BREAKING: I don’t need overpriced junk

by , posted on Thursday, December 17th, 2009 at 3:32 pm

I need health care. Which the Senate bill will neither provide, nor provide access to for uninsurable people like me.

Sorry to put the “Breaking” into the title, but this appears to be news to so many diarists and commenters that I thought it was justified.

Also, sorry to be repetitive, as I posted much of the same appeal here recently, but there seem to be so many people deluded by the belief that at least the Senate bill offers access to care for the uninsured that I can’t help thinking someone, possibly lots of people need to repeat this, in real terms, until we are debating reality.

This is a piece of junk legislation, that will lead to junk “coverage” and continued lack of care for people who are currently most damaged and most at risk because they have been uninsurable – in some cases for quite a long while. In short, for people like me, uninsurable people, it is worse than the status quo.

First I want to make a distinction between the uninsured and the uninsurable. The latter are necessarily both in America, unless and until they are completely depleted of resources and so ill that they can not work and are forced onto Medicaid – at which point it is often the case that it is too late to save them and/or they leave behind bankrupted families. You can be uninsurable because you currently have a “pre-existing condition” that is expensive to treat, making you unprofitable for insurers, or you can be uninsurable because you have a medical history of once having had a pricey condition – as is my case, I am a leukemia survivor, currently free of that or any other disease.

The uninsured are uninsured for a variety of reasons. Many, many of them are uninsured because they are not dumb. They are young, healthy, have no dependents, and the odds of them getting sick enough to need extended or expensive care are slim to none. In such a case you might tally up what insurance will cost you and make a decision that you are better off concentrating on paying off your student loans or saving a down-payment on your first home, now, while you are young and healthy. Of course, it makes sense that if these young and healthy decline to participate, the insured groups are sicker and older collectively, and the collective risk of payouts is higher, and this older and sicker population is more at risk of suffering ruinous, calamitous expense. Mandates are meant to address this problem. They are meant to get everyone in to spread the risk evenly across the healthy as well as the sick population. Single-payer proponents will point out that “duh” that’s why we need single-payer. And, imho, they are right. Put everyone in Medicare and voila! we aren’t, as taxpayers, supporting a collective medical system populated entirely by those 65 and older, so most at risk of needing continuous ongoing expensive medical care and we don’t just get everyone covered, we do it in the least expensive manner and create the sort of Medicare solvency that is only a dream at this point. Will the Senate bill force the young and healthy in? Hey, if they are already making the calculations and coming to the decision that they will take the risk – and they know there is risk – I have my doubts that imposing a $750 fine for failing to comply will make them fork out thousands in premiums over a year instead.

Then there are those who are insurable and uninsured and would desperately love to be insured. If they could afford it. But they can’t. I know couples and single-parents with kids who are in this group. They aren’t offered insurance through work, they cover their kids through Illinois All Kids, which is relatively cheap, but gradually, over time, their private insurance has creeped up so high that they’ve dropped Mom and Dad’s coverage just to make ends meet. They just can’t pay it, at least not without selling their homes. And they might well make too much to qualify for the vaunted subsidies we are all talking about, which frankly aren’t that great. Will these people comply with the mandate? I have my doubts about that too. The people I know in this category really, really worry about going around uninsured, but their backs are already being broken by their living expenses. Mandating them to pay thousands for private coverage – which many in this group already know from bitter experience is junky enough to offer them little in return by way of benefits they actually use – probably won’t do the trick for many. They’d already have insurance if they could afford it and this legislation is not going to drive down premiums.

Then there are those who, like me, are uninsured because we are uninsurable. There are degrees of uninsurable too – in my case uninsurable means that no one will carry me, not for any amount of money. In some cases it means that no person, short of being a millionaire, could afford the punitive premiums designed precisely to drive them away. We uninsurable seem to be the people that I see countless comments and diaries addressed to lately – the poor, sick people who will at least have care for a change. In the first place, we don’t really account for 36 million uninsured, we just account for the small percentage of those 36 million who are most at risk.

In the second place, there is not a lot in this bill that will help change the status quo for us, and if it does change, for many of us, it will make us poorer and further limit our access to care.

I am healthy, and have been pretty healthy since I recovered from leukemia more than a decade ago. But I had it. It was expensive despite the fact that I had great insurance when I did and in more than just one way – for instance I missed an entire year of work at a point in time when I had four children, two of them in college. And I was in the middle of a divorce. And then I got to be a single mother of two who struggled to pay premiums to my state’s high-risk pool for uninsurable citizens while ALSO paying any medical expenses I accrued out of pocket, because it was junk insurance.

Here’s how it worked. If a company sells health insurance in Illinois it is required to participate in the pool for unisnurable Illinoisans. There aren’t really strict controls on premiums, so they are sky high for people like me, who are employed, and employed pretty well, but have no dependents so also do not qualify for subsidies. But if you already have plenty of debt you are servicing (in the case of many uninsurable people mountains of debt is a foregone conclusion – see the medical bankruptcy stats if you don’t believe it) layering sky-high private insurance premiums on top of this is just not possible. As in, can’t be done. At least without pushing these people further in debt or all the way into bankruptcy, as they struggle to meet their monthy premiums, debt repayments, and continue to pay out of pocket for all their medical care.

But, heh, you may ask, you have coverage right? So why are you paying out of pocket for everything? It’s simple: the coverage doesn’t cover anything. Really, it does not. The policy I paid sky-high premiums for – more than COBRA on my “great” insurance – covered exactly this and only this: 50% of hospitalization, provided it was pre-approved, and with a cap of $50,000 annually, and a really huge up-front deductible – I’ve forgotten what the exact deductible was. Quite frankly, what with my existing debt, if I’d needed a hospitalization that came anywhere near getting me any part of that benefit, I would have gone under anyway – I was just that much in debt already. And then the premiums went up and I just couldn’t pay them and eat as well.

That’s the wall I hit, and that’s why I no longer have any kind of coverage. Just as well, really, because I have since taken on more debt paying out of pocket for both my own and my adult daughter’s medical care and living expenses while one or the other of us was too sick to work. So I’m going to be frank about this: I don’t need to pay for junk, I need access to health care. I don’t expect it to be free, I’ve paid plenty for care over the years, and expect I will continue to do so in one form or another. But I’d like to get some actual return on my investment in insurance company shareholder profits, a return that might help me do frivolous stuff like go to the doctor when I’m sick, have tests I was supposed to have years ago, buy medications, that kind of silly stuff.

And I’m currently healthy. Go check in with someone who has continuous monthly ongoing medical expenses and ask them how much they are looking forward to continuing to pay for them out of pocket – as the Senate bill will almost certainly condemn them to do, considering it’s lack of annual caps and lack of regulation that will prevent junk insurance being the only option available to sick people and lack of control on premiums and lack of recission protection, etc – while also being required to pay large amounts of money to the industry that is doing it’s best – and will continue to do so – to ensure they comply with the Republican plan: die quickly.

Those of us who are uninsured because we are the sickest and the poorest can least afford to be burdened with a bill that will make us poorer and sicker too – since there goes that much more money we can’t dish out of pocket for actual care.

So for those of you who think it is a valid argument to say “at least we will get the sick and the poor insurance” I can only say this: I know from experience that paying for junk I don’t need will not get me care, and will make me less able to pay for all my care out of pocket.

Which apparently I will continue to be forced to do.

No one is sadder about that than me, but there it is. So can we at least debate that reality?

crossposted at DailyKos


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