I am so so sorry for what your son is going through. I am also very impressed by your writing and agree with you 100% I will keep you in my thoughts and spread this story as far as I can.
Karoli
· 3 months ago
thanks to you and trish for your kind words. We really have to get this done...lives depend on it. :(
trishs
· 3 months ago
what davidnorman said.
Patricia Shannon
· 3 months ago
Best wishes.
Marie Carnes
· 3 months ago
Very well said, Karoli. I'm so sorry for what Sticks and your family are going through, now. Unreal.
disgustedbyyourblog
· 3 months ago
Sorry to hear about your son's health issues.
For his situation alone, think you should take your own advise and sit in your son's time out chair. While there, think about the impact on our nation if we use the single payer approach to pay for you and your sons's medical bills. While I understand that you are in an emotional state regarding your son, and more easily swayed to look to government to pay you and your son's way here, the single payer plan will cause further financial strain on our entire nation. Your son's financial coverage for his two diseases will be further strained and reduced. If we get single payer, you will rejoice and will have won your own battle, but you will have contributed to our nation losing the war on health insurance reform. We are in agreement that something needs to change to bring down the cost of health services and insurance, but following your path to the government will only make things more costly.
Your words say a lot about what you're really up to "Get out of my kid’s way and let the big boys forge a realistic pathway for him to work toward his goals. He has been a taxpaying contributing member of society since he was 14 years old. He pays his own way through school with no loans while remaining on the Dean’s list and representing his college at jazz festivals around the state. At the ripe old age of 20, he deserves a better future than indentured servitude to an employer with a health plan and a Senator planning his retirement on insurance company payrolls."
Maybe your son could begin to figure out how he in fact will take personal responsibility for his on going health issues. Also, you mentioned his father. If he's not alive, my condolences, but if he is alive, how is he contributing to the financial support of his son and his health issues?
I find it hard to believe that you and your son would prefer to embrace a losing proposition that would brake the bank of our country in order to pay your medical bills rather than support reforms that would allow people in your son's position to have more affordable, effective coverage for his medical bills.
Hopefully, your emotions will settle down and clear thinking will prevail when you get up from your time out chair.
Karoli
· 3 months ago
When you figure out how to take personal responsibility for a genetic disorder which was out of his control, let me know. Being the responsible parent that I am, i currently pay for his insurance, no matter what the expense. This will not last forever. Musicians are self-employed. They do not have the luxury of having an employer to pick up a piece of their insurance costs. This plan of Senator Baucus mandates a buy-in to a monopolized market at a 500% premium. I do not view that as fair, or reform in any way.
I wouldn't expect compassion from you, but as a purely economic matter, one would think you'd understand the gravity of this situation. He's not unique. He didn't *do* anything to bring his health situation on. He weighs 132 lbs right now and stands 5'7". It wasn't obesity, inactivity, or anything else. It was simply genetics. We don't live in a society full of islands. We live in a society where people understand that certain infrastructures must exist to advance the goals of corporate and individual interests. Our economy will not pull out and head back toward productivity and growth until insurance costs are managed alongside the cost of health care.
Have a great day. I mean this: I hope that no one in your family or you is faced with an illness that was not preventable nor the fault of their lifestyle or their choices. It's quite an experience.
rfbarnes
· 3 months ago
You're very long on criticism and very short on anything constructive. Four big paragraphs casting judgment on a person you must not know, and one sentence that says you agree we need to do something, but absolutely nothing about what that something is. Typical.
No, tort reform won't solve the problem. Yes, removing the pre-existing conditions could help, but not under the Baucus bill. If they remove the pre-existing clause, but allow unfettered premium costs, we just have to pay on the front end, to the insurance company. I can't freaking afford $30,000+ a year for insurance. That's 3 times what I pay for my house.
So what do you propose? Seriously, do you have any ideas? Because criticism without solutions is useless and intellectually dishonest. 14,000 people a day are losing their insurance, but they don't stop needing health care. Don't you see that this will break the bank for everyone? And it will be your pocket those costs eventually come out of, through continued increases on those that do have insurance. This is a perpuating problem, which will get exponentially worse. Either offer something meaningful or get out of the way.
disgustedbyyourblog
· 3 months ago
"Get out of my kid’s way and let the big boys forge a realistic pathway for him to work toward his goals. He has been a taxpaying contributing member of society since he was 14 years old. He pays his own way through school with no loans while remaining on the Dean’s list and representing his college at jazz festivals around the state. At the ripe old age of 20, he deserves a better future than indentured servitude to an employer with a health plan and a Senator planning his retirement on insurance company payrolls."
