Why I Broke up with Health Insurance
For someone in their mid-twenties with a mid-level private insurance plan, many would assume the bill following childbirth and delivery would be fairly standard. After a few days in NICU for a minor complication, however, I was hit with a bill close to $10,000 after insurance. Several people in my life contested that this total must not be true. They encouraged me to fight the state-run hospital I gave birth in, going over the explanation of benefits line by line. “Insurance should have covered it,” they commented.
In the end, there was no error in the billing. Many perverse incentives from the government, insurance companies, and hospital corruption were at play in totalling my out-of-pocket cost. For young professionals like me—married, financially planning, paying private insurance, and researching options for optimal healthcare—being “prepared” is not enough. Affordable deductibles are hard to come by and costs of procedures are almost never disclosed beforehand. If one adds factors into a hospital experience like unforeseen complications, even an insured person might be left out in the cold.
This was by no means my first experience being frustrated with medical bills. It seems more often than not, I needed to carve time out of my work day to get to the bottom of the majority of medical bills that made it to my mailbox. “Was this really the cost?” “Did I get charged properly?” “How could I have mitigated this cost by making different choices?” These are questions I asked myself after the most basic, mundane doctor’s appointments.
Following the birth of my son, I was fed up with the system altogether. I will admit that self-pity got the best of me at times. I asked myself how someone like me, who was “responsible” and healthy could end up paying off childbirth and a short NICU stay for years. Many of my friends shared my experience, and I learned from organizations like Birth Monopoly and Patient Rights Advocate that many were robbed of their bodily autonomy while being massively overcharged and blind-sighted by costs.
My progressive friends, understandably so, attribute these failing systems to what they perceive to be a “free market medical system.” The behemoth that has become healthcare and government is falsely labeled capitalistic. In fact, it is arguably the least capitalistic system in our nation aside from the government itself. Prices are hidden, costs and incentives are misaligned, and new options are stunted by special interests.
This is why I decided to break up with insurance.
I had heard financial experts like Dave Ramsey discuss the concept of Health-Care Sharing. Several policy-focused conferences I attended had sponsors of healthshare organizations like Medi-Share and Solidarity Healthshare. Many of these organizations were formed in response to the passing of The Affordable Healthcare Act. I reviewed and compared what I needed in medical care and what health-sharing had to offer and decided to make the jump.
For some, the concept of health-sharing is intimidating because it is not insurance. Terms commonly found in the standard insurance world like “deductible” and “network” don’t exist in this new solution. With health-cost sharing, customers are free to choose their providers, regardless of location, even out of state or country, as long as it meets the requirements for their code of ethics and acceptable procedures. Rather than a deductible, customers choose the “plan” or package best for their needs and have a percentage of their costs covered by other members of the organization after they meet an unshared amount they are responsible for out of pocket. This “unshared amount,” annual costs limits, and the percentage of costs covered are determined by the package purchased by the member. As an added benefit, healthshare customers allow members to opt into communications with fellow members, so they can engage with fellow health-sharers as they go through medical trials. These people never met, yet they care by virtue of belonging to the same community with similar frameworks of belief.
Customers nominate healthcare providers, present their membership cards at doctors offices, and bills are either submitted to the healthshare company or receipts are submitted for reimbursement. The organization negotiates costs as an insurance company would. For many, this opens the door to unconventional options like seeing a family planning coach or seeking an alternative type of treatment. For people like me, who have basic medical needs and are burnt out on paying for insurance that never seems to bring benefits, this is a much cheaper option.
We must ultimately seek a completely free-market health system to fix the issues we see in our healthcare system. Patients will never be completely prioritized until we are truly allowed to choose the healthcare options we desire and can compare the costs. The budding sector of health cost sharing is providing a way to bring price transparency, options, and ethical accountability into our broken system. I’m glad to have broken up with traditional insurance. My only regret was not doing it sooner.