Denied
December 10th, 2005We’ve been refused health insurance from the monopoly health care provider in our state. All three of us were refused. Irony 1: This same company who covered my successful cornea transplant in 1998 used this against me and declined coverage. Irony 2: Heather’s post-partum depression being successfully treated was used against her and she was denied. Irony 3: Leta’s two MRIs, which proved she was healthy have been used against her. Denied.
I feared this might happen when I left my day job. But none of us has diabetes. Or cancer. So I naively figured we’d pick up an individual plan at a higher rate than we paid from my previous employer. I figured it might be as high as double or double and a half the amount with a higher deductible. Oh how wrong I was. COBRA was five times what I paid. Five. Per month. We could buy a second home for that amount of money. And furnish it entirely with Sasquatch-related paraphernalia.
I believe the United States is on the brink of a health care something. I read this piece in the Kansas City Star by Paul Krugman (which ran in the New York Times) about how the free market doesn’t work with health care. I couldn’t have stated it better. The “free market” for health insurance is subsidized by tax dollars and is geared to delivering coverage to those who don’t need it most. Insurance companies apparently only insure the healthy. Or those who work for companies with more than 3 employees (and who offer a group plan for employees). They spend great amounts of money and energy weeding out the sick and needy. It’s sheer insanity. I can hear the conservatives cracking their knuckles to comment now. Save it. As a small business person recently self-employed, all the Hannity in the world isn’t going to fix this problem. It’s going to take creativity, genius and sacrifice from every side.
We qualified for a state “high-risk” plan (Irony 4: it’s managed by the same monopoly company that denied us coverage), but the premiums are about three car payments a month. Two if it’s a really nice car. And that is with an enormous deductible. Enormous.
I’ve read where Costco is doing a test of offering it’s members health insurance in certain parts of California which was started this past summer. Since every state has different laws, Costco can’t just roll out a plan for all their members. How crazy is it that a company with millions of private members, who are ripe for health care coverage can’t offer a simple plan across state borders? What if Wal-Mart or Target started offering customers health coverage? I think we’d see some interesting options arise, but I don’t think that is going to solve the crisis.
I’m a believer in universal health care. Especially if the rich pay more. If I make a million bucks a year, I should have a portion of that money go to those who need it more than me, just for the opportunity of making that kind of money. I’d gladly pay it. GLADLY. Whether that’s in the form of a tax or part of my national insurance or whatever you want to call it, it would be wonderful to know that if I didn’t need the coverage, someone who did would get the benefit. I’m afraid I’m in the minority.
The biggest issues facing universal health care in the United States seem to be the powerful insurance lobby (remember the scary ads from the insurance companies in the 90s when Clinton wanted to give a health card to everybody?), the failed notion that free markets and competition will keep prices low and the paranoia that universal health care will somehow be a huge step towards socialism/communism. Add to this the decreasing employer contributions to health care for employees and in the next 5 to 10 yearsof continued inflation of health care costs this country will be in serious shit. I believe that it’s time to put some brain power into solving this issue. There has to be a better way. Creativity, genius and sacrifice.
I plan on writing my local and federal representatives about this situation, but I don’t have a lot of faith that I’ll be heard above the insurance lobby. Individuals who need health care coverage have little recourse. If I’m part of a group, I have guaranteed coverage, but guaranteed at what cost?
So anybody have a great health care plan that takes cornea transplant recipients, depression survivors and very cute toddlers that doesn’t cost three cars a month?
December 12th, 2005 at 9:43 am
Try looking into Bluecross TONIK healthcare.
That’s what I went with for my family after I got laid off. It’s not ideal and I can’t get maternity coverage. The good thing is that you sign up everybody individually, so one person’s conditions won’t affect the others. It’s pretty inexpensive and will cover the big things if need be. It’s limited but certainly an affordable saftey net.
Goodluck and I have been there (still there) as well.
December 12th, 2005 at 9:51 am
Claire wrote:
“Contrary to what some of my Republican friends think, Germany is not a socialist country”
Really? Let me give you a little breakdown of what *I* pay, as a freelancer, for all contributions here in Germany:
14% of income for health insurance (this varies slightly from company to company, but this is the order of magnitude)
19.5% retirement
1.7% nursing home insurance
5.5% “solidarity supplement” (for re-building East Germany)
35% income tax (varies; increases with income)
19% VAT = sales tax (currently only 16%, but will be increased to 19% on 01 Jan 2006)
-
Total: a staggering 94.7%!
If that’s not socialism, I don’t know what is. Moreover, the more I work (i.e. the more I earn), the higher my tax bracket; fine in principal, but the burden can easily go beyond 95%.