Karoli's quote above suggests that her son will be free to explore his future in music while the government pays his health bills for him. She implies that working for a living in the private sector is as low as indentured servitude. What she and you don't seem to realize is that once the government provides a single payer system in our country, she, her son and all of us will know what indentured servitude is with a "one place only" option for help to pay for our medical bills. She and you don't seem to realize as Thatcher said, "The trouble with socialism is that it runs out of money". Without the private sector's capitalist economy, we will find ourselves with the economy Jimmy Carter presided over. Your son's health care bills will be exhorbitant, and you will be crying the blues. Karoli likes to point out the private sector's ability to make money and spend it on themselves. I wish she would expose the way the public sector leaders do the same thing. Problem with the public sector's spending on themselves is that their resources aren't generating any more money for them to continue spending on themselves. As they continue to tax us for their luxurious friviolities, the money well will soon run dry. Not sure why that doesn't bother Karoli. She's running down a lose - lose path. But one thing I will say for her. . . She is doing it with passion.
rfbarnes
· 3 months ago
Karoli - I'm so sorry to hear about all of this. And I feel your anger and frustration. I seem to be fighting the insurance battles on two fronts right now. My son, who currently works as a machinist, severed 2 tendons in his hand. He had insurance through his work, and his surgery was covered, with a $1,500 deductible. Okay, that we could handle.
Then, through no fault of anyone's, the microsurgery on his hand failed, and he was scheduled for a 2nd surgery. At that exact time, his employer suddenly changed insurance companies, because their premiums had suddenly been raised over 30%. It's a small business and it was more than they could afford. Enter BC/BS. Now he was facing a new insurance company in the middle of treatment for a "pre-exisiting" condition.
First, we had to fight them to cover this treatment at all. Got that settled. Next was paying the $3,000 deductible that this new insurance demanded. No kid can afford to shell out $4,500 in three months, so his dad and I took care of that. Now the fight is over his PT. Without it, he will not regain more than 70% use of his hand. But the insurance company thinks he has had enough PT, despite what the therapist and the doctor both say. So who is getting between the doctor and the patient?
Like your son, mine is also a musician. He chose the path of a "regular" job, for insurance specifically, and does his music on the weekends. He's a bass/guitar player, and is very, very good. Was in a band that played in local spots around the city. This injury meant he had to leave the band, and if he only has a 70% usage when it's all over, who knows if he can ever get back his skills. We're still fighting to get the PT reinstated with the insurance company, and in the meantime, that is coming out of my pocket. Again.
And I don't have to tell you about my husband. You know that story. I've learned this month that the price of an artificial leg, no bells and whistles, just a stick on a foot, has gone up a bit in price. Now, they are about $48,000. We've paid for a Cadillac plan through his work for years. Now, thanks to Max, his work will be taxed on that, and guess whose premium will go up. Again. And if he wants to retire before age 65...well, forget it. Our premiums to continue our current insurance will be $3,000/month. And of course, we're stuck with that, because who is going to insure a one-legged man? It's a hell of a pre-exisiting condition.
I don't mind paying for insurance. I understand paying for insurance. But I want it to be fair and affordable. I want to be able to have some choices in my insurance. I don't want to have to go deep into debt, just so my husband can walk. We've worked hard, saved carefully, and face the possibility of financial loss, because of something we have absolutely no control over, just to maintain what most people would consider a "normal" quality of life.
Baucus' bill is a nightmare for people like you and me. I used to say I wouldn't wish our health care situation on anyone, but not anymore. I would like some of these folks to walk a decade on my husband's leg. Let them see what it's like to have to face these decisions. Until it smacks you in the face, you just don't get it. They talk about kids feeling invincible...from where I sit, it looks to me that it's the adults that seem to think it will never happen to them. They don't look farther into the future than tomorrow. Time for them to look at the reality and understand we are real people with real problems and the insurance companies are not our friends, but are actually a roadblock and profiting off the pain and suffering of others.
Sorry this is so long, but your blog set off a lot of thoughts that have swirled around in my head. I'm frustrated and tired of the constant fight. To know that there are treatments and care out there, but not be able to access them, because of money, just pisses me the hell off.
Karoli
· 3 months ago
Man....I'm so sorry to hear about your son. It drives it home that much harder to hear that he's a musician who may not retain his ability to play. I'm going to pray that he will, by miracle of medicine or God. We need those kids to keep making music.
