and people

Canonical link: https://siderea.dreamwidth.org/1889543.html


Preface: I had hoped to get this out in a more timely manner, but was hindered by technical difficulties with my arms, which have now been resolved. This is a serial about health insurance in the US from the consumer's point of view, of potential use for people still dealing with open enrollment, which we are coming up on the end of imminently. For everyone else dealing with the US health insurance system, such as it is, perhaps it will be useful to you in the future.

---

Understanding Health Insurance:
Introduction

Health insurance in the US is hard to understand. It just is. If you find it confusing and bewildering, as well as infuriating, it's not just you.

I think that one of the reasons it's hard to understand has to do with how definitions work.

Part of the reason why health insurance is so confusing is all the insurance industry jargon that is used. Unfortunately, there's no way around that jargon. We all are stuck having to learn what all these strange terms mean. So helpful people try to explain that jargon. They try to help by giving definitions.

But definitions are like leaves: you need a trunk and some branches to hang them on, or they just swirl around in bewildering clouds and eventually settle in indecipherable piles.

There are several big ideas that provide the trunk and branches of understanding health insurance. If you have those ideas, the jargon becomes a lot easier to understand, and then insurance itself becomes a lot easier to understand.

So in this series, I am going to explain some of those big ideas, and then use them to explain how health insurance is organized.

This unorthodox introduction to health insurance is for beginners to health insurance in the US, and anyone who still feels like a beginner after bouncing off the bureaucratic nightmare that is our so-called health care system in the US. It's for anyone who is new to being an health insurance shopper in the US, or feels their understanding is uncertain. Maybe you just got your first job and are being asked to pick a health plan from several offered. Maybe you have always had insurance from an employer and are shopping on your state marketplace for the first time. Maybe you have always gotten insurance through your parents and spouse, and had no say in it, but do now. This introduction assumes you are coming in cold, a complete beginner knowing nothing about health insurance or what any of the health insurance industry jargon even is.

Please note! This series is mostly about commercial insurance products: the kinds that you buy with money. Included in that are the kind of health insurance people buy for themselves on the state ACA marketplaces and also the kind of health insurance people get from their employers as a "bene". It may (I am honestly not sure) also include Medicare Advantage plans.

The things this series explains do not necessarily also describe Medicaid or bare Medicare, or Tricare or any other government run insurance program, though if you are on such an insurance plan this may still be helpful to you. Typically government-run plans have fewer moving parts with fewer choices, so fewer jargon terms even matter to them. Similarly, this may be less useful for subsidized plans on the state ACA marketplaces. It depends on the state. Some states do things differently for differently subsidized plans.

But all these different kinds of government-provided health insurance still use some insurance industry jargon for commercial insurance, if only to tell you what they don't have or do. So this post may be useful to you because understanding how insurance typically works may still prove helpful in understanding what the government is up to. Understanding what the assumptions are of regular commercial insurance will hopefully clarify the terms even government plans use to describe themselves. Just realize that if you have a plan the government in some sense is running, things may be different – including maybe very different – for you.

---

On to the first important idea: Health Insurance is a Contract.

---

I see that I didn't note last year's Annual Introverts Liberation Feast. Perhaps I wrote a draft that I never got around to posting. It was something of a grueling deathmarch. Because my physical disability makes me largely unable to participate in food prep or cleaning, it almost entirely falls on Mr B to do, and he is already doing something like 99% of the household chores, so both of us wind up up against our physical limits doing Thanksgiving dinner.

But the thing is, part of the reason we do Thanksgiving dinner ourselves to begin with, is we manage the labor of keeping ourselves fed through meal prepping. And I really love Thanksgiving dinner as a meal. So preparing a Thanksgiving dinner that feeds 16 allows us to have a nice Thanksgiving dinner on Thanksgiving, and then allows us to each have a prepared Thanksgiving dinner every day for another seven days. So this is actually one part family tradition, seven parts meal prep for the following week, and one part getting homemade stock from the carcass and weeks of subsequent soups. If we didn't do Thanksgiving, we'd still have to figure out something to cook for dinners for the week.
The problem is the differential in effort with a regular batch cook.

So this year for Thanksgiving, I proposed, to make it more humane, we avail ourselves of one of the many local prepared to-go Thanksgiving dinner options, where you just have to reheat the food.

