I’ve been lucky for several years – and by lucky, I mean that by eking $350 a month out of my tiny salary, I have had access to most of the medical care that I need.
I worked a decent job my first year out of college (this was 2007, mind you, right before everything went to hell) which offered an insurance plan. When I left that job, I continued that insurance through a provision of US law known as COBRA, which allows people to retain their health care for a certain number of months from a former employer, if they pay the full cost of the insurance. It’s expensive as hell, but when you have a tricky chronic illness like I do, better than nothing.
So I paid COBRA til I landed my next job, which, happily for me, came with health insurance. Eighteen months ago, I lost that job without warning, but continued the insurance policy out of pocket. Now my time has run out.
I know some of you, my valued readers, are joining us from outside the US, from places where, perhaps, there is a modicum of humanity and reason in the health care system. Here’s how it works over here.
Got health insurance through a traditional job? Great.
Are you self-employed? I’m sorry. I hope you have several hundred dollars – or even thousands, if you want to insure your family – per month to spare for insurance premiums with deductibles of at least a few thousand dollars. Oh, you’re not rich? Hm. Well, that’s too bad. I hope you don’t break a leg or get cancer or anything.
Because here in the great United States, you’ll probably die before you can come up with the money for that care on your own.
What a lot of people in my position do is cross their fingers and wait. But most of my impecunious twenty-something friends have fallen under the health-care axe sooner or later – often through bike accidents or broken limbs. When folks like them can’t pay the bills, these costs get spread through the system, causing higher costs for care and insurance for everyone else.
My husband is uninsured, but he’s only been sick twice in about five years.
I brought him to my own doctor once, even though he was sans insurance, because he was having chest pains (fortunately it turned out to be a muscular injury). The appointment involved the doctor listening to him with a stethoscope and asking him questions for ten or fifteen minutes. The bill was $170.
A few years later, he got a severe case of tonsillitis. He had a high fever and couldn’t eat. We were in South Africa, so we found a neighborhood clinic and he got a doctor’s consultation, an immediate penicillin injection, a course of oral antibiotics, painkillers and restorative vitamins all for about the equivalent of $40.
That’s less than the copay for one prescription fill of my daily medicine on my current insurance policy.
My husband doesn’t like being uninsured, but he takes it in stride. The prospect of losing my insurance next week is terrifying, because medically, I ain’t doing so well.
I don’t engage in dangerous activities, smoke or drink. But I have a very painful chronic illness whose symptoms are manageable with daily medication. I’m currently trying to stop taking it every day, in preparation for when I may not be able to get it at all. Because that’s another common gem of the American health-care system. You had that condition before you bought this policy? Sorry, we don’t cover any of THAT care.
Next week, if all goes well, I’ll be purchasing a new policy with a premium of a few hundred dollars a month for my husband and me. This’ll cover five doctor visits per year (with a $30 copay for each). If one of us ends up in the hospital, we’ll be responsible for 40% of the total cost, after a deductible of a few thousand dollars, of course. Non-generic medications? As if! Maternity care? Don’t be ridiculous. But this is the reality of what we can afford (and there is no guarantee another plan will agree to cover me at all or that I could pay what they decide to charge, based on my history).
We’re willing to scrape about $3,000 a year out of our budget so that, God forbid, if one of us ends up in the emergency room, it’ll be a crisis to the tune of $350, not bankruptcy.
Of course, a lot of Americans are foaming at the mouth right now because the infamous President Obama thinks he can patch things up. The US Supreme Court is now debating whether Obama’s new healthcare law is allowable under the Constitution.
Obama and many liberal allies want to improve Americans’ quality of life (or, depending who you ask, take over the world in his dastardly big-government socialist grip) by making sure that the rich or those with job-related insurance are not the only ones with health care. Obama also wants people to be able to access care for conditions that existed before they obtained their current insurance policy, and he’d like to prevent insurance companies from taking people’s money while they’re healthy, and then revoking their coverage when they get sick (another shining gem of health care in America).
Sounds great, right?
NO! Say conservatives.
To help insurance companies realistically bear the costs of better access to care for everyone, no more would people like my healthy husband be able to opt out of buying insurance. Everyone would be required to buy it, with government subsidies available for those who can’t afford it on their own.
Excellent, say most liberals. A huge influx of healthy new insurance customers will balance the increased costs of sick people’s care. And besides, nobody ever makes it through life without getting sick or hurt. When it happens to uninsured people, those costs are still borne by the larger system and ultimately passed on to all of us. Let’s make every individual responsible for this human inevitability.
This is an American tragedy! Say most conservatives. How can there possibly be a Constitutional basis for forcing every American to buy a certain product? It’s an unprecedented government intrusion.
