Your Health Care In The USA: Tales From Your Sick Bed… (III)
Saturday, August 22, 2009Posted in: Health care in America, Tales from your sick bed
Readers share their experiences of health care in the USA.
A KKB regular writes:
No one says that the American brand of universal healthcare has to an exact copy of the UK’s NHS or any other country. All of these country’s programs are great starting points and there’s no reason they can’t be improved upon by our policy makers. Personally, I’m quite fond of the idea of being able to access the same insurance plan provided to members of the senate and congress. I’d almost bet the farm their health insurance policy isn’t as shitty as mine.
What’s really depressing though is my private health insurance policy is supposedly *great*. DH works as a medic so he gets his insurance premium paid by his employer. My monthly cost is $120. Our *fantastic* plan is a High Deductible/Health Savings Account plan. We have to hit our deductible of $3500 before we see any benefits. His employer seeds our HSA with $1500/year. We then have to shell out $2000/year before we get any coverage.
DH has fairly well controlled Type II Diabetes. His routine biannual blood tests cost us $900-1200 *after* the hospital applies the reduced rates they’ve promised to customers of our insurance company. The meds he’d like to try to improve his blood sugar control aren’t covered by our insurance. Out of pocket, they’d cost us $800-1200/month.
I have PCOS and POF. Because they’re infertility conditions, even simple blood tests that have absolutely nothing to do with fertility treatment but simply to do with monitoring my hormone levels have to be specifically coded by my doctor’s office or else our insurance company refuses to cover them. Obviously, any fertility treatments, monitoring, meds are denied too. And, of course, any money we spend out of pocket on infertility doesn’t count toward our overall deductible because those aren’t *covered* illnesses.
Oh, and if DH and I ever lose our group health plan provided by his employer neither one of us will ever be able to get private insurance. When I lost my insurance coverage through my dad at 21, I was denied health insurance by every company I contacted because PCOS and POF are considered *rare* conditions. I was also overweight at the time and have a benign heart murmur.
People who have great insurance and have never had problems with their insurance coverage don’t seem to understand just how bleak it is for the average American. If you’re overweight, have Type II diabetes, a heart condition, high blood pressure or any multitude of seemingly non-threatening conditions, you either won’t qualify for a policy or you’ll be priced out of a policy. People can’t afford $1000 or more a month for a crappy plan.
I don’t think universal health care is the panacea for the USA’s healthcare woes, but, Christ, it’s a start. At least with a centralized health care insurance provider (like the senate/congressional plan), hospitals might be induced to provide services at similar costs across the country. That alone would bring a huge monetary relief to the families struggling to pay for their kids’ asthma treatments or for that person putting off a much-needed colonoscopy because of the up-front payment required
If you would like to share your health care in America experiences, please email me at Hairylemony @ gmail.com
Ann Bruce
August 22
5:28 pm
I haven’t been watching the health care debate south of the border because I don’t understand why “universal health care” is such a vile phrase to many Americans, especially the ones who need it the most.
Then a CNN article on the blatant untruths being spread by Obama care’s opponents made it clear. “Death panels”?!? WTF?!? Are Americans so susceptible to propaganda that they really believe the US government would promote the killing of grandma and grandpa? Seriously?!?
Janean
August 22
6:52 pm
I don’t think most Americans really believe that Obama will kill their grandma – at least I hope not.
Most Americans have been absorbing propaganda their whole lives about the evils of “socialism” and the superiority of “capitalism” without even knowing what exactly those labels mean.
I don’t think any of the people shouting about “Nazis” and “death panels” have actually read the actual proposals.
The thing that REALLY makes me furious is the retirees that are shouting angrily about the government getting involved in healthcare when they are receiving government healthcare through Medicare. I can’t decide if that is based on ignorance (do they not know what Medicare is???)or selfishness (only they deserve it?).
Anon76
August 22
7:23 pm
Yeah, it’s sad really, Ann. Americans are very susceptible to propoganda when it involves Federal control of anything.
The real ticker of it is, that each state has it’s own ability (to a point) of making their own laws. Often people get pissed at the federal government when it is really their own state making the mandates. Worker’s Comp Insurance is one of those things.
What makes me crazy is that people aren’t thinking things through, IMHO. Okay, so you have great insurance from work that costs you at minimum, very minimum, $200 bucks per month. But, that policy has a ton of copays on it, and a max yearly and lifetime limit. And…a deductible of like $2000 you must meet for some things before the policy kicks in.
Let’s see, that is 200 x 12 months, equalling $2400 bucks you’ve already paid just to have the privelege of insurance. Now, add in your co-pays on the simple stuff, like a doctors appointment for you and only you. $60 bucks, min, very min. Oh, the doctor wants to run tests? Check it against your 2K limit and wrangle to see if they will pay it, or if you can pay it. At this point we aren’t even talking about the meds that some insurance companies won’t pay for.
So, would it be worth it to have nationalized health care where you pay that $200 per month in tax, even though you don’t want to subsidize the lazy (as one friend put it)? And then you are part of a system where you can actually go get health care when you need it?