We decided to go with a local barbecue joint that offered a smoked turkey. It came in only two sizes: breast only, which was too small for us, and a whole 14 to 16 lb turkey, which is too large, but too large being better than too small, that's what we got.
We also bought their mashed potatoes, green bean casserole, and – new to our table this year – baked macaroni and cheese. Also two pints of their gravy, which turned out to be spectacularly good. We also got a pan of their cornbread (also new to our Thanksgiving spread), for which they are justly famous; bizarrely, they left the cornbread off their Thanksgiving menu, but proved happy to add it to our order from the regular catering menu when we called it in.

We used canned sweet potatoes in syrup and grocery store cubed stuffing (Pepperidge Farm). The sweet potatoes were fine but as is traditional I had a disaster which coated half the kitchen in sugar syrup. The stuffing was... adequate. Our big compromise to save ourselves labor was that we didn't do the big stuffing production with the chopped and sauteed fresh veggies. The place we got the prepared sides has a stuffing but it's a cornbread stuffing, which is not the bread cube version I prefer. We did add dried sage to it.

Reheating the wholly cooked smoked turkey did not go great. We followed the vendor's instructions – leave it wrapped in foil, put two cups of water in a bottom of the roasting pan, 300° F for two hours to get the breast meat to 165° F – which turned out to be in Mr B's words, "delusional". We used a pair of probe thermometers with wireless monitor, one in the thigh and one in the breast, and an oven thermometer to make sure the oven was behaving. The oven was flawless. The temperature in the thigh quickly spiked up while the breast heated slowly, such that by an hour in, there was a 50° F difference in temperature between the two. The thigh reached 165 in about 2 and 1/2 hours, at which point the breast was 117 ° F. By my calculations, given how far it had gotten in 2.5 hrs, at that temperature we'd need another hour and a half to get the whole bird up to 165° F (for a grand total of 4 hours) at which point the drumsticks would probably be shoe leather.

There was a brief moment of despair while we entertained heating the turkey for another hour and a half, but then decided to just have dark meat for Thanksgiving.

The turkey turned out to be 1) delicious and 2) enormous. Mr B carved at the rest of the bird for our meal prep and picked the carcass; I broke the carcass and other remains into three batches this year. There is going to be so much soup.

Mr B had the brilliant idea to portion the sides leftovers into the meal prep boxes before the dinner, so we dispensed two servings of each side into the casseroles we were going to warm them in, and portioned out the rest.

I had the brilliant idea of checking the weather and realizing we could use the porch as an auxiliary fridge for all the sides we had sitting there in the crockery waiting for the tardy turkey to be done so they could go in the oven. Also it was wine degrees Fahrenheit out, so that worked great too.

For beverages, Mr B had a beer, and I had iced tea and a glass of wine. Happily, the packie near the caterer's 1) has introduced online shopping for easy pickup, and 2) amazingly, had a wine I have been looking for for something like 20 years, a Sardegnan white called Aragosta, to which I was introduced to by the late lamented Maurizio's in Boston's North End. Why the wine is called "lobster" I do not know, but it is lovely. The online shopping did not work so happily; when we placed the order the day before (Tuesday), we promptly got the email saying that our order was received, but it wasn't placed until we received the confirmation email. Forty minutes before pick up time (Wednesday), since we still hadn't received a confirmation email, Mr B called in and received a well rehearsed apology and explanation that there was a problem with their new website's credit card integration, so orders weren't actually being charged correctly, but to come on down and they would have the order ready for payment at the register.

As is our custom, we also got savory croissants for lunch/breakfast while cooking from the same bakery we also get dessert. As is also our custom, we ate too much Thanksgiving dinner to have room for dessert, and we'll probably eat it tomorrow.

The smoked turkey meat (at least the dark meat) was delicious. I confess I was a little disappointed with the skin. I'm not a huge skin fan in general, but I was hoping the smoked skin would be delicious. But there was some sort of rub on it that had charred in the smoking process, and I don't like the taste of char.

The reason the turkeys I cook wind up so much moister than apparently everybody else's – I've never managed to succeed at making pan gravy, for the simple reason I've never had enough juice in the pan to make gravy, because all the juice is still in the bird – is that I don't care enough about the skin to bother trying to crisp it. There really is a trade-off between moistness of the meat and crispness of the skin, and I'm firmly of the opinion that you can sacrifice the skin in favor of the meat. The skin on this turkey was perfectly crisped all over and whoever had put the rub on it managed to do an astoundingly good job of applying it evenly. It was a completely wasted effort from my point of view, and I'm not surprised that the turkey we got wound up a bit on the dry side.

