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Readers share their experiences of health care in the USA.

A KKB regular writes:

Karen,

I quit my job a few years after getting married to go back to school full time and finish my degree. I can’t buy private insurance even though I’m willing to pay high premiums because of pre-existing conditions. The only way I will ever get insured without reform is by getting a job after earning my degree that offers insurance benefits. Even then it will be six months to a year before any “pre-existing conditions” will be covered. I still owe over $12,000 for a miscarriage last year, and am currently pregnant.

I don’t even want to think about how much I’m going to owe the hospital after this pregnancy. I’m actually lucky because I have enough money to make regular payments on my medical bills; I have several family members that work full time and still can’t afford to go to the doctor when they are sick. My mother’s leg suddenly started swelling up a few months ago, and she has been limping around with no idea what’s wrong because her insurance has a $2,000 deductible to reach before she will be covered. My parents are barely able to stay afloat right now, and can’t afford an office visit.

My father has to pay a quarter of his salary for this useless insurance. My brother was turned away from his doctor’s office when he suffered a mild concussion because he owed money for a previous visit that his insurance didn’t cover.
I could tell several stories that demonstrate why we need health care reform, but an event that occurred in my family very recently showed me just how bad things can be.

A close family member of mine suffers from bi-polar disorder. He is an adult but is unable to live on his own and take care of himself. His parents have managed to afford visits to a psychiatrist because the doctor is kind enough to reduce his charge for them. The medication that would help him the most is too expensive so the doctor has been forced to prescribe medication that he has samples for or can be purchased cheaply.

Just last week this family member had a psychotic manic episode. He was suffering from sort of religious delusion; his parents had to call for an ambulance to take him to the emergency room. The police had to come and force him into it and he was put in restraints. Once he was in the ER his mother learned that he would have to stay there instead of going to a decent psychiatric hospital because he had no insurance. His only option for treatment was a drug given to him in the ER. If this drug helped well enough over night for him to be able to consent to treatment he would be able to go to the psychiatric floor of the hospital and receive care from a pschiatrist. That unit is only set up for willing patients able to give consent, so if the ER doctors hadn’t been able to bring him back down enough he would’ve spent two or three days restrained in the ER before POSSIBLY being accepted into a psychiatric hospital or (more likely) being sent out with no further help.

Luckily the meds helped enough for him to sign himself in, and he was able to get appropriate medication before going home. But now his parents are struggling to purchase the medication he needs. The doctor had to re-presciribe him a cheaper drug. He was sent home before he was truly stable because the hospital knew they weren’t likely to get paid. The only option they have at this point to get him the treatment he needs is to try and get him on disability so he can receive government covered health care (medicaid). He could be a functional member of society and stay employed with the appropriate treatment, but the only way for him to receive treatment and afford medicine is to be labeled “disabled”.

Even though he qualifies for it he will most likely have to apply and go through several denials before eventually getting an attorney to get the medical coverage he so desperately needs. He was lucky enough to have his mother there in the ER to intervene for him and insist that he receive some kind of treatment. If she hadn’t been there they would’ve given him just enough meds to bring him out of the psychosis and send him back out on the street.

I think it says something about our health care system when even people that have literally snapped and gone psychotic can’t get treament.

If you wish to share your own health care experiences, please email me at hairylemony @ gmail.com

17 Comments »

  • My husband makes $65k a year and we don’t have health insurance. He is supporting three people, as my boyfriend is recovering from a work injury, and I can’t work because of health conditions. I need various bloodwork and tests like an MRI but we can’t afford it. MRI alone costs several thousand dollars. My medications are several hundred dollars a month. I am not getting the intensive treatment I need because I can’t afford it, and most places will not offer payment plans if you have shitty credit. Which I do, because of medical debt.

    Because he makes what he does, we don’t have recourse for aid. I’m probably not disabled enough to get SSI/D coverage, plus the way it works over here, if you receive a lump sum like you do on a print book contract — you get cut off. It’s not worth going through the utter HELL of trying to get disability only to lose it if I get a print contract because the first fucking check came in.

    I am probably over 15 grand in debt for medical, and that is over a couple years without insurance, without a “major” medical emergency, just regular work.

    The people that are all over “OMG, we can’t trust the government for our health care!!!” piss me the hell off, because the insurance companies aren’t going anywhere. It’ll just give the rest of us who can’t fucking afford medical care and won’t qualify for private insurance an option besides suffering needlessly.