Federal legislators narrowly passed Obama’s law. Individual states with conservative majorities challenged it in court. And now the nine justices of the US Supreme Court, five of whom lean conservative, and four of whom lean liberal, are going to decide the issue once and for all.
Political writer Paul Begala, in a recent Newsweek Magazine/Daily Beast column, applauds Obamacare – or at least denigrates the conservative Justices (no surprise there – his pieces are usually a mix of liberal cheerleading and big-time political name-dropping).
He echoes what a lot of commentators have noticed about the Justices’ arguments. Conservative Justices see a slippery slope: if the government can force us to buy health insurance, who’s to say it can’t then force us to buy cell phones, burial insurance or broccoli?
It’s bad enough when your parents tell you to eat your vegetables. But the President? Ouch.
Begala points out an obscure 1792 law signed by George Washington requiring every white, able-bodied man between 18 and 45 to purchase a musket and ammunition. Clearly, the Founding Fathers imagined a Constitutional precedent for forcing us to buy something for the good of the nation.
Begala says it’s ludicrous to compare burial insurance to health insurance in this context: “we don’t have a burial-insurance crisis in America.” A lack of burial insurance is not bankrupting American families, eating up 17% of our national budget each year, and leaving Americans to die – as in one recent California case Begala cites, of an uninsured man whose appendix burst when he put off going to the doctor, afraid of the cost – because they can’t afford medical care.
I’m glad the Justices are there to decide this question in the best interest of the American people, according to our laws.
Were I on the Supreme Court, I would have to recuse myself immediately. In fact, I’m so personally biased I probably shouldn’t even be writing this blog post, in case my simple, self-pitying, ham-handed analysis influences anyone’s opinion.
Unlike the impartial Justices, I lose a lot of sleep to dark worries about what’s going to happen to me when my current insurance runs out. On bad days, I wake up to a forest fire under my skin and lie there wondering if I should take my medicine today, or save the limited supply for a day that might be worse.
The Justices, as well as their legislative colleagues, probably don’t have these worries. As Begala points out, the health care of uninsured people in America adds over $1,000 per year to the policies of those who buy insurance, but Justice Samuel Alito dismissed this as a “small” concern.
Perhaps he only thinks it’s small, Begala says, “because as a government employee his health-care bills are paid by We the People.” Indeed, the ones in charge of the nation’s health-care policy enjoy remarkable health-care themselves.
As Congress furiously debates the so-called Buffett Rule, a liberal election-year stunt which would up millionaires’ tax rates to thirty percent, I watch and shrug. Between my federal, state and local taxes as a self-employed person, thirty percent is about what I pay. As a freelance journalist, I suspect that that 30% hits me a little harder than it would hit Presidential candidate Mitt Romney, who paid about 15% last year on his $250 million fortune. I’m putting off grocery shopping till my next check arrives, and he’s installing an elevator for his cars in his $12 million villa.
But when I pay my taxes every quarter, I imagine myself paying for police and traffic lights and sidewalks and Grampa’s social security, and I don’t mind too much.
Congress and the Supreme Court Justices apparently have no problem with requiring us to pay taxes. Since our taxes support their top-notch health-care plans, I guess the principle is this: it’s ok to require me to pay for YOUR health-care, but heaven forbid I be required to pay for my own.
When I whined intemperately about my woes on Facebook this week, a friend replied sharply with her own suggestions, including getting family to lend money for my care, or pawning my belongings. Or I could “register as poor and go to a free clinic.” She also suggested going to Canada or England so I could get my care for free.
My generous parents have helped me to get care when things were really desperate, but that’s not a sustainable solution, and I’m an adult who doesn’t want to ask. I do have some nice wedding gifts stashed away – maybe a lovingly given crystal pitcher could pay for a round or two of meds, but the thought makes me sad. I bet a free clinic could patch me up if I sprained an ankle, but even experienced practitioners frequently know nothing about my medical condition – it’s not very common and is poorly understood. I respectfully doubt that a free clinic is equipped to deal with me. Maybe another country would take me in, but airfare’s pretty expensive. Plus, on a system-wide level, I bet taxpayers in those countries wouldn’t view my care as “free”.
I do deserve a lecture, for making such a public show of my problems while also shooting down well-meant suggestions. But I’m writing this because I bet many people can relate to my situation, and no-one – from my Facebook friends to my doctor, who recommends physical therapy at $100-$400 a month (from a practitioner who does not take insurance at all) – has provided a viable answer.
Good luck, Supreme Court. You could never trust me to figure this out, and besides, I have enough to worry about.