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Sunday, April 18, 2010

Health Care Bills and Health Care

I mentioned that I have been chasing my tail in my previous post. Part of this has been struggling with my health insurance. My husband works for a "small" company which employs approximately 250 people.

This year, we switched to a HSA, next year, the HSA will be mandatory for all employees. This is a cost saving move for his company as the rising costs of insurance have hit them even though they are doing a lot of things to reward people who try to safeguard their health by not smoking, keeping a good body weight and encouraging visits to the doctors office before things become problematic. Even so, I've been finding that the coverage isn't what it used to be.

Recently, I was switched to another drug and put on quarterly IV doses of Zometa to try to control my cancer as my tumor markers have been rising after 13 years of stability. The experience has been breath taking.

A three month supply of Aromasin costs me $937--that's with a co-pay. My cost for one infusion of the Zometa was $1,15.68 with the insurance deduction. I don't want to think about my upcoming P.E.T. scan as last year my portion was $1,000, and I'll likely need to have 2 this year as there is an area of interest. My daughter has to have a tonsilectomy.

When the mail order pharmacy called me to approve those high co-pays (and yes, I use a mail order pharmacy as part of the insurance in order to keep the costs down), I was stunned. I said to the intake person "Of course I'm going to approve it. What else can I do?" Her response? "Call your doctor and have him prescribe something else. " There is nothing else. This is an anti-cancer drug and this is the next level up--there is actually one above it, but they are holding this for the future if this doesn't work. I was disgusted that the assumption is that there is always a cheaper alternative. I suppose death is a cheaper alternative. I am also disgusted with the fact that the insurance company is playing the doctor. After all, the insurance company is a for-profit entity, it doesn't really care about my health and well being--it's primary concern is making money.

Shortly after this conversation, I got another call from the pharmacy. It seems that my daughter's asthma medications (she has a light case of exercise induced asthma, easily controlled and not a serious case) were going to cost a total of $600.00. This time, the conversation was a rather snotty one. Me: "Hello?" She: "This is the mail order pharmacy. I'm calling about your recent prescription. You're going to have to call the insurance company and see why your co-pays are so high." Huh? They are the ones working directly with the insurance company...I have no control over what they pay or what they don't. I am responsible for making my payment and keeping my daughter healthy.

Thus, when I got a Facebook invitation from one of my high school friends to join "I Bet I Can find 1,000,000 people who oppose the Health Care Bill," I really wondered. First, I support some kind of health care reform and a change in the way we take care of ourselves (and others). Is this bill the only way? I doubt it, but it is a start. Besides, I wonder exactly what all the provisions are. At 1,000 pages, I haven't read it, just the snapshots provided by the media. I doubt most of the congresspeople have read it front to back either. If anything, I am one of the people who believe that it doesn't go far enough, if what I have read is accurate.

First, ours system is one of the few, if not the only, which ties health insurance and health care to employment. If you have no health problems, then you don't realize the problems inherent in the system. In addition, the cost of the company providing health coverage is factored into the cost of the product. Since most of the other countries producing items have nationalized health care instead of requiring companies to kick in, they don't factor this cost in, potentially causing our goods to cost higher and therefore not making us competitive in the global market.

While some people complain about not wanting the Government to provide our health care, I'm guessing that most of those same people would complain if we took away their, or their parent's, Medicare and Medicaid--both programs sponsored by the Government.

I can also tell you that I was terrified when my husband lost his job. I was terrified that we would run out of Cobra before he was able to get a new job. If that happened, and our insurance coverage lapsed, I would not be able to get coverage or would have to pay astronomical amounts in premiums because of my pre-existing condition. I also know of people who were diagnosed with breast cancer only to have their husbands divorce them leaving them with no coverage (as they were not working at the time but were dependents either because they quit to handle the cancer or that they were at-home moms). I know of women who have stayed with abusive husbands because to leave them would mean leaving the insurance. These situations are intolerable and shouldn't exist.

