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?
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?
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.
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!
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.
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?
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.
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.
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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