Is this another rule I should break?

I’ve written a few times lately about my revelations re: seeing through the bullshit and kind of noticing that the emperor who is supposedly standing there wearing his expensive new clothes actually has his ass hanging out. It’s occurred to me lately that society tells us that we’re supposed to do a lot of things that kind of really don’t apply to all of us, all the time, and that sometimes (maybe often), it’s okay and it’s cool and it’s best to break those rules.

What I’d like y’all to know is that this isn’t me sitting on some philosopher’s cushion and declaring from on high that I’ve had some esoteric, metaphysical realizations that you might want to try.

This is me living my life and realizing — in a very, very visceral way — that a lot of things have been presented to me that aren’t necessarily true or right, and starting to defy them. To actually do, in my daily life, what I’m writing about here.

However, despite that Cool Guy intro, I’m running into one thing that has me stumped. One convention that is begging to be defied, but which I honestly don’t know if I should maybe just bow down to anyway.

Maybe you can help me decide what I should do.

As some of you may know, I’m an insulin-dependent diabetic. Since 13 days before my 13th birthday (I love that stat), I’ve been monitoring my blood sugar, injecting insulin, watching the things I eat. That is absolutely no big deal to me; it’s simply part of who I am at this point.

But since I moved out of my mother’s house… and here comes the rub… I’ve also been paying for health insurance to cover myself, as a diabetic.

Every year, the rates go up. Almost always significantly.

I got my new renewal rates in the mail a few weeks ago. And I found out that they’ll be going up almost 50%… again. And once that happens, I’ll be paying around $800 per month to insure myself.

And that’s JUST myself. My wife and kids have a separate policy. And by the way –that $800 policy? It’s the worst one I’m able to get. It has a $5000 deductible, meaning that I’m essentially paying for everything out of my pocket anyway.

Now, let’s go back to the rules thing, and to fear.

Society tells you (tells me) that you (I) must have insurance. Plenty of people don’t, but almost all of those people wish they did, and are only uninsured out of ignorance or lack of funds. But the vast majority of those people want insurance. They feel they need it. Because… what if something happens?

But “what if something happens” coverage for $800 per month for the shitty policy, and rising fast? Really?

And so here we come to my rule-breaking question: Can I decide not to have insurance?

I don’t like the idea — not one little bit. It bothers me that I could have an accident, or a sustained illness, and I wouldn’t be able to pay for it. And currently, while it feels like I’m being robbed at gunpoint if I pay $800 per month, I could do it. But what happens next year, when it’s $1100 or $1200? And what happens the year after that, when I turn 35 and move into a new risk bracket, and things really start to change?

What happens when I’m 65? Will the insurance company be asking me for $5000 per month by then?

I’m fucking 33 years old and am in stellar health. I’ve broken a bone one time and was hospitalized only when I was diagnosed with diabetes. I’ve done everything right; I’ve taken care of myself; I’ve done everything the doctor told me to do. But am I being rewarded in any way? Or am I, instead, being lumped in with the people who eat cake all day, don’t check their blood sugar ever, and have a foot amputated every spring?

Am I being treated like — and charged as part of — a demographic that I don’t really match? Am I being punished for the negligence of thousands of people I don’t know?

Do I maybe have a far better chance of costing less than they do as a medical patient — of costing less, even, than what I’m paying in for insurance?

Yes, I could get hit by a bus.

But am I being financially raped each month simply because my fear of a catastrophic event outweighs the likelihood that it will actually ever happen?

I’m really not trying to talk myself into this. I’m trying to raise questions, and see if it makes sense or not. So we’ll see.

But here’s something to think about:

Insurance companies know the odds. They pay actuaries large salaries to determine how much any one type of person is likely to cost for medical care. To them, you are a number. And on average, they know that if enough of your type of people pay in and and then cost what the actuaries tell them you will cost, they will make a lot of money.

In other words, the game is fixed. If you have health insurance, you’re essentially betting against the house. The average person in each demographic will always pay more in to insurance than they will get out of it.

That’s not conspiracy theory. It’s fact.

The question then, is, are you willing to pay in more — to bet against the house — on the chance that enough bad stuff will happen that you will “beat” the odds?

It feels to me like I’ve been lumped in with a shitty group. I don’t think I match the odds of most diabetics — not by a long shot. If their lifetime costs are X on average, I’m going to be a small fraction of X.

