ACA. AHCA. So-called Better Care. Are you paying attention to proposed health care and health insurance changes ahead? Are you stymied by this discussion, feeling like real people are lost in the mix, bound to pay a terrible price… one way or another?
I recently decided to estimate my health care expenditures of the past 10 years. I included insurance premiums, co-pays, out-of-pocket payments, prescriptions, and services simply not covered. This is a rough estimate, mind you, but the total as a percentage of my net income ranges from approximately 25% to 200%.
That was just for me.
Yes, you read that correctly. After my divorce, being an older mother and responsible for two young children, I was afraid to be without some kind of health insurance. And given a few instances — one emergency in particular — good thing I had paid to remain insured.
Now, to be clear, those estimates span pre-Obama years and bring us up to the present, and 200% was during a pre-ACA enrollment year. That 25% to 200% of income price tag also explains, in part, the enormous debt I accrued during “bad years” post-divorce. Likewise, the liquidation of savings and other assets for which I worked throughout my life as I hit 50 years of age and my age-based premiums skyrocketed.
Little has changed for me in the past decade except that I’m more worn down, more cynical, more afraid.
And in more pain.
For those who like to blame the victim (and their lifestyle choices), my health obstacles over the years have largely been due to injuries, ensuing misdiagnoses, and subsequent absence of treatment or insufficient treatment. These last two, a matter of insurance restrictions and money.
So where are the real solutions? After expending big bucks — tens of thousands of dollars over a decade — why am I still living with chronic pain that has a straightforward path to improvement?
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I’m upset this morning, this week, this month, this year. I’m frustrated by what I see happening in this country. I’m frustrated by mobility issues that have solutions I can’t access. I’m frustrated by my own increasing inability to calmly contemplate the topic of health care, much less to write about it dispassionately.
Health care is personal. So say the pundits. I agree. I’m sure you agree, too. So I’m getting personal and talking about things I generally don’t. I’m doing so without worrying too much about the words I choose, knowing that my political leanings aren’t something I hide. But the health care — not health insurance — of 300+ million people shouldn’t be about politics. Nor should it be left to 50 smaller “nation states,” especially when mobility is a must in order to find work.
We are, in theory, one nation. And if ever there ought to be a non-partisan conversation, this is it. And by the way, those who make the argument that health care “consumers” should shop around for health services on the “free market” have obviously never been low income or broke, much less truly ill or incapacitated. And when was the last time a victim of stroke or heart attack could hop online and then make a few phone calls? What about the parent of a child with ongoing medical needs since birth?
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Politics. Health care politics. Party lines. Uh-huh. This entire process stinks. My health care options have been lousy since long before the Affordable Care Act (ObamaCare), and for me, they improved in some key ways with the ACA, thanks to nixing the constraints of pre-existing conditions. But the costs have been prohibitive for me as an individual both before and since. Less so since, to date, because subsidies have helped a small amount. And as an independent with variable income and periods of time with no income — like millions of workers in this country — tax credits would be of little use.
Moreover, as one in the 55 to 64 age bracket (there are some 41 million of us in that group), and like too many others, I am witnessing opportunities dry up, and with them my income. The situation grows more dire each year, not coincidentally as premiums and deductibles climb… by age.
How many of us just hope we can somehow hang on until we hit 65 and can enroll in Medicare?
Something has to be done. Many things have to be done. I don’t care what you name the legislation — or the many pieces of legislation to deal with moving parts. I don’t care who it’s nicknamed after. I don’t care who takes credit or what your political affiliation is. But a country in which your health is dependent on genetic good fortune, no accidents, and wealth — including in order to avail yourself of critical preventive services, “essential benefits,” or early treatment measures — is ridiculous.
We don’t choose our genetic fortunes — healthy or unhealthy. We don’t choose to be in the wrong place at the wrong time and undergo injuries in car accidents. We don’t choose to be laid off and see our livelihoods reduced by advancements — yes, I say advancements, because to “go back” to some fictitious “better time” is utter foolishness. Technology advancements and globalization are facts. Likewise, demographics. Most of us work hard; we may have relatively few choices as to where we work, especially as we age, and no option but to work for an “employer” or series of organizations who pay us for work through which we have zero ability to get health insurance.
