Ponderings of a slightly political nature

[vg_ford]

I'm leaving this as an open, unf-locked post, because I'm interested in hearing what people think on this.

I've been reading the CNN coverage of "Sicko" and thinking long and hard about things, from both sides of the arguments. I work in health insurance (recordkeeping), so I see not only what people pay every paycheck or month, but what the companies pay as well. I also have a chronic illness, and I've dealt with it with and without insurance, and I know first-hand how much medicines cost. As I've been reading the comments in the blog below (and I have not seen "Sicko," so I'm only going on what I'm reading here), I've been doing a lot of thinking.

I have at least one Canadian on my flist who is going through hell right now dealing with the socialized medical system. As Canada is the country normally held up in the "well, we should have universalized health care!" debate, that's why I'm bringing this up.

For those who don't realize it, when you pay for health care premiums out of your paycheck every month or week or however often you get paid, your company also pays a premium. Let's say, for example, that you are paid weekly, and you cover yourself, your spouse and your two children on your account. You pay $125 a week in premiums for your medical.

What you may not realize is that your company pays as well. If the premium for Member Plus Family is $1100 (which is fairly typical), then your company pays $975 per week for your health insurance. Which is why, when people leave a company and get their COBRA information, they freak. COBRA, btw, isn't a medical company program: it's a government act that allows you to continue your CURRENT health care coverage at 102% of the premium for up to 36 months. So, in our hypothetical situation here, you get laid off. You get your COBRA paperwork, and your monthly premium would be $1122 to cover your family. Once your 18 months (36 if you were disabled, or a dependent that