Saturday, August 29, 2009

Your Health or Your Wallet? The "Choice" is Yours.

Note from Ronnie: I'd like to present as many different views as I can over the coming months about this debate on Health Care Reform. To see last week's post, "Health Care We Can Afford? Not Likely." please click here. If you would like to chime in on this topic, please contact me and we may be able to use your commentary on this blog. Comments and questions are encouraged, I just ask that you keep them constructive and respectful. Thanks.

This blog post is brought to us by Talana who is "27, married, with CF from Oregon, former teacher, uh uh uh, and I have a lot of fur children, I mean cats!"

To be alive with Cystic Fibrosis at 27 is an achievement to be proud of. But there is only one reason that I’m still here, 27 years later, and that is by the grace of God, I’ve had medical insurance that entire time. It’s never been easy, I’ve compromised my health to keep it, and I’ve spent more hours fighting with them through mail and phone than I’ve spent communicating with close relatives. These, and countless other reasons, are why I’m a strong advocate in having every single American insured, despite their health, work status, and the blows that life has given them.

My first brush with insurance denying vital care came when I was only four years old. After my diagnosis, I enjoyed good health. All I needed was the occasional oral antibiotics, the “thumps” of cpt on my chest by my parents, and my ‘”zymers” with food. Then I came down with a severe case of appendicitis. Hospitalized for a week, after an extensive surgery to remove my appendix, my parents counted on their insurance to help pay for the cost. Months went by, then a year, without a bill, and they figured that the insurance paid for my procedure and stay in full. Then a bill arrived… for the full amount. Not a single penny covered by my insurance. Why? Because they determined that my appendectomy was a pre-existing condition of cystic fibrosis. A blatant lie, as the two are as unrelated as an iguana is to a monkey, but they decided that they were not paying for it based on that. Also, I had been covered by insurance since birth, which should have exempted me from the pre-existing condition issue entirely. It was only after demanding the name and medical license number of the doctor at the insurance company did they decide to pay for my bills in full. The insurance company tried to use a 4-year-old girl to make a dime, lying by doing so, and it was only the vigilance of my parents that stopped such a gross abuse.

My childhood memories are also colored by worry over paying for my care. Neither of my parents have a college degree, but my father made a good living, working in the lumber mills, something that is a deep tradition in my family. My mother stayed at home, tending to my sister and me, as well as medical needs. Then the bust of the timber industry rippled through Oregon. I watched the fear in my parents’ eyes as my father lost his job. Not only were they worried about how to put food on our table, but they also had great fears because if I went without insurance, I would never be able to be covered again by a private insurer. Thankfully, we always found a way to keep me covered, but the pain and the struggle was not something that any family should ever face.

I went on to college, knowing that once I graduated, I would be on my own for care. I didn’t qualify financially for any state coverage in my state, so I knew I would have to have a job that offered care, and I began looking for such job when I was only a sophomore in college. I found a retail job that offered insurance if I could work 24 hours a week at minimum, but many weeks it came much closer to forty hours, in addition to being a full time student. My senior year I started my student teaching. I was leaving my house at 6:45 in the morning, teaching all day, driving an hour to work, working nearly six hours, arriving at my home at 11pm, so I could lesson plan and sleep. My care for my CF went totally by the wayside as I simply didn’t have time, but I also didn’t have any choice. If I stopped working, then I would not have coverage in a few short months, a death sentence for a CFer. If I stopped student teaching, I would lose my scholarship, owe money to my college, and watch my dreams go up in smoke. I was forced to literally work myself to the bone, in the name of keeping insurance. Nobody should have to do that, but it goes on everyday in this country.

Insurance companies are also far more concerned about making money than they are taking care of subscribers. Our current system locks you into whoever you get through your employer. Competition would be an amazing thing for our market, but doesn’t happen, so they get away with whatever they want. Over the years I’ve had them deny several drugs, some of them after several appeals, charge several thousand dollars for a year of drugs, a piece of medical equipment, or a hospital stay. All of these charges after my premium was paid, my deductible met, but still, it was more and more money bleeding out. I have triple digit copays on more than one of my medications. My vest, which helps me clear the mucus choking out my lungs, was only covered at $5,000 of the $16,000 cost. Without a grant, I would not have my vest. Every time I’ve gone into the hospital the last several years, I know that a $1,500-$3,000 bill will be waiting for me… believe me, I’ve held off going into the hospital because I knew I couldn’t afford it. My choices in my care should not be made by my pocket book, but they are, all the time. I haven’t even began to mention the struggle it took me under more than one plan to get my pulmozyme or tobi, or under another plan my azithromycin.

