Today, Miss Britt started a dialogue about our right to health care as American citizens. Her post made me pause and analyze my family’s health care situation. Some would say we shouldn’t complain because we have insurance. Let me tell you something…it comes with a cost.
Over the last eight years my family’s life has changed dramatically. Eight years ago we lived on one income easily…with money to spare. We had great health insurance coverage with Dude’s employer. He paid $240 a month and we had $5 co-pays for doctors visits, $100 in-patient hospital stays and $50 ER co-pays.
In eight years the cost of our health insurance has more than doubled. Dude pays over $500 a month for our coverage. We have $40 co-pays for doctor visits and pay for a lot of things we NEVER paid for like 10% of surgery, $1,000 co-pays for in-patient hospital stays and $500 ER co-pays.
Yet in TEN years Dude’s salary has only increased $5,000.
Here we are eight years later living again on one income in a very different time with a catastrophic illness that is draining our financial resources. Just this year we have paid over $10,000 out of our pockets…and we aren’t done paying the medical bills off.
We are lucky that Dude works for CORPORATE AMERICA. His company has the resources to offer their employees health insurance because although Dude is paying over $500 a month for our insurance, his company is also paying a portion of our premium.
On average it costs an employer $12,000 a year to provide one employee with health insurance.
However, it’s that time of year where we are holding our breath. Soon we will find out what the benefits are for 2009. My guess is much higher premiums, less coverage and more our of pockets. And even with health insurance, my illness is catastrophic financially.
That’s just one aspect of our health care situation…
The other side of my family’s health care coin is not just with the co-pays, which stack up quicker than pancakes on a Sunday morning, but with WHO can treat us. We started out eight years ago with an HMO where in an ideal world our Primary Care Physician (PCP) would coordinate and make all REFERRALS in an attempt to control health care costs.
Last year we were pushed into Consumer Driven health care. Like we were supposed to take the reign and THINK about the COST of care before actually getting care. And in order to make sure we THINK we no longer paid co-payments but to THINK we pay 10%.
But we still can’t THINK without a REFERRAL from the Primary Care Physician.
In all honesty I believe that part of the reason I’m battling cancer a THIRD time is due to the EPIC FAIL of the health care system I have to battle to access care. Just a part of the reason.
So, when people criticized me for worrying about money maybe my critics will understand better why. People without access to health care have poorer outcomes than those who do have access to health care. It’s a FACT.
It’s my opinion that insurance companies are a large part of the health care crisis in the United States. Malpractice suits and malpractice insurance are another problem crippling the system. I don’t know if Universal Health Care is the answer but at some point there has to be some standardization and some regulation.
It’s time for SOMETHING to happen with health care but with the economic crisis at the forefront will anything REALLY happen or will health care take a back seat just like it has for the past eight years?
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It can’t take a back-seat. With our economic woes, it’s more important than ever.
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People who have access to health care and actually take advantage of it have a better outcome probability. I know plenty of people who just don’t wanna know what the damage is to their body so they just don’t bother. And right now I really wish I could hand over their health care plan to you right now…
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One more right now for the road: Right now!
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Dave2: Let’s hope the fact that 48 million people DO NOT have insurance because they CANNOT afford it finally gets ACTION and not just words. I hear what the candidates are saying. I just want the one I’m voting for to really come through and do something.
Poppy: It’s so sad to hear when someone feels they are beyond getting the help they need. I hope they change their mind and seek care.
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I know I shouldn’t complain, but the voters denied us a new contract. Compounded on that, our district stopped matching insurance, so now I have a hell o’ lot out of pocket. Granted, it is still better than what others have or don’t have. It just burns my ass that I work in an *honored* profession, but wonder when we get the real respect…
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Chatty: I don’t understand why the general public doesn’t get it where teachers are concerned. It’s like no one wants to pay school taxes but they want their kids to get an A+ education.
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You’re right. This is a very important issue, and it’s becoming completely critical for so many families. I hope our public servants begin to take the health care issue seriously.
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We ‘joke’ that my kids are having a copay contest. I can’t imagine how a family with a tighter margin of error on the budget has to make those decisions. When my girls were in private therapy in the spring–those 4x a week ot/pt copays add up. fast.