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  • HeatherK
    August 19
    1:41 pm

    I feel your pain. My meds need increased, but first the insurance company has to be called to see if they’ll cover the higher dosage. If not, I have to stick it out with the current level, which we can barely afford as it is. And they just aren’t working as needed. I also need to get put back on a preventative for migraines, but I’m not sure we can afford the extra $$ each month for yet another medication. I’m 33 years old and take a handful of pills each morning and night or I cannot function in the most basic of ways, and yet those medications cost an arm and a leg.

    The cost of our crappy insurance has gone up, and coverage has gone way down. I don’t know how I lucked out and they paid most of my MRI bill, when they only pay around $8/doctor visit and I have to go frequently. I need to have more blood work & some other tests done just as a check up on other things, but can’t really afford them right now. And in a few years, my husband will require regular check ups because of his family history. I’ll need to start in with regular ultrasounds before long, but who can afford it with the way things are now? The deductible is a joke. Because of their whacky calculation system, it’s pretty much impossible to meet the deductible, which is not all that high a number. And with what my husband makes, we don’t qualify for state insurance. We’re very lucky that our son, at least, IS on state insurance. Between that and insurance through my husband’s work, he’s 100% covered. Otherwise, the treatments he’s gotten over the last few years that have made so much progress within wouldn’t have been possible.

    And that’s just the medical side. Our dental insurance is a joke. I need to have my teeth worked on but can’t afford it or get financing for the pricey procedures. I also wear glasses, which our insurance covers NONE of, and the cost of glasses keep going up.

    I’m not even going to go into how the medical system treats the elderly. The current system is very obviously NOT working. Something needs to change and soon. It’s pathetic that people have to decide between food and medication. That those who need help aren’t getting it. That life saving medical treatment is denied to those who need it most because they don’t have medical insurance.

    It’s a sad, sad world we live in.

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  • I’ve already told the sad tale of why I, a woman who has been working since I was 14 years old don’t have health insurance. Basically, we had insurance at my husband’s job, not great insurance, but we had it. When he was laid off, we lost insurance. I was able to get our son on a state program, but nothing for us. Even if we could’ve paid COBRA we didn’t qualify because his company was a small business. We moved for his new job and the health insurance premiums would literally cost a quarter of his income. I still haven’t been able to find a job over here. I tried to buy individual plans but because I have elevated insulin levels, no one will insure me.

    I also want to point out something else crazy about our system. I mentioned before that I take a drug called Metformin. (If you’re prescribed Met for ANY reason you cannot get health insurance, btw.) Anyway, if I get the prescription filled at CVS, a major chain, it’s over $100. At Wal-Mart it’s $80. Explain to me why it’s less than $20 at Costco? And yes, that’s for the generic. Too bizarre. For anyone with high drug costs be sure to check Costco, you don’t have to be a member to get meds there.

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  • Universal health care is a good thing.

    Every health care system limits care–it’s just that the means of limiting care may be different. In Canada, they limit it with wait lists. In the U.S., they use money.

    If I need an MRI to diagnose migraine, I might have to wait 6 months. If I need one to diagnose a possible brain tumor, I’ll get one within a week. A brain aneurysm? Probably within the hour. Speed of care is based on whose need is greater. And you’re never stuck with the bill.

    People in Canada can wait a long time for things like knee and hip replacements, necessary but non-emergency surgeries and specialist visits. But they get them. And it doesn’t bankrupt them.

    Low income people can get basic dental and eye care coverage for their kids (but not themselves) through many provinces’ Healthy Kids programs.

    In the States, if you’re rich, you can get what you want when you want. If you’re not, too bad. Sell your house and maybe that will be enough to cover it.

    However. The problem with “free” is that people abuse the system. I know people who bring their kids to the doctor for a sniffle or diaper rash, which is ridiculous. My own kids have been to the doctor maybe a dozen times between the three of them, because I only bring them in for stuff I can’t deal with myself. But when my youngest needed his head stitched up, I didn’t have to worry about getting stuck with the bill. When he needed a tooth pulled, my only problem was finding a dentist who would do that kind of work on a four year old without insisting on general anaesthetic.

    “Free” is never free. In Canada, everyone pays for it. Hospitals and clinics are privately run, but insurance for anything medically necessary is run by the government and everyone is covered. Doctors get paid less than they do in the States, but guess what? They still get paid a LOT. And they don’t run unnecessary tests because the money is all coming out of the same damn pocket.

    When my friend in the States was cramping during her 13th week of pregnancy, the ER ran an STD panel–even though she’d had one done less than two weeks before during her first PN visit, and told them she hadn’t even had sex since. Why? Because her insurance would pay for it and it’s money in the hospital’s pocket. But the uninsured? Just let their genitals fester, since there’s no money to be made…

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  • MB (Leah)
    August 19
    6:10 pm

    Because her insurance would pay for it and it’s money in the hospital’s pocket. But the uninsured? Just let their genitals fester, since there’s no money to be made…

    This reminds me that the uninsured are also getting screwed in every orifice, not just one.

