pair of sunglasses. And I’ll hope I don’t have any other copays for hospital visits or dental work. Thanks to the Affordable Care Act of 2010, my younger son will be allowed to stay on my insurance until he turns 26 in April. But then what? I definitely need to educate myself about healthcare issues before next year’s annual enrollment period comes around.


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