Our Journey to the Inevitable

Into the Unknown

This is long, and some of you won’t like it- but we need to talk about American healthcare reform. I don’t want to drive people away, especially if we disagree. I am sharing my thoughts here because healthcare reform is one of the few things I am truly passionate about. If I am going to subject you to my ramblings about genealogy, modern technology, and dishonest priests- you can hardly be surprised by a healthcare post. I hope you will stick around.

I don’t want to talk about all the different parts of reform and what they mean. I don’t even want to talk about how it affects our autism world. I want to talk about the very basic concepts that we should all be able to wrap our minds around in a few short minutes. I don’t care if we agree on solutions, but right now we aren’t even solving the same problems. I want to pretend as if political sides do not matter, and this is just what one might see if we were able to remove all the clutter. If only.

The Affordable Care Act is an incomplete solution. It is, however, a solution for some of us. I don’t want a debate on this. I want the next better answer. I want a way forward; not another step backward, or a standstill. For some of us, having a real solution isn’t just a series of talking points. It is life or death. That should mean enough for all of us to stick around and try harder. 

That being said, I want to (cautiously) start with the mandate. Forget right or wrong. Let’s just ask ourselves why. Why the mandate? Because a percentage of our population still believes in free market insurance. In order for free market insurance to survive, we have two choices: Deny and cap coverage for the sick, or require the healthy to all pay in. Well, at least enough of the healthy. There is no free market insurance option that can offer affordable care for the sick while the healthy opt out. Now that a lot more of the sick are about to qualify for insurance, the mandate is the last chance for free market insurance to exist in America.

We can say the mandate is unconstitutional. We can also say that undermining a Supreme Court decision is unconstitutional. We can fight the mandate, delay the mandate, and encourage people to opt out. And really, why not? I don’t want insurance. If I get cancer, insurance companies now have to give me affordable coverage, so why waste money in the meantime? With insurance premiums being more expensive than out-of-pocket routine doctor visits, opting out of insurance makes good sense. As long as figuring out exactly who will pay for the newly insured sick doesn’t keep us up at night. Make no mistake, we will still be paying for it one way or another.

And yes, there is a pretty good chance this whole thing will fail. Even if all Americans could truly be insured and no one opted out, it would be a difficult balance. But it won’t mean failure for Obama and Democrats- it will mean failure of free market health insurance. Should “Obamacare” be held accountable….or is it just revealing the truth about our broken system?

Sad

It’s not as if the republicans have a genius idea waiting in the wings. Most of us don’t understand either political party’s plan, and that is the number two reason we are going in circles. The number one reason is that we have become so stuck in our like-minded worlds, we have now divided ourselves into two groups labeled good and evil. Guess which side we all think we are on? Let’s face it. Some of you wrote me off as a person as soon as you suspected my healthcare opinions didn’t match yours. And you didn’t think that was unfair.

With all this effort to save the insurance companies, have the fully insured really won the healthcare lottery? The ACA is an impressive effort to get as many Americans insured as possible. Even among those who are waiting for something better, there is strong support for this plan. The popular changes that the Affordable Care Act brings will still be popular even after this whole thing blows up. Available, affordable healthcare for everyone should never have been negotiable in the first place. But while it may be the best solution for some, for most of us the Affordable Care Act is neither the solution or the problem. As more and more of us are finding out, the problem has always been insurance.

Have we thought about what happens next? I hope so, because we are already past the point of no return. With the system already failing (both financially and philosophically), we were left with three options: Do nothing, introduce a mandate, or switch to single payer. Years have been spent looking for better options. Ironically, it was the Republicans who finally came to the mandate solution. Why? Because doing nothing is unrealistic, and America isn’t ready to leap straight to single payer. So here we are.

I know some of you are not entirely with me. Let’s not waste time debating, because we don’t need to agree. The road has been chosen, and we are all on it together. Even if some of us are in shackles. But there’s more to consider while we are on this journey. Many are afraid of a government takeover of healthcare, while others have found out the hard way that it may be the only realistic answer. Remember those three options? There are a lot more Americans ready for that third one now. A failed mandate will reveal single payer as the next city on the horizon. Some of us can already see it.

