#Healthcare4All – Got it Covered? Why Private Insurance isn’t Enough

Post by Megan Ryland, a member of our #Healthcare4All volunteer team.

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Most Canadians are covered by some kind of private insurance, so people might not see what all the fuss is about introducing more private health care. Two thirds of Canadians already take out private insurance to cover what the public medicare doesn’t. It isn’t so bad, I guess. You go to the dentist, you pay the fee, and (if you’re lucky) your insurance company sends you money to pay for the appointment. If the insurance company hasn’t agreed to cover everything, you pay a “co-pay”–you share the cost with the company. Private insurance lessens the cost of services that you might need (but often does not pay everything), and in exchange you pay an agreed amount each month (a “premium”).

BUT, for private insurance to work for you, a few things are necessary:

  1. You have to be able to pay premiums each month and co-pay when necessary (Some people can’t)

  2. You have to convince an insurance company to cover you in the first place (Again, some people can’t).

In our current system, a reported 1 in 10 people cannot afford their prescription medications and 20-25% of people cannot afford the dental work they need. These are people without private insurance or with private insurance that doesn’t provide enough coverage to make these things affordable. The cost of insurance has real health consequences for people, even though “basics” are supposed to be covered.

Already, many people don’t have private insurance coverage, and expecting these people to get private coverage if we made basic services for-profit seems unrealistic. The barriers to coverage–like price–are not going to disappear if we open up more private clinics. We would only make their situation poorer by asking this group of people to pay out of pocket for essential services, like doctor visits or hospital stays. A health care system that leaves you worse off in life is not the change we’re all hoping for. This means that people that already most need help are the least likely to benefit from the addition of more private health care opportunities.

Private companies are not required to think in your best interest and they are not obligated to cover you. Their job is to make money for the company. […] That’s not evil, that’s just math.

In addition, private insurance is precarious: it is not guaranteed. Private companies are not required to think in your best interest and they are not obligated to cover you. Their job is to make money for the company. That means collecting as much money as possible in the form of premiums paid monthly and paying for as little as possible for their insurance users. That’s not evil, that’s just math. If they paid for too much for their insurance users, they would go out of business and no one would get paid for anything. However, their priorities are the company (and their own jobs), not the patient.

In the provincial, public insurance system, the shareholders are all the people of British Columbia. We are all invested in this program. The province has to cover any Canadian citizen who is a BC resident. Although some people may find paying for the Medical Services Plan (MSP) annoying, especially because it is mandatory, that pulls two ways: citizens must participate, but citizens must be covered. In the private sector, citizens “choose” to participate (but they kind of have to if they’re sick) and companies choose who is covered.

Those choices have a real impact. If you’re an insurance company, you don’t want to take expensive risks, and so you can choose not to cover someone who needs a lot of care. This is what happens when an insurance company chooses not to insure someone (or only do so for a lot of money) who has pre-existing conditions.

Pre-existing condition: A health issue that you already have when you apply to an insurance company. This could be something like diabetes, chronic pain, scoliosis or any on-going disorder or disease.

Insurance that is designed to avoid making payments to sick people isn’t the kind that is going to be behind you 100%.

You must tell any insurance company about these conditions before they agree to cover you, because if they discover them later, they can deny you all coverage. You may have heard the recent stories of travel insurance being denied based on pre-existing conditions or even small gaps that the average person wouldn’t expect to void their policy. Insurance that is designed to avoid making payments to sick people isn’t the kind that is going to be behind you 100%. For example, giving birth in Canada under medicare, this family wouldn’t have faced a $950,000 bill. Because they relied on private insurance while travelling, they were left hanging.

There is a worry that in a two tier system where a public system still exists, private companies would cover the cheaper patients and leave the patient who require more care (more expensive, more sick patients) to use the public system. This would increase the burden on a public system at a time when resources and doctors are dividing between a private and public system, potentially putting significant pressure on the public system.

If you were a private company and you wanted safe bets, you probably wouldn’t want to cover sick people either, but the point of health insurance is that sick people need coverage for their care. This puts private insurance in a tough place. It is why we need public systems in place where the motivation is not to make money, but to provide the care that people need. We want our health care system to be designed for sick people, not just for healthy people (the kind that private companies want).

If your insurance coverage is tied to your job, how does that make your career decisions harder? How much more devastating is it to lose your job and your health care coverage at the same time?

Finally, private insurance is often tied to employment. However, these days we rarely work at one place all of our lives, so this kind of coverage will stop and start when our career does. In the current economy, young people often move between many jobs, by choice or by necessity. Anecdotes and data agree: many youth have contract positions that don’t offer benefits (or great pay). If your incurance coverage is tied to your job, how does that make your career decisions harder? How much more devastating is it to lose your job and your health care coverage at the same time? In this case, just when you need coverage the most (when you are least able to pay for it), your coverage dries up. Under a public system, your income determines if you must pay for MSP–if you don’t make enough, you don’t have to pay. However, in a private system, your income doesn’t matter. Your employment status may determine your health status. [Check out a prior post that goes more in depth here.]

We are all going to be sick sometimes. Some people will be be more sick than others, but no one is in peak condition at all times.

We are all going to be sick sometimes. Some people will be be more sick than others, but no one is in peak condition at all times. Unfortunately, it’s difficult to plan on our sickness. Maybe you’re healthy for years, and then you have pneumonia. In a private system, if you haven’t planned for that, you might find yourself panicking about what to do. In a public system where paying into the health care system is automatic, your health care isn’t just an issue that pops up with your health is poor. It is a constant part of your life. Some people complain about this, but just ask anyone who has ever dealt with an insurance company: you don’t want to be submitting insurance forms and crossing your fingers in between coughing up a lung.

Public health care is part of how we care for each other when we’re sick, and how we care for our future ourselves. Not because it’s profitable, but because it’s right.

Public health care is part of how we care for each other when we’re sick, and how we care for our future ourselves. Not because it’s profitable, but because it’s right. Your health should not depend on someone else’s bottom line.

 

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