Thursday, July 30, 2009

Just A Story


The health care "system," or "crisis" if you prefer, in the United States is too difficult for me to parse by far. As far as I know the Obamahaters are as right as the folks in my, less fanatical, camp. The one thing I do know is that what's going on right now is laughably inadequate and setting up precedents and habits in both consumers and health care providers that must be squelched. Since I don't totally get it, though, I can't say how. I liked when Mihow asked her readers about their health insurance situation and I would love to hear about yours (be specific so we can try and compare apples to apples!). This here will be my health insurance story.

I never thought about health insurance until I was over 30. Well over. I guess I must have had it through my parents and then through my college and it's possible that someone helped me out with something for a couple of years after that but I didn't think about it so I didn't know. No money of mine was spent on health insurance. Mostly I paid out of pocket and went to sympathetic doctors. Please know that sympathetic doesn't mean cheap or even affordable. Because I didn't have insurance I didn't go for check ups unless mandated by a school or job and I was (still am) a relatively healthy human. However, when I needed someone, it was usually on the verge of an emergency and I was usually in the middle of something that sapped me of any time to deal with the problem. Once, two days before a show opened, I had an ear infection so bad it gave me neuralgia all along one side of my face. It couldn't be ignored. I had to miss dress rehearsal so as not to miss a performance. The doctor's visit cost me $125 which was just over 1/3 of my weekly gross salary at the time. There were antibiotics on top of that and yogurt to combat the medication and more over the counter meds to do what the yogurt could not. That sort of thing happened, at most, once a year, though.

At 25 years old I got a job that included health insurance. After you were employed for 3 full months you were eligible for their major medical coverage through a NYC-based provider. I felt safer but it didn't teach me anything about health insurance because, unless I lopped off an arm in the service of a production, I wasn't going to use it. When I departed that job 8 months later on winged, fleeing feet I had not used the insurance at all.

I went away to a country with socialized medicine. Didn't use that.

I came back and continued on as I had left off with no insurance and the occasional important, required visit to an understanding health care professional. I worked as a freelance theatre technician, a pet sitter, an office worker, a studio cleaner and an actress.

I worked for a major credit card company and had health insurance that I don't remember much about. I think you had a month or two before it kicked in. No dental. There was flex spending for eye and day care. I got some kick ass glasses just before I left the job. Don't think I ever went to the doctor. Never learned how the insurance really worked.

While I lived in MI the theatre company paid $200 per week gross. If you became ill (something you were never to do because it would mean canceled performances and all the attendant problems for them) and required medical attention the founders offered up to a $200 advance to help you get the help you required. Repayment terms would be agreed upon at the time of the loan.

I came back, I tried to find my place in life, I temped a lot (temp agencies do not offer insurance) and then it was September of 2001.

In November of 2001 I took a temp assignment at a financial firm. By the beginning of 2002 I had agreed, for reasons still somewhat unclear and probably having to do with the death of my grandfather, to accept a permanent position. Health insurance kicked in immediately and was lavish in its coverage. $10 co-pays, $5 to $10 co-pays on prescriptions, no employee contribution, few network restrictions, flex opportunities for eye care and child care, even some of our dental was covered. It was impressed upon me repeatedly how rare and beautiful such a package of benefits was. I saw it in action too. Since the maternity coverage was so stellar at least 10 women I knew of stuck out hellacious jobs and intense pressure to quit in order to have their pregnancies covered by this insurance. When someone left on maternity leave you made sure you got back that book she borrowed before she left. The only women I know who came back afterwards did it because they were planning to have more kids. I went to the dentist once or twice. I had a check up or two. I had a couple of problems that needed taking care of and I did, no muss, no fuss. I was just learning how I could get at least partially reimbursed for some things that I had thought weren't covered when I had to leave. So I learned a little about health insurance but wouldn't have passes a test on the subject certainly.

When I left that job in 2005 I knew enough to negotiate health care into my new package. It should cover all the things I had covered in my old job and do it with a similar ease (i.e. few network restrictions and lower co-pays and the like). The agreement made was that my premium would be paid into my salary pre-tax and I was in charge of finding coverage when my COBRA ran out. COBRA was just under $570 per month. When that ran out the only comparable plan I could find that was available to an individual was from AETNA and cost just under $770 per month. No dental, no flex. Having the money come into my account pre-tax amounts to an employee contribution, I've never done the math to figure out how much, though. Like clockwork every year the premium amount has gone up $200 per month. For just one individual, me, my premium is $1204 every month and if AETNA continues as it has since I started using them that will rise to approximately $1400 in September. Co-pays are $15, there's a $100 per year prescription deductible (about which I always forget). I have gone to the emergency room once and done ortho follow up. I have had 4 surgeries (technically, they all happened in one day at the office but were billed as separate surgeries, though I paid just one co-pay) on my forehead and done all the follow up on that. I have had numerous dermatalogical appointments and tests. I had an epic double ear infection and a year of follow up to cure and banish that. I have yet to go to a gyn appointment or the dentist. I get annual check ups and I have tried a bunch of different allergy meds and come up with answers I feel comfortable with on that front and I get a flu shot every year (no appointment necessary, no co-pay!).