So if you’re betting against the house with your insurance, I’m apparently hoping to hit the Powerball.

I’ve gone 20 years without any of the traumatic “diabetic costs” like hospitalization, retinopathy treatment, fancy foot care, amputations, renal failure, etc. etc. etc. Yes, I do have ongoing needs for medications and supplies, but beyond that, I have the medical expenses of a nondiabetic.

Or, I’d wager, I probably cost less even than the average nondiabetic, since most Americans are less active than I am, eat more poorly, and so on.

I insure myself out of fear. We all do. The question will be whether or not the fear is justified. Whether it’s possible to honestly mitigate that risk well enough without insurance (or with some crazy insurance alternative), or whether doing so is a foolish gamble.

So let me pose the question: Should I break this rule? Should I consider dropping my insurance now, while the rates are only moderately fucking ridiculously insulting?

Alternatively, what else can I do?

  • I’m self-employed and am not about to go get a 9-to-5 so that I can get on a health plan.
  • I already have the worst plan offered. I cannot opt for a plan with a higher deductible because there is none.
  • Isn’t there some coverage I can get cheap, even as a diabetic, that says, “If you have expenses over $20k or something, we’ll cover it, but otherwise, you’re on your own”?
  • I do have substantial ongoing monthly costs. I pay around $150 per month for insulin, but that’s not even covered by my current plan, so I’m paying that anyway. I also have other stuff (testing supplies, supplies for an insulin pump and real-time blood glucose monitor) that is apparently pretty costly but that I now get for free as part of a diabetes management plan. Basically, by giving me this stuff free, they reason that I’ll use it and not have kidney failure later. If I ditch insurance, I have to start paying for all of it myself.
  • I haven’t calculated that cost yet, but have a really hard time believing it’s EVEN REMOTELY CLOSE to $800 per month.
  • My other costs are minimal. Doctor’s visits are infrequent and cheap. Lab work is infrequent and not hideously expensive. Knock on wood, I’ve only had one traumatic medical event, when I broke my arm at the gym while weightlifting.
  • This one’s the kicker: If you don’t have insurance for a period of time and then want to get it again later, the company does not have to cover you at ANY price. So if I ever don’t have insurance, I can probably forget about ever having it again down the road, thanks to my rather expensive preexisting condition.

All ideas, thoughts, opinions, alternate means of covering my ass are welcome. I honestly don’t know what to do.

Ultimately, the question is: Is $800 per month (and likely to increase by at least 30% per year going forward) a fair price to pay for “just in case” coverage? Or should I maybe just put that same $800 per month into a bank account, and draw from it when needed?

Ugh, I don’t know. Fucking stupid insurance.


Now that you've read this post, go here:
WHAT DEFINES YOU?

Comments

  1. Kristi says:

    I guess I won on a long shot… ;)

    I was healthy until I was diagnosed with a heart defect just before my 30th birthday, while pregnant with my daughter.

    I had surgery. It went poorly. I had to have another surgery to fix it.

    Because I am insured, I had the luxury of seeking the best care. I can’t overemphasize how that gave me a sense of control when I felt very little.

    Over three months I had medical bills of almost $250k, the vast majority of which was covered by insurance

    People knock insurance, and I get it.. But as I went through that process, I was nothing but grateful.

    I won’t represent my situation as likely — I’m the anomaly that puts you in your conundrum. But the thought of not having choice in my doctor and care because I can’t pay and knowing that I was headed for financial ruin… I’ll keep paying my premiums, thanks.

    Good luck sorting it out, and let us know if you find a solution that works for you!

  2. Aislyn says:

    Dude, even if something did happen they most likely wont even help you.

    You should move to Canada. We’ve got you covered up here. Not as warm, sure, but the beer is way better.

  3. Kaushink says:

    I’m in a similar situation. I have mediocre coverage from Mega Ins for about $600 a month, and it keeps going up. As you point out, there are no easy answers. I know there are well-meaning comments here, but stopping the insurance is not a good idea. You will have a very difficult time getting insured again, and if some something happens, you will have to depend on county services. What you and I are really paying for is catastrophic events like finding out we have cancer or need surgery for something. $10k will not cover surgery

    If you come up with an answer, please share.

