Wednesday, June 24, 2009

My Story

Everyone has a health care story these days. Some are very dramatic. Some are tragic. Some are happy, upbeat and hunky-dory. (Those are the people who believe that President Obama wants to stand in your hospital room so he can unplug your life support as soon as you hit the age of 80. They are also the ones who have lifelong health care with dental, vision, and a $5 drug co-pay and they assume that everyone else does, too. Except the illegal immigrants, who need to die immediately.)

Anyway, my story is not terribly dramatic. But it does illustrate some of the problems of our current system.

It's a very long story, so if you want to skip to The Point at the end, that's fine. I'll understand.


Hubby and I are both 55 years old. We're in pretty good health. We don't take any prescriptions. We don't smoke. We exercise.

Up until a couple of years ago, we were both self-employed. We finagled ways to find health insurance, and paid hefty premiums for very little coverage.

The Finagling: How to get health insurance if you are sneaky and self-employed
Several years ago, I took an office job for a while. I qualified for their health plan after 90 days. After another month or so, I quit and converted to a group conversion plan (this was in Michigan, where the insurance companies have to let you convert).

The Down-side:
By 2005 we were paying nearly $1000 a month, with no prescription, dental or vision coverage. The premiums went up by a very predictable 10% every year.

I thought perhaps we should switch to a cheaper policy. The insurance companies said no. They wouldn't cover Hubby because he has a history of high cholesterol.

The Move to Texas:
When we decided to move to Texas to be near the grandbaby, we were in a quandry. Our insurance was a Michigan policy. We could not bring it along. We also could not buy our own policy. Hubby's company came to the rescue. They put him on the payroll and put us on their insurance. They were wonderful. They gave him a new territory, which requires traveling 2 weeks out of every month. But they made it possible for us to move. I am very grateful.

The Frustration:
Even with good health insurance, there are plenty of frustrations. Take my last check-up for example. The doctor recommended a bone density test and a mammogram. So I checked to make sure the hospital was 'in network' and scheduled the tests.

On the day of the test, the technician told me that a bone density test costs $1500. I hadn't met my deductible yet, so it would cost me $500 out of pocket. Payable immediately. I told her forget it.

I went ahead with the mammogram, and soon received a bill in the mail for several hundred dollars, because the doctor who read the results was 'out of network.' How the heck was I supposed to know that? I called the insurance company and they said, well, I needed to check ahead of time. So I'm supposed to check on every medical person who might be involved in my care? How do I even know who that would be? I called the hospital and they said, well, it's impossible to really know who will read the films. Some are in network and others are out. Tough luck.

Please don't put me in charge!
This is why it makes me crazy to hear the Republicans say they want "the consumer" to be in control. The consumer is never in control. The insurance companies are. I don't want to have to check on the price of every q-tip ahead of time. I want reasonable price controls, and flexible access to care. Is that so much to ask?

Back to my story ... the New Quandry:
In the past year, Hubby's work has slowed down (he works for an automotive supply company). We are not sure how much longer his job will last.

If his job goes, our insurance goes. We don't live in Michigan any more, so we can't convert the policy. We also can't buy a policy. We'd be stuck. Hubby would need to find a job, any job, with benefits. He'd probably end up in retail. Or we could go without insurance, and roll the dice. One car accident or major illness, and our savings could easily be wiped out.

The New Down-Side:
At this point, even though we have health insurance, we are afraid to use it. When I went to the clinic recently and my blood pressure reading was high, my first thought was NOT "Oh dear, what should I do about that?" ... it was "Oh dear, do you have to write that on my chart?" Any little thing could make us even more uninsurable. So we are not getting checkups, and not pursuing warning signs that we really should pursue. We can't.

If we had access to affordable health insurance, with no exclusion for pre-existing conditions and a lifetime cap so we would not go bankrupt from medical bills:

1. We could be much more pro-active about our health. We might even get health CARE instead of just health insurance.

2. Hubby could retire and work on charitable projects. Or he could take a meaningful, low-paying job without benefits instead of taking a retail job away from someone who really needs it.

3. We could be more generous with our money. Our retirement funds would be more secure, so we could help the kids, donate to our church, and find other worthwhile causes to support.

There are probably other benefits, as well. Let me know if you think of some, and I'll add them! Meanwhile, I need to go find out what Mark Sanford was doing in Argentina.

Talk to you later. Thanks for listening.



  1. Hmmm... auto industry? I retired (early mutual) from Delphi/GM. It's not much, but better than what my friends that weren't over 50 got. Read my latest 'essays' blog.

    Last year we had our prescription co-pays go up 500% and lost coverage for office calls. I pay around $80 just to walk in for my asthma!For the very first time in my life, I was able to deduct medical expenses! We're not that unhealthy. Just stuff happened! We just lost our dental, vision and some drug coverages. Still not too bad. Our out-of-pocket deductibles are manageable at this point. But more cuts will come.

    Like you, it's those behing-the-scenes people that whack us! At our local hospital, if you went to the ER at night, any CT or similar test was sent to Australia to be read! Seriously, Australia? Do you suppose they're in the network?

    Question: Why do we (taxpayers) pay so much money for medical research, when the drug companies keep the profits? Other businesses must reinvest their profits to stay on top. Shouldn't we get dividends on this investment? You seem like the person to ask... Maybe tomorrow's blog?

  2. Australia?? Ok, that's just weird. And yes, your question about the medical research is a good one. Let me give that some thought ...