Thing is, right now we are all paying for the health care of the poor to a point anyhoo. So what is so vile and disgusting about changing the system to remove the strangle-hold private insurers have on us now?
Anon76
August 22
7:26 pm
Oh, and by the way, in the US, if you have a health policy at work, they pay you less. Must make up for that premium, even though you usually pay half of it from your check.
Emmy
August 22
7:36 pm
I’m not sure that the government would pay for you to get pregnant under a universal care plan either, so the public option would likely be of no use to you for fertility treatments. It wouldn’t make financial sense for them to pay for someone to have a child that they would then have to pay to cover.
Also…no idea where you got your numbers, Anon76, but they seem to only apply to you. Those numbers are nowhere near what I pay per month for the premium, or for office visits. Inflated 300-500%.
Ann Bruce
August 22
8:18 pm
I don’t believe fertility treatments should be covered under UHC either, but your comment rubbed me the wrong way. Is the only reason anything should be done because of financial gain? Should non-profits close their doors and leave the poor, homeless, hungry, and other disadvantaged to fend for themselves? After all, there’s no financial gain in helping them. Not at first glance, anyway.
Nonetheless, sometimes it shouldn’t be about financial gain. Sometimes it should be about being the ethical thing to do. And this is coming from a die-hard capitalist. Yes, there are those of us who believe things like education and health care are rights, not privileges.
Although, I should note the current US health care system is the most expensive in the world, yet it’s ranked as one of the lowest in terms of care.
Ann Bruce
August 22
8:37 pm
Cripes. I hate this topic because I always come off as idealistic and I hate that. It really ruins my image.
Anyway, to counter some of those people who are focused on the bottom line:
UHC = more preventative care = less costly major treatments = healthier work force = more productive work force = more income tax dollars
Simplistic, yes, but that’s essentially the big picture. And keep in mind UHC will essentially give Americans a big ass group discount.
Sure, you’ll have people who abuse the system, but they are a small percentage and they shouldn’t be allowed to poison everyone against the system.
(Oh, damn. I just said system and made it sound palatable. I need to pop in a Monty Python DVD.)
Emmy
August 22
9:55 pm
Color me surprised. It’s part of my intrinsic charm.
Not suggesting there should be death panels or baby panels or panels of any other sort, only that it would be highly unlikely for a public health system (which, like it or not, MUST contain costs or be bankrupt in a very short period of time) to cover fertility treatments.
Marianne McA
August 22
10:47 pm
I think in the UK it varies from region to region – theoretically you normally get 3 tries at IVF, though if one partner has a child from another marriage, some areas won’t fund the treatment.
But I know my brother and his wife were on a waiting list, and just when they were about to be treated their trust was facing a financial shortfall, and they (temporarily, I assume) stopped treating infertility to cut costs.
It cost my brother and his wife £10,000 to have private treatment, which covered three attempts. Happily, they were successful first time.
Janean
August 22
11:15 pm
Anon’s numbers don’t seem that inflated to me. When I had a job that offered insurance benefits I paid close to that amount in premiums. It took $45 from my weekly pay check to cover my husband and I, which was $180 a month. My office visit copay wasn’t $60.00, but we’re also talking about a plan I had six years ago and insurance prices had started climbing even then. I believe the last copay I had was $20 for an in-network primary doc and $50 for a pre-approved specialist visit. I worked for a large retail pharmacy chain that had one of the better insurance plans available, and co-pays varied widely depending on which doctor you decided to see. “Out of network services” had a $1500 deductible.
Smaller companies often offer insurance policies with high prices if they offer insurance at all, because they can’t afford to buy group plans that offer the same prices as a large company. My uncle used to own a small trucking company, and they had to keep switching which insurance company they bought insurance from because any time the employees used their plan the price the company paid rose dramatically.
People that have to buy insurance policies on their own have a good deal if they only pay that much; of course only people with perfect health records are allowed to buy insurance on their own.
Lolita Lopez
August 23
3:06 am
Er, I think this post was a comment of mine from a few months back when the idea of universal health care was first floated. Just to be clear, I’ve never expected universal health care to offer fertility coverage. It would be nice. If nothing else, it might bring down the cost so normal folks could afford to try an IUI or IVF without having to mortgage their houses or take out loans.
Honestly, I just want to be able to have my hormone levels monitored and have the necessary ultrasounds on my ovaries and uterus so I don’t, you know, die of ovarian or uterine cancer at 25. I’d like to be able to try different therapies so I don’t have to suffer through golf ball sized boils and cysts or have male pattern hair growth that rivals the Wolf Man or soul-crushing acne or clumps of hair falling from my head or periods that go missing for three years at a time. That’s it.
I’m mainly aggravated that a hormonal/fertility condition kept me from getting insurance coverage all those years. What the heck does the state of my ovaries have to do with my ability to get insurance to cover my access to a GP or a cardiologist?
There are so many women in my support group who are going through the same nightmare. They’ve lost their jobs and can’t afford COBRA or can’t get an individual plan. Some of them have just been diagnosed with PCOS and now can’t afford treatment. These are women who aren’t trying to conceive. They just want their lives back. But when a reproductive endocrinologist or OB/GYN specializing in PCOS charges two or three hundred dollars for a visit, it’s simply too expensive for them. Factor in the necessary ultrasounds and blood work and medications and it’s impossible.