The fact that I pay that much money per year (even if it's not all technically "my" money) chaps my ever loving ass. I simply do not use that amount of service every year and it keeps going up anyway. I looked around for other choices and there just aren't many. I'm committed to keeping my coverage national since I do go to New England fairly frequently and you just never know what can happen. The best choice I could find was through Freelancer's Union. I'm not 100% sure I'd be eligible but I'm at least 90% sure I would be. The premium is significantly less, between $400 and $500 per month. The network restrictions are much, much stricter and, from what I can tell there are many more hoops to jump through when getting specialty care like dermatology which I now require regularly for the rest of my life. The co-pays are around $25. Outpatient surgical co-pays are $200 or 20% depending on some rules - now would this mean that I would have paid, for instance, $200 for my facial surgery or $800? There's a larger deductible for prescriptions and the co-pay is at least as much as that for doctors visits. That's a lot of complicated math (for me) to see if I would come out ahead of the current high premium. It would certainly be more headaches and it would depend year to year on what sort of health issues I had to address. The intricacies would, I suspect, make me even more reluctant to address my health issues.

The bottom line is, I still don't understand health insurance but I'm using more of it and I'm doing my best to learn as I go. Even on the most basic level of comprehension, though, I think it's clear that we must change our way of doing business in the health care industry and we must do so soon. I have no answers, just my story which is only one of many across the land. Go on. Tell me a story.

6 comments:

  1. I have no health insurance. Thru the salon, I pay for vision (which will only pay for "materials every other year" so I've been wearing the same pair of contacts for eons. I also pay for dental. which is good for cleanings twice a year *shudder* but you'll pay a butt load for anything over that.

    I haven't been to the whoo haa doctor in oh....about 6 years? I need to go. yes. I need insurance.yes. I need a lot of things as do most people. and I have no answers. Just the reality.

    ReplyDelete
  2. Reading Zelda's comment I realize I should have specified that we should say what we do so that when we meet other people in similar professions we might have an idea what their situation is.

    I am a secretary for 2 families who are relatively but not SUPER wealthy. They're both wealthy enough to employ a secretary part time. (I work 2 days per week per family.)

    Zelda is a hair stylist, she's not out on her own, she works for a small chain of salons and she puts in at least 40 hours a week. Due to the economic "slow down" she is considering a second job to make ends meet. So next time you get your hair cut maybe wonder if your stylist is in a financial position to be purchasing his or her own insurance.

    ReplyDelete
  3. The fact that you've poked around quite a bit and still don't understand it is really the problem. As I've said many times before, we don't have a "system" here, we have an industry.

    Health care cannot get better or worse if this industry dies because they don't provide health care, they provide management. Which we don't need. All we need are doctors, who will remain once the middlemen have gone buh-bye. And they'll have more time to treat patients rather than filling out forms and begging insurance companies to cover things.

    For the record, I'm fortunate enough to work for a company that provides me full coverage, which I rarely use, ox that I am. But it's something we shouldn't have to think about, like whether the cops will show up if I'm robbed or the fire department if my house is burning.

    ReplyDelete
  4. For what it's worth, here's my take on the current health care debate:

    http://nhfalcon.wordpress.com/2009/07/31/i-am-not-a-doctor/

    ReplyDelete
  5. I started to read it but then you were talking about the importance of freedom of CHOICE for the purchase of care for the health and integrity of a person's body. Since we've already had the discussion about you not believing that people with vaginas should have freedom of choice over the health and integrity of their bodies I just figured you weren't talking to me.

    ReplyDelete
  6. *Sigh*

    Let me try to address this one last time...

    My opinion on abortion is exactly that - my opinion, nothing more, nothing less. It's the way I happen to feel about it.

    It is NOT something I try in any way, shape, or form, to project on to other people. I don't look down on people who are in favor of it or have actually had one themselves. It is the law of the land, and I feel no overriding desire to change that law. If I were ever to become President (try not to run screaming at THAT thought :) ) I would not seek to overturn that law, nor would I choose to nominate Supreme Court Justices based solely on that criteria. If Mrs Chili were to tell me that she found out she was pregnant and that she didn't want another child and was going to have an abortion, I wouldn't end my friendship with her, nor would my opinion of her be lowered in any way. If Cookiemaker told me she was pregnant and wanted to have an abortion, I wouldn't divorce her because of it, nor would my opinion of her be lowered in any way.

    We had our "discussion" about abortion because I was explaining why I was voting for McCain, abortion is one of many political issues, and McCain's stance on the issue was closer to mine than Obama's. CLOSER to mine, not exactly mine. It's not an issue that ranks very high on my list of priorities when I consider a political candidate.

    It IS about freedom of choice. I don't want that taken away from people. In this instance it is simply a matter of me disagreeing with the decision they make with that choice.

    My opinion is only my personal feeling on that matter. It is NOT something that I feel everybody else has to live by.

    ReplyDelete