The Insurance Buying Guide: Remember When?
Once upon a time, people could go to any doctor they wanted. If their general practitioner decided they needed to see a specialist, they could see any specialist they pleased. If they needed medicine, they could go to any pharmacy and get exactly what the doctor prescribed.
For the vast majority of Americans, things have changed. Today, we have HMOs, PPOs, generic drugs, lists of doctors insurance companies say we can and can't see, treatments we are allowed -- but only after two or three doctors agree they're necessary.
Health care -- and health insurance -- have been changed radically during the last couple of decades.
It all started with skyrocketing medical costs. According to the Washington Insurance Council, in 1969, per capita expenditures for health care were $268 per year in this country. By 1990, the figure had increased to $2,567. During the same 20-year period, health expenditures grew from 5.3 percent of the gross national product (GNP) to 12.2 percent.
By the year 2000, the Health Care Financing Administration projects the annual per capita expense will be $5,712 -- and the national health expenditure will be $1,616 trillion a year, or approximately 16.4 percent of the GNP.
Health insurers have had to pay for much of these costs -- and they've had to contend with ever-increasing fees for doctors, lab tests, prescription drugs and hospitals. These growing costs meant insurers either needed to keep increasing their premiums, or they needed to find another way. To some degree, they did both.
They certainly have passed along increasing costs to their customers for years. But there comes a time in every business's life when it realizes it can't just pass along its costs any longer. It has to do something else to remain competitive. It has to cut the costs themselves.
What have insurance companies done to cut costs? They've set up agreements with doctors or health provider organizations that enabled them to standardize fees for various services. They've limited your choices to generic drugs, if they're available. And, they've limited you to a select group of doctors in your area, or only to one primary care physician. Want to see somebody else? You'll need permission -- or you'll have to pay the bills yourself.
But you do still have choices when it comes to health insurance, whether you are buying your own or getting it through your employer. And that's what this chapter is about.
