An
explanation of health insurance, in terms a comic book fan would
understand.
by
Zorikh Lequidre
A
father and his son are in a comic book shop.
SON:
Dad, my doctor says I have to read that comic book on the shelf.
DAD:
Son, that is a deluxe hardcover edition of "Watchmen" with
extra features and leather slipcover. It costs $125. Do you have
$125?
SON:
No. But the doctor says I have to read that story.
DAD:
Well, here is a trade paperback reprint of the story. It doesn’t
have all the extra features, but if your doctor says you can do just
as well without them, it may work for you. It's only $24.95. Can you
afford that?
SON:
Barely. He says I may need to read comics every month for the rest of
my life. What will I do?
DAD:
Tell you what: If you give me $20 each month, I will buy whatever
comics your doctor says you need.
SON:
I can't afford $20 every month!
DAD:
Then here's another idea. Give me $10 every month and just give me a
little bit extra when you need a comic book.
SON:
How much extra?
DAD:
Well, if it's a regular newsstand comic, you don't have to give me
anything. If it's a trade paperback reprint or paperback graphic
novel, give me one dollar. If it's a hardcover reprint edition
or hardcover graphic novel, give me three dollars, and if it's
one of those big deluxe editions, give me one quarter of the cost.
SON:
What if I don't need any at all?
DAD:
Then I get to keep the money.
SON:
That's not fair!
DAD:
Consider this: I'm going to be shelling out a bunch of money for
these comics when you need them, and you'll be paying close to squat.
I'm taking a pretty big risk here; I'm gambling that you won't need
another comic book this year. But if you do need one, I am going to
have to get the money from somewhere, right?
SON:
Well, if I need a lot of comics right away, where do you get the
money?
DAD:
There's a bunch of other kids in the neighborhood with whom I run
this deal. I also make a deal with the comic book store.
SON:
Then why don't I just save the money until I need it?
DAD:
Sure you can, but what if you need a comic before you have the money
saved for it, and by the time you do it'll be too late?
SON:
Hmmm...well, why don't I just wait until I need a comic and start
paying you then?
DAD:
This offer is only good one month a year. If you turn it down, you
will have to wait until this month next year for me to make the offer
again.
SON:
Well, how about if I only pay you on the months that I need comics?
DAD:
It doesn’t work that way. If you miss a month, you will have to
catch up the months you owe before I will pay for your comics.
Basically, when you start paying me, you will owe me for a whole
year.
SON:
So how do I get out of this if I change my mind?
DAD:
Just wait until the 12 months end. Or you can move out of the area.
SON:
Then who is going to buy my comics for me if I do move out?
DAD:
I have friends all over the country. One of them can offer a similar
deal.
SON:
OK, let me see if I understand: I and other kids give you money every
month and you get deals from the store. You shell out the cash when
we need comics, and depending on how much I pay you, and the cost of the comics, I may have to pay a little bit as well. What happens if so many
kids need so many comics that you run out of money?
DAD:
Well, if the total cost of your comics adds up to a certain
amount, you will have to pay a bigger share of the cost.
SON:
But then I might go bankrupt!
DAD:
Don't worry, after what you pay adds up to another, higher amount,
I'll cover most of it, you'll wind up paying even less than you did
to start. I figured out the likelihood of this happening to minimize my risk.
SON:
Wait, is this legal?
DAD:
Actually, by law it’s mandatory.
SON:
What!?!
DAD:
That’s right. In 2005 they passed a law called the “Comic Book
Reader’s Protection Act.” It went into effect in 2006.
SON:
What does that law mean?
DAD:
It means that from the time you become eligible to read comic books
you have to join a plan like mine or pay a penalty.
SON:
A penalty!?! How does that work?
DAD:
It’s real simple. All children become eligible to read comic books
when they turn 5, or if they have been able to read for at least two
years, whichever comes first. When you first became eligible you had
a few months in which to join. If you don't join, the government is
going to count up all the months you should have had have coverage
but didn’t. They will figure what 1% of the average monthly cost of
the plans like mine all over the country is for each month you didn’t
have coverage, then add the total to the monthly amount you pay me
when you do join.
SON:
Wow! That doesn’t sound fair!
DAD:
It pays to pay attention, kid. The government doesn’t want you
dying for lack of comics, and some people need a stick more than a
carrot.
SON:
Well, what if I never need any comics? What’s the cheapest plan you
got?
DAD:
Just give me five bucks a month, but you gotta pay for the first $35
worth of comics yourself, then you gotta pay for additional comics at
the rate I told you earlier for the $10-month plan.
SON:
What if I decide to shop at a different comic store in the area?
DAD:
Sorry, I only work with this comic store here. You’d be on your own
if you went to another comic shop in this town.
SON:
And what about in other towns?
DAD:
You remember those guys in other towns I talked about earlier? If
they work with me, you are covered at the shops they work with.
If the shops don’t want to work with us, we can’t help you.
SON:
But what if the comic I absolutely need is at a shop you don’t
cover?
DAD:
Tell you what, my friends and I will start a new kind of plan. In
this plan we would prefer that you go to a store that works with us,
but we will still cover you if you want to go to a different shop.
Your contribution when you buy a comic will just have to be a little
bigger.
SON:
Well, that’s better than nothing, I guess.
DAD:
So there you have it. Pay a lot up front and don’t worry about the
cost when you need a comic. Pay less on the front end and you
pay a little on the back end. Pay a little more if you want to go
where you want to go.
SON:
Thanks for explaining it all to me. I think I’m going to go get a
job so I can afford all this!
DAD:
Hmmm…the boy has learned a valuable lesson and has taken his first
step into a larger world. I guess my job here is done!
Study
questions:
- Can you identify the points in the conversation that represent:
- Premiums
- Annual election period
- Co-pays
- HMO
- Brand-name drugs
- Co-insurance
- Special election period
- PPO
- Generic drugs
- Coverage gap
- In-network and out-of-network
- Late enrollment penalty
- Tiers
- Specialty drugs
- Catastrophic coverage
- Shared risk
- Individual mandate
- Which plan would you be best for you?
- Which plan would be best for someone who has very little need to read comics?
- Which plan would be best for someone who had to read a lot of deluxe-edition comics?
- Which plan would be best for someone who expects to read just one or two newsstand comics per month?
- Why would someone get a deluxe edition instead of a paperback reprint?
- How would someone avoid falling into the “coverage gap?”
- Why would the government pass a law making comic book insurance mandatory?
- Who would benefit most from having insurance?
- Who has the least need for insurance?
For those who need more details, here are some weighty tomes for you to peruse:
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