The Health Of Our Care – Yes, this is personal!

First, some good news. Very good news. I have signed up for new health insurance through the New York State Marketplace. It was easy. I had a couple of questions which were quickly and politely answered with phone calls. The information I needed was there. I could easily search for policies that covered my various doctors. It all seemed pretty straight forward.

For the first time in more than a decade, I will have health insurance that is actually affordable. Hooray for the ACA!

I know that is not everyone’s experience. I know some people are frustrated by problems with the federal website. Others are unhappy because their current policies are being canceled. A small percentage of people are finding their insurance costs are going up slightly.

I understand people’s frustration. I understand disappointment – I agree, there are problems with the current plan.

What I do not understand is the anger of many of the attacks on the plan. I am fed up with politicians and pundits spending all of their time complaining instead of trying to fix the flaws. And I am definitely fed up with the vitriol of people’s complaints, often quite personal – largely from people, quite frankly, who have never had to deal with a serious illness or injury, and never had to deal with finding health insurance on their own.

I have been told that I’m a fool and clearly too stupid to understand. I have been told that I am bankrupting America. I have been told that I am careless with my money, with my health, that I abuse the healthcare system. That I must be lazy. That I’m a drain on the American economy. That I have no “skin in the game.” And my personal favorite, that because I chose to work in a profession that is largely made up of freelancers, I don’t deserve to have access to affordable healthcare. That even though I pay my taxes (at a higher rate than many with cushy corporate jobs), and contribute to society in many ways, because I chose to be a musician, I don’t deserve care that won’t bankrupt me.

I confess that I find it difficult to not take this personally. Because I am none of those things. Because if I were just slightly less lucky, I would be dead. Because way too many people just like me are dead, dying, or suffering greatly. Because it is very personal.

You can read about my insurance saga in early posts in this series, but basically, I had insurance. Once I was sick, they didn’t cancel me, something I was quite grateful for. Instead, they started jacking up my rates. Just about every year I had increases of 20, 30, 40%. Every year. They also routinely denied coverage of things that I knew were covered. I would call them to complain, and they would immediately agree and cover the charges – but only because I noticed and called them. Because my insurance was already expensive (since I was in the individual market), these increases would have been impossible for me had I not been lucky enough to live with someone who was able to pick up a larger percent of the expenses, especially since I was working a lot less because I was sick and in treatment. I finally was forced to switch insurance a few years ago because of the huge increases. (If I had kept that plan, my policy would be somewhere around $3000 per month now, assuming a similar rate of increase) For the last few years, I have had a very high deductible plan – high enough that I pay for every bit of my followup care. But at least I knew if something serious happened, I would have coverage that would kick in eventually.

Sadly, there really is nothing unusual about my situation. People have been denied coverage, had coverage canceled, gone bankrupt, lost their houses, doomed their children to poverty because they were unlucky enough to get sick or injured. For years, people have been dumped by their insurance companies once they got sick – or, like me, simply pushed out by rates rising exponentially faster than the cost of living or the actual cost of healthcare. Many have paid their premiums, only to find out that their policy actually covered little to nothing once they got sick or were injured.

This has been true for everyone, but those in the individual market have been hit hardest. We have faced poor policies, refusal to honor agreements, and paid rates at levels that would be considered criminal in any other market – terms like price gouging, breech of contract, fraud come to mind. We pay the most (even though some health insurance companies suffered the largest losses from group policies), and have no one to turn to when there are problems. There is no group administrator who might be willing to help us out; no one to potentially throw their weight around with the insurer.  People I know have chosen to have no insurance because the cost of coverage on the individual market was so high that they had to chose between insurance or a roof over their (and their family’s) head. Yes, it is possible to still get care, but often with delays. And when you really need care, delays can mean much more costly and difficult care choices or death.