The most frustrating part of this is that your story and mine aren't unusual. They're more likely to be the norm than the exception. Since I wrote this post 3 days ago, the diagnosis of diabetes has been confirmed. He has an odd type -- not type 1, not type 2. It's called type 1 1/2 informally, meaning that it he was born with the condition, but it did not emerge as problematic until adulthood. Until now, it's remained dormant because of his active lifestyle. Once they identified it and we knew what we were wrestling, he started measuring his glucose levels. The first measurement was 517. Normal high is 127, just for comparison. It's a wonder he didn't go into a coma. Fortunately we have a great doctor who is available to us by phone whenever we need him, so he had him come in immediately and showed him how to self-inject insulin, which he will do once per day until he is stabilized at a level between 60 and 120, then wean him off.
All of this will come out of pocket, it seems, since my COBRA administrator is insisting that premiums were not paid by the grace date (even though they were). I spent most of yesterday writing a request for appeal, which might work but probably won't. If that doesn't work, the next step will be to appeal to my former employer, who would probably allow me to reinstate but only if someone reviewing actually knew me.
You and I have paid for health insurance for our entire working lives, I'm guessing. By my lightweight estimates, at least $250,000 has gone into a system on behalf of each of us, with a corresponding equivalent for our kids and spouses (employer/employee contribution combined). Since we haven't utilized anywhere near that much in benefits, let's assume 30% of that has gone to fund lobbyists, expensive CEOs, and other non-insurance related perks. So when I hear about personal responsibility, it makes me want to puke. In this country, personal responsibility seems to begin and end with the poor and middle class, while the elite and the robbers dance on our dime. Enough.
I think Congress should pass HR676 alongside the Medicare reforms in HR3200, let those of us who are working buy into Medicare if we wish and be done. Enough bending over to accommodate insurance companies. They'll survive and land on their feet. Or, they could just open up FEHB to all of us. Either way, I'm tired of the effort to accommodate them while we go broke. I'm not willing to lose my home and assets that we have managed to preserve in spite of the Republicans in the name of 'bipartisanship'. Personal responsibility goes both ways, and only one side has shown none. It isn't ours.
TheMacMommy
· 2 months ago
I feel your pain. Back in March I nearly had a nervous breakdown when I found out my pregnancy, birth and complications (– the ones I knew I'd likely have – which is why I made sure I had health insurance in the first place!! – like gestational diabetes and a c-section) were NOT going to be covered after I was told they would be by an insurance broker <snake> almost 2 years prior.
You see, I had purchased PRIVATE insurance for my son and I because to put us on my husband's employer insurance policy was going to cost us over $600 A MONTH in premiums. My husband is a public school teacher here in the state of Arizona and anyone can tell you, they don't make much. With two mortgages (the second to cover student loans and credit card debt from college) plus all the utilities and living expenses, we just couldn't afford the monthly premiums for which they were asking. I quit my job to stay home because my entire pay check was going to day care and we were all miserable and sick all the time because we were all in education environments. I wasn't able to properly recover from my C-section with my first son when I went back to work 8 weeks later. I could never get well working in a school for 10 bucks an hour with all of the stress and responsibilities for which I was not properly compensated. It wasn't worth it to keep that job and so there went my health insurance employer coverage. As we know, COBRA is a joke. So, after almost a year of being uninsured, I purchased private insurance after doing extensive research on different vendors. (yes, competition is good, but if you're not a lawyer, it really doesn't do you any good is what I found out the hard way.)
I thought I asked all the right questions. I thought I was making a good investment with the insurance provider I had chosen. The hard part was the high deductibles, but we were just hoping we'd never be sick seriously enough to warrant having to deal with them. We just wanted to be able to have basic health care for going to the doctor. Turns out, there really isn't such a thing. When I found out I was pregnant, I called my insurance company to get some more details in addition to the ones I had been given when I first signed the paperwork. It turns out an addendum issued spelled it out in black and white that a C-section, nor any complications would NOT be covered. It was MY fault that I did not understand the legalese language in which they wrote that addendum. Here I was paying additional money each month for a maternity rider I bought specifically to cover my prenatal and postnatal needs and all it got me, after thousands in premiums, was a $2000.00 maternity "benefit" that could only be applied to a NORMAL, UNCOMPLICATED vaginal birth. Had I known that was what I was shelling out for, I never would have purchased that plan! It's not like I didn't precisely spell out to the insurance broker that we were planning on having another baby and that my first pregnancy and delivery was complicated and I anticipated the next one to be complicated as well. I suppose my needs are no competition to commission and insurance company incentives.
