• Rosalind Kaplan, MD

Back to Reality

by Rosalind Kaplan, MD

Yeah, I really digressed with that last post. No talk of medicine at all. It was fun and liberating. There are lots of other parts to my life, as I am finally able to see!

And yet, even the content of my last post leads me back to the world of medicine, as I spoke about my daughter moving from Austin to Philadelphia.

She is starting a new job in Philly. With the shift of jobs, she had a change of health insurance. She is lucky, by US standards, to have a full-time job that provides full benefits, including health insurance. Still, it's never simple. She's kind of an old pro at this, as this is the sixth job she has had since her graduation from college. This is far from unusual for someone in their 20's-- in fact, multiple jobs, particularly in early adulthood, is the norm. Adult children can stay on a parent's insurance until age 26, if they have a parent with a good policy, but after that, they are on their own. Many younger adults have jobs that don't provide insurance--gig economy jobs, part-time jobs, hourly-rate jobs...so either they have no health insurance at all or they must buy their insurance as an individual.

Even on the 'market' of subsidized insurance, even the most basic plans cost upward of $300/month. Add the copays for medication and doctors visits, not to mention the very high copay that an emergency room visit or hospitalization could generate, and health care costs are quite high for a young adult who doesn't make a lot of money. New tax breaks help a bit, but not enough. Unfortunately, in urgent care, I encounter many young adults who work, but have no health insurance because it is not affordable. An urgent care visit generally runs $100-$150, but if they require more--an ER visit, labs, X-rays or other studies, or certain medications, the cost can sky-rocket.

Now, back to my daughter's situation, the 'lucky' situation. She starts her new job this week and there is a 60-day waiting period before her benefits kick in. As physicians, her father and I know all too well the risk of being without insurance for 2 months. A single illness, injury or accident can send someone without insurance into extreme debt. This can, in turn, affect one's credit rating, one's ability to manage other unexpected expenses, and one's mental health. So she will use COBRA from her last employer in Austin for 2 months. COBRA will cost $700/month, but she needs to have it to cover any emergencies, as well as her usual daily medication, for the next 60 days. One of her medications requires a 'prior authorization' from her insurance company. So she will need to see a new doctor in Philly, who will have to begin a new 'prior auth' request, even though she has been doing well on the medication for years. Not only is it extra work for her new doctor, but if the insurance company is slow in authorizing the drug, she may have a gap in her medication use, which will likely destabilize her medical issues.

I will also mention that she is lucky in that her parents have an 'in' to new doctors for her.

Finding a new primary care doctor is a whole job of its own, and it often takes months to get an appointment once one is located. Without a primary care doctor, no prior authorization, and thus no medication...

You see what I'm saying. Our system - payment, appointments, prescriptions--is very far from user friendly. Given 'gig economy', geographical relocations, and job changes, it seems crazy that health insurance is so tightly tied to employment. It makes no sense in our current society. Some form of portable universal coverage is what makes sense, and I still doubt that it will happen during my time on earth.

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