My story is not unique, sadly it is very common. I have married friends right now living hours apart, one working to keep their insurance, the other taking care of an elderly family member. They don’t have a choice, because they need to keep the insurance. I’ve watched friends not get married, because if they made a bit more money they would lose their government coverage and not be able to get access to care. I’ve watched others stay in loveless marriages to keep insured. I almost had to marry a friend to get on his insurance once, but met the love of my life and married him. I didn’t get my dream wedding because we got married as soon as we could so I could get on his coverage and stop paying over $600 a month in COBRA insurance because my retail job, that I worked so hard to keep, decided to stop offering insurance to employees, leaving me in a lurch, both with insurance and financially. I still made too much to get any state or federal help and I didn’t qualify for other programs because I had the option of COBRA. Without the help of my parents, I would not have made it through that very dark time. Even with their help, I often rationed care, not buying vitamins, not going to the dentist or the eye doctor, because there was no way I could pay.

I have several friends right now who are too sick to work, but continue to do so, because it is their only way to get insurance. They qualify for disability, but can’t take it, because they can’t wait two years for Medicare to start covering them. That’s right… you are too sick to work, but you can’t get insurance for two years. If we had a public option, the pre-existing condition was struck, and fair pricing despite level of health, my friends would be able to focus on their health, but instead they have to continue to compromise it to stay alive.

When I talk to friends in other countries, they all have said the same thing. “I would never trade my care for what you have to deal with in the US with insurance companies.” That to me says it all about this debate. People just as sick as I am are not scared of how they are going to pay their bills. They focus on their health. I’ve watched friends go through expensive procedures like lung transplant, and their care wasn’t rationed, like so many talking heads would like you to believe. Yes, non-emergent care may have to be waited for, but it is here as well. But when you really do need care? You get it. My CF friends went into the hospital when they needed it, they got their drugs without having to play phone tag with a nameless insurance person for hours. They didn’t have to have their doctors send countless letters documenting why the care was needed. Doctors focus on healing, patients focus on living… a utopia in my mind.

Lastly, I don’t understand how any human can look at another human and say, “you don’t deserve care because my health is more important.” My health is just as important as every other person, and their health affects me. If they don’t go to the doctor for a bad infection, because they can’t pay for the visit to get a few dollars in antibiotics, they could get me sick. The hours long wait in an emergency room filled with those without insurance affects me… filled with people that had a simple UTI turn into a bladder infection. Filled with those who have care, but couldn’t afford a co-pay or worried that taking a day off of work to tend to their health would cause them to lose their job, then in turn cause them to lose their insurance. The every growing number of bankruptcies because of medical care affects me, from rising interest rates on loans and credit cards, to less interest on my savings… and I was nearly one of those that became bankrupt had it not been the intervention of my parents.

We need to strike all pre-existing condition clauses. We need to make sure everyone is covered, from day one of life. We need to make insurance companies compete for business instead of lording the fact that they are the only choice over subscribers then dropping them when they become too expensive. Lifetime caps need to be abolished. Runaway out of pocket costs have to be reined in. Food or drugs should never have to be a choice. They only way I see this happening is if there is a government option, one that forces insurance companies to start actually insuring rather than stuffing the pocket books of their executives, shareholders, and lobbyists.

P.S. – This was written during another day of “health in America” from my trip to the pharmacy this morning, where I had to refuse to pick up several drugs because they are going to be cheaper through mail order under my new coverage. Written while answering my phone four times to speak with the clinic that is doing my sleep study tomorrow, trying to figure out my insurance, and what will be covered. I now get to call the insurance company and find out how to transfer my deductible that I’ve already paid this year to this new coverage, write a check for the uncovered part of my sleep study tomorrow, and wait for the next shoe to drop, and wonder if this time my choice will be my health or my pocketbook.

To view Talana's blog, please click here or go Remember, keep all comments constructive and respectful. This is a chance at some open dialogue between people who will be directly impacted by new policies formed in the Health Care arena.

10 people had something to say...:

Jason Addink said...

Hey Ron, do you have to have CF to do a healthcare guest post on your blog? I've got lots of thoughts brewing, but not sure I could put them together in a coherent post.

One thought though... For CF'ers (and others as well) you aren't really buying health "insurance." Insurance is a bet, on your part and on the part of the insurance company. They are betting that the premiums they charge you, will, on average, be a larger amount than the healthcare they are obligated to pay for. You are betting that it will be cheaper for you to pay a monthly premium, just in case some huge medical bill occurs.