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Issues of coverage content and limitations must be addressed. We all have pre-existing conditions eventually; some are born with them, others may be acquired through routine “living” of our lives, and to hand over the ability to make potentially damning decisions about who will and won’t receive care to politicians, much less individual states, particularly when conditions worsen without it (ultimately costing more), seems illogical.
In the coverage discussion, let’s not forget the counterproductive constraints imposed by insurance companies via lifetime caps, or equally obvious foolishness in the form of “this many visits per calendar year” but not to worry… there’s always the dispensing of painkillers, regardless of whether or not the underlying cause is addressed.
Yes, I’ll speak from experience. I’ve been the victim of this one for a number of years now. Common but painful and limiting conditions, readily addressable through physical therapy, have been extended rather than resolved. I’ve been cut off because of timing in terms of injuries, pain, and the calendar year. This resulted in reduced or halted treatment, a continuation of pain, and by the time I’m allowed to “return” to treatment the following January, the underlying situation is generally worse.
The alternatives I was offered? The very sort of pain prescriptions that we hear so much about these days. Right. Our ongoing opioid crisis.
I refused the pain meds. I managed on Advil, heating pads, cranking away (and cranky) — sitting behind my laptop from a home workspace, doing the best I could with good days and bad. Looking back, I believe refusing potentially addictive meds was the right decision. But I also see the progress that was made when I was allowed treatment — light at the end of the tunnel! — and the unnecessarily wasted months and years in pain when I wasn’t, as my life seemed to shut back down.
One of the reasons I uprooted and relocated last fall was in the hope of accessing slightly more covered medical treatment in a “bluer” (different) state. How crazy is that? I was literally online trying to discern where I might have a shot at even 10 more PT sessions in a calendar year. To quote our commander-in-chief… Sad!
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Let’s look at another vital issue that the current Senate bill isn’t addressing though it’s surely the elephant in the room — the cost of drugs. Big Pharma is making money hand over foot, and that’s a factor in rising premiums. Then there are the decisions as to those prescriptions that insurance will not cover — who knows why — as Big Pharma jacks up the prices, and if we wish to continue with our meds, we’re paying outlandish amounts out of pocket.
Hello… EpiPens?
Surely, you’ve read the reports of ongoing EpiPen price gouging:
Though this simple medical device contains only about $1 of the drug epinephrine, the company that sells it, Mylan, earned the public’s enmity and lawmakers’ scrutiny after ratcheting up prices to $609 a box.
Shall we add this report’s mention of Medicaid fraud of more than $1 billion from the same pharmaceutical company? And what about this?
The company [Mylan] has an effective monopoly on a lifesaving product, which has allowed its leaders to see public outrage as a tax they must pay, and then move on.
Mylan has been called out again and again over the years — by the company’s own employees, regulators, patients, politicians and the press — and hasn’t changed, even as revenue has skyrocketed, hitting $11 billion last year.
Who’s dealing with this issue in the proposed legislation?
Now about those premium prices and high deductibles…
Of course the steep rise of premiums, deductibles, and co-pays is untenable! Of course we have to do something!
That brings us back to pricing, and yes, to other elements of health care delivery that put undue strain on the system.
Let’s not forget the sort of malpractice insurance that physicians must carry in our litigious society. Let’s not forget the sky-high costs of becoming a physician. Let’s not forget that the ACA has imposed serious financial hardship on small businesses. This is something of which I wasn’t fully aware until about a year ago. There’s no question that this is a serious issue. And we know there are more. I haven’t addressed Medicaid. I haven’t yet said what I suspect is true: Like millions of others once firmly ensconced in the “middle class” as a full-time working person, I can see the time when I will have exhausted every financial resource and my old age will be spent on Medicaid.
If Medicaid still exists in the state, geographically speaking, where I wind up.
Not a happy prospect.
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My kids? And their kids, if they have them some day?
