One in 50 million: Carpenter favors paying out-of-pocket

Tuesday, October 27, 2009 | 12:01 a.m. CDT; updated 9:06 a.m. CST, Thursday, November 12, 2009
Jamie Kroll, a private contractor in Columbia, disassembles a deck on Oct. 3. Kroll, his wife and two sons do not have health insurance because at a cost of $18,000 a year for the entire family, not including dental, they cannot afford it.

COLUMBIA — Jamie Kroll has been running a carpentry business from home for 13 years. In that time, he's had health insurance for only seven months. But that was when the 39-year-old was just getting his business off the ground and was working at a restaurant.

He paid $600 a month for the plan, which he said he never used, and it had a high co-payment. Eventually, he decided he couldn't afford the plan.


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Kroll then tried to get insurance independently for himself and his son, who was 3. And though the price he was quoted was without dental and vision coverage, it was out of his price range. "I was surprised because neither my son and I have prior illness," Kroll said.

For Kroll, who now supports two children and a wife, who is a counseling psychology student at MU, health coverage is "bleeding expensive." Whenever he has accidents, which he estimates happen once in three years and are an occupational hazard, he has to pay out-of-pocket. Same goes when his wife and children get sick or need some kind of medical attention. Kroll said he does not set aside money for medical expenses.

A few weekends ago, Kroll accidentally ran a saw over one of his fingertips. He went to the emergency room because the clinics he usually visits were closed.

"(The emergency room doctor's) bill was $193 to look at my finger for half a minute and call in the plastic surgeon," Kroll said. "The plastic surgeon stitched up my finger and charged me $384.47. The hospital charged me $702.70."

The expenses have reached a bit more than $1,200 so far, he said.

Kroll estimates health coverage for the entire family would cost about $18,000 a year, which is approximately one-third of his annual income.

The family's yearly health care expenses total around $2,000, but only if they don't have an accident. "If I take the kids to the doctor or the dentist, it is more," Kroll said.

Then there's the hit his business would take if he also had to cover the people who work for him.

None of the subcontractors who work for his company, On the Level Carpentry, has health coverage.

Kroll has one subcontractor who works full time and a couple who work part time.

He pays their medical expenses when they get hurt at work. Once, after a metal splinter flew into the eye of a subcontractor, Kroll paid $180 in medical bills.

He's worried that health care reforms might include a mandate that would require him to provide insurance for his employees.

"If I have to cover them, I have to go out of business," he said.

The Senate Finance Committee's version of the health care reform bill introduced in the Senate on Oct. 20 does not include a provision that would force small-business owners to cover subcontractors. They are also exempt from covering seasonal workers. The committee bill proposes that a tax credit be provided to qualified small-business employers for purchasing health insurance for employees. To get the tax credit, the small-business owner must have 25 or fewer full-time employees.

Kroll has not read the health care reform bill. He said he won't even read through an insurance contract. "It is doubtful I would take the time to read through the 100-plus pages of 'lawyerspeak' in a insurance contract," he said

The family incurred another major expense a few years back when his wife required surgery.

Kroll said they were able to reduce the costs by, "filing for charity from the hospital, a gracious doctor reducing her charges, and minimizing costs by (my wife) leaving the hospital the day of the surgery.” The expenses still totaled more than $10,000.

Still, Kroll opts to stay uninsured. He's gone without coverage for so long, it seems normal to him. Paying out of pocket, he said, " turns out cheaper."

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charlotte pogue October 27, 2009 | 12:19 a.m.

You can get instant quality full coverage medical insurance for entire family at the best price from

(Report Comment)
Ray Shapiro October 27, 2009 | 12:38 a.m.

There are many ways, other then a government public option health insurance policy, to bring down the premiums for working families such as the Kroll's.
(Heck, there are even ways to just bring down the cost of medical care.)
However, even with access to lower premiums, folks should still be allowed to not participate in insurance.
I admire their fortitude and perseverance.

(Report Comment)
Mike Jennings October 27, 2009 | 5:52 a.m.

Nothing against Jamie, because he seems like a good guy, but he does have full health insurance coverage--from us. He's basically taking a chance knowing that in a real emergency, the hospital or the government will pick up the tab. When he pays his bills by "filing for charity from the hospital," he is really just pushing the cost onto other people. So he wants to pretend to not have coverage--for his family and his employees--knowing that "we" have his back in a real emergency. Doesn't seem too fair to me.

(Report Comment)
Layton Light October 27, 2009 | 7:36 a.m.

I agree 100% Mike. Another irresponsible person who is adding to the health care costs of you and me. Where does he think this "charity" comes from, heaven? I'm sure he doesn't want mandates, because he would have to carry his share of the burden. I get that small business owners would be crushed by a mandate that they would have to cover employees. But individual coverage should be the law. A public option without the mandate for individual coverage would not be "socialized medicine" it would be another handout to habitually irresponsible people that is financed by the more responsible ones. See my comments regarding Fergus Moore:

They apply equally here.