At the same time I was finding out about the lack of coverage for my pregnancy, my son needed eye surgery that was going to cost over $6k and that was AFTER the $2500 deductible needed to be met (just for him, mine was also $2500.) Only 3 months into the beginning of this year and we were staring down the barrel of having to file for bankruptcy or else being severely crippled financially by mounting medical bills due to come our way. We had already taken out a second mortgage to help tackle our student loans (the ones with horrible government interest rates that had compounded over the past decade) and credit card debt. Any more and we were in danger of being upside down on our home. (Did you know that a self-pay C-section can cost around $10k and one covered by insurance can cost up to $40k?) I felt like I was standing in front of a speeding train. It was awful. I was experiencing panic attacks. It's a wonder I didn't miscarry this baby with all the stress and anxiety I was under in the beginning. I felt so doomed.
With summer approaching, we had been hoping to install air conditioning in our 1950s home in which it would get up to 93 degrees inside our living room at times. I couldn't bear the thought of going through my pregnancy this summer with a swamp cooler for yet another year. When it was just my husband and I living in this house, that was one thing, but now with a young child and another on the way, you tend to want to make your home as comfortable as possible. I didn't think this was too much to ask, but when it came down to what our monthly premiums, deductible and co-insurance was going to cost us, well, how dare I think about upgrading our home!
So, when you talk about imagining having to choose between health care and other things, in our case – between desperately needed home improvement and 2 surgeries for 2 family members (my son's eye surgery and my probable c-section), I know exactly what that feels like. Despair is about the only word that comes to mind.
These fat cat politicians don't know what living like that is all about. They don't have to make choices between their health care and the things they need or want. They want for nothing and it makes me sick, quite literally.
Luckily for me, I was diligent and resourceful thanks to suggestions from friends and my beloved online community. I was able to get both my son and I onto public medical assistance because we qualify as a low income family with the baby on the way making us a family of 4. We pay a very small monthly premium for my son's health care and then everything else is covered. For the remainder of my pregnancy, my health care needs are covered, including my delivery. Finally I could relax a little and try to have a healthy pregnancy. As a result of qualifying for state medical assistance, we can now afford most of the things we NEED as well as a few of things we WANT — which, by the way, ALSO allows us to be contributing members of a STIMULATED economny. When we're not so burdened with outrageous health care costs, guess what? We can actually afford to make purchases beyond food, clothing and housing! What a freakin concept!!
My son was able to get his eye surgery and we were able to upgrade our home with air conditioning thanks to my husband taking a second summer job and me picking up a few additional freelance clients with my mother in law babysitting. My prenatal care has been covered including my prescriptions and things I need to manage my gestational diabetes. We can at least breathe now, but it's not at the cost of waiting for the other shoe to drop. Since we're on state medical assistance, we have to, well, basically remain "poor" enough to qualify so we can afford to have medical coverage. If we make too much or if the government cuts programs, we will be back to making some difficult choices we'd rather not make. Basically, our life and well-being now hangs in the balance so it's still a bit stressful. We try to be as conservative as we possibly can without allowing ourselves to become too depressed when we can't afford all the things we want. We don't use credit cards and when there is something we want, we wait until we can afford it. There is no such thing as instant gratification here much of the time and that's jut the way it is. We just try to be responsible with our lives.
My question is, why can't our representative do the same? Why is that too much to ask?
Karoli
· 2 months ago
I can't even imagine for one second walking in your shoes. That is the scariest story I've heard yet. You know what bothered me the most (besides the almost unimaginable medical bills...)? That you were facing summer in AZ without air conditioning. I can't imagine such a thing...I've been to AZ in the summer and it's not pleasant at all.
The sigh of relief I heaved at reading that you'd been able to get into public health care was palpable here. What is wrong with this country that they want any of us to suffer this way?
I have the same question as you. Why can't they? Well, they can't because they don't want to. They don't see any benefit in representing people like us. We can't or won't fund their campaigns, or give them power. (Though we actually would if they actually represented us...)
It's wrong that you have to stay 'poor enough' to continue to qualify. That's not American, either, but it's what we have because we've managed to push past the selfishness for the elderly and the poor. Now if we could just manage to do it for the middle class folks who can't afford to live like rich folks.
Also...it's REALLY WRONG that public school teachers are not afforded the right to cover their families at reasonable cost, and that their salaries are so low they end up qualifying for public assistance. I'm grateful it's there for you, but why the hell aren't we supporting our teachers better than this?
