Why is affordable health care not really that affordable?

Health care options when you make very little money...

The inspiration

I remembered recently reading an ad on the subway about some kind of health care alternative that was like a club membership, where you pay monthly fees for access to a range of services offered among a group of health care providers. In researching health care options online, costs for even those with no real income seemed out of my range (over $200/mo.); and, so I thought if the advertised fees of less than $100 per month was legitimate, it was worth my research. At the time, I had very affordable health insurance through my graduate student union (the one major benefit of it all), and, due in part to the the slightly sketchy nature of the subway advertisement, my piqued interests washed away in the haze of daily life. 

The motivation

Several months later, when I as no longer insured but still very penniless (yay, I get to use that word!), I tried to remember what I could about health care options. My preliminary internet research revealed no new affordable options. Stuck in the back of my mind was the idea that out there, somewhere, you could pay a monthly fee to get a range of clinic services directly to the health care providers--insurance companies not involved on any level. Well, today, spurred by my lack of health care coverage in the past eight months and foreseeable future, I began my search anew. I am happy with the results. 

The revelation

About a month ago, I looked at what options the Freelancers' Union offered. It seemed somewhat affordable, but I wanted to fully understand what options were out there. So, first searching with the terms health, care, and membership, I found in the Google news database an article about Qliance ("Health care by monthly membership," 16 June 2010), a membership based health care provider in Seattle. Actually, it's more of a press release, but it gave me the language I needed to return my search back to the New York area. That's when I found the listing of direct primary care practices state by state from dpcare.org. It was through this listing that I once again found the instigator of my brain tease, the subway advertiser itself: AMG Medical Group, a New York area affordable direct primary care practice (vs. concierge or elite). You can get direct primary care providers like the ones featured on Royal Pains on USA, but obviously that doesn't help in reducing health care costs. 

"Get insured. Get health care. Get creative."

Finally, the biggest blow in the fight to understand health care options was made when I came across the Artists' Health Resource Center web page on the topic: How to Get Affordable Health Care in New York City. I've been looking for a page like this for a long time, something that explains all of the options without the bias of the market and in a way much more concise and coherent than government agencies. At this point, I plan to look further into the details and options listed on this page, as well as investigate a few more direct primary care providers, such as Health Plus. 

The reservation

As of yet, I am not sold on the direct primary care providers because they only cover a very set, very limited range of non-serious services. Care for emergency, surgery, hospitalization, and chronic conditions are generally not included in the range of services covered by direct primary care providers. So, you are still gambling with your life given that a bad car accident could have you in debt, without notice, tens of thousands of dollars. Perhaps there is another alternative health insurance that covers the top end at a discount rate, while clinic providers like AMG make the bottom end of services affordable. 

Actually, now that I am thinking about it, the health care coverage offered by the Freelancers Union is exactly that: you pay two hundred dollars per month, but you have a five hundred dollar deductible, which means you won't be using that insurance for any medical expenses that you would need on a regular, preventative basis, which are exactly the expenses covered by affordable direct primary care practices. You would end up paying $220 for the group insurance and $79 for the membership fees, a total of about three hundred dollars. Fortunately all of this can be deducted from you taxes at the end of the year if you really are a freelancer or small business-person.

In conclusion, it is a tangled web of relationships and fees: it's best to be on top of the web so that when you fall it will can catch you rather than hang you.