"Unaffordable co-pays"

Recently, I ate lunch with a group of Michigan health insurance agents. Earlier that morning, they had endured my talk, “Arming Agents for Health Care Reform.”

Table talk turned to the plausibility of employees choosing high deductible health plans (HDHPs) over traditional HMO or PPO (networked) health plans.

Then the talk turned to unions, and their contracted health plan designs.

“So the UAW fought the automakers over a $5.00 co-pay,” I said, “saying they feared it would grow to $20.00.” I shook my head in disbelief.

“I’ve got groups with $2.00 co-pays!” one agent said, referring to a public school teachers’ group she serviced. “Try talking to them about HDHPs, HSAs and anything that costs them out of pocket.” Actually, I would like to, but that’s another story.

Going to a Tigers’ game

The teacher and her electrician husband drive two hours to Detroit for a Tigers’ ball game. They hand the parking attendant $15, and walk to the park, handing the ticket-taker a pair of $35 seats.

They have a great time. The Tigers even win.

He drinks three beers at $7.00 each; she sticks with diet Cokes at $5.50 each. They eat three hot dogs each, at $5.00, and share an order of nachos with cheese - $7.00.
After the game, they walk down the street, and pop into a restaurant for a leisurely dinner, spending $49.50, plus a tip.

On the way home, the wife begins feeling faint, turns pale, and throws up (thankfully, she had saved the plastic souvenir Coke cup). Her stomach starts cramping up, and she feels rotten. Since it came on fast, they pull off at the first sign saying “hospital” and head to an emergency room.

“Okay,” the admission’s clerk says to the husband, while his wife lay in an ER bed, “all I need is your $50 co-pay, and we’re set.”

“I thought it was $25,” he protests.

“It is, but only in a hospital in your insurance plans’ network,” she explains.

“Hey, this is about my wife’s health!” he exclaims. “I don’t get it. Why should we have to pay anything?” He launches into a rant about greedy insurance companies and selfish employers as he reaches for his credit card.

“This is just unfair, and who can afford it anyway?”

Indeed.