To be fair, the calculation for an employee is slightly better:
7% health insurance (employer pays the other half, i.e. 7%)
9.75% retirement (employer pays the other 9.75%)
0.85% nursing home insurance (employer pays the other 0.85%)
6.5% unemployment insurance (a benefit I can only dream of as a freelancer)
5.5% “solidarity supplement”
35% income tax (varies, increases with income)
19% VAT = sales tax starting in 2006
-
Total: 83.6%
Do I even need to mention gas prices of $5-6 per gallon? Even if I earn EUR 10,000 per month as a freelancer (which is a lot of money!), that leaves me essentially EUR 500 per month in my pocket for rent + groceries + essentials for my family. How should I pay a mortgage then, let alone a car payment? Why should I even bother working, when welfare recipients in Germany get all of the above benefits plus their rent paid, plus a small allowance of EUR 100-500 per month, depending on family situation?
My point is: it’s of course nice to fantasize about how great socialism/universal coverage is; the reality however (in my experience in Germany) is quite different.
December 12th, 2005 at 10:05 am
Carl Camden, President of Kelly Services has some interesting ideas.
December 12th, 2005 at 10:06 am
Seeing all these comments only reinforces your prediction of a “health care something” on the way. I would estimate that at least 80 percent of the people I know and meet have no reasonable health insurance. I myself don’t, though I’m in grad school an covered by a “health fee.” I can see a doctor if I’m sick, but doesn’t cover anything more serious. I’m always wondering stuff like, “What will happen if I slip on the ice in my driveway?”
My father is a cancer survivor (no chance of remission) and a type 2 diabetic. He works out regularly, eats a good diet, and is in better health than most people half his age (including me, I think). But because of his preexisting/previous condition, his monthly payment is around $450 ó and the deductible is astronomical. He’s lucky that he can pay it, but I fear what might happen if he ever had to use his insurance. I feel a lot of people are in a similar position: they have insurance, but they don’t use it as they should out of fear of their premiums going up. It is a totally non-functioning system.
It’s such a frustrating situation, and one I feel I can do little to correct ó all I can say is that I thank Jeebus for Planned Parenthood and other public health organizations.
December 12th, 2005 at 10:16 am
Michele, while I know that universal care is expensive, I question your numbers. is your retirement contribution mandatory or voluntary?
VTOL. Give me a break. Have you joined an HMO or are you on insurance? What “freedom” do you have on those plans? Freedom to be covered or not. Freedom to choose ONLY THEIR DOCTORS. That is not freedom. You are mistaken to label it as such. Again, agenda pimping and partisan talking points aren’t going to move this forward.
December 12th, 2005 at 10:30 am
Blurb, you’re confusing the issue, as well as spouting off about ‘talking points’ every time you read something you disagree with. I said nothing concerning HMOs or insurance. I was speaking about the freedom of choice. Freedom to choose is not a talking point. By creating additional taxes, I have less freedom to choose what I believe is financially best for me and my family. I’m a small ‘l’ libertarian and this is not a talking point. It is fundamental to the political theory behind the movement (albeit a small one in these days of big government).
Again, do I think something needs to be done, absolutely, but not at the expense of lessening my liberty. This is where the creativity and genius you originally posted about come into play. A compromise that is ultimately tax neutral by downsizing or eliminating some programs in order to create a much needed benefit for those who cannot get health insurance/coverage any other way.
December 12th, 2005 at 10:32 am
I see that you have a million comments already, but I wanted to chime in. I am a fully “Hannitized” conservative, and I agree with you whole-heartedly. I have a very healthy family. I also have a son with a rare form of hemophilia, but he has never had a problem - yet. My husband is in a residency right now, but he finishes in June. At that point he will open his own practice. What kind of country do we live in when 2 healthy professionals who pay way more than their fair share of taxes can’t afford health insurance? I may have to go back to work full time just so that we can once more be covered under federal health insurance. Totally sucks.
December 12th, 2005 at 10:46 am
Yeah, there’s a way around it–you don’t give insurance companies any of your prior health information. They’d have to subpoena your medical records to get it. NOT helpful if you apply to the same provider as you were with previously. But it’s an unfair system, so why fight fair when they don’t? Don’t give them ammunition.
December 12th, 2005 at 11:37 am
I did not realise the extent to which the US healthcare system was broken until I moved here 2 years ago. I have spent many years working in the NHS in the UK, and nothing has prepared me for the mountain of health needs that are unmet in the USA.