HeatherK
August 23
3:16 am
We have a $20 copay, however, when the bills came in, the insurance company only paid $8 on the remaining balance and everything else WE had to pay out of pocket before I could go back. How much of that doctor bill is applied to the deductible? Little if any.
One of my medications is over $130/month (30 day supply). It still costs us $40 out of pocket after the insurance covers whatever they decide to cover. My inhaler costs me another $25 each because I can’t use the cheaper stuff, though thankfully I don’t have to have that one refilled every month. And that’s not counting the other meds I have to take on a daily basis. Some are OTC, which really aren’t all that much cheaper in some cases.
And we really don’t want to go into how much they paid on a surgery they said they’d cover. Or how much is paid on an emergency room visit and how much goes toward the deductible, which isn’t even all that high.
Damned if you do. Damned if you don’t. As for eye exams and glasses, they don’t pay a penny on those. Every bit is out of pocket, which is why I usually have to wait for income tax time to get new ones, and heaven forbid anything happens and they get broken. I’d have to go blind if that even occurs because we just can’t afford new ones without careful planning and saving.
And as I’ve said before, if my husband ever loses his job or changes jobs, there’s no guarantee I can get insurance coverage, nor could my son if he ever loses his state insurance. I have like 10 separate things wrong with me that’s been diagnosed, which is like preexisting condition hell where insurance coverage is concerned. I won’t even go into my son’s issues, because thankfully he’s covered by dual insurance—by my husband’s through his work and through state provided health coverage. So at least where he is concerned, we’ve been very lucky.
lilitu93
August 23
10:36 pm
PCOS being treated as just a ‘fertility’ disease really pisses me off. Yes, it impairs fertility, but it’s way more than that.
It’s an endrocological disorder that has many symptoms, of which infertility is only one. Acne, hair loss (on the head), hair gain (everywhere else), weight gain, fatigue, depression, etc., are all other symptoms, all of which bother me more than infertility. It also puts you at higher risk of developing other serious diseases including heart disease, heart attacks, strokes and Type II diabetes.
Plus it’s connected with metabolic syndrome, which is a group of symptoms (high blood pressure, high bad/low good cholesterol, glucose tolerance problems, and central obesity – i.e., weight gain all on the belly). The more of these symptoms you have, the more likely you are to get heart disease, Type II diabetes, etc.
Guess how likely it is that women with PCOS also have metabolic syndrome or at least some of the symptoms? I have all but the high blood pressure, and I know I’m not unique.
If there were a disease that affected men of which infertility was only one of the symptoms and had other, life threatening ones, it would probably be covered and not dismissed as just a ‘fertility’ issue but an all-over medical issue. I’m not saying that impaired fertility isn’t a bad thing – it is for those who want children – but a disease that can make you more likely to develop something that can kill you is more serious IMHO.
As for public health, lack thereof is one of the reasons I’ll probably never move back to the US. (Lack of decent holiday time is the other – I get 4 weeks minimum guaranteed, and that’s from when I start with a company.) I’ve been in the UK for around 10 years, and I pay around £100/year for a prescription pre-payment certificate. That pays for all my prescriptions, except for birth control which is free anyway. That’s less than I used to pay per month in the US, even with prescription insurance.
Plus in 2001 I was made redundant and came down with anemia – I was both too ill to find work, plus there wasn’t any work for me to find. It took me 6 months to get a new job. In the US getting the tests and treatments I needed to get better could have bankrupted me. I won’t say I was financially well-off by the time I started working again – it took a while to pay my cards off – but paying for medical treatment wasn’t an additional worry on top of being unemployed.
Kylie Creel
August 24
12:19 am
I’ve noticed a lot of ladies on here have issues with PCOS, and Karen I hope you don’t mind, but there is a GREAT message board out there for anyone who suffers from it. It’s a great support group and lots of advice, articles, research, etc. It’s called SoulCysters and the address is http://www.soulcysters.net. I don’t know what I’d do without it (much like this blog!)
Lolita Lopez
August 24
12:27 am
Kylie, that place is a life saver! I’ve met some of the most wonderful women on there over the last few years. The issue of insurance coverage comes up quite a bit there, especially when women in the US are comparing their coverage to cysters in the UK, Australia, etc. It’s been eye opening for me to see what a huge shaft we’re getting over here.
Anon76
August 24
1:42 pm
In the US there was a major kerfluffle when a tiny blue pill for men (Viagra) was almost instantly included as covered in many, many insurance plans.
This article is from 1999.
http://www.nytimes.com/1999/06/30/us/insurance-for-viagra-spurs-coverage-for-birth-control.html
Can’t get him up, boys, no sweat. We got ya covered.
And then I found the article below while doing the same search on viagra. True, it isn’t a US article, but it shows the mentality when it comes to men and their wanks. Sickening really.
http://www.telegraph.co.uk/news/uknews/crime/6080282/Judge-bans-paedophile-who-abused-girl-11-from-taking-Viagra-on-NHS.html