TheMacMommy
· 2 months ago
Yep. That's the question we all (in the education field here) ask and never hold our breath for the answer. My family back east can't understand why we don't just (uproot ourselves, destroy my husband's tenure & lose his career ladder benefits) and move back east so he could make double his salary all so we could afford to break even because of the higher cost of living there. Healthcare reform and education reform are the biggest challenges we deal with in this family. It's like we live with a constant double-whammy. We all suffer from "No Child Gets Ahead." Just when we think we have it bad with healthcare issues in this country, then we turn around and see even more red at what the Republicans propose gets cut from education and teacher compensations. It's sickening and I can only hope and stomp and tweet and blog that something gets done about it. Hope is all we have to hang on to anymore, but at least there is that, thanks to Obama.
Elizabeth
· 2 months ago
I'm sorry your son and your family are having to deal with an issue like that. I can empathize wholly. I've got a spinal cord injury that I sustained when I was 16 and had Tricare (active-duty father). Well, I'm almost 23, supporting myself obviously, and there is no way in hell I'll ever get insurance until I can qualify for Medicare. I can't GET Medicare because even though I have a hole in my spine and titanium rods and screws holding it together, I'm not REALLY considered disabled, because I can walk. Nice right?
Well, we'll be fighting the good fight and in the end people like Baucus will be people remembered only in jest.
Thank you for writing such a great blog!
Elizabeth
· 2 months ago
Oops! I meant Medicaid!
Karoli
· 2 months ago
Thanks, Elizabeth, and thank you for stopping by. I do believe we will see health care reform pass, and pass with a public option. If there's one thing experience tells me, it's that President Obama knows what he's doing and how to do it in a way that accomplishes the goal. (Even if Congress is a pain...)
All Comments
this done...lives depend on it. :(
For his situation alone, think you should take your own advise and sit in your son's time out chair. While there, think about the impact on our nation if we use the single payer approach to pay for you and your sons's medical bills. While I understand that you are in an emotional state regarding your son, and more easily swayed to look to government to pay you and your son's way here, the single payer plan will cause further financial strain on our entire nation. Your son's financial coverage for his two diseases will be further strained and reduced. If we get single payer, you will rejoice and will have won your own battle, but you will have contributed to our nation losing the war on health insurance reform.
We are in agreement that something needs to change to bring down the cost of health services and insurance, but following your path to the government will only make things more costly.
Your words say a lot about what you're really up to "Get out of my kid’s way and let the big boys forge a realistic pathway for him to work toward his goals. He has been a taxpaying contributing member of society since he was 14 years old. He pays his own way through school with no loans while remaining on the Dean’s list and representing his college at jazz festivals around the state. At the ripe old age of 20, he deserves a better future than indentured servitude to an employer with a health plan and a Senator planning his retirement on insurance company payrolls."
Maybe your son could begin to figure out how he in fact will take personal responsibility for his on going health issues. Also, you mentioned his father. If he's not alive, my condolences, but if he is alive, how is he contributing to the financial support of his son and his health issues?
I find it hard to believe that you and your son would prefer to embrace a losing proposition that would brake the bank of our country in order to pay your medical bills rather than support reforms that would allow people in your son's position to have more affordable, effective coverage for his medical bills.
Hopefully, your emotions will settle down and clear thinking will prevail when you get up from your time out chair.
disorder which was out of his control, let me know. Being the
responsible parent that I am, i currently pay for his insurance, no
matter what the expense. This will not last forever. Musicians are
self-employed. They do not have the luxury of having an employer to
pick up a piece of their insurance costs. This plan of Senator Baucus
mandates a buy-in to a monopolized market at a 500% premium. I do not
view that as fair, or reform in any way.
I wouldn't expect compassion from you, but as a purely economic
matter, one would think you'd understand the gravity of this
situation. He's not unique. He didn't *do* anything to bring his
health situation on. He weighs 132 lbs right now and stands 5'7". It
wasn't obesity, inactivity, or anything else. It was simply genetics.
We don't live in a society full of islands. We live in a society where
people understand that certain infrastructures must exist to advance
the goals of corporate and individual interests. Our economy will not
pull out and head back toward productivity and growth until insurance
costs are managed alongside the cost of health care.
Have a great day. I mean this: I hope that no one in your family or
you is faced with an illness that was not preventable nor the fault of
their lifestyle or their choices. It's quite an experience.
