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Life and Times of a Working Cowgirl

The Fleecing of an American

 

Let me start by saying I’m mad. I’m damn mad and if you are looking for my usual lighter side of life article this isn’t it. I promise to return to my more jovial self but sometimes anger is the motivator we need to affect change and change is what needs to happen. Four years ago the majority of Americans voiced their opinions that as Americans we should not be forced into bankruptcy as a result of healthcare costs. The majority of Americans agreed we needed a system of healthcare that would protect us both physically and financially. Somehow what the majority of Americans wanted, talked about and agreed upon morphed from healthcare to health insurance reform. Somehow the conversation was swayed away from healthcare and the fundamental rights of all our citizens to have access to healthcare to the need for all of our citizens to be insured. Now some of you may think that is just semantics but I assure you it is anything but.

Health insurance is a designed to be a profitable business. The top priority of a health insurance company is to make money. That is not a bad thing or is it fundamentally wrong however there exists a conflict of interest inherent in this business model. In order to provide it’s shareholders with maximum profits, insurance companies must find ways to control costs. The easiest way to control cost is to limit benefits and or increase premiums. This is a gross oversimplification of the process but it holds true. Insurance companies have no long term commitment to their policy holders and have no guarantee that any benefits they provide will save them money in the future. Therefore their business model must be based on current need and current condition.

Healthcare is a life long issue. This single issue affects every citizen from cradle to grave. When profit and loss sheets include quality of life, length of life, suffering and happiness the picture develops a lot differently. As Americans we have a long term vested interest in the health and well being of our citizens. Ensuring our citizens healthcare needs are met promptly and efficiently provides us with the long term benefits of a healthier workforce. When we collectively accept the responsibility of our nation’s healthcare we gain some control over our future. Our citizens are free to live healthier lives based on our national conversation not a profit and loss sheet for some multi-national corporation.

How about some real life perspective. When I was a child my father was a teamster. The teamster’s union provided our health insurance. It was a good plan that covered most things in a time when most people didn’t have health insurance. The teamsters were self insured, which meant my dad’s union dues went to cover the medical bills of every member. Dues were collected, bills were paid and the remainder stayed at the union. Simple enough, right? When my mom went to work she to worked for a union, her insurance would pay anything that dad’s didn’t, even better. This worked out great for us and the unions. Each union only had to pay a portion of the bill and still collected the full union dues. Two working adults with insurance was good for the entire community. When I started working, my husband and I both worked for the same company, same set up until after our first child was born in 1993. Then things began to change. First even though we both paid, only one of us could carry insurance. Our second daughter was born in 1996, her birth cost around $5,000 of which we paid 20%. Then we began having to pay for our health insurance, it was no longer considered part of our salary. This resulted in an annual 3%-5% pay cut as the premiums rose, our wages stayed stagnant and co-pays were added. Along with the premiums rising, the cost of services have been on a steep upward trajectory. In 1993 an emergency room visit cost $75 of which the insurance would pay 80% so the net out of pocket was $15 pretty affordable for most people. Now our co-pay is $75 and then we are billed 20% of the bill which there is no way of knowing what that will be.

In 1999 my oldest daughter was diagnosed with Type 1 diabetes. Although this is not a terminal condition it is a life long condition. There is no cure, she will alway require medication and medical care. My goal for her life is to ensure she is healthy enough to be cured when they finally find a cure. We have been proactive in her healthcare and managed her diabetes with a keen awareness of long term effects. I am happy to say she is very healthy and has no long term damage from being insulin dependent for over twelve years. She has maintained a quarterly regiment of appointments with an endocrinologist and has never been hospitalized for complication due to her diabetes. She is the poster child of how well you can live your life with diabetes. This has not come without a tremendous commitment or significant financial stain on our family. Thankfully we have been in a position to provide both for her.

