By rights, this should be an open letter to former Vice President Joseph Biden, a man who has nothing but good to say about employer-based health insurance. It actually dovetails fairly nicely with the first episode of my political podcast, Strange Sound, which was dedicated to that topic. As I mentioned therein, I am a subscriber to such a health plan – one of perhaps 170 million subscribers in the U.S., though that number has gone down by millions in recent weeks due to massive layoffs, furloughs, etc. I had cause to make considerable use of my coverage over the last month or so, and I am now experiencing the second wave of trauma that typically accompanies major illness in the United States: medical billing.

I’ll preface this with a brief “explanation of benefits”, as they say in the insurance game. I have what is known as a high deductible plan: health coverage that carries a $3,600 annual deductible, which means that I pay for the first $3,600 in medical charges, with some small exceptions, via a Health Savings Account. My employer kicks in about two-thirds of that. (They also cover about 80 to 85% of my premium costs, so as I said on Strange Sound, they are what makes the plan remotely affordable.) If I meet the deductible (i.e. incur $3,600 worth of medical charges), the insurance company starts picking up 90% of my medical costs; I pay a 10% co-pay until I reach another $3,600 hurdle, which is my “out of pocket maximum” of $7,200 per calendar year. After that, the insurance company is supposed to pay for everything.

Now there are various caveats having to do with out-of-network providers and the like, which I won’t get into here. Suffice to say that if I am fortunate enough to have a serious illness that doesn’t straddle two calendar years, the most my illnesses should cost me is about $4,400, allowing for my employer’s contribution. That may not seem like a lot of money to Joe Biden or Donald Trump, but in MY world, it’s close to a fortune. In fact, for most people, it’s a near-impossible hill to climb. If treatment for my illness started in December of one year and ended in, say, February of the next, I would be on the hook for at least twice that amount.

Part of the problem here has to do with how providers have structured costs around the private health insurance market. I’ve received a number of bills related to my hospitalization. The ambulance (a municipal ambulance, by the way) bill was $7,400. The hospitalization bill (minus charges from all of the medical personnel) came to $49,360. My portion of that last one is in excess of $5K, and I have yet to see a bill from my surgeon. Why does a four-day stay in a hospital (sans Doctors) plus some tests come to such a princely sum? It’s what the traffic will bear. You can see why rich people are fine with this system. It just doesn’t work for anyone else.

So, Joe Biden, what the fuck are you going to do about this broken system? And more broadly, Democratic party leadership, why are we patching this disaster with massive infusions of cash into COBRA plans when we could just be expanding Medicare/Medicaid to cover people who’ve lost their crappy employer coverage (and those who had none to begin with)?

You are going to need to be able to answer those questions if you want to win this year’s election … or at least minimally serve your constituents.

luv u,

jp