HEALTH BENEFITS UPDATE
Why do health benefits
cost so much?
Now that most of our members are fully
phased in under Chapter 78, everyone wants
to know why our benefits are so expensive. The
answer is very simple: We allow providers to
manipulate us and we don’t ask what anything
truly costs.
The basic principle of insurance (any kind) is
that risk is spread across a group. That means,
at its most fundamental level, if you and one
other person were in a plan, and you incurred
no expenses, and the other incurred $20,000
in expenses, your premiums would be $10,000
per year (plus fees, reinsurance and inflation). The problem
lies in our lack of being consumers when it comes to healthcare. We are so indoctrinated into the system of paying a flat
copay, that we never think to ask what a service truly costs.
If you disagree with that statement, I ask you to think about
the last time you asked what something cost outside of your
copay.
Hospitals and big pharma are the biggest offenders with regard to manipulating insurance plans and, until we put our
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NEW JERSEY COPS
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finger on them, we will continue to make choices between restricted benefits and higher premiums. For instance, why can
hospitals charge 10 times what doctors charge for a service?
Then use the money to advertise? How can a hepatitis C cure
cost $120,000 in the U.S. and $588 in India for the same exact
drug? Then advertise on every channel to the tune of millions
of dollars which is built back into the cost of the drug? We will
not change this trend until we become consumers who demand healthcare that produces health and not profits.
Now please understand that all is not lost. There is currently legislation pending that has the PBA’s support, which will
increase transparency in healthcare costs and regulate some
out-of-network payments. We hope that this legislation is
passed in its original form, but we are up against a few huge
machines that want us to continue to be led like sheep to the
slaughter.
Going forward, please question every cost before and after
you see a provider, demand to be treated like a customer not
a policy number and use your primary care provider on a regular basis to keep yourself healthy; we owe that to the people
we serve with. d