In most developed countries, health care coverage is a right for all citizens, not something that is an option for the wealthy. Those I know who have not had health care coverage here in the US have somehow considered it a “freedom” to avoid having to pay for it when they believe they can’t afford it; those individuals have blamed Obama’s Affordable Care Act for requiring Americans to purchase coverage or pay a penalty. That’s quite a sales job we’ve done, convincing the poor that they are more free because they choose to be uninsured! Taste the freedom!
I was talking with a church friend recently about our own health care situations. In 2013, after decades working for large corporations with access to the health insurance they provided, my husband and I decided to start a small business together. The Affordable Care Act was new, and there were very few health care providers willing to offer plans in Arizona due to how many old people live here. Given the limited options, we ended up with a very bad health care plan that had high deductibles and no max out of pocket. Despite paying $12,000 a year in premiums to our provider, very little was covered. We are pretty healthy people, generally speaking, but during that plan’s coverage, I had a melanoma that required outpatient surgery and stitches as well as follow up appointments. I paid hundreds of dollars for each procedure, office visit, and test that was done. Still, I was pretty healthy overall. I just paid it all, along with the premiums that didn’t cover much; it was a big financial drain, particularly since our earning potential as a new business was about 25% of what we used to make in corporate.
Last April, I had two severe migraines. Since I am not a migraine sufferer, I went to the doctor. She ordered an MRI (that cost me several hundred dollars out of pocket). The scan revealed that I had something called a cavernoma, a cluster of blood vessels in my brain. These aren’t apparently that rare, although I had never heard of them before; 1 in 200 people has one. Many people only discover they have one when it leaks into the brain, causing brain damage (e.g. you wake up, but your arm won’t work or you suddenly have aphasia). I was referred to a neurosurgeon who recommended a craniotomy to remove the cavernoma as a way to ensure I wouldn’t have future brain damage. I began the process to schedule the procedure. They took my “insurance” information, and said the various departments would contact me to tell me what my payment obligation would be. By the first call, I knew I wasn’t going to be having the surgery while on this insurance plan. The doctor’s fee for the surgery was going to be $60,000 out of pocket (not counting the $24,000+ my insurance would cover). That amount didn’t include the OR staff, the ICU stay, the anesthesiologist, or the MRIs to verify the procedure was successful; all of these would be additional costs. The woman from the billing department was appalled at how bad my coverage was. Ultimately, she recommended I just agree to pay, then default and go bankrupt. I have never contemplated bankruptcy in my life. Should I ruin my credit rating forever or risk brain damage? Should I get a second mortgage? Should I risk the next four decades, hoping the cavernoma doesn’t leak?
Prior to the Affordable Care Act, this cavernoma, which was suddenly a pre-existing condition, would have made me ineligible for insurance coverage for life. I would have to live the rest of my life waiting until the day I would wake up with irreversible brain damage. Thankfully, the Affordable Care Act made it so that I could not be denied coverage. Our business had grown to the point that we finally had a few employees interested in insurance coverage. In the past, they had always declined coverage because they didn’t want to pay their portion of the premiums, and we were too small to get good enough rates to pay for more than 50% of their premiums. We had recently acquired a second location with additional employees. so we were able to change insurance companies mid-year. Our premiums for our family were around the same as they had been on the terrible plan we had been on, but on the new plan we had HMO coverage with a modest co-pay for office visits and procedures, and a max out of pocket under $8000 per year per person. I knew I was going to blow right past that max amount.
My surgery was complete in November, and with a new plate in my head and 30 staples holding it all together, my recovery process began. Two weeks later, on Thanksgiving, I realized that my left leg was swollen and I was having a hard time walking. I had a DVT (blood clot) during my first pregnancy in 1995, and while this was less severe, I knew that’s what it must be. I went to the emergency room and was immediately put on blood thinners. Two weeks later, my leg was much worse and swollen again. My doctor ordered an ultrasound, and we discovered that the blood thinners I was on hadn’t worked for me and now I had several clots instead of just one. I knew from my 23andme DNA test that I have a genetic predisposition for blood clotting, and major surgery can trigger clotting. Since the medication failed, they put me on abdominal shots twice a day of a different blood thinner. While this medication worked, it left me covered in bruises all over my stomach and legs. I begged my hematologist to switch me to something in pill form, and he agreed.