    I was uninsured for years and years because I was self employed. Unfortunately, I was making too much money, although less then many people making the same because I was paying my own taxes, which included full social security. But private insurance or publicly funded insurance based my qualifying on my actual take home pay. This meant that I would have had to pay out more than 1/2 my salary per month to have basic health insurance. I mean it was pay rent and eat or have health care. What’s my choice really?

    I went without because I figured that I’d spend more in premiums than what I actually spent going to the dr. But it was a crap shoot and I didn’t go to the Dr. when I should have. I was afraid of the cost and that maybe then some condition would be found that would prohibit me from getting actual insurance if the time came. If I don’t know it’s exists, then it’s not pre-existing, you know? Stupid, but this is how uninsured people have to think.

    I was lucky in that WA state has a good publicly funded health care system so I was able to see a Dr./Nurse practitioner (much better than Dr. in many cases) on a sliding scale fee, which helped a lot.

    What I learned though, was that if you are not insured, you pay the highest cost if you have to go to the hospital, see a dentist, get tests done, or go to private Dr.

    This pissed me off so much. See, insurance companies only pay a certain percentage of a Drs. bill. The rest is made up in co-pay or eaten by the Dr. So who foots that bill, the uninsured who are NOT classified as indigent or who are making too much to be subsidized. Yep, they don’t get a discount like insurance companies. They have to pay full price.

    I was sent to the local hospital from my clinic Nurse practitioner who’d done all the basic tests and all came up normal. This hospital Dr. was a specialist and the NP told me that she’d sent all my info to them.

    Of course, I got a bill from the hospital and I noticed that one of the tests was a basic test that I had done already. I asked my roommate who was a lab tech and she told me what all the tests were. All were the very tests I just had done and which were all negative and they knew that! And besides which, although it was requested from my NP to see this specialist, who I actually got was a resident whose specialty was another field. Jerks.

    I called them up and bitched that they screwed up and that I shouldn’t have to pay yet again for tests I just had done and, I might add, 3x as much for their lab tests, and they knocked some of my bill down. But that’s when I got it that these places just automatically do unneeded tests and charge full amount.

    Currently, I have great health insurance through my husband’s job. It’s one of the best in WA so I’m very lucky now. But I know that that can change at any moment and it’s scary. I didn’t worry so much about this kind of thing when I was younger, but now as I’m aging, it’s very important.

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  • For anyone with high drug costs be sure to check Costco, you don’t have to be a member to get meds there.

    Oh thank you Rosalyn! My mom is a diabetic, and because of insurance and job issues I buy a lot of her medications. We do have a Costco on my side of town. She just got insurance and gets her prescriptions at Wal-Mart, but depending on what, if any because of her pre-existing conditions, the insurance charges, I’ll definately check out Costco. She’s over here often enough to see me that it would be worthwhile.

    THANK YOU!!!!!!

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  • Throwmearope
    August 19
    6:57 pm

    Roslyn, metformin is available in Colorado for $4 a month, if you’re not taking the ER or extended release version. WalMart, Target, King Soopers (Krogers). They’re doing it in other states too.

    The sad thing is that the ghost of Sam Walton has done more for American health and pocketbooks than the government.

    I adore Obama but he has done something unnatural to the pooch and universal health care is doomed. I happen to believe that health care is a right not a privilege.

    By the way, I am a physician, but I don’t have insurance. Because of my age, all I can get is catastrophic for $1000 a month. Being self employed (not unlike a lot of authors) sucks.

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  • Myra Willingham
    August 19
    7:24 pm

    My DH retired from the Marine Corps four years ago. We are so lucky we get military insurance through Tri Care. Our deductible is $300 per year for family of four…we have two kids under the age of 18. One daughter is diabetic and the other has severe migraines that require two different meds per day. My DH takes blood pressure meds and I have take a blood thinner for a heart condition. I don’t know what we would do if we didn’t have this. God only knows what it would cost us otherwise.

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  • Randi
    August 19
    7:26 pm

    Throwmearope: Do I understand you right? You’re a self-employed physician? Can you explain how that works?