There are serious problems with the NHS in Britain, but you would never get people being excluded from healthcare because of their inability to pay. I have heard numerous horror stories of people caught up in catastrophic health events who go without medical care because of cost here in California.
Although the exhorbitant price of health insurance premiums astounds me, what I find even more remarkable is that there is no truly widespread outcry about the gross unfairness built into the system.
December 12th, 2005 at 11:37 am
When Toby and I worked in San Francisco, we didn’t have health insurance because we missed the window to sign up. Whatever. Pain.
When we moved to NYC we got insurance through Toby Joe’s job. However, we would not be covered for any major issues since we didn’t have existing insurance. Basically, they would not cover us because we couldn’t prove by way of another insurance agency that we didn’t have any pre-existing medical problems. (Maybe you would have had better luck had you said you had no previous insurance. This is only just occurring to me. I have no idea.) We had a 6 month window where they would cover doctor’s appointments but nothing more. So we just crossed our fingers and hoped for the best. After six months, we proved to be healthy individuals and they covered us again.
When he left that job and took another job with a new design firm who is based out of Boston but decided to open a NYC office as well as a San Francisco one, we didn’t have insurance for a bit while they worked out their incorporated status. Anticipating a long wait, I began to shop around.
I called all the big ones. The one woman quoted an amount to me (more than our NYC monthly rent). Here’s how the conversation went.
“HI, how much is it for my husband and I to get PPO coverage?”
(Answered a few questions about my age, how much we drink, smoke, etc.)
“For what you had before it will cost 1300 dollars a month.”
(Silence)
“Hello, ma’am, are you still there?”
“Yes, I am here.”
“Ah. Yeah, most people hang up at that point.”
“Yeah, I can’t afford that. We can’t afford that. That’s more than our rent.”
“I know. There is one other option.”
“Shoot.”
“You pay 265 a month and we cover any emergency procedures. That way, should anything go horrible wrong, you’re insured. You, however, pay all doctor’s visits, etc.”
That’s what we did up until Toby Joe insurance came through via his new job. Now, we’re fine. We have a PPO and can walk into any doctor’s office we want (out of network and everything.) It includes dental, too. But what a pain it was getting to this point. And we both have full-time jobs now. Before, I worked from home and he contracted. Sometimes, I wonder if you’re better off just taking as much money as you can and putting it in a Roth Fund of some sort. Pay out of pocket for doctors visits and keep money on hand should anything come ups. However, should something go horribly wrong it’d most likely break the bank if not bankrupt someone.
On the flip-side, if nothing ever goes wrong, you end up thinking like my father. Recently, he calculated how much he spent over the years on insuring our family. It came out to something astronomical. He then calculated how much we spent over the years on doctors, even major operations. In the end, he’d have been better off paying everything personally and passing on the corporate health insurance.
But hindsight is one thing. Taking that kind of a risk can prove devastating.
I know it’s a NYC based site, Does Utah have anything like HIP or Working Today? (http://tinyurl.com/68nmb) A freelancer I work with uses them. Affordable, more or less.
December 12th, 2005 at 11:38 am
Very sorry to hear that. I am a small business(restaurant) owner and I was married(now divorced) to a woman who had a health plan. When we divorced, I had to get my own health insurance. Mine is not so bad as a monthly payment, but it is high deductible. I agree that if I was rich, I wouldn’t mind a portion of my payments/deductible going for those in need. I hate the great inequalities in this country between those that are rich and those in need or poor. As a side note: The people with money that come into my restaurant are usually the worst tippers
December 12th, 2005 at 11:42 am
Healthcare isn’t necessary. Just ask Tom Cruise what to do!
(sorry, couldn’t help it)
December 12th, 2005 at 11:55 am
One more thing, I agree with many of the above suggestions, become an LLC.
December 12th, 2005 at 1:07 pm
I agree that it’s insane, but I sell health insurance and here’s what I see most of the time: our company won’t insure anyone with more than 2 violations per household, not per driver in the past year. Same goes for health insurance: if you had a cold last year, there’s a chance that they may have to pay out a claim, and that would mean less money for the company. I think it’s complete and total crap, but there’s nothing that we can do about it.
I would try checking out some independent insurance companies. They can usually write those who have been declined by another company, although I don’t know how the rates would compare.
I see it everyday and it makes me sad that those who need health insurance are the ones who cannot get it. Cobra is ridiculous, and there are lots of jobs that do not offer health coverage to their employees. That makes it really tough.
December 12th, 2005 at 1:12 pm
One more thing: In OK, at least you cannot be denied care because you are unable to pay. I belive there is some sort of law that states that a health care provider cannot deny coverage to someone in need.