No, tort reform won't solve the problem. Yes, removing the pre-existing conditions could help, but not under the Baucus bill. If they remove the pre-existing clause, but allow unfettered premium costs, we just have to pay on the front end, to the insurance company. I can't freaking afford $30,000+ a year for insurance. That's 3 times what I pay for my house.
So what do you propose? Seriously, do you have any ideas? Because criticism without solutions is useless and intellectually dishonest. 14,000 people a day are losing their insurance, but they don't stop needing health care. Don't you see that this will break the bank for everyone? And it will be your pocket those costs eventually come out of, through continued increases on those that do have insurance. This is a perpuating problem, which will get exponentially worse. Either offer something meaningful or get out of the way.
Karoli's quote above suggests that her son will be free to explore his future in music while the government pays his health bills for him. She implies that working for a living in the private sector is as low as indentured servitude. What she and you don't seem to realize is that once the government provides a single payer system in our country, she, her son and all of us will know what indentured servitude is with a "one place only" option for help to pay for our medical bills. She and you don't seem to realize as Thatcher said, "The trouble with socialism is that it runs out of money". Without the private sector's capitalist economy, we will find ourselves with the economy Jimmy Carter presided over. Your son's health care bills will be exhorbitant, and you will be crying the blues.
Karoli likes to point out the private sector's ability to make money and spend it on themselves. I wish she would expose the way the public sector leaders do the same thing. Problem with the public sector's spending on themselves is that their resources aren't generating any more money for them to continue spending on themselves. As they continue to tax us for their luxurious friviolities, the money well will soon run dry. Not sure why that doesn't bother Karoli. She's running down a lose - lose path. But one thing I will say for her. . . She is doing it with passion.
Then, through no fault of anyone's, the microsurgery on his hand failed, and he was scheduled for a 2nd surgery. At that exact time, his employer suddenly changed insurance companies, because their premiums had suddenly been raised over 30%. It's a small business and it was more than they could afford. Enter BC/BS. Now he was facing a new insurance company in the middle of treatment for a "pre-exisiting" condition.
First, we had to fight them to cover this treatment at all. Got that settled. Next was paying the $3,000 deductible that this new insurance demanded. No kid can afford to shell out $4,500 in three months, so his dad and I took care of that. Now the fight is over his PT. Without it, he will not regain more than 70% use of his hand. But the insurance company thinks he has had enough PT, despite what the therapist and the doctor both say. So who is getting between the doctor and the patient?
Like your son, mine is also a musician. He chose the path of a "regular" job, for insurance specifically, and does his music on the weekends. He's a bass/guitar player, and is very, very good. Was in a band that played in local spots around the city. This injury meant he had to leave the band, and if he only has a 70% usage when it's all over, who knows if he can ever get back his skills. We're still fighting to get the PT reinstated with the insurance company, and in the meantime, that is coming out of my pocket. Again.
And I don't have to tell you about my husband. You know that story. I've learned this month that the price of an artificial leg, no bells and whistles, just a stick on a foot, has gone up a bit in price. Now, they are about $48,000. We've paid for a Cadillac plan through his work for years. Now, thanks to Max, his work will be taxed on that, and guess whose premium will go up. Again. And if he wants to retire before age 65...well, forget it. Our premiums to continue our current insurance will be $3,000/month. And of course, we're stuck with that, because who is going to insure a one-legged man? It's a hell of a pre-exisiting condition.
I don't mind paying for insurance. I understand paying for insurance. But I want it to be fair and affordable. I want to be able to have some choices in my insurance. I don't want to have to go deep into debt, just so my husband can walk. We've worked hard, saved carefully, and face the possibility of financial loss, because of something we have absolutely no control over, just to maintain what most people would consider a "normal" quality of life.
Baucus' bill is a nightmare for people like you and me. I used to say I wouldn't wish our health care situation on anyone, but not anymore. I would like some of these folks to walk a decade on my husband's leg. Let them see what it's like to have to face these decisions. Until it smacks you in the face, you just don't get it. They talk about kids feeling invincible...from where I sit, it looks to me that it's the adults that seem to think it will never happen to them. They don't look farther into the future than tomorrow. Time for them to look at the reality and understand we are real people with real problems and the insurance companies are not our friends, but are actually a roadblock and profiting off the pain and suffering of others.
