Gupta’s show may have been inspired by FactCheck Wire, part of FactCheck.org, the Web site project funded mostly by the Annenberg Foundation and housed at the University of Pennsylvania. FactCheck Wire quoted from the same AHIP study:
As AHIP says, premiums at businesses that offer insurance reflect the cost for a large pool of people, both the young and healthy and the old and the sick, with the same rate normally being charged to all workers at a company. On the individual market, people are “very price sensitive,” since they are paying the full cost of the plans. (They may choose a lower-cost plan with high deductibles or copays.)
FactCheck Wire seems to be saying that people are buying less comprehensive plans, but the point was so muddled that CNN’s producers may not have understood. Aren’t fact checkers supposed to promote clarity?
We have a better idea. Instead of trying to parse the complexities of pooling arrangements, which elude most folks’ comprehension, why not find out what $5,000 really will buy? Do some shoe-leather reporting in pursuit of an old fashioned consumer story exploring what’s actually being sold. Gupta might have better served his audience had he answered the question that the show posed at its beginning.
To get some comparison shopping started, we looked at a family policy being sold in Cleveland by Anthem Blue Cross and Blue Shield—its Blue Access Value $5,000 plan. The premium for a two-person family is $4,834 a year. Each family member must meet a $5,000 deductible and then pay 30 percent of their medical bills after the deductible is met. The family’s total deductible is $10,000. So if the family has an especially sickly year, it could pay as much as $10,000 out-of-pocket before the insurance kicks in. There is no maternity coverage during pregnancy, and no hospital coverage for labor and delivery; if the family does have a child, and if that child is healthy, there is some coverage.
For the first twelve months, the policy covers the cost of the baby’s checkups and shots, subject to the deductible and coinsurance. (The deductible, and a thirty dollar copayment for each doctor’s visit, does not seem to apply to the first two visits.) Between the ages of one and eight, the policy offers only $500 of coverage for well child care—a maximum of $150 a year. A family with a sick kid might have to incur debt to pay for the child’s care.
So what does $5,000 buy? The answer may be very little.