We have a ginormous deductible, and we just have to make monthly payments on our health care the same as any other bill in addition to our health care coverage
December 12th, 2005 at 1:56 pm
Sorry to hear about your coverage. It’s very scary. There’s a program here in California that pays for children’s insurance, maybe there is something similar in Utah. Also, there have been a few laws passed recently that say that insurance companies can’t deny health insurance to you if you are eligible for COBRA (within certain guidelines) I’d suggest checking them out just in case, they are HIPAA (Health Insurance Portability and Accountability Act) laws.
The lack of access to health care in the richest and most powerful country in the world _is_ going to cause something to happen. If it happens on its own, it will be messy and the people who are the least powerful will likely get most screwed. If we help it happen, there is a chance that we can bring about a change for the better.
I’m a medical student who is very apprehensive about the world I will be practicing medicine in. I personally believe that access to medical care is a basic human right, especially since doctors have complete power over life-saving medications and technology. (Even if you choose to provide your own healthcare, researched the medications you needed to buy and the lab tests you would need to perform, you would not be allowed to do these things. Your “life/limb” depend on your ability to pay.)
Here are a few embarrassing but true statistics on the quality of care in our country.
- There are more than 40 million uninsured and 80% of them are employed or family members of those employed.
- A person who is making two-three times over the poverty level is expected to spend more than 10% of their income on insurance and could still be forced into debt by an illness because of high co-insurance costs.
- companies like walmart that provide substandard benefits have the highest number of their employees on state poverty support programs. (basically, walmart enjoys multi-million dollar profits while taxpayers pick up the tab)
- and here’s one for those who still believe that “government” is the most bureaucratic organization :
Percent of every dollar spent on NON direct health care expenses (administration, paper work, billing, etc.):
Health Net $0.29
Blue Cross $0.25
Kaiser $0.11
Medicare $0.04
December 12th, 2005 at 2:18 pm
Blurb, can you give me an idea of what payment you’re talking here? 2 car payments is what — $500-600? I agree that healthcare is a mess, but considering what you guys have been spending in healthcare over the last few years, I think you better take it.
Or, let me put it this way: How much did the cornea transplant + a pregnancy + heather’s treatment + 2 MRI cost the insurance company? Nevermind all the office visits a pregnancy and baby require.
Or, let me try it this way: Insurance is crazy in America these days, but health care costs are CRAZIER. If I were you, I’d pay the 6-8 grand a year. Let us know what you decide to do.
December 12th, 2005 at 2:35 pm
as a med student who just took a healthcare economics final exam this morning, i thought this might be relevant: it is one of the exam questions we had today (yes, i know it’s easy basic math, but i think the point was to get future doctors to realize what it means for a “lower middle class” american to get health care):
“sandy works at store clerk and earns $25,000 before taxes. her employer does not offer insurance, and sandy pays for her own coverage at $500 a month. in july, she finds a breast lump, which is biopsied and determined to be an in situ carcinoma. it is removed and she does not need chemo or radiation, but the cost of her treatments are $75,000. if sandy’s health insurance has a $5000 deductable and she is required to pay 20% co-insurance, how much will her health care cost her this year? (assuming that she has no other medical conditions)
answer, of course, is $25,000.
the scary thing is that the question didn’t address what sandy will do about her health insurance once her premiums skyrocket (because she now has a history of breast cancer).
December 12th, 2005 at 2:59 pm
my honey-man’s son was denied coverage because he has a rather large (silver dollar size is all), hairy birthmark on his right ankle - otherwise perfectly healthy. No coverage. Totally baffled.
December 12th, 2005 at 6:20 pm
Have having repeated problems with a broken bone that didn’t heal properly and eventually required surgery to fix (the bone had to be screwed back together) I can say that health insurance would’ve been nice, especially since I’m unemployed. I was very lucky in that my family was able to help with the bills (roughly $5,000 to $6,000 so far).
Is it possible to have universal (national if you prefer) health care without bankrupting the country or increasing the taxes so much that people - rich or poor - can’t afford anything else?
December 12th, 2005 at 6:38 pm
I read this post comments last night and all day I’ve been thinking about it. I have no answers or solutions but I keep thinking how what is happening to you and millions of others is unethical.
When Mother Jones held up children’s hands with missing fingers that worked in factories, people came to see that child labor is wrong and it was legislated out of existence here. But when a woman’s son dies today b/c he couldn’t get the proper tests run due to lack of insurance, what do we do? What is happening to my country?
The free market is a false god.