My boys are in their early twenties now and healthy. But what happens if one of them is in an accident? What happens if one of them falls ill — even to something manageable — but pre-existing conditions returns as law of the land, or rather, law of the state they’re in? What if they are, like me, working as independents? What about the fact that tens of millions of us in the US, roughly 20 to 30% of the workforce, have no “employer relationship,” not necessarily by choice? If sick or injured, there is no shared health insurance cost, no short term or long term disability, and no money coming in if unable to work.
What happens when our twenty-somethings are saddled with medical bills they can’t possibly pay?
I haven’t mentioned the mind-numbing complexity and cost impacts of the medical coding industry.
I haven’t mentioned the poor, the chronically ill, the aging in nursing homes. Their dependence on Medicaid.
I haven’t mentioned the diseases in which there is far too little “approved” coverage, diseases like Lyme that can devastate a family.
I haven’t mentioned the millions of women who use the services of Planned Parenthood, their funding on the chopping block again, as women’s health remains the moralistic purview of middle-aged white men.
I return to this: Accessing functioning health care should not require that we go bankrupt or even close. Accessing functioning health care should have as its goal to get us better — not just pay insurance companies in this calendar year, along with facilities, pharmaceutical companies, and service providers — with more profits to come. Accessing functioning health care should not be a matter of genetic good fortune, good luck in general, or a fat wallet.
Fuck politics. We just want decent lives. A shot at a decent life. We don’t care which party puts the plans and organizational fixes in place to enable us to have that shot. And while it’s all well and good to engage in philosophical discussion on the role of federal versus state government, real people in the real world are either helped or not by addressing core problems in our health care systems.
We’ve become talking points, dollar figures, stats in a CBO score. Yet all we want, as individuals, as mothers and fathers, as siblings and spouses, is a chance to do what is routine in other western industrialized societies — see a doctor when we’re sick or hurt, know that our loved ones can see a doctor when they’re sick or hurt. We want to get better, get back to our lives. And that ought to exist regardless of employer relationship and without putting undue strain on small businesses.
It doesn’t seem like a lot to ask. I’d like to think it isn’t. But I fear the worst, though I’m trying not to. Even writing this much, saying this much, I can feel my blood pressure shoot up.
I will stop momentarily, turn to more pleasant subjects, attempt to push back the fear and frustration that is now quite literally housed in my body. How many others are living with this kind of uncertainty and anxiety?
Regardless of what happens in the Senate this week, I can’t help but worry. What is being proposed — what we know of it — is a mess. What we have now is in need of serious repair. The sword hangs overhead for millions of us.
Yes, our reasons may be different, but the staggering human and financial cost ought to justify a more measured, mature, and apolitical approach to such a complex set of challenges.
No matter where you stand politically, how you envision yourself being harmed or helped by this pending bill, rushing the process is callow and unconscionable. Likewise, not addressing underlying issues is like putting a band-aid on a large, festering wound. Untended, the infection spreads. Yes, yes, I know. It’s about money, money in politics, power. But people can be so kind to each other. You know that. I know that. You’ve lived it. I’ve lived it. When we see a stranger who is hurt or in need, we don’t stop and ask what their political party is before rushing to their aid, do we?
Of course not. And that’s what we need to tap into. The fact that we do help each other, that Americans at heart do care about their neighbors, that we do, most of us, truly want to live in compassionate community. These are the beliefs I cling to, naively perhaps, but in the hope that we will deal with the issues in earnest. If not soon enough to help people like me, at least to pave the way for our children and grandchildren.
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D.A., From my simple flip flops ??to your desires of high heels ?, I do feel and share the pain of our health care system and our economy for 55+ as the American lifestyle has changed for all sorts of messy or complicated reasons. Yes, I am paying attention, listening to assortment of news reports and making my day-to-day bill payment decisions the best I can to survive as an unemployed over 50, single, childless, responsible human being. It is difficult!
I think what I have to keep in mind is that all insurance, be it auto, property, business liability or work disability is not a “maintenance plan”, but a “catastrophic plan”. We Americans purchase into a system to support all those in the need when the catastrophic happens; and then the insurance is there to reach out to support that event or person(s). I do not and have never been an insurance sales person, but I am definitely a (high) consumer of all sorts of insurance.
