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On the Third Hand: Miserable

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So, you’re a smart, educated person who’s sophisticated enough to be reading health insurance news (and blogs).

You somehow lost access to rich old health insurance with easy access to a huge network of great health care providers, and you’re trapped in Patient Protection and Affordable Care Act (PPACA)-compliant plan heck.

If you are still stranded in application limbo, and can’t even get a valid insurance card because of computer problems: OK, that’s a genuine problem.

But, if you have a working card, and your individual “qualified health plan” (QHP) works about as “well” as promised, and the problem is that you have a network of 10 overworked barber-surgeons who have to trim 10 guys’ mustaches before they can start on your gallbladder: Your QHP is working.

President Obama looked at everyone and said, calmly, sweetly, “If you like your plan, you can keep it.”

In the fine print, if anyone had recited the fine print, the fine print TV commercial narrator whose voice you can never really make out would have murmured, “But, if you change plans, and you have decent health and money, we’re going to give you skin in the game on steroids. And amphetamines. And ramjets. Till you are miserable.”

On the one hand, one point of PPACA is to give poor people and sick people — the helpless people who really need health care and have no ability to influence anything, at this point — pretty good Medicaid coverage at a price they can probably afford, or that is saving their life to such an extent that they will scrape up the money to pay for the coverage, because, really, what other choice is there, other than to just roll over and die.

On the other hand, another point is for you to get really, really mad, and go get your pitchfork, and use your pitchfork to poke someone who’s driving up the cost of your health coverage and giving you rotten coverage. Because, in theory, you’re the one with the ability to figure out who the bad folks are and poke them, hard.

On the third hand: I am not yet in a plan hit by the full force of PPACA, but I was in a high-deductible plan with a health savings account (HSA) for two years. I went into the HSA experiment full of knowledge of health policy and enthusiasm for the concept of skin in the game.

I did yell and email so hard at the primary care physician who billed me $400 for what I thought was a free checkup that he seems, apparently, to have retracted the bill. So, at some level, arming me with skin in the game worked.

On the fourth hand, I’m now terrified of going to the doctor. I’ve only been to the doctor since when I had a 105-degree fever and for a checkup, and I’m too scared of what would happen if I went and got the recommended “free” preventive services diagnostic tests (will I then be billed $200 to go in for a “consultation” just to find out the results?) that I haven’t even gotten the “free” preventive services. I am probably one of the best-informed, least-compliant patients in the risk pool.

On the fifth hand: The main alternative to patients with the ability to influence policy having skin in the game seems to be more government oversight.

So, do you wield the pitchfork, or do hand the pitchfork to the government and let the government decide who to poke?

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