I also know that there is nothing that I could have done to prevent getting cancer. I was sideswiped by this disease. I was a vegetarian for 7 years and even after that point, I didn't eat much meat and certainly ate more fruits and vegetables than most mid-western farm girls. I never smoked. I never used birth control pills. I was slender and active, riding my bike more than 150 miles a week during the summer months and swimming and running year round. I am lucky in that my husband has a good job. If I had remained in the museum field, I probably would only now be making in the vicinity of $45,000 per year if I were lucky and to be able to handle the co-pays etc. which I am facing now would be a stretch after paying for food, housing and transportation.

We also pay presently for the un-insured and under-insured, although most of us don't realize it as the costs are written into our insurance premiums. I was faced with this first hand when I lived in Connecticut and underwent my first cancer surgery. About six months after my lumpectomy, I received a bill for over $2,000 from the hospital. When I called they said that it was my portion of what I owed to cover the un/under-insured based on a percentage of my hospital stay. Evidently, insurance companies have agreements or exclusions with some states in order to cover this. Since I had my surgery in Connecticut where I lived, but my husbands insurance was with Blue Cross of Ohio (he worked for Goodrich at their Connecticut facility but the insurance was out of their home office in Ohio).

What do I want? I want a comprehensive, affordable plan which covers all Americans. I want us to have as good as a plan at the same price as our Congressmen are able to get through their position as Congressmen (they pay premiums to private companies--it isn't provided free of costs according to the website I looked at, but it is apparently affordable). I don't want to be excluded for pre-existing conditions.

I don't think that direct advertising for drugs should be allowed. This drives up the cost of the drugs (think about how much all the E.D. advertising during the Super Bowl cost, and how much the never-ending commercials must cost about the blood pressure, depression and ED drugs are over the course of a day). After all, why should I "ask (my) doctor if this drug is right" for me when ostensibly he/she IS prescribing the best possible for me without me having to ask?

It is said that a country is only as great as how it cares for it's poor and unfortunate. I don't know what the answer is, but it would seem that doing as much as we can to make it easy for people to find out when a problem is small and take care of it would be the best for all of us. I also know that if we don't take steps to take care of the cost and method by which we take care of our health, it will implode on its own and then we won't be able to make pro-active decisions with care and consideration, we will be re-acting and just trying to stop the deluge.

In the mean time, I'll be looking into getting drugs from out of country pharmacies and looking for another job.


Gerrie said...

Thanks for sharing your story. I do not think the current reform package is the answer, but it is a start.

Michigoose said...

I think that's where I stand Gerrie, but like I said, I need to study it some more. I'm afraid of throwing the baby out with the bathwater, and I think this needs a lot of consideration. Some of the statements I've been hearing (saying that health care in any form is "socialism" for one) and as I see it the Facebook invitation are inflammatory as opposed to useful.

As I said, I don't know what the answer is, but I can't see the present state of affairs as being useful or maintainable.

Anonymous said...

What a difficult situation to be in - I have little idea about the US Health Care System, but it sure sounds like it needs to be changed if you have to carry so much of the costs personally. I really feel for you. This must add so much to the stress of being ill.
Very simply - In Australia we have optional private health insurance, and not tied to employment - mine costs about $150 a month for top private hosp care when you need it, leaving an excess of about $500 per hospital admission to pay yourself, but with an annual cap on the excess, so more admissions you still pay the same amount. There is free medical care and hospital admission for those who are on benefits and have no insurance, but waiting lists are long for non urgent things. Medications are fully subsidised so a prescription costs $30 approx, unless you are on a Social Services pension or benefit, and then they cost $5.50 each. I have rheumatoid arthritis so am on lots of meds, and I've had breast cancer too. Last week I had a heap of scans and biopsies as there was something strange showing up, but luckily it was benign....Medicare paid most of the costs, and I only paid $48 because I now have a pension.
It is hard to believe that the US, which prior to the GFC was such a wealthy country, has such a poor health system - it just does not seem fair. Good luck to you, I hope you stay well, and that the administration eventually does the right thing for the people.

Marti said...

Reading this caused such a pang of...of what?...anger, sorrow, but mostly anger...that our health care is being dictated NOT by health care providers - rather - by Insurance companies. I have had my own battles with insurance companies during my daughter's younger years of terrifying ill health and there is no doubt that I will have further battles as my husband and myself age. I do think President Obama's heart was in the right place and yes, this is a step in the right direction, albeit a baby step. It is very difficult to fight greed.