One of my bright spots is blue cross waiving copays on generics and other meds for a time.
I just don’t know what the good news is on health insurance, yk?
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I think about your family every time someone talks to me about healthcare and ‘fair’ and ‘well who will pay for it’.
I think about how limited you are – how SCREWED you’ be if Dude lost his job – how you TRIED to work – and how you are in no way responsible for where you are at.
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I’ve spent the better part of today researching not only California’s issues but global ones as well. I am saddened that it comes down to money versus doing what is right.
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I hear you. My co-pays to see my PCP just went from $15 to $40 – even if I just want to pick up a prescription for Euphorazine. Then the copay for THAT just went from $10 to $15. The system is broken… completely broken.
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I had such awesome insurance in Vegas, I paid $100 TOTAL for my back surgery. Now? I’d cancel (because I truly don’t get sick), but I know the minute I cancelled I’d be screwed. So I pay…and pay…
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Atomic Bombshell: For some families it’s more critical than whether or not they can pay a sub-prime mortgage and I hope that message doesn’t drown in a mess of bad mortgage debt.
HeatherK: I understand what you mean about a co-pay contest. I started to feel that way about doctors this year. My only bright spot has been the out–of-pocket maximum which our family hit for the first time EVER this year. I actually hit it single handedly. And let me tell you that was a chunk of change.
Miss Britt: And we are one of the lucky people who have employer provided coverage.
You are completely right. If Dude lost his job I’d be completely screwed.
I’m now fighting with our government to prove that I’m dying and that I’m not responsible for the position I’m at. Two weeks into the process and I’m already finding it maddening.
Hilly: It also comes down to status too. Ever notice that those people who are famous or wealthy have access to the BEST doctors and hospitals?
Nina: When co-pays went up to $40 for prescriptions I found myself making the decision between medicine and gas. Since I was working at the time gas was more important.
So broken? Yes, I agree.
Tug: I hear you because I’d have to pay 10% of that back surgery. I’d never be able to afford it.
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(RIGHT NOW!)
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My health insurance is a clusterfook too. If I laid it out here I’d be hijacking your comments, but the long story short means that by getting one benefit I got handed another and between those handed to me and applied for I lost the one that would fund my doctor’s visits but does let me eat–I lost over 20 lbs trying to deal with medication co-pays and since I got a whole 3 months of doctor’s coverage I may be at the “food or doctor bill” crossroads again.
It’s a shitty diet but it’s working so far.
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Okay, I’m going to play the devil, here. There may indeed be 48 million people without healthcare. But how many of those are working and under, say 30 without children who have been taking advantage of their youth and being healthy? They would rather take that extra 200 or so and spend it on that fancy car. Because truth be told, they don’t get sick and if they do, they go to the Doc in the box for 75-80 bucks( in NC where I used to live) and then pay for that RX.
Then there are the illegal aliens being counted in those statistics because they seek care as indigents and we, the American Taxpayer foot that bill. Estimated illegal Aliens here have the number at 14-18 million.
And then, we have the shit part of the equation. Malpractice suits and insurance which drives the price of everything up. The only question I have is that when something goes wrong and a patient dies, no amount of money would ease the pain and suffering of that event….yet we have people who knowingly smoke, get cancer and then sue and get money for their own choices.
Is any of this fair? No fucking way. I am currently paying $1700. a month because my sugar Daddy is a partner…But we cannot really afford that. So, with him having a congenital heart issue, he gets to keep that coverage and I am shopping for the rest of us to save money. When he was unemployed we got coverage for 440.00/month. I’m hoping I can get close to that and at least save half that from what we pay now. The ceiling on any catastrophic plan is 5 million. IT won’t do diddly if I get as sick as you, Lisa.
(Chatty- if you have a life insurance policy, call them. They might be able to get you cheaper insurance ad they can also do health.)
I wish healthcare were more affordable, too. That being said, I do not believe in a National Plan. Seen it “work” and I don’t like it at all. There are better solutions, but politicians need to stay out of it.