I have survived a tornado, a hurricane, a rear ended total auto accident, house fire, and health disability. I made good decisions with insurance purchases (perhaps unknown really). I only wish that an insurance company would offer the marriage fairytale policy. I’d buy it! (Giggles) Although maybe, I do own that too in the form of life insurance. It’s a “catastrophic plan”, not a threat.
We cannot expect government to maintain our privilege to breathe anymore than we can expect any particular person to give us oxygen that they need to survive.
My existence and yours (spoonies like us, so to speak), medical needs and lifestyle are not the crucial topic for the children or grandchildren that you speak. Their challenge is that the “Population is growing and jobs are disappearing.”
~ Chuck Todd Meet the Press
Don’t get me wrong, I’m with you in the struggle to survive. I am of that age and in that category. I’m with you with pre-existing conditions are an issue. Say what you need, say what you want, and definitely shout it out in however you feel comfortable. I have to adapt to whatever new rules apply in order to individually survive.?
I woke to a full rainbow in this morning’s field behind my patio. I was told that I am so kind that the world needed more of my kindness in the world to make it a better place for us to live. That was all very nice indeed.
Yes, kindness is important, but it doesn’t pay my monthly living expenses! Flip flopping and dancing ? the best I can! ?
Thanks for the good thoughts and smiles (from footwear of all sorts), TD. Respectfully, I would not lump health insurance or more importantly, health care with auto insurance much less vehicle maintenance. We don’t all need or use cars. We do need and use our bodies and minds. If a car breaks down, we may have other options. I’m not saying they are easy, depending on how dependent you are on a vehicle for getting to / from work, meeting other responsibilities, and so on. However, when your body breaks down, that’s another matter entirely. You can’t take care of yourself, your family. Then what? What are the repercussions in a “civilized” society? Don’t we have medical care for a reason? Should it only be accessible to the wealthy?
What about pregnancy and childbirth, the cost of proper pre-natal care, of a C-section? Who has $20,000 or more to cover this? Is it catastrophic? What about those $602 EpiPens?
If people are ill, injured or in pain, without insurance, they wind up in the ER. That sends prices UP. Doesn’t reasonable insurance — and access to affordable preventive care — make far more sense? What about the severely disabled? The mentally ill? Do we leave them to fend for themselves because we may not deem their conditions catastrophic?
Again, no disrespect, but even in my weary state this evening, I do not share your viewpoint.
And no disrespect to you either. ❤️.
I think I was referencing my thoughts about the purpose of insurance in general. And perhaps you are referencing something more specific. My missing something… I’m sure of that! Sorry, no intent of harm.
No harm done! This is a conversation. We have different angles on this very very complicated topic, that’s all. 🙂
On government and our privilege to breathe –
Almost by definition, the role of government is to act for the betterment of the society and its members. People can quibble about what is better, who it is better for, and who should pay for the better, but broadly speaking, Life, Liberty and the Pursuit of Happiness is a good summary of government purpose. While it can’t be guaranteed, it should be a goal.
Today Scott Pruitt of the EPA reversed a ban on a widely used food pesticide, chlorpyrifos, which had been banned due to overwhelming evidence that ingestion of the minutest amounts can interfere with the brain development of fetuses and infants.
So where does a parent, or a prospective one, go to buy Life, Liberty and Happiness insurance to defend themselves against medical and financial devastation caused by their own government, especially when the millionaires who control government believe that, because of who they are, the general population doesn’t deserve it and should just die?
Seriously, how do you defend yourself against a sociopathic government that has only limited interest in your continued existence (possibly only as a wage slave to their industry)? The more control they have over your health, the more control they have over your life, period. Income inequality isn’t a defect of the American system, it is designed-in. Talking points about personal responsibility exist to distract from what is behind the curtain….
I think I see this too, Robert.
The problem is that healthcare is hard to do right as a for-profit proposition because the interests of individuals/patients are at odds with the interests of the providers, be they doctors, pharma, insurers or employers. Doctors and pharma want to do what’s expensive (I do believe many are acting in patients’ interest, but there’s a % in their own interest). Employers and insurers want to give patients the least amount possible. Patients are stuck in the middle with no power and little or no information.
The howling about picking one’s doctor is hogwash, too. People get to pick a doctor that’s on the sanctioned list of in-network providers.