December 12th, 2005 at 6:49 pm
There really isn’t a need to increase taxes in order to nationalize health care - it would just need to be PRIORITIZED. We’re spending $200 M/day on the war in Iraq alone. If you moved just a small fraction of the Pentagon’s budget into a national healthcare budget, the problem would be solved, no additional taxes needed.
What it really comes down to is that the 30-something million Americans (we’ll focus on them for now, talk about the immigrants later) who don’t have health insurance are not lobbying effectively or organzing effectively enough to overpower the health care industry lobby (which wants to keep things privatized and profitable) and the war industry lobby.
Why is that? What are we going to do about it?
If every person without health insurance made daily phone calls and meetings with their elected officials until the health care crisis was resolved, we’d probably have universal health care legislation passed within a year and it would be implemented within five.
December 12th, 2005 at 7:25 pm
That is a very difficult issue, Marcus.
It’s true, health care is expensive and every country that has a national health care system spends a lot of money on it. Many of these countries have deficits. (Of course, none of them have a deficit as big as ours.)
However, if you don’t have guaranteed health care in, an illness can completely derail your life (this includes people who pay for their own health care and can see their rates astronomically rise). 1 out of 100 women gets breast cancer each year. 1 out 100 men get prostate cancer each year. And there are many other common cancers out there, as well as chronic diseases like asthma, diabetes and heart disease that affect an astounding number of people around us. At some point in our lives we will all get one or more of these, and if we don’t have insurance, the disease and its treatment will permanently alter our lives, as well as the lives of those who are financial dependent on us.
Now imagining that scenerio playing out in 1 out of 4 households in the United States. It is not a problem that this country can ignore.
The solution to our health care crisis will probably not be a perfect one, but it will be better than nothing. Scare tactics against nationalized healthcare systems are ill-informed, at best.
Here are some well-researched facts that counter many of them:
- The US spends the most on healthcare than any other country, but has lower life expectancy and higher infant mortality than any country with universal health care.
- Satisfaction rates for health care services are higher in Canada, the UK, and Germany than in the US.
- Waiting times for elective surgeries in these countries are much longer than in the US, but average emergency room watiing times are shorter.
- Pharmaceuticals cost 40-50% less in countries with governmental health care because the governments can buy in bulk and negotiate the prices. (Don’t worry, pharm companies aren’t suffering. They’ve had the highest profit margins, after oil companies, for the past few years)
- The costs (as a percentage of total) of health care administration in the US is 2-5 times higher than in countries with nationalized health care systems. (A large chunk of health care money is going towards paying for profit insurance companies. Another big chunk is spent by doctors who have to hire administrators to do the enormous amounts of paperwork require for reimbursements).
December 12th, 2005 at 7:31 pm
John,
Why don’t you move to a country with universal healthcare and tax rates of 70% on all income? I believe Sweden, Canda, and Belgium just to name a few have what you are looking for. I think it just that you need to live in a society that agrees with you and you can redistribute the wealth with these other countrys instead of trying to change a system that people in the USA want, which is to have the most modern up to date second to none health care in the world. I love when people say if I earned a million dollars a year I would gladly pay more for everything to cover all those who can’t afford it. What a joke. Once you pay up to 60%-70% total taxes on that kind of income state and federal. You will think twice about that comment because you will still then drive the same Yugo and live in the shoebox house and work for that million dollars so others who don’t do anything will have more than you. Think through your comments before blathering.
December 12th, 2005 at 8:06 pm
In response to Al:
Before taxes, I make roughly 30K; after taxes, about 22K. Okay, so this is nearly 30% of my income that’s taxed (and to be fair, I’m probably taxed a little more than others in my income bracket because I’m an adjunct who holds two part-time contracts that actually equal more than full time). Okay, so after my taxes, I have 22K for the year. This means less than $2000 a month. I don’t have health insurance because my job doesn’t give it; I’m not one of those “others who don’t do anything [and] will have more than you.” I work nearly 70 hours a week.
Let’s pretend you make $200,000 a year. Let’s pretend that you pay 70% of that in taxes (and that’s to use your example. No one in the United States pays 70% in income taxes). Still, if you did, you’be be left with $60,000. May not seem like much but it’s still three times more than I have. And you have health insurance. And you’ll at least be able to drive a Corolla with a cd player. C’mon, Yugo?
The point is, those who have more will still have more, even after contributing to universal health care.
And what if we were both taxed 70%? Then I’d have 9K and you’d still have 60K. That’s pretty disproportionate to me.
The poor aren’t trying to take money away from those who have it; the poor just want to support themselves.
And regarding your claim that we have second-to-none health care: this is only true for those who have enough money to pay for it.