    While I have insurance, and a health savings account, I’m not a big fan of the way I’m just a number to a doctor (gyno ESPECIALLY-oh man, I hate hate hate the gynos in Pennsylvania). There was a story awhile back, about a guy in NJ, who went old-school, and actually went to his patient’s houses for visits. Basic doctor stuff. Is that what you do? Because I want one of those…

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  • Janean
    August 19
    7:29 pm

    I wish more of our Democrat representatives would respond like Barney Frank to some of the stupidity that comes from health care opponents.

    http://www.youtube.com/watch?v=tWwyjwmYMEs&feature=channel_page

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  • Randi, even in Canada, most physicians are self-employed. Out of the approx. $250/hour a GP makes in private practice, he pays lease/heat/electricity for his office, salaries for staff, and purchases medical equipment, furniture for the waiting room, insurance, etc, etc.

    Only difference is that in the U.S, he has to collect from individuals and multiple insurance companies. In Canada, there’s only one insurance provider per province, and that provider sets rates for services.

    Specialists make more, which is why they have nicer offices. 🙂

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  • Myra Willingham
    August 19
    10:34 pm

    A few years ago when my husband was stationed at a base that had only a clinic and no hospital facilities, I got horrible pains in the upper part of my abdomen. They put me in the hospital because they thought it was my gall bladder. (Turned out to be gastritis, an inflammation of the stomach lining). They gave me something that made me very dizzy and when I was getting out of the bed to pee, I fell and whacked my noggin on the bed frame. I mentioned it in passing to the nurse at the shift change at midnight. I didn’t think I had a concussion or anything. Nevertheless, they hauled my ass down to x-ray at one o’clock in the morning. There was no concussion, nothing wrong. But the next morning a neurologist showed up at my door. MARK THAT: at my DOOR. He never actually came all the way into the room. He stood IN THE DOORWAY. He asked if my head hurt and I said no. He asked if my vision was blurred. I said no. He asked if I was nauseous. I said no. He nodded then walked out without another word. When I got the hospital bill, there was a charge there for….are you ready for this????….a FULL neurological workup with a price tag of over $500.00! Man, I went fucking ballistic. This bastard asked three questions, never laid a hand on me, never came close enough to the bed for me to see the color of his eyes and he billed me $500????? The military insurance only paid him $35.00 and he had to take it but can you imagine people who don’t have adequate insurance or insurance at all getting stiffed by that joker?

    It is just plain nasty.

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  • @Throwme, I know, but I have to have the XR, I can’t tolerate the regular.

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  • Kylie Creel
    August 20
    3:06 am

    Roslyn, I am in Colorado, but I was on Metformin (and later the XR version) for my PCOS, which is a pre-existing condition. I have United Healthcare through my husband’s job now and they obviously didn’t turn me down, even though they asked for medical records, etc. They knew I was going through fertility testing and such and now that I’m pregnant, my out of pocket expense will only be about $400 for delivery, etc. Anyways, my point is that my Metformin XR was still only $4… are you sure you can’t get it for cheaper? http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf Walmart says it’s only $4… Also, when you say “If you’re prescribed Met for ANY reason you cannot get health insurance, btw.” I’m wondering what you mean by that, since Metformin is the generic of Glucophage for diabetics.

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  • You can get group coverage, but not an individual policy. When you apply for an individual policy they ask for your medical history going back ten years. If you’re on Met, you’re denied. If you’re diagnosed with PCOS, you’re denied. I know one person who can’t get coverage for her kids because they have eczema. They can’t deny you under a group policy, but if you try to get individual coverage, you can’t get it. They have group coverage at my husband’s job, but since the employer doesn’t subsidize family coverage it costs literally a quarter of my husband’s take home pay and we can’t afford it. He had his insurance through his job, but we can’t afford the family coverage. We have an individual policy for my son. It just went up, and they charge us a higher premium because according to their charts he’s overweight. My son is 5 years old and 48 inches tall. He weighs 48 pounds. According to his pediatrician his BMI at 15% is “perfect” but not according to those jackasses who run the insurance companies.

    I take Metformin 750 XR. It’s not on Wal-Mart’s list. I’ve tried the others, it’s the only one that doesn’t make me unbelievably sick.

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  • Kylie Creel
    August 20
    5:27 pm

    Ah, okay Rosyln. I get it now. I’m so sorry you (and anyone else) have to deal with not having insurance. 🙁 One thing I don’t miss is the horrid side effects of Metformin… it’s an evil, wonder drug!

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  • Cece
    August 28
    11:55 pm

    Roslyn…I take metformin and pay about 12.00 a month at my local Kroger grocery store (that’s 500 mg three a day for 30 days) and it was the same when I got it filled at Walgreens so check around! Not sure if it’s the same as yours or not.

    But between that, hormones, etc etc AND my son’s meds (thank GOD their dad has decent ins) Im still shelling out 150.00 to 200/month for pills and inhalers for the two of us.

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