When I went to fill the prescription, I was told that the insurance company wouldn’t agree to the dosage, so they would have to give me fewer pills than I needed. I was gobsmacked. Why does the insurance get to override what the doctor prescribes? To carry me through, I had to beg for a free sample from the doctor’s office to make up half the difference. Then I received another call from the pharmacy saying the insurance company wouldn’t allow them to fill the prescription until the end of the month. I explained that I would be dead by then if I wasn’t on the prescribed blood thinners. That was apparently the pharmacy tech’s mistake, but given the hoops I was being told to jump through, I was ready to believe the insurance company was capable of anything.
I have lived in two countries with public health care available: Spain and Singapore, both of which have socialized health care. Singapore is a far more expensive country than the US, but its health care is not (unless you use the available private option). I am not afraid of socialized health care as I’ve seen firsthand that it is much more straightforward than our approach with a corporation inserted in the middle to arbitrate what medical professionals recommend. Mitt Romney famously said “Corporations are people, my friend,” a legally true statement, but they are pathological people obligated to turn a profit to stay alive. They are not obligated to provide a public good or to act morally, but they are obligated to protect their interests by making money. They make money when healthy people pay more than unhealthy people cost. Friends, that’s already socialism; everyone pays so that everyone benefits. The problem in our country is that healthy people bank on staying healthy, and they don’t want to buy insurance, and they for sure don’t want to cover medical costs for the poor. We all think we’ve earned our health and good fortune, and that other people’s problems can stay off our lawn. Add to that the fact that people are living longer, running up health bills, rather than dying off (which would benefit the insurance companies), and you can see why the model gets dicey.
I was talking with my friend about this ridiculous encounter over the blood thinning medication when another church friend joined us. She hadn’t heard our conversation, and she said she was really worried because she and her husband have great insurance and “the Dems” want to take it away and install government-run death panels to prevent them from getting the care they need. I said to her, “The insurance companies are already death panels! I was literally just explaining how they can override my doctor’s recommendations and deny coverage even though I’ve always paid my premiums! I’m dealing with death panels today.”
The first friend I mentioned was talking to me privately later. She and her family couldn’t afford their own insurance, so they chose to join one of those Christian affiliation programs. I mentioned to her that when we considered those, 3 of the 4 available required us to sign a belief statement that was intended to exclude religions like Mormons (and JWs, for example). She was running into the problem that the cost for office visits was so high and not covered that she wasn’t willing to get a problem she was having looked at because her daughter had already been to the doctor that month and used up their budget. Her injury would have to wait.
Needless to say, it was galling to me to hear Trump lying at the State of the Union that he was fighting to protect people from being dropped for pre-existing conditions when the Republicans are in fact fighting to overturn that protection that was legislated in the ACA. This issue is very divisive in the US right now with Republicans fighting to save the insurance company model and the freedom to be uninsured and Democrats fighting for at minimum more government oversight up to full socialization of health care. Where do you sit? For those who already live in a socialized health care system, please share your views!
- Are you bothered that access to affordable health care is tied to employment for a large corporation? Is this a problem with the system we have?
- Do you believe insurance companies should be allowed to refuse to cover pre-existing conditions as they used to be before the Affordable Care Act?
- Should “healthy” people (or others) be allowed to opt out of health care coverage, even if that means their bills will go unpaid if they incur a high medical cost?
- How do you feel about affiliation groups as an alternative to health insurance?
- Should health care companies be able to refuse coverage in contradiction to doctors’ orders? If so, how can this be prevented?
- Do you favor socialized health care? If not, what do you favor? If so, how do we get there from where we are?
- Why do so many people fear socialized health care more than they fear the insurance system?
- Have you had any health care horror stories you care to share?