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I just returned from a wonderful trip visiting family. While I was there, I ended up in a conversation that put me in an awkward situation, given my job. I was talking with one of my sisters and some of her friends, about half of whom are uninsured. One friend, who is a self-employed 39 year old, asserted, “I don’t believe in health insurance.”

“How’s that?” I asked, preparing myself to tout the importance of health insurance and primary health care.

The friend said that certainly the cost of health insurance is prohibitive, but her main concern was that you can’t be sure of what you’re getting when you pay your premiums. If you have pre-existing conditions, insurers will likely not cover costs associated with those. If you are diagnosed with some unrelated but expensive condition, insurers will likely fight having to cover those costs. She continued. The small print may exclude a number of common events or conditions. And, you may still have an absurdly high deductible or burdensome co-pays.

I was deflated. She’s right…particularly for people who would be finding their insurance as individuals and especially for those who are unable to afford a Cadillac insurance plan on their own.

Insurance is important, but only when it really protects its clients. Too often, we get calls at the Consumer Health Action Network (toll-free in Connecticut at 888-873-4585) from people who have upheld their side of the insurance contract only to find that the insurance companies have built in loopholes that exclude their conditions or key parts of their treatments, or that their “insurance” is not insurance but simply a Medical Savings Account, which offers little in the way of negotiating power to reduce the cost and nothing in terms of offsetting the cost itself.

As I listened to my sister’s friend, I thought about the calls I’ve taken from people here in Connecticut who have seen significantly higher costs than benefits to having health coverage. In order to convince these people (and my sister’s friend) that health insurance is an important and worthy expense, there must be more meaningful standards for what’s covered, clearer explanations of coverage, and better cost controls. Short of either this kind of regulation or of a system that provides truly universal health coverage, we will always have people who forego preventive care, rely too heavily on safety-net providers, and take their chances that they’ll stay healthy enough. That approach is not good for them and it’s not good for our society.
Connie Razza