A hidden problem is that many insurers are not insuring at all. They are managing plans for companies that are self-insured (called captive insurance). This is a financial boon for companies, as long as their employees don’t make too many demands on the insurance. It may be illegal to discriminate based on health, but I am sure companies do it.
Especially small ones (not self-insured), who don’t want to see their premiums skyrocket if, say, three out of 50 workers have big claims.
I don’t get the meanness of forcing women to have kids by making birth control expensive and hard to get and abortion impossible, while not giving any help for childbirth or child-raising. Much less for children born with severe problems.
I am happy to live in France where what I pay is based on what I earn and I get the same coverage no matter how much I pay. This is logical. I started out working part-time and paid little, and as I grew my business, I paid far more. My health coverage didn’t budge. I can pick my doctor. I can take my kid to the emergency room (meningitis–tell me how THAT can be avoided by being more responsible!) and not pay a cent.
Yes, there are abuses in the system that could be eliminated or tightened up. But I know many people here with big problems–numerous friends with cancer, a 10-year-old girl with a genetic disease, a neighbor who just had a kidney transplant–and their health problems are limited to that–health problems. They are not also financial problems or family problems.
Another thing: Medicaid. My parents had to move to assisted living. They died before using up their nest egg, but the time to Medicaid was one of the criteria in choosing a facility. It can vary from 18 months to 3 years, where you are expected to pay out of pocket. Will people have to choose between paying for Grandma’s nursing home or paying for their kid’s university tuition? These are insane choices.
As a Canadian, I can’t understand the need for health care that makes money for someone…other than paying the salaries of doctors, nurses, pharmacists…etc. I know many Canadians complain about our health care system… too slow, too expensive, hard to keep doctors in many small communities… and I know our taxes pay for all of that. But jeeze… I don’t have to pay out of pocket if I need to see a doctor or visit the emergency room. And neither does anyone else who lives here. Okay… you might have to wait longer for that hip replacement, and maybe you could travel south of the border and get it done in no time…as one reader of my blog commented… but you’ll still always get it done. I wonder if Canadians who travel south to pay for treatment because they can get it faster and they can afford it… ever think about the American person who is not getting their operation because they couldn’t afford it.
My oldest daughter is 30 and had her first baby last year and now baby girl has just turned 1.
During delivery, my daughter experienced a Level 4 tear and even with stitches had on-going issues that required pelvic floor therapy sessions at 1K per session to avoid having to get surgery.
She carefully went through her insurance approval to get these PT sessions which were ordered by her OBGYN. Although her insurance from her job said they would pay part of each PT session, they were reviewed over again and the insurance supervisor recently called her last week and said that due to a loophole they are retracting their agreement to pay for any part of all the PT sessions. My daughter is a librarian so paying for all 1K each of the sessions is a hardship for her! In addition, baby girl was born with torticollis which required a full year of PT sessions for baby, neurology appts, on-going scans, and a custom-fit head positioning helmet which cost 4K that she wore for the last 5 months so that her skull grows correctly. None of this could be anticipated before birth. This baby will definitely be an only child – daughter and son-in-law can’t handle any more bills, med appts and work their jobs as well!
I have a friend who cannot afford the epi-pen, so she has none. She has anaphalactic reactions to carrots and peanuts.
She also has had triple zero breast cancer (requiring the most aggressive cancer and radiation treatments there are) diagnosed in the past 4 years. During that time she went through a divorce and lost her health insurance. “OBAMACARE saved my life” she told me. And her premiums went up only $4 during the entire time she has had it.
Granted she lives in CA. Apparently CA will continue to have its own protected coverage. She would like to move out of state, but since her cancer may recur, she can’t.
Last week I called every Republican senator to tell them to vote no on the heath care bill. My DH has called them twice. Some I called to thank (Collins and Heller) for resisting. I also called my own Democratic leaders to thank them too. I would like to think that we, as individuals, do have some impact on the decisions that are being made.
What else can we do but persist.
For the immediate concern of not being able to afford an epi-pen, there are generic versions available now for a very reasonable price (smidgen over $100 for a two-pack), search for “CVS epipen” to find them (I assume CVS is a nationwide chain?).