Two weeks ago Amelia was home for the weekend for college. She brought her diabetes supplies, her diabetes alert dog, and like most college kids, her laundry. Our weekend was off to a great start and we had just enjoyed some pizza and a movie when she went to the fridge to get insulin to change her infusion site for her insulin pump. She dropped her insulin on the brick floors in the kitchen shattering the glass vial. Suddenly things weren’t going to well, since she was going to be home for just a few days that was the only bottle of insulin she brought. The current local time was 10:00pm on Saturday. The nearest 24 hour pharmacy is over 30 miles away and since her medical supplies are shipped directly to her as stipulated by her insurance company, she doesn’t have a prescription for insulin on file with any local pharmacy. Our only option was to go to the emergency room at the hospital and ask for some insulin. So off we went to the ER. Now Amelia was in no immediate danger, however since she has an insulin pump she had no insulin in her system, she had just eaten pizza and her blood sugar would soon be dangerously high. We checked into the ER and asks if they could just give, sell or donate a bottle of insulin so she could fill her pump and prevent her blood sugar from rising. Predictably we were told she would have to go through the system and to have a seat. A triage nurse weighed her and took her blood pressure then we waited two hours for the doctor to come in and hand her a bottle of insulin. She drew 300 units of insulin out of it and gave it back to him. In the time it took for them to get her insulin, her blood sugar had risen form normal to 300. The kicker to this story is not the inconvenience or the lack of actual care, but the $4,330 her insurance was charged. An entire bottle of insulin costs $60-$70 retail and holds 1,000 units, so she used about $20 in insulin. She required no diagnosis, no care, not even so much as a needle. She provided her own infusion site and reservoir and pulled the insulin from the bottle herself. Our system of health insurance dictates share holders need to be protected, not patients or our nation, therefore they can justify charging as much as the market will bear.

We will contest the charges and the hospital will amend the bill but not without a lot of time and energy and it will still be astronomically inflated. ¬†In the end we will be responsible for several hundred dollars, which is a small price to pay for Amelia’s life, however if she were on her own, like many people her age, working at an entry level job, how would she be able to manage several hundred dollars for twenty dollars worth of insulin? What would she do without in order to pay her medical bills? How much does our economy suffer as a result of this outdated and antiquated system we cling to? What are we doing to and for our citizens by ignoring the evidence provided by the rest of the industrialized world, that healthCARE is as much a public issue as the fire department, the police and public education?¬†Amelia has done nothing wrong, she has Type 1 Diabetes. She is capable of being an extraordinary citizen and contributing great things to this country. All she needs is insulin to keep her alive so she can make that happen. Should her physical and financial health be risked over the simple act of dropping insulin on the kitchen floor?

I have a prescription for insulin now, I got it from my Veterinarian. If I get it from the doctor we will be charged out of network for going to the local pharmacy and the insulin will cost $100 but if it’s for the dog I can pick up a bottle at Walgreens with a coupon for $40. Yeah it’s a great system. I don’t know how to fix our system and I know there are flaws in every system but I would really like our national conversation to go back to health care instead of health insurance. Our country can’t succeed without healthy citizens. It is in everyones best interest to find a way to ensure every American has access to health care that will not send them to the bankruptcy court after the ER. Please listen closely the next time someone talks about healthcare in the media. I bet they are actually talking about health insurance and I have 4,330 reasons to not say that’s not semantics.

4 Comments

  1. I couldn’t agree with you more, and if I weren’t so angry myself right now, I would tell you my own story about corporate interests and healthcare (or the lack thereof), or a different but similar story about insurance companies, greed and our lawsuit happy American lifestyle.

    But, I’m really pissed off right now too, coincidentally enough and can’t trust myself not to say things I wouldn’t necessarily say later.

    I read your blog all the time and really enjoy it. Thanks for writing.

    • Thanks for reading and supporting my blog. I’m sorry you are having healthcare (or lack thereof) issue and unfortunately I think we are in the majority not the minority. Maybe if we all find our voices something can change. If not, at least I got it off my chest so I can move on. Thanks again for your support and let me know if I can do anything to help.

      Karen

  2. I couldn’t agree with you more, and if I weren’t so angry myself right now, I would tell you my own story about corporate interests and healthcare (or the lack thereof), or a different but similar story about insurance companies, greed and our lawsuit happy American lifestyle.

    But, I’m really pissed off right now too, coincidentally enough and can’t trust myself not to say things I wouldn’t necessarily say later.

    I read your blog all the time and really enjoy it. Thanks for writing.

    • Thanks for reading and supporting my blog. I’m sorry you are having healthcare (or lack thereof) issue and unfortunately I think we are in the majority not the minority. Maybe if we all find our voices something can change. If not, at least I got it off my chest so I can move on. Thanks again for your support and let me know if I can do anything to help.

      Karen