  4. bobby one time says:

    You have insurance to protect your assets, not to guarantee medical services. Hospitals (in most states) can not deny you services based on insurance coverage or lack of. Shit, if you get hit by “the bus” or truck, most likely the bus or truck is at fault and your rolling (or wheeling) in the big bucks. Plus you can bump up your medial coverage in your auto or motorcycle policy and poof, you don’t have to worry about those sort of injuries – whether you are at fault or not. Just stay away from rock climbing, serious downhill skiing, the hood, bar fights, cage fighting, etc and keep up with your insulin, exercise and you are fairly set.

    There are plenty of people who fit in the gray areas who have smoked for 40 years, are pear shaped and are a few years away from needing a quadzipple bypass where insurance may offer them better care to extend their lives, although many are denied better care anyways. Keep out of overnight hospital stays and even broken arms are not that expensive – relative to your combined annual payments and deductible. When the doctor says, “I think you need to stay for the night” – he means, let’s make some money, just reply with “I’m uninsured and filing Chapter 7.” Nine times out of ten, you’ll be out the door and fast.

    What about cancer, what about this or that? If the shit hits the fan, you are not going to be worried about how to pay for it.

    Let’s say you do have big medical bills one day. So what? You don’t have to pay. We just believe we have to pay. Nobody puts a gun to your head and says “Pay.” They can’t even take your house, even in bankruptcy as long as you are living in it. They might get a judgment to garnish wages from a 9-5 job you don’t have. Less anything with a title registered in your name and bank accounts with your name stuffed with cash – there is not much to go after. You are just storing that hot tub at your place for your buddy, right? That’s your kids college fund, isn’t it?

    Seems you need to restructure your assets legally. There are all sorts of ways. What keeps you from moving your assets into a trust that you control and floating your health expenses out of pocket until either you begin making big bucks and can pick it up again (insurance companies still will want your money if you have not been covered) or pickup national insurance that will be available in less than 10 years?

    We are all told we NEED health insurance. We are also told to become doctors and lawyers so we can make big bucks and have the best 9-5 jobs (21st century volunteer slavery). Most people reading your blog know – there is no good 9-5. Furthermore, how many doctors that actually make any real money work only 9-5? So who is giving the advice? Sure back in the 80′s you could get a kick ass HMO that covered everything, your employer picked up the whole tab and all you had to do was initial the paperwork – not any more. Just by the numbers, making the most of a health savings account is a good place to start.

    Johnny, your blog rocks. Thanks for posting.

  5. Johnny says:

    That’s a reeeeally interesting comment, man. Thanks.

  6. Johnny-
    I just started reading your blog via the Third Tribe seminar. I had no idea you were Type 1. I am too. Have been for 33 years now – I am now 35. This is a tough situation. I understand the math involved, I just know that the physical and psychological dependence on health insurance has been ingrained in me so profoundly that it it were me, I couldn’t do it. Even with out of pocket expenses, it’s like a safety blanket, even if it’s just psychological.

    Good luck with whatever your decision is. I may have to pick your brain about autoimmune disease and working for yourself sometime!

  7. Johnny says:

    The annoying thing is the way you’re penalized for having an entrepreneurial spirit and starting your own business. Want to start a business? Can’t… you’re fucked without an employer covering insurance. Ugh.

    Still haven’t decided what to do, but will have to in a week or two.

  8. Archan Mehta says:

    Johnny,

    Thanks for sharing. This is a great post. Sorry to hear about your pain.

    What worked for me was changing my lifestyle choices. I quite smoking.

    I started to eat three meals a day. And smaller portion size.

    Go for a stroll in the outdoors every single day. Keep your body moving daily.

    Drink more water. Take a shower. If you feel hungry, snack. Take a siesta.

    Meditate daily. Practice yoga. Eat plenty of fruits and vegetables. Buy a juicer.

    Eat lots of yogurt. And drink hot tea/coffee and flush the toxins out of your system.

    Make sure to get enough fresh air and sunshine. Hope this helps. Cheers.

  9. Archan, all of that sounds like great advice. Except how does it reduce the cost of medical insurance for someone with diabetes?

  10. Johnny says:

    So my wife went on one of those cost-comparison insurance sites and signed up and now we’re getting 50 calls a day from insurance companies, and *I* have been tasked with following up with them.

    At least the situation got less complicated and more straightforward.

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