In case you don’t think it really is a problem for the majority of Americans, remember that researchers at Harvard (Drs. Himmelstein & Woolhandler) found that 62% of bankruptcies in 2007 were attributed to healthcare. These were mostly solid middle-class families, most of whom owned their homes and had college educations. These were not irresponsible people living on the edge. They were just people who had a sudden major medical issue. A study from 2008 (Robertson, Christopher T. and Egelhof, Richard and Hoke, Michael, Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures (August 18, 2008). Health Matrix: Journal of Law-Medicine, Vol. 18, No. 65, 2008) found that 49% of home foreclosures were the result of medical problems, including cost of illness or injury, loss of work due to illness or injury, or cost of caring for other family members’ health problems. Think about that when you think about the last great recession and our continuing economic problems, and how those problems affect you and your family.

The American healthcare system, as it has existed, benefits no one – except perhaps health insurance executives and shareholders (many execs pull in astounding compensation increases – 50 – nearly 200%! and profits abound….You can find such interesting information when you read the publicly available SEC filings!) Our healthcare is not the best in the world, as we’re sometimes told. The annual survey by the Organization for Economic Coordination and Development found the U.S. healthcare system cost the most, yet provided only mediocre results. The U.S. ranked 26 out of 34 rich countries for healthcare. We spend far more, and get far less care than other countries.

And now we have a change. Is it perfect? Far from it. There are people who fall through the cracks. It will not cover everyone. There needs to be more help for small businesses. But it is a first step in fixing a completely untenable situation.

Yes, the website has problems. Some people have had a hard time getting through or getting all the information they need. Of course, if you’ve ever had to try to find insurance information on your own, you know that it has never been easy or fast. I have spent weeks calling every insurance company, trying to compare plans that were set up in ways to make it impossible to compare with another company’s plans. I have weeded through plans and sales pitches from brokers offering me “great plans – very affordable!” that would have covered nothing. Hours and hours and hours and hours and hours….

The new standards are causing some people to lose their current policies. Most of those policies are crap and always have been – sorry if I offend anyone. But the only reason that many of those people like those plans is that they don’t cost much, and because they’ve never really had to use them. I know because I’ve read many of those policies. Because I’ve spent a lot of time researching policies over the years (and because I’m the kind of person who actually reads the policies), a whole lot of people have come to me for advice. I’ve looked at a lot of insurance policies. I’ve seen lifetime caps as low as $50,000. That wouldn’t even get someone out of the emergency room. The policy holder would be left open on the operating table if they required surgery.

And with my involvement in the cancer community, I long ago lost count of the people who discovered how poor their insurance was once they were diagnosed. I have seen people go forever into debt to try to stay alive because their insurance covered so little of their treatment. I’ve seen people lose their homes. I’ve seen people go bankrupt. And I’ve seen people die.

I would be one of those had I not been so lucky.

I hope that all of you who are complaining about the Affordable Care Act think about how you are complaining and what you are hoping for. Do you really want this to fail? Just to prove a point? And quit with the totally unfounded personal attacks.

Because this is personal. Very.


(if you want to read some of the other stories in this series, search this blog for The Health Of Our Care.)

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5 Responses to The Health Of Our Care – Yes, this is personal!

  1. Peter Borten says:

    Amen, Julie. beautifully said. I’d send it to the NY Times right quick if I were you.

    Peter Borten

  2. Racn4acure says:

    Hey there – you must be a very powerful person to be bankrupting America! ;^) I want to read your post in more detail later, but just wanted reach out and say that I am happy you got your insurance. That’s great! Art

  3. Hi Julie,
    Bravo! Good for you for writing this! It is personal isn’t it? And guess what? It’s personal for every single family in this country. I truly believe quality healthcare is a right. Every American deserves affordable and high-quality healthcare. It’s been disheartening and then some to listen to all the bickering of late about the ACA. I’m glad to hear your personal experience with it has been positive. Thank you so much for putting your story out there. And happy holidays to you, Julie.

  4. It’s just that if the presentation (website, etc.) already smells like fail, it’s hard to trust the thing itself

  5. I know there are problems – spent time this morning trying to help out a friend figure out options because her application is delayed. But I assure you, this is not what failure smells like. Not to those of us who have been trying to deal with this on our own for years. Whatever these problems “smell” like, they smell a whole lot better than going bankrupt, losing our homes, or going hungry!

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