That said the smokiness was great. I thought maybe, given how strongly flavored the gravy was, it would overpower the smokiness of the meat, but that was not the case and they harmonized really nicely.

The instructions come with a very important warning that the meat is supposed to be that color: pink. It's really quite alarming if you don't know to expect it, I'm sure. You're not normally supposed to serve poultry that color. But the instructions explain in large letters that it is that color because of the smoking process, and it is in fact completely cooked and safe to eat.

(It belatedly occurs to me to wonder whether that pink is actually from the smoke, or whether they treated it with nitrates. You know, what makes bacon pink.)

The cavity was stuffed with oranges and lemons and a bouquet garni, which was a bit of a hassle to clean out of the carcass for its future use as stock.

The green bean casserole was fine. It's not as good as ours, but then we didn't have to cook it. The mac and cheese was really nice; it would never have occurred to me to put rosemary on the top, but that worked really well. The mashed potatoes were very nice mashed potatoes, and the renown cornbread was even better mopping up the gravy.

The best cranberry sauce remains the kind that stands under its own power, is shaped like the can it came in, and is perfectly homogeneous in its texture.

We aimed to get the bird in the oven at 3:00 p.m. (given that the instructions said 2 hours) with the aim of dinner hitting the table at 6:00 p.m. We had a bit of a delay getting the probe thermometers set up and debugged (note to self: make sure they're plugged all the way in) so the bird went in around 3:15 p.m. At 5:15 p.m. no part of the bird was ready. Around 5:45 p.m. the drumsticks reached 165° F, and we realized the majority of it was in not going to get there anytime in the near future. At this point all the sides had been sitting on the counter waiting to go into the oven for over a half an hour, so we decided to put them outside to keep while we figured out what we were going to do. We decided to give it a little more time in the oven, and to use that time to portion the sides into the meal prep boxes. Then we brought the casseroles back inside, pulled the bird from the oven and set it to rest, and put the casseroles in the oven. We microwaved the three things that needed microwaving (the stuffing, which we had prepared on the stove top, and was sitting there getting cold, the gravy, and at the last moment the cornbread). After 10 minutes of resting the turkey, we turned the oven off, leaving the casseroles inside to stay warm, and disassembled the drumsticks. Then we served dinner.

After dinner, all ("all") we had to do was cleaning dishes (mostly cycling the dishwasher) and disassembling the turkey (looks like we'll be good for approximately 72 servings of soup), because the meal prep portioning was mostly done. We still have to portion the turkey and the gravy into the meal prep boxes, but that can wait until tomorrow. Likewise cleaning the kitchen can wait until tomorrow. This means we were done before 9:00 p.m. That has not always been the case.

Getting the cooked turkey and prepared sides saved us some work day of (and considerably more work typically done in advance – the green bean casserole, the vegetable sauté that goes into the stuffing) but not perhaps as much as we hoped.

Turns out here's not a lot of time difference between roasting a turkey in the oven and rewarming one. OTOH, we didn't have to wrestle with the raw bird. Also, because we weren't trying to do in-bird stuffing, that's something we just didn't have to deal with. OTOOH, smoked turkey.

But it was still plenty of work. Maybe a better option is roasting regular turkey unstuffed and shaking the effort loose to make green bean casserole and baked stuffing ourselves a day or two ahead. We were already getting commercially made mashed potatoes. It would certainly be cheaper. OTOOH, smoked turkey.

This was our first year rewarming sides in the oven. We usually try to do the microwave, and that proves a bottleneck. This time we used our casserole dishes to simultaneously rewarm four sides, and it was great. Next time we try this approach, something that doesn't slosh as much as the sweet potatoes in syrup goes in the casserole without a lid.

But I think maybe as a good alternative, if we're going to portion sides for meal prep before we sit down to Thanksgiving dinner, we might as well just make up two plates, and microwave them in series, instead of troubling with the individual casseroles. This does result in our losing our option for getting seconds, but we never exercise it, and maybe some year we will even have Thanksgiving dessert on the same day that we eat Thanksgiving dinner.