For CF'ers... it ain't a bet. You and the insurance company know there is absolutely no way you could pay premiums high enough to cover the cost of your care. So bottom line... you are asking other people to pay for care you can't afford for yourself.

I would much prefer an insurance system that functions as insurance, and find the best way to provide that as cheaply as possible. And then find a way to deal with those who are un-insurable. Rather than designing all kinds of perverse incentives into an insurance system, to deal with people who insurance isn't really the appropriate means to pay for care.

Jason Addink said...

Some more random comments on the post above:

Strike all pre-existing condition clauses?

We don't demand that you be able to buy fire insurance to pay for the damages AFTER your house has burned down. Or flood insurance AFTER it is filled with water. Or car insurance AFTER you've gotten in a wreck. Or life insurance AFTER you've died. If we required the above, it should be pretty obvious that what you are buying is no longer "insurance" in any sense of the word.

So why do we demand that people be able to buy health insurance AFTER they have gotten sick?

As I said above, if you have a pre-existing condition, you aren't insurable in the true sense of the word. I'm not saying I know what the solution is for those with pre-existing conditions, but I do think that basically dismantling the insurance system to deal with those issues is the wrong way to go.

Jason Addink said...

More random comments:

"fair pricing despite level of health"

I assume you mean by "fair" that all people pay the same price, regardless of their health?

Once again, compare this to other insurances you buy. Do people demand "fair" pricing for car insurance for someone with a perfect 10 year driving record versus the high school student who has been in 3 accidents already? Or "fair" pricing for life insurance for the 20 year old health nut versus the 95 year old chain smoker? Or "fair" pricing for home insurance for the $100,000 home versus the 4 million dollar mansion?

So why do we demand that all people, regardless of health status, pay the same amount for health insurance?

I know, I know... people don't always have a choice in their health status, while most of the above situations are a choice. But for those who do, I'm not sure I see why their shouldn't be a consequence for health choices. For those who have no choice in their health status... like I said, I'm not sure insurance is the appropriate vehicle for paying for health care.

Jason Addink said...

"My choices in my care should not be made by my pocket book, but they are, all the time."

Not trying to be offensive, so if it sounds that way, blame it on the limits of internet communication...

Why shouldn't choice in health care be made (at least in part) by money? You make choices every day based on money. Where to live, how big your house is, what kind of car to drive, what kind of job to take, what to eat, how to entertain yourself, etc. Why should health care be any different?

In my mind, part of the problem with the current insurance system is that there isn't ENOUGH decision making based on cost. With most PPO type insurances, there is very little connection between what I pay, and how much something costs. I might only pay 10%, or a $20 co-pay, for something that costs far more. Of course, I am also paying for the rest of it, but through my premiums. There is very little direct connection between the value of a health service, and how much I pay for it.

I really think the HSA route is the way to go, because it has a huge connection between cost and value. We just switched this year, and I find myself constantly asking "Is what we are going to pay for this really worth it?" (just like I do for everything else I purchase.) I NEVER recall thinking that on our PPO. If people aren't asking that question, health care is only going to get more expensive, not less. And the public option makes even MORE of a disconnect between the cost and the value.

Samuel's Mommy said...

Yes, this idea of healthcare for everyone is fabulous. And, in theory, it sounds great. However, covering everyone regardless of work status, is ridiculous. Do you really think it's a good idea to reward those who won't work (not contributing to the system) with a blank check to whatever healthcare directives they wish?

But the notion that all pre-existing conditions would be covered just isn't true. The fact is, a group of 27, with only one (1) physician among them, will have the power to determine what's covered and what's not. That's not the kind of "care" I had in mind.

It's interesting, Talana, that you describe this perfect plan as a healthcare utopia, where physicians can treat, patients can be healed, and we would never have a worry about a bill. I say it's interesting because you are absolutely right! A utopia is an imagined place or state of things where everything is perfect...'imagined' being the key word there. It sounds good in theory but just not possible.

Ronnie "Sickboy" Sharpe said...

Hey Jason- Anyone is welcome to write a guest post on RSR concerning the Health Care Reform topic...It's been interesting thus far to see the different opinions and I'm definitely getting a better handle on the issue. As long as people keep reading, I'll keep posting.


Princess Talana said...