Look around and you will find people carrying maps to this city in the form of medical bills. If you do not understand why millions of insured Americans go broke and file bankruptcy from medical costs, then you need to figure it out. Lack of knowledge on this may be the Achilles’ heel of your whole healthcare philosophy. When the ACA and free market fail, opponents of a single payer system are going to need some kind of counter offer. Right now that counter offer does not exist. So if you are afraid of government-run healthcare, you had better pay attention to what these broke Americans are saying.

surgeryI can help you understand, because it happened to us. My husband Dave has had epilepsy since he was six years old. Dave often had daily seizures and has never had a driver’s license. While covered under his employer’s plan (and after waiting the required 12 months for pre-existing illness coverage), he was approved for surgery. It required 2 surgeries, many tests, and constant observation. It wasn’t cheap. Insurance paid over $250,000.

Now let’s look at Dave’s coverage at the time. His plan was better than most. Added up, his premiums only cost us around $1700 a year. His deductible was $1000, his coinsurance was 90/10, and out-of-pocket limit was $5600.

Our total owed after insurance…..over $50,000.

I know. It doesn’t sound right. And I know every single bill that didn’t add up, along with the bullshit reason I was given. The hospital room and board was the only accurate one. Some were actually less than expected. Others were not covered at all. For example, each surgery had a different anesthesiologist. One was out-of-network, and not willing to offer any discounts. Dave’s 70/30 out-of-network coverage was only applicable if the providers were willing to honor it. Unfortunately, there were several tests that were only available out-of-network, since they only did this type of surgery at one hospital in our area. Out-of-pocket limit did not apply to these bills, either. Not that it seemed to matter. Even among our in-network bills, out-of-pocket limit loopholes were everywhere.

But even if it had added up, it still would have been more than we could afford. And Dave certainly cost the insurance company a lot of money. It would take 100 insured customers like me to just break even for what they spent on him.

I made too much money for charity assistance through the hospital. They gave us 10 months to pay most bills in full; and yes, they did attempt to garnish my wages soon after that. Dave was no longer working while he recovered from surgery. We couldn’t afford that amount of garnishment. And for the amount of time that garnishment would last, and what damage that judgment would do to our credit- bankruptcy was the clear answer.

This was a single event. Now imagine if Dave had required ongoing, long-term treatment for a chronic illness. What if he had lost his job and insurance over it? What if the bills kept coming, even after bankruptcy? What if lost insurance meant lost access to certain types of services and care? I don’t know what we would have done.

How many of us can afford what insurance offers? No one is hiding this information from us. Look at your own plan if you are lucky enough to have one. Add up your premiums that get taken out of your paycheck. Add the deductible. What’s your coinsurance? 80/20? Figure out what 20% of $100,000 is. How about 20% of a million dollars? Most of us are one illness or accident away from financial ruin. I bet you’ve heard that before.

Delivery

I am texting my boss from the delivery table. Insurance made nothing on me that year….

And what about regular care? A recent hospital stay added up to about $4500. That is what I would have paid without insurance. Now let’s look at my insurance costs for the year, assuming insurance pays out according to my plan. Add $2500 in premiums out of my paycheck, $1500 for deductible, and $600 for my 20% coinsurance of the amount after deductible (20% of $3000). As an insured person, it costs me $4600. Most years I spend $2500 in premiums just to stay at home and be healthy. Triple those premiums and my deductible if I add Dave to my plan. Many families are paying over $10,000 a year in premiums, with a $3000+ deductible.

It’s a gamble we take in case something bigger happens. You know, like Dave’s situation with the brain surgery. Would I prefer paying zero premiums while raising my taxes by $2500 a year- then having a free hospital stay? Or no $50,000 price tag for a surgery that changed our lives? Yes, I suppose I would.

Maybe you are so misinformed about healthcare, you don’t realize how much we are already paying for the uninsured and under-insured. Maybe you don’t realize that we are all under-insured. Maybe you believe we should each fend for ourselves and hope for the best; but most of us don’t want to live in a country where people who are able to help just stand around and watch each other die. It may be time for you to find a more practical plan to support.

The Affordable Care Act does not address this particular insurance issue. How could it? It’s an insurance based compromise, designed to fix other (equally important) parts of the problem. Maybe you have a happy insurance story. Great. But there is no scenario where insurance companies can insure everyone and also pay out benefits to everyone at 100%. And while few would deny that this is a crisis that needs to be confronted, you will also find no mention of it from politicians unless they are proposing a single payer future. These are the politicians I am voting for. Why? Because we are not invisible to them.