Sorry this is so long, but your blog set off a lot of thoughts that have swirled around in my head. I'm frustrated and tired of the constant fight. To know that there are treatments and care out there, but not be able to access them, because of money, just pisses me the hell off.
much harder to hear that he's a musician who may not retain his
ability to play. I'm going to pray that he will, by miracle of
medicine or God. We need those kids to keep making music.
The most frustrating part of this is that your story and mine aren't
unusual. They're more likely to be the norm than the exception. Since
I wrote this post 3 days ago, the diagnosis of diabetes has been
confirmed. He has an odd type -- not type 1, not type 2. It's called
type 1 1/2 informally, meaning that it he was born with the condition,
but it did not emerge as problematic until adulthood. Until now, it's
remained dormant because of his active lifestyle. Once they identified
it and we knew what we were wrestling, he started measuring his
glucose levels. The first measurement was 517. Normal high is 127,
just for comparison. It's a wonder he didn't go into a coma.
Fortunately we have a great doctor who is available to us by phone
whenever we need him, so he had him come in immediately and showed him
how to self-inject insulin, which he will do once per day until he is
stabilized at a level between 60 and 120, then wean him off.
All of this will come out of pocket, it seems, since my COBRA
administrator is insisting that premiums were not paid by the grace
date (even though they were). I spent most of yesterday writing a
request for appeal, which might work but probably won't. If that
doesn't work, the next step will be to appeal to my former employer,
who would probably allow me to reinstate but only if someone reviewing
actually knew me.
You and I have paid for health insurance for our entire working lives,
I'm guessing. By my lightweight estimates, at least $250,000 has gone
into a system on behalf of each of us, with a corresponding equivalent
for our kids and spouses (employer/employee contribution combined).
Since we haven't utilized anywhere near that much in benefits, let's
assume 30% of that has gone to fund lobbyists, expensive CEOs, and
other non-insurance related perks. So when I hear about personal
responsibility, it makes me want to puke. In this country, personal
responsibility seems to begin and end with the poor and middle class,
while the elite and the robbers dance on our dime. Enough.
I think Congress should pass HR676 alongside the Medicare reforms in
HR3200, let those of us who are working buy into Medicare if we wish
and be done. Enough bending over to accommodate insurance companies.
They'll survive and land on their feet. Or, they could just open up
FEHB to all of us. Either way, I'm tired of the effort to accommodate
them while we go broke. I'm not willing to lose my home and assets
that we have managed to preserve in spite of the Republicans in the
name of 'bipartisanship'. Personal responsibility goes both ways, and
only one side has shown none. It isn't ours.
You see, I had purchased PRIVATE insurance for my son and I because to put us on my husband's employer insurance policy was going to cost us over $600 A MONTH in premiums. My husband is a public school teacher here in the state of Arizona and anyone can tell you, they don't make much. With two mortgages (the second to cover student loans and credit card debt from college) plus all the utilities and living expenses, we just couldn't afford the monthly premiums for which they were asking. I quit my job to stay home because my entire pay check was going to day care and we were all miserable and sick all the time because we were all in education environments. I wasn't able to properly recover from my C-section with my first son when I went back to work 8 weeks later. I could never get well working in a school for 10 bucks an hour with all of the stress and responsibilities for which I was not properly compensated. It wasn't worth it to keep that job and so there went my health insurance employer coverage. As we know, COBRA is a joke. So, after almost a year of being uninsured, I purchased private insurance after doing extensive research on different vendors. (yes, competition is good, but if you're not a lawyer, it really doesn't do you any good is what I found out the hard way.)
I thought I asked all the right questions. I thought I was making a good investment with the insurance provider I had chosen. The hard part was the high deductibles, but we were just hoping we'd never be sick seriously enough to warrant having to deal with them. We just wanted to be able to have basic health care for going to the doctor. Turns out, there really isn't such a thing. When I found out I was pregnant, I called my insurance company to get some more details in addition to the ones I had been given when I first signed the paperwork. It turns out an addendum issued spelled it out in black and white that a C-section, nor any complications would NOT be covered. It was MY fault that I did not understand the legalese language in which they wrote that addendum. Here I was paying additional money each month for a maternity rider I bought specifically to cover my prenatal and postnatal needs and all it got me, after thousands in premiums, was a $2000.00 maternity "benefit" that could only be applied to a NORMAL, UNCOMPLICATED vaginal birth. Had I known that was what I was shelling out for, I never would have purchased that plan! It's not like I didn't precisely spell out to the insurance broker that we were planning on having another baby and that my first pregnancy and delivery was complicated and I anticipated the next one to be complicated as well. I suppose my needs are no competition to commission and insurance company incentives.