Jason -

Few things that I feel like addressing:

1. Your analogy of other types of insurance is flawed in several ways. If all insurance was ran like health insurance, then we would have a lot of problems. Say that you had a small fire in your house five years ago. It caused no structural damage, few possessions were damaged, you didn't even use insurance money for it, but called out the fire department just to make sure your house was safe. Now five years later you buy a new home and want fire insurance. If they were like the insurance company, they could deny you because of your past history of fire. Or say, you are going to get car insurance. You've never had an accident and have a perfectly clear record. You expect to be covered without a problem. However, it seems your family members seem to crash into anything on the road, and off the road, and have several tickets. The insurance company denies you because of your family history of car wrecks. Both would happen if insurance was ran anything like "health insurance".
Also, not having fire insurance, I take a financial risk if something happens. Not having car insurance, I take a fiscal and legal risk. Not having health insurance? Not only is there a huge financial risk, but you are also risking your life. No other insurance is that true of.

2. Making decisions based on pocket book. Yes, I decide where I live, what I spend descresionary funds on, and how much I drive based on pocket book. But I can live in a cheaper house, not buy that shiny new computer, and drive a 10+ year old car... it's not going to kill me. But not getting drugs, going to the doctor, and millions of other things that are involved in health care very well could kill me.
3. I think of health insurance, or how I think health care should be paid for like the police, or the fire department, or like countless other services that my tax dollars go to. I haven't needed police help in years, but I'm very happy they are there if I need it, and I know that my community is a better place for it. My neighbor had a garage fire this week, that without the quick reaction of my neighbor and the fire department, I would have lost my own home. Again, something I pay for, rarely use, but am very glad they are there when I need it. I don't have kids, but I know that my community is better by tax dollars that go into their education, removing them from abusive situations, and helping them get vaccinated if they can't afford it. I've never been on food stamps, but I know that my community is better if everyone has something to eat. The same thing could be said about healthcare. Yes, I use it often, and many people out there wouldn't, but everyone's lives are made better by everyone having a chance at health. I don't understand how anyone could think differently.
4. HSAs are a crock. Spend a single day in a hospital and the $6,000 bill will eat through nearly every HSA account I've seen. Let's hope you don't need surgery, ongoing medication, or more than one day in the hospital... because not only is your healthcare money gone, but you also can't be insured again.

Karla said...

Well said !!! Thankyou,,,standing with you 100%...God Bless,,,Karla

Lucy's mom said...

Talana! I am with you 100% about having a single-payer public OPTION and will be blogging about my health care views very soon! As we have seen in America's history it is not an easy road fighting for what is morally right but it can be done! Keep speaking your mind because people do listen!

Lucy's mom AKA Kacie Tuck

~PS Thanks Ronnie for allowing this health care forum on your blog!

Jason Addink said...

Talana, thanks for the response. On your four points...

1) Sure, the analogy isn't perfect. But it is true that people are demanding things of health insurance that we don't demand of any other insurance we buy. And those demands transform it into something that is no longer insurance.

2) Again, I'll agree health care is somewhat different than other things you buy. Although where you live or what you drive could also kill you. My point was more that your comment implies you should be able to decide on your health care options regardless of cost. That isn't reality, just as you don't make any other decision regardless of cost. Which is why people argue that public healthcare always leads to rationing. Because when we don't pay for it directly (ie we make healthcare decisions with little regard to the true cost) we end up demanding far more healthcare than if we paid for it directly. We demand more healthcare than we can collectively pay for. And since the gov't controls the public option, they end up deciding based on the collective pocketbook. Which is exactly what many people are opposed to.

3) So did your neighbor have fire insurance, or did the fire department pay for all the damage caused to his house by the fire? The police only come to collect the evidence after the crime. They do nothing to reimburse you for the ongoing effects of the crime. The fire department shows up to put out the fire. They do nothing to pay for the damage your house suffers (in fact, that is why you buy fire insurance.) I would argue the healthcare equivalent to the police or fire department would be EMTs, which, oddly enough, already exist.

4) Our HSA is working just fine, thank you. And yup, one day in the hospital (which my wife already had this year) will wipe out your HSA account for the year. Which is exactly why you have an insurance policy connected to it. After her hospital stay, we had paid our deductible, and the insurance covers 100%. If I desire, next year I can switch back to the PPO that my employer offers, although I see no reason to do so. HSA's provide an incentive for me to actually attempt to save money, to consider whether the value of the service is actually worth what I am paying for it. It works exactly like insurance should... I pay for the little day to day stuff, but have insurance in case of an emergency. It's not a crock for us, and is actually working quite well so far, even with a major hospital stay.

Here's a great article in the WSJ with some excellent suggestions for how to reform the system, without going to single payer...

And Lucy's mom... are you really saying that I am immoral for arguing against single payer government healthcare? Really? Care to explain that one?