I am not asking you to become a supporter of single payer. I am asking you to examine this problem of insurance for a moment. I want you to see this breakdown of numbers and the people who are affected by it, and really acknowledge us for the first time. Because some of you think the system is working, and politics will keep you from seeing us. Some of you look at us just long enough to proclaim that waiting for healthcare would be worse than getting no healthcare at all. Some of you look at polls claiming Americans do not support the ACA, and underestimate what percent are withdrawing support because it doesn’t do enough. As long as this remains true, single payer will keep gaining momentum. For these Americans, no other way has even been presented.

There are a billion other things we could talk about concerning healthcare reform, but let’s take one at a time. Let’s start here. The Affordable Care Act is about to offer a lot more sick people access to care, but it will also usher them into the financial realities of insurance. If the system buckles under imbalance, a new debate will come to the table. Talking points about other things will not move us forward. Solving this is a priority, and changing the subject is not an option. It affects many of us physically, but it affects all of us financially.

All of us.

I am glad the best parts of the Affordable Care Act will happen, most of which I haven’t even mentioned here. A lot of it is pretty awesome, and Americans are never going to give those things up now that we have them. I am happy for the lives that are being changed now, instead of waiting for a perfect system that doesn’t exist.

I know it’s not enough. I am not happy with where we are, but I also know we are on a necessary path. We need to keep moving forward. We no longer have a choice. Even those trying to push back are only pushing us ahead faster. And for the first time, I am content in knowing that real change in our lifetime is no longer just a possibility. I do believe it is now inevitable.

 

8 thoughts on “Our Journey to the Inevitable

  1. To me single payer is the only way to go. If we raised the eligibility of medicaid and lowered the age for medicare we wouldn’t even have to deal with the paperwork. If they met in the middle. And the cost of health care is off the charts stupid. Grandma paid over 100 dollars for a three dollar pill. And I paid 8 bucks for a single aspirin. Mayo Clinic is the way to go, they get paid to cure their patients…not just treat them.

    • I agree. And a lot more people agree than ever before. It used to be a dirty word, and now we are being hit with it over and over again. Popular voices are calling for it, and there are even more younger voices onboard. I wish others would understand why, because like it or not they are along for this ride now, too.

  2. Jenny,
    Well written and insightful. I suffer a chronic and at times debilitating illness that was not diagnosed until quite late. It has effected my ability to find employment and every other area of my life. When the first signs of my illness began to affect me I had good medical insurance. It took ten years to be correctly diagnosed because my condition is quite rare. I lost my insurance long before that point, and have not been insured for over a decade now. Finding medical attention when needed has always been very difficult, what county programs existed have all but dried up over the past decade. I have been looking forward to 2014 since the passage of the affordable care act as an opportunity to find a doctor so i can finally get consistent care and management for my illness. Thanks for constantly reminding people that some of us desperately need this to happen.

    • Thanks for your story 🙂 I really do think we have passed the point of no return. Both sides have figured out that everyone needs access to care. They just can’t agree on how to pay for it. Eventually that will work itself out when no other options are left. In the meantime, at least people are getting healthcare- which, when we really need it, is more important than figuring out how to pay for it.

  3. Great Post! I am from Canada and I never knew about medical insurance hassles until I moved here. Canada doesn’t have the perfect answer, but I prefer the system there to the one in the US. Canadians don’t declare bankruptcy due to hospital bills and their system is significantly more cost effective. (Yes, I’m sure there are people asking “Why don’t you go back,” and the answer is that my husband has a job here that he likes.)
    At the same time, the truth is that our population is getting sicker and no system is going to be able to support it if this trend continues. We need to invest in having a healthier population. Right now that is not the priority for Big-Agra-business, Big Pharma, Big Telecom and another of other anti-health industries that surround us. I don’t know what it will take to make that our priority, but with a healthier population we all do better.

    • Agreed. A healthier population should be our first priority. I also hate when people try to use “horror” stories from Canada to somehow distract us from the horror stories here. As if imperfections elsewhere somehow result in our automatic perfection. It is possible for other countries to have an imperfect system that is, in fact, still better than our own. And maybe we could learn something from that information. Thanks for reading 🙂

  4. I live in England, and the idea of not being able to access medical care when needed seems shocking. Our NHS isn’t perfect, but I truly am grateful for it.

    • I suppose perfect doesn’t exist. Only better. And despite what people try and tell us, I never see other countries rioting in the streets to get what we have in healthcare over here.

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