Medical Insurance woes

Alright, so I have a few thoughts about this topic I just need to spit out.
So most of us are what is referred to as, "insurance poor". What this means is that for whatever reason we find ourselves paying out 1/3-1/2 of our yearly income just for 'insurance', not to mention if we actually use the said insurance, then we pay out even more. Now the 'idea' behind having insurance is so that if something 'happens' we have paid this company to pay our bill for us. Sounds simple enough. But this company runs like a business, with profit margins it wants to grow and such, so they are banking on the fact that we never use our 'insurance', we just lose the money to them. Now having said this, it would seem to make more sense to just set aside the same amount of money ourselves (be our own insurance company, per se) and use it when and if we ever needed to pay for a service. Now, this is the theory, but insurance companies have pretty well made sure we dont even consider this option. The way they have done this is by jacking up the price of care, particarly critical care (ER, Surgery, ICU, etc...). Most of us never need such services and could easily afford random office visits here and there but if in an accident we needed surgery we would more than wipe out our 'health savings account'. So most people carry insurance 'in case' the moment ever arrives that they need this critical care. Many people think their doctor or hospital is setting the price of their visit but that is not the whole truth. The insurance company (each one varies) tells the hospital, 'we will reimburse you this % of that procedure'. So the hospital says, "okay, performing that procedure cost us $80.00 and the insurance company will only pay us back $45 of it, so we either need to a) find something else to bill for, or b) bill the patient the rest, or c) jack up our prices in hopes that the insurance company will pay a percentage of it.

Now unto why this is on my mind:

Many of you know that while in school we have been on state medical insurance. There are pros and cons to this. I do not like being on this insurance because I am too aware of the fact that the doctors providing me service receive no or little compensation for caring for me, most especially if it is care received in a hospital receive absolutley no reimbursement (for those who dont know, many hospitals in maine are suing the state for back payments up to 10 yrs ago!!!). So by caring this insurance, like most of Maine, I am in a way forcing docotrs to take on more patients in order to cover their cost. We all gripe about waiting times and not long enough appts with our care providers but this is a result of insurance companies not paying out all or any of the doctors bill.
Now the plus to being on this kind of 'insurance (if it can even be called that) is I do not have monthly premiums, nor co-pays or deductibles, which has allowed us to save money and have the 'luxary' (and yes, in todays world, it is a luxuary) to pay cash for services I want/need that are not covered by Mainecare. For exmple, we paid cash for Mattie to see a Naturapathic doc inorder to find out about her food sensitivites/ her rashes/ and start her on the road to recovery. We thankfully found a doctor who does not charge as much as she could. For our 90 min appts we pay around $100.00 and she is willing to let you pay little by little if need be and Matties 'remedy' for helping her healing cost all of $5.00. But this is a result of actually living somewhere in Maine where care ilke this can be found, most have no or little access to care like this, even if they had the money to pay for it out of pocket.

So, now many of you also know that Jacob is only a few short weeks from being a legitimate, paid (severly underpaid) doctor. We requested info on the benefits offered to us through his employment (the hospital of all places) and it was very clear, right off, that we could neither afford to pay for the health insurance, nor would we still qualify for state insurance. We find ourselves int hat lovely middle place that gets talked about by politicians who could mostly care less. I had a range of emotions yesterday about this, mostly anger. I mean seriously, my husband is providing healthcare and we cant even afford to have it ourselves. I understand why. I mean the hospital is not reimbursed enough from all insurance companies in order to run a healthy business, so it needs to cut cost where it can, including what it can offer its employees.

So, what is the answer? Well we will do what many do. Save money aside and pay cash for services needed, as needed and hope nothing major comes up that we cant afford.

What will jacob do in practice after residency? He will not take any insurance, none! Now there are more and more doctors who are either not taking any insurance or are selecting a few they feel reimburse them in an okay nad timely fashion. What this means for regular people is that more and more people who spend a ton of money every year for insurance are and will find that having that insurance is pointless if wanting to see many docotors. The patient ends up having to pay cash nad then a) send in the bill to their own insurance company and try to get reimbursed or b) try to afford paying for insuarnce and then afford paying cash as well. Incidently, if the patient submits the bill to the insurance company they will always gets reimbused more of a % then if the doctor submitted the same bill for reimbursment.

I dont know what to do about hospital care. If the prices go down for that kind of care, and people actually pay their bills, then it would be possible for many people to put aside money incase of an emergency. but I am almost certain what will happen will be that kind of care will be taken over by the government and well we know how well they run things (including their own military hospitals) and we will be taxed more for having access to a hospital and then if we wanted to actually see a good doctor it would be cash based.

So being pregnant and getting ready to arrive in an area that is new to me, pretty much on the eve of having a baby it is on my mind alot on who and how the baby and I will get care. I already told jacob that I would just call him home and he could deliver the baby. He wouldnt mind doing this but thinks his employeers would frown upon this, you know, a homebirth performed by one of their residents no less. Seriously folks, for most of time we have been having our babies at home (anyway, that is a different topic altogether)

I am done. I will post one more thing later about this.