At the same time I was finding out about the lack of coverage for my pregnancy, my son needed eye surgery that was going to cost over $6k and that was AFTER the $2500 deductible needed to be met (just for him, mine was also $2500.) Only 3 months into the beginning of this year and we were staring down the barrel of having to file for bankruptcy or else being severely crippled financially by mounting medical bills due to come our way. We had already taken out a second mortgage to help tackle our student loans (the ones with horrible government interest rates that had compounded over the past decade) and credit card debt. Any more and we were in danger of being upside down on our home. (Did you know that a self-pay C-section can cost around $10k and one covered by insurance can cost up to $40k?) I felt like I was standing in front of a speeding train. It was awful. I was experiencing panic attacks. It's a wonder I didn't miscarry this baby with all the stress and anxiety I was under in the beginning. I felt so doomed.
With summer approaching, we had been hoping to install air conditioning in our 1950s home in which it would get up to 93 degrees inside our living room at times. I couldn't bear the thought of going through my pregnancy this summer with a swamp cooler for yet another year. When it was just my husband and I living in this house, that was one thing, but now with a young child and another on the way, you tend to want to make your home as comfortable as possible. I didn't think this was too much to ask, but when it came down to what our monthly premiums, deductible and co-insurance was going to cost us, well, how dare I think about upgrading our home!
So, when you talk about imagining having to choose between health care and other things, in our case – between desperately needed home improvement and 2 surgeries for 2 family members (my son's eye surgery and my probable c-section), I know exactly what that feels like. Despair is about the only word that comes to mind.
These fat cat politicians don't know what living like that is all about. They don't have to make choices between their health care and the things they need or want. They want for nothing and it makes me sick, quite literally.
Luckily for me, I was diligent and resourceful thanks to suggestions from friends and my beloved online community. I was able to get both my son and I onto public medical assistance because we qualify as a low income family with the baby on the way making us a family of 4. We pay a very small monthly premium for my son's health care and then everything else is covered. For the remainder of my pregnancy, my health care needs are covered, including my delivery. Finally I could relax a little and try to have a healthy pregnancy. As a result of qualifying for state medical assistance, we can now afford most of the things we NEED as well as a few of things we WANT — which, by the way, ALSO allows us to be contributing members of a STIMULATED economny. When we're not so burdened with outrageous health care costs, guess what? We can actually afford to make purchases beyond food, clothing and housing! What a freakin concept!!
My son was able to get his eye surgery and we were able to upgrade our home with air conditioning thanks to my husband taking a second summer job and me picking up a few additional freelance clients with my mother in law babysitting. My prenatal care has been covered including my prescriptions and things I need to manage my gestational diabetes. We can at least breathe now, but it's not at the cost of waiting for the other shoe to drop. Since we're on state medical assistance, we have to, well, basically remain "poor" enough to qualify so we can afford to have medical coverage. If we make too much or if the government cuts programs, we will be back to making some difficult choices we'd rather not make. Basically, our life and well-being now hangs in the balance so it's still a bit stressful. We try to be as conservative as we possibly can without allowing ourselves to become too depressed when we can't afford all the things we want. We don't use credit cards and when there is something we want, we wait until we can afford it. There is no such thing as instant gratification here much of the time and that's jut the way it is. We just try to be responsible with our lives.
My question is, why can't our representative do the same? Why is that too much to ask?
The sigh of relief I heaved at reading that you'd been able to get into public health care was palpable here. What is wrong with this country that they want any of us to suffer this way?
I have the same question as you. Why can't they? Well, they can't because they don't want to. They don't see any benefit in representing people like us. We can't or won't fund their campaigns, or give them power. (Though we actually would if they actually represented us...)
It's wrong that you have to stay 'poor enough' to continue to qualify. That's not American, either, but it's what we have because we've managed to push past the selfishness for the elderly and the poor. Now if we could just manage to do it for the middle class folks who can't afford to live like rich folks.
Also...it's REALLY WRONG that public school teachers are not afforded the right to cover their families at reasonable cost, and that their salaries are so low they end up qualifying for public assistance. I'm grateful it's there for you, but why the hell aren't we supporting our teachers better than this?
Well, we'll be fighting the good fight and in the end people like Baucus will be people remembered only in jest.
Thank you for writing such a great blog!
health care reform pass, and pass with a public option. If there's one thing
experience tells me, it's that President Obama knows what he's doing and how
to do it in a way that accomplishes the goal. (Even if Congress is a
pain...)