(Report Comment)
Clara Allen October 27, 2009 | 8:21 a.m.

Hooray for Jamie - I too am responsible for my own health care. You are not being irresponsible. Just because you are not dependent upon a profit-focused third party sitting between you and your care provider does not make you irresponsible. Particularly since that third-party profit focused entity plays all kinds of games with the way it moves money around in order to make its profit.

I'm all for a public option, and I would not oppose single-payer, but unless and until one of those two options is available, I, too, choose to be responsible for my own self.

(Report Comment)
Ray Shapiro October 27, 2009 | 10:42 a.m.

Mike Jennings says:
"He's basically taking a chance knowing that in a real emergency, the hospital or the government will pick up the tab."
I say:
Or, maybe his neighbors, a private foundation or a caring church would do the right thing and help him out of a tough spot.
Voting for mandated enrollment with a government administered bureaucratic public option would be taking an even bigger chance with one's political career and the future of America's economy. Let alone the quality of care we might get or the availability of a physician when doctors refuse to accept the plan.
(Unless, the next step will be to outlaw private practice and have only government employed physicians.)
Of course by then, everyone will be totally dependent on government controlled needs distribution, as "they" become the only employer in Amerika.

(Report Comment)
Mike Jennings October 27, 2009 | 3:32 p.m.

So every time somebody needs a heart or liver transplant, or a few rounds of chemotherapy, they have to hope that friends, charities, and churches can raise the $500,000? I think I'd prefer a more rational and humane means of taking care of people. And even those methods Ray mentions require that the burden be pushed onto other people. By that logic, why have automobile or home insurance? Just get a church to help you out when you're in need.

If as a culture we are willing to say, "Sorry, you decided not to purchase health insurance so you'll have to die," THEN you can make the honest choice to take the risk of not having insurance. Until then you're just sidestepping the issue and not taking responsibility.

And I'm not sure anyone is suggesting "mandated enrollment with a government administered bureaucratic public option."

(Report Comment)
Mark Foecking October 27, 2009 | 3:46 p.m.

First of all, health insurance industry profits are not terribly high. In 2008, this Fortune 500 ranking had them 28th, with a 6.2 % profit margin:

However, the discussion should not be so much about who pays, but how much one pays, and for what.

Time was that a GP would have stiched up Jamie Kroll's finger in his office or emergency room, and for a heck of a lot less than $1,200. Medicine has added a whole layer of specialists, gatekeepers, and support personnel, as well as technology. All this comes at a price, and since most people do have insurance, health care providers aren't shy about using all of it.

Defensive medicine also adds greatly to the cost of medical services. While the actual payout in malpractice suits is small as a percent of total costs, avoiding those suits leads doctors to prescribe a lot of expensive tests to cover themselves.

I sometimes hear how much uninsured people cost "the rest of us". Well, since about 85% of Americans do have insurance, and since some of the 15% that don't still pay all or part of their bills, there isn't really a lot of unpaid expenses to spread around, relatively. Much indigent care is paid for by general tax revenues (state and federal), also. Health care costs, and insurance premiums, would be only slightly reduced by having everyone purchase insurance.


(Report Comment)
John Schultz October 27, 2009 | 3:53 p.m.

Mike, some of the bills discussed in Washington D.C. do include individual and business insurance mandates. There has also been talk of the government subsidizing the insurance for some of those who would enroll in the so-called public option. I'm not sure what Baucus' bill currently says since the language for that has been closely guarded. For example, I believe his finance committee passed the bill out, then was working the next week on the actual language. Not the shining example of transparency Obama promised us during his campaign.

Just happened to read this NY Times piece with some additional information on some of my points above:

(Report Comment)
Betsy Murphy October 27, 2009 | 10:56 p.m.

What about Workers' Compensation? In Missouri, employers in construction must carry workers' comp (which covers on the job accidents and illnesses for employees) if they even have one employee. He'd better hope that his subs are actually subs and not employees in disguise.

(Report Comment)
Ray Shapiro October 28, 2009 | 12:13 a.m.

Good post.
@Mike J:
Obama and McCain were asked... Health Care?
A privilege? A right? A responsibility?
Obama answered A right.
McCain addresses responsibility?
And is it only about the insurance industry or how we manage affordable, accessible quality health care in a multi-tiered system within our republic?

Mike, Do you agree with Obama in this video or McCain?

(Report Comment)
Ayn Rand October 28, 2009 | 8:05 a.m.

Mark, regarding the amount of unpaid expenses spread around, you might be right. See

(Report Comment)

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