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Lisa,
Eloquent post – last night I helped my younger son write a college essay. His choice – universal health care. The problem with extending health care coverage is the knee jerk reaction those entrenched in power (and here I mean corporate power, not political). The first step to lowering costs is mandated coverage which would have the impact of increasing the size of the risk pool. A larger pool, risk is spread around, and some pay more, but most pay less. After that, with coverage, people who now end in up ER’s for routine care and critical care (because they could not get routine care) – wouldn’t end up there and costs would go down.
ER care is expensive – and many who turn to it cannot pay. Since nothing is ever free, the cost of treating the uninsured gets picked up by you, the insured.
I urge everyone to learn about the health care issue- because after the election nothing will get done no matter who is in office unless we as Americans demand that the problem be addressed.
And just as an aside – as a lawyer who has worked both the plaintiff and defense side of the aisle – medical malpractice lawsuits are very difficult and expensive to prove. There are far fewer frivolous lawsuits than people are led to believe.
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I think you hit on part of the issue with insurance companies. They set the “Allowable” rates they will pay to a clinic/doctor/hospital. The place where I receive my monthly treatments (a 15 minute infusion…not a chemo drug) submits a bill to my insurance company for $2383; and the insurance company allows (or pays) only $1429. I pay a $20 co-pay, and am not responsible for the difference (thankfully). When I see my oncologist (which is monthly), the doctor submits to the insurance a bill for $250; and the insurance pays $142; I pay a $20 co-pay (and again, not responsible for the difference). So are the invoice charges inflated by the doctor/clinic? Or is the insurance company holding the clinic/doctor hostage with lower premium with the tradeoff of referring more patients???
I was once referred to a surgical oncologist and he did not accept my insurance plan (I don’t think he took any insurance). The receptionist was upfront and told me his office visit fees (payable at time of service). I paid him the $253 for the office visit and then submitted the invoice to my insurance (they paid me back $17). Now, I think the $253 was a bit high for a 5 minute visit (not kidding — I got 5 minutes) but he got 100% of his fee, and I knew the price and condition of payment upfront. I told my regular oncologist I would have to go to another surgery doc in future (if needed) that was covered by my plan. So, I guess the insurance company has me “trained” to stick with their preferred physician list. Is this good or bad? Am I stuck with inferior surgeon? I don’t think so, but it makes you wonder why the surgeon (or any doc) would agree to less money — in return to see more patients? I’ll spend 1-2 hrs waiting to see my oncologist, and spend maybe 10 minutes with him. I sometimes think I could skip seeing the oncologist, and just have my blood drawn and call me if something is wrong. Otherwise, let the doctor take his time with the patients that really need his full attention; don’t bill me or the insurance company for the doctor’s time (just bill for the blood draw/test).
I think the system is a mess. But I don’t think Universal Health care is the solution.. That sounds like a cookie cutter approach to health care — one plan, one price — at the sacrifice of the “care” of the patient. This is America – land of opportunity. If we take the opportunity away from doctors to make a living, we will end up with less doctors, less specialists, less care. But we’ll only have to pay $5 (is that worth it?). I don’t have a solution, but there are definately a lot of people in America going without health coverage, and suffering from poor care because of it. There are foundations out there that do cover the uninsured (Komen foundation has free screening and care provided for those in need). I’d rather give money to the Komen foundation (or similar foundation) to assist with health care costs/coverage — than have the gov’t decide how to spend the money.
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I’m covered too. But because husband and I are both self-employed, we pay a pretty penny for that coverage, and it basically does not cover shit. We are on the verge of foregoing medical insurance and switching to a medical savings account, which is freaking scary to do.
The system is screwed.
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Lisa – Sorry you’re in the hospital, hope things work out sooner than later.
I hate to be a pain in the ass folks but you are already paying for other people’s coverage and the government is already deciding how your health care dollars are being spent. Between Medicare, Medicaid and Tricare (military) the decisions are being made. More and more companies are switching to medical savings accounts and I have one friend who needs to go to the doctor but can’t afford the full out of pocket for the visit. Illegal immigration is another topic entirely but I can tell you that children who are born here are citizens and as such entitled to Medicaid. Medicaid pays for many services that private insurance that we all pay for does not and would not consider. Anyway, we were having this discussion on a BlogHer site and a medical student wrote a really interesting comment you can read it here. http://www.blogher.com/mccain-moving-right-direction-healthcare-reform#comment-66179
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