NEW HAVEN REGISTER
May 8, 2003

It seems that the day doesn’t pass without a new casino opening. Amid all the glitz and glamour, though, the emergence of the largest gambling concession in our country has gone unnoticed. It’s Health Care, baby.

I learned this 5 years ago when my cousin moved to California. She called me for my advice about Health Plans. Examining the plans offered, she found one that did not have, as a covered benefit, outpatient psychiatric services. And another that did not have, as a covered benefit, inpatient psychiatric services. Which could she best do without?

It was thrilling, trying to decide this, and just the beginning. Now the insurance industry has brought us the “Consumer directed”, or “Defined Benefit” plans. They are, it seems, the hottest item on the shopping lists offered to employers, conveying cheaper premiums, and stripped-down benefits. Much of the risk is passed to the subscribers, but clothed as choice. The choices are, what to do without? At least one health plan offers a web based interactive form so that subscribers can pick their coverage, and their premiums, to meet their budgetary (and presumed medical) needs.

Do we need preventive care? Do we need home care now, or may we need this in the future? Do we need rehabilitative services?

Should we look for first dollar coverage? Or accept a large deductible? Should we go even further and insure only for catastrophic care? Or go naked into the world, and accept what comes with no health insurance at all?

Then, what happens if you make the wrong choice of disease? No catastrophic care? Better not develop cancer, or have a major automobile accident necessitating an intensive care stay.

No drug benefit? Don’t, whatever you do, develop a chronic disease such as diabetes, or rheumatoid arthritis, or Parkinson’s disease.

No psychiatric benefits? It would not be wise to become depressed.

Insurance through your employer? Don’t lose your job. Want to work part time? But most part time jobs don’t come with health care benefits.

Own a home? You could lose it if health needs overwhelm your ability to pay. Have children? Are they covered? Have parents? Who will pay for their medications? There is no easy way to obtain drug coverage if you are a senior citizen.

So, first pick your parents carefully. You don’t want mom and dad to have illnesses, or pass along nasty genes to you. Then, never lose your job. Never have an accident, don’t get ill, and you will do fine.

Those with the funds, or the health, welcome to the table!

But what of those who do not have discretionary income, or good health? They will be left behind. Their insurance will be proportionately more expensive. People who are healthy will choose the large deductibles, or do without drug coverage, and pay cheaper premiums. Those who know they will need services will try to obtain coverage, but find these plans to be even more costly, as the healthy people move out.

And those who have no insurance? They will be outside, their noses pressed to the window, watching the gilded players choose their cards.