Americans need to talk and discuss healthcare. Americans also need to educate themselves and debate the issues. I am astounded how many Americans did not know the ACA was “Obamacare.” Unfortunately things are tribal and there is no talking about much, other than yelling. Hopefully this changes. There is no sense of we are Americans and we are in this together. There is no sense or agreement on facts hence it is hard to discuss and debate issues and approaches to address issues. There are economic and value choices to be made by Americans.
Glad you weighed in from Canada, Curtis. And… one of the things too many people forget is that the ACA, (or “Obamacare”) ensured critical protections for participants in employer-based plans. See this article for some specifics, including requiring employer cost-sharing for routine, preventive care and nixing the inability to deny / impose waiting periods for coverage for pre-existing conditions.
While I am in Canada now, I have lived in the US and Europe for several years and travelled all over the world. As you know I worked in the US healthcare industry and dealt with Washington. I think there are some basic facts that many understand but do not embrace or deny. First no one gets out alive. In the process most of us get older, naturally have health issues and since we age longer approximately 2/3 of us will contract some form of cancer. While many do not consider any level of health care a right, all of your rights are worthless if you are not able to breathe or function. That said there is a lot of money being made in healthcare, sometimes it is obscene (such as some of the drug and device profits) and therefore there is a lot of pushback. While I personally think France may have the best health care system (I am not including Norway since they are a country of athletic supermodels and no poor people) and that Canada is good (and more comparable to the US culture and economy) the USA has to find what it wants and works best for it.
Part of the problem is there are no real guiding principles or vision. The only one I can see is that many democrats support universal coverage and republicans think the market can best deliver quality and cost effective health care. The best thing I see coming out of the ACA is that many Americans now do not want there to be pre existing condition clauses or costs. While a small step, it is an important one.
I think a private and public option system could both ensure universal coverage and use the market, but I do not see any chance of this happening soon. An aging population, declining economy and higher unemployment due to automation and AI do not bode well for resolution.
The only way to make change in the near future would be if a state or states implemented their own health care systems and began to regulate on a state level. If it then worked and or became popular other states would be forced to follow.
This is such a complex issue that I cannot even begin to touch on all the aspects. That said the political parties need to focus more on Americans and less on the political wins. A good start would be to regulate pharmaceutical drugs and drug prices.
As a Canadian, I agree with Curtis, Americans need to agree on the health care principles first and then the solutions should be evident.
Start with some basic principles. Everybody needs healthcare eventually therefore everybody should pay in into the system, end of discussion. It’s cheaper for people to have basic healthcare where they can deal with prevention or conditions like diabetes early on rather than wait until their leg needs to be amputated, end of discussion. The government has finite resources, this may mean doctors will have to make difficult cost-based decisions and prioritize treatments so continually work to improve this over time but life sometimes sucks so get over it, end of discussion. Drugs cost money, sorry drug companies but once your research costs are covered, generic versions of your drugs will be purchased in bulk for lower costs, end of discussion. Freedom to litigate against doctors may need to be restricted so that doctors don’t have to order every test in the book (clearly gross negligence is unacceptable and second opinions should be available), end of discussion. Health care is expensive, some people might die when millions of $$$ of treatment could have given them six more months to live, end of discussion.
One principle you have to decide as a society but no one should lose their home or become bankrupt because they get sick, hopefully end of discussion.
Medicaid for all paid via income taxes seems like the right path, hopefully the fact that it will be cheaper in the end will let it happen; Americans pay more per capita for healthcare than any industrialized country even though less people are covered. Single payer health care is not perfect with its inherent tradeoffs but isn’t it better to know there is a basic level of healthcare available so you can visit a doctor anytime? Doesn’t that peace of mind count for something?
I could go on about the misconceptions about the Canadian healthcare system but suffice to say, average working people can get treated for something catastrophic like breast/colon cancer without going bankrupt. My blue collar elderly parents don’t worry about losing their home even though my dad is very sick; I see my doctor when I need to and honestly don’t give it a second thought. I’m not blind to our healthcare system’s imperfections but on the whole, people can live their lives and not have to worry about affording healthcare.