[I began this post a couple of days ago. Now, with fallout from Ike, all the trouble with the U.S. market, and the documentary on 9/11 that I watched last night, I feel like this might be just too much complaining. But I'll try and wrap it up and hit "post" anyway. Pardon my self-involved-ness.]
I'm not entirely sure how to begin this post, except to say that the state of health care in the United States (sorry, my international readers, to bother you with this) is failing the the middle-class almost entirely. I can only speak for my family and our experiences, but I believe that we are fairly representative of the middle class in this country in most ways, so extrapolate as you will.
This family's past experiences with health insurance have been less than ideal. And I don't think we're alone there. Some of you may remember that it cost us $17,000 to bring Hannah home from the hospital. And that's WITH insurance. To make sure you know I didn't accidentally add a zero, that's seventeen THOUSAND dollars. That was the cost of an uneventful (as these things go) five-day NICU stay. The hospital, birth, and NICU stay were all covered under our insurance. But the NICU doctors? Well, they were out of network. "Oh, you want doctors with your hospital stay?! Well, that's extra, ma'am." Apparently, you're supposed to shop around for an in-network physician when your newborn stops breathing.
I filed three appeals, taking it all the way to the Texas State Board of Insurance. When they informed me that my plan (an employee plan under Todd's job at the time) was a loop-hole policy that was not governed by the state board, and that I'd have to take it up with the U.S. Department of Labor, I gave up. I had a nine-month-old and too many other issues going on. And that's exactly what the insurance company was hoping for.
Our next health insurance plan was also provided by Todd's employer - but it was done as a favor, and so we covered our part, plus the part the employer usually pays for. Which mean we shelled out close to $1,000 a month for our coverage. Our deductibles weren't high, but they weren't low either. We still paid out-of-pocket for my post-Hannah surgery and diagnostic procedures, as well as Caroline's birth. Lucky for us, Caroline didn't test this plan's NICU provisions - though I had already worked for phone for more than four hours to discover that the same problem existed. I literally carried a list with me of NICU doctors who were covered under our plan and a phone number for my mother to call immediately, should Caroline have needed treatment from a non-network doctor.
Shortly after Caroline was born, we switched to an independent policy. Our new policy was quoted around $450 a month - a significant savings for us - even though it didn't cover maternity, mental health, and came with super-high deductibles. When they reviewed our application, however, they deemed Caroline a risk because she was on reflux medicine, and Todd a risk because of his BMI. So we ended up paying $580 a month. Which still looked good, compared to the other.
It wasn't until after we were on the plan for a month that I began to feel the pinch of some of the drawbacks. Each family member has a $500 prescription deductible, so we paid for all of Caroline's medicines out-of-pocket last year, and this year. To say nothing of the medicines they simply choose not to cover, which we pay full price for. And each individual family member has a $2500 medical deductible, which means we are now paying the full $2300 for Caroline's ear tubes.
At this point, my family is actively avoiding medical diagnostics, treatment, and medications specifically because of our insurance.
Case in point: I had my annual exam yesterday. There were several issues. Firstly, my period has not returned, which my doctor and I feel likely indicates the Asherman's has returned and the scarring is preventing my period. When I had my last hysteroscopy following Hannah's birth, my doctor made a point of telling me that he found calcified scars and necrotic tissue. He advised me not to wait as long the next time. It seems that harboring decaying tissue in your internal organs isn't a particularly good idea.
In order to diagnose Asherman's, I'll need an HSG. But I have serious doubts about whether or not my insurance will pay for it. And even if they do, the surgery I'd need to remove the scarring would have to be paid for out-of-pocket ($2500 deductible). [I called this afternoon, and they do not cover any lab work or diagnostics until after you've met your deductible.]
Then there's my father's heart attack. My doctor feels (as I do) that it would be a good idea to get baseline levels for cholesterol and basic blood work done, given my family history. Actually, it's a good idea, period. But we received notice from our insurance company that they're upping our premium as of November to $640 per month. So, if we're going to need to shop around again, I can't have any borderline blood work or bad diagnostics of any sort floating around in my file.
So my doctor wrote out orders for all my various test and told me to pursue them when we can.
If you'll recall, we just moved from our big, comfy, middle-class suburban home to a free home in the boonies specifically to save money. This move, as well as our general financial situation cannot entirely be attributed to our health care costs, but a significant portion can be. After all, when you take $17,000 and put it on credit cards, home equity loans, and the like, you know what it does? It grows. Then, heap on another bill every time you think you're about to get ahead. Then let that grow. Then increase the cost of the coverage you do have while simultaneously diminishing the actual services covered.
What you get is a woman standing at the counter at CVS crying for all the world to see because she never, ever thought she would have to choose which of her children got medicine and which didn't.
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Let me also touch on a bigger quality-of-life issue that my family is facing: no maternity coverage.
Both Todd and I are independent contractors. We don't have any company to provide coverage to us. We have to submit to physicals and qualify for a plan. And here's something people don't realize until they're in our position. Independent health plans do not cover maternity.
A few have maternity riders, which pay out LESS THAN YOU PUT IN, if you take the time to do the math, and cap at around $2500. But beyond that, they simply don't cover it. As a result, I spend a good week or so every few months freaking out. We cannot afford to have a baby. And I don't mean that in the "gee, kids are expensive" way. I mean we cannot afford to get past the first trimester - let alone the delivery.
And yet, the current government administration has made more moves against birth control that I care to count - even going so far as to try and classify oral contraception as a form of abortion just last month. (That really deserved a whole other post about how the people involved really should have taken a science course in high school, since the pill prevents ovulation entirely, and thus there is no fetus or clump of cells or even an EGG!) But I digress...
My point is this: How can you try your level best to encourage me to get pregnant ("you" being our current governmental institutions, and "me" being a married, monogamous, white American) when you refuse to offer any reform or intervention to provide for my medical care so that I can actually give birth safely?
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I've mentioned before that I don't feel well-aligned with either of our two dominant political parties. I think they both miss the boat by a pretty wide margin. Overall, I find myself agreeing with most Libertarian stances, but with a few big exceptions. And since the Libertarian party is not able to put forth a viable presidential candidate, I have to make my political decision based on the issues that are most important to me, and those that impact me most directly.
Health care is one of those exceptions and one of those issues.
I saw a report on 20/20 a while back where John Stossel talked about approaching health care in the U.S. as any other free market, where supply and demand self-regulate cost. It was all well and good when you're talking about the common cold and LASIK. Sure, shop around. Ask questions. Bargain. Ask for discounts. Put aside money in your health savings accound.
But the instant something major happens, the free market concept goes out the window. Whether it's an infant who's not yet ready to breathe, or cancer, or a massive injury - nearly every family will, at some point or another, face a medical crisis that cannot be boiled down to the least expenisve vendor - a crisis that revolves around split seconds, or geographical limitations, or specialized expertise.
Something has to change. I do not believe that the United States is incapable of coming up with a solution that can adequately care for our citizens. Our current system is failing. It isn't providing adequte care and it is driving average, middle-class Americans into bankruptcy with regularity.
On an entirely different 20/20, I saw Stossel reporting on the "happiest people in the world" (Denmark - accorind to this study). It turns out that when you add a homogeneous population with a stable economy and tons of government-sponsored programs for everything from education to health, you get some remarkable contented people. "Yeah," I scoffed, "but they're paying taxes out the wazoo!"
And the are - about 50%, on average. "But wait!" I said to Todd, "as independant contractors we each pay 33% of our income in taxes, and we get NONE of the benefits they just outlined!" I had a bit of a hard time wrapping my head around that one.
To be clear - I am not in favor of socialized medicine. For one, I don't think it will ever work in this country. There is too much power and money tied up in the private insurance industry to ever completely dissolve it. But secondly - and just as important - I do not trust our government to make medical decisions for me. (Perhaps I've hinted at this in the past.) The reach of our federal and state governments into our personal lives (medical care and privacy ranking near the top of said personal life) is already too far and deep, in my opinion (see also, Libertarian tendencies). To have a health care system that is in actuality another arm of the government, just imagine what liberties could be taken away.
I believe there has to be a middle-of-the-road solution. And so far, Obama's health care plan is only one that seems to incorporate both a privatized system with more oversight and intervention, plus an extension of coverage to those who cannot participate in the private option. To me, McCain's plan reads more like a list of suggestions and ideals than actual steps. And it relies heavily on the industry itself to respond to "pressure" from individuals to reform itself. I might have believed that was possible, had I not been on the losing end of that teeter-totter so many times in the past.
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What do you think? Have you got a great idea to heal our insurance woes? Or do you need a moment to vent along with me? I'm praying that someone finds a solution - and fast.
