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Everyone remembers their first day at work.  As a newly minted pharmacist, I went in thinking that I’d change the world, one patient at a time.  But within my first hour, I met someone that would end up changing my world instead.  A mom came in with a prescription for her daughter.  The prescription was for a common antibiotic that we’ve all probably taken before.  However, this mom did not have insurance and the prescription came out to $40.  The mom did not have $40 to pay for that prescription.  So I did what I thought was right and took out $40 to pay for her daughter’s prescription.  The daughter was grinning from ear-to-ear and the mom was on the verge of tears.  The mom left with a prescription that her daughter needed; and I felt like I was making a difference in the world.  

That feeling lasted until I saw the next patient, who didn’t have insurance and couldn’t afford his medication.  And that feeling vanished with the next patient … and that feeling turned into helplessness with the next patient after that.  Everyone that I encountered, who faced this situation, were hard working people.  But they were caught between a rock and a hard place.  Their employer did not provide healthcare benefits.   And they worked so they were not eligible for Medicaid (government-sponsored health insurance) but they didn’t make enough to afford to purchase insurance.  So they were stuck paying out-of-pocket for all of their healthcare needs.  Despite my desire to help every one of my customers, I quickly realized that I would go broke paying for everyone’s prescriptions.  

 

The reason that this story bothered me so much was that I only got $10 back from the insurance company for that same antibiotic.  Yet  the mom had to pay $40 because she didn’t have insurance.  Being that this was my first job, I didn’t understand why someone without insurance would pay 4 times more than someone with insurance.  (I later learned that this is how insurance contracts work.)  I also didn’t understand why I couldn’t just sell that same prescription for $10 to someone who was uninsured.  (My home office explained that charging less would violate their insurance contracts.)  All I wanted to do was make sure people got the prescriptions they needed.  Yet I felt helpless trying to do this!

Increase in Healthcare Expenses compared to Wages

It’s been almost two decades since my first day as a pharmacist.  Since then, I’ve been on a journey to understand how the healthcare system works.  I’ve worked in every part of the healthcare system with corporate giants across the United States.  And yet, wherever I go, the problem remain and seems to only get worse.  Today, people can’t just afford their prescriptions, they also can’t afford their medical appointments.   Since my first day as a pharmacist, what an employee pays for out-of-pocket for healthcare has risen 4x faster than inflation!   And healthcare expenses are eating up more of our paycheck without an end in sight.

 

kff-employer-contributions-to-insurance-premiums

Today, we are paying more for our health insurance and getting even less back from our health insurance.  Health insurance for an average family of 4 costs $16,000 a year.  $16,000!!!  That’s almost the cost of a new car … every year!  And while employers are paying around $4,000 for health insurance premiums, employers are subsidizing $12,000 for that health insurance.

And to control insurance premiums, more costs are being shifted to the average employee.  The employee at small businesses now have a deductible of almost $2,000 while employees at large businesses have a deductible over $1,000.  That’s money that many average Americans don’t have lying around.  So instead, many of us are just avoiding healthcare altogether.  This is probably the most depressing part of what’s going in with the healthcare system.

Now, I don’t share these statistics to bore you, scare you, or turn you off.  Instead, I want to impress upon you how important it is to understand the healthcare system and how vital it is to become a healthcare consumer.  We need to shop for healthcare, just like we shop for other products and services.  Whenever we make a big purchase, we do research, ask friends and family, and seek professional advice.  Many of us may not realize that healthcare and healthcare benefits are the biggest purchase we will make each year!  Since most of us haven’t seen a meaningful change in our salary, it’ll be crucial for us to take stock on where our money is going for healthcare.

boat-1044723_960_720Many people I speak with get it – healthcare costs are rising and I’m paying more for healthcare.  The issue most of us have is not knowing where to start.  And that’s why I started this blog.  I want to share my knowledge of the healthcare and health insurance system to help you make informed decisions.  I’ll be the first to admit, healthcare is confusing … super confusing!  Healthcare has its own language and health insurance has its own rules.  And like I’ve heard from everyone trying to navigate the system, the language and the rules seem to change all the time.  That’s why I’d love to be your guide as we navigate healthcare together.

 

It’s important to distinguish that this blog will not provide medical information or medical advice.  There are great resources to help you, such as WebMD and Mayo Clinic.  Instead, what I hear from countless individuals is that they need help navigating the healthcare system and their healthcare benefits to find out what’s best for them and their family.  And that’s where I’ll focus.  Helping you understand how things work and find out what’s best for you to do.

Like I mentioned, I have almost two decades of healthcare experience since my first day as a pharmacist.  However, that also means I am almost two decades older since my first day as a pharmacist.  (And I’m reminded of this every day when I get out of bed!)  So I’ve had to navigate the healthcare system and my health insurance benefits.  Luckily, I haven’t had any major medical issues; only minor and common medical issues, such as back pain, dental needs, contact lens, allergies, etc.  But my experiences are typical of every American.  Despite what you might think after reading the news, only 1 in 10 Americans and only 1 in 100 Millennials get admitted to a hospital each year.  So hopefully, sharing my personal healthcare experiences to save time and money will help you save time and money when you need healthcare.  Granted, I know that talking about healthcare and health insurance is enough to put anyone asleep.  (On the other end, I’ve had people slam the phone down when I tell them that I’d like to help them with their healthcare benefits.)   But as we are forced to pay more and more for our own healthcare, knowing how the healthcare and health insurance system works will be as important as planning for your retirement.

As you can tell, I have a passion for making sure everyone gets the healthcare they need.  And I would love to help you and in turn, help others like you.  So please send me your questions about the healthcare and health insurance system.  I will do my best to help you get thru the maze so you can make the best decision.  And anything shared will be blinded and kept confidential.  But I bet that the questions you have are the same questions thousands of others have too.  So you can help others by helping yourself.

Going back to the mom and daugther I mentioned at the start of this post.  Although I did what I felt was the right thing, I now realize that it wasn’t the best thing.  As a dad, I know that kids don’t get sick only once.  So I often wonder what happened the next time the daughter got sick and they couldn’t afford the prescription?  If I had to do everything over, I would’ve called to find another cheaper pharmacy.  Or I might’ve called the doctor back and see if he would prescribe a cheaper alternative.  Had I done this, I would’ve helped this family become better healthcare consumers so they can afford to get healthcare the next time they needed it.  My hope is that we all become better healthcare consumers so we all can get the healthcare we need, whenever we need it.

Wishing you health, wealth, and happiness!

Shaun

Shaun Young

When people tell me about their frustrations with healthcare, it’s always about the healthcare and health insurance system; it’s never about the actual healthcare. My sole purpose is to help you navigate the healthcare system and your healthcare benefits. I’ve spent almost two decades inside and across the entire healthcare system with corporate leaders, such as Eli Lilly, Kaiser Permanente, Walmart, and Cardinal Health. And my professional experiences cuts across clinical with a Doctor of Pharmacy from University of the Pacific and business with an MBA from Harvard Business School. Please reach out and ask me your questions about navigating the healthcare and health insurance system.

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Everyone remembers their first day at work. As a newly minted pharmacist, I went in thinking that I’d change the world, one patient at a time. But within my first hour, I met someone that would end up changing my world instead. A mom came in with a prescription for her daughter. The prescription was for a common antibiotic that we’ve all probably taken before. However, this mom did not have insurance and the prescription came out to $40. The mom did not have $40 to pay for that prescription. So I did what I thought was right and took out $40 to pay for her daughter’s prescription. The daughter was grinning from ear-to-ear and the mom was on the verge of tears. The mom left with a prescription that her daughter needed; and I felt like I was making a difference in the world.