Category: Universe Surfing

Today I cancelled my dental coverage because they denied a claim for a $125 tooth filling because it occurred during the 6-month waiting period. When I called to find out about the denial, I also learned that there is a 12-month waiting period for any major work, such as root canals. The only thing the insurance pays for immediately is preventative stuff like clean-and-check.

I also decided to check on the medical insurance I purchased in a rush after finding out my COBRA coverage renewal was declined. It has a $5K in-network and $10K out-network deductible and then pays 80% (in) and 60% (out) of medical costs. My max out-of-pocket, including deductible is $7K (in) and $26K (out). The price for father and son is around $850/month, or about $10K/yr. So, my in-network annual cost for medical is $10K-$17K and if I need to go out-of-network, then the max cost is $36K.  I believe if anything major happens and I get too expensive, they can decline to renew my policy at some point.

With this same insurance, my antiviral generic drug was full price at $101 (because I haven’t met my drug deductible yet and for some reason I get to pay full list price until I do meet it). I didn’t use my insurance and instead downloaded free GoodRX app to instantly get over 50% off and pay “only” $46.  Why do I need to go through GoodRX and how does GoodRX make money here?

I no longer have vision “insurance” since COBRA ended. I’m surprised that vision “insurance” isn’t included with Amazon Prime by now.

I may give Sidecar another look. It has a model where patients shop around for the best “cash” price for medical coverage and then get reimbursed at a rate of approximately 80% of the “cash” price in the neighborhood.  It’s possible to even get reimbursed for more than the “cash” price if you find a cash price cheaper than 80% of the going rate for your neighborhood.  For places like hospitals and ER, Sidecar has a negotiator to help you negotiate down any bills that come in above the regular cash price for the area.

Bernie is pushing a Medicare-for-All plan:

• Create a Medicare for All, single-payer, national health insurance program to provide everyone in America with comprehensive health care coverage, free at the point of service.
• No networks, no premiums, no deductibles, no copays, no surprise bills.
• Medicare coverage will be expanded and improved to include: include dental, hearing, vision, and home- and community-based long-term care, in-patient and out-patient services, mental health and substance abuse treatment, reproductive and maternity care, prescription drugs, and more.
• Stop the pharmaceutical industry from ripping off the American people by making sure that no one in America pays over $200 a year for the medicine they need by capping what Americans pay for prescription drugs under Medicare for All.

I have often wondered about combining Life and Health insurance with a combined product that would provide a variable amount of life insurance (more when you need it more, such as when you have a family). I also now see the problems with IRAs – it’s too easy for people to get their money out and so it’s not there during retirement. With this in mind, I see a universe where in addition to a plan like Bernie’s, we have:

1. Increased funding available to universities and private companies to create new drugs. Funding would include filing patents and individual inventors and universities would get recognition. The government funding organization would be the owner of the patent and receive any royalties, although these would likely be waived for domestic drug maker partners. Patent royalties would be paid by foreign companies and used to reduce costs of otherwise developed drugs.
2. Social Security is upgraded to Social Security Savings, which gives everyone a cash balance of everything they have contributed plus earnings from a combination of U.S. Treasury Bond interest and gains from investments in an index fund of public companies weighted by how much total salary they pay to American workers.
3. Healthy people who don’t use a lot of medical care will have additional money added to their Social Security Savings account. The amount will be determined like a co-op, where extra funds not paid out for medical expenses are paid out to everyone – more to those with less health care expenses.
4. Unhealthy food is taxed at a rate to pay for twice the expected medical costs associated with that food being eaten. Check prices for soda and chocolate in Norway to see an example.
5. Liability insurance, such as home and auto, no longer covers medical since these are covered by universal medical coverage. One can still be liable for pain, suffering, and lost wages.
6. Included with Social Security Savings, is a variable payment life insurance policy that pays out variable multiples of your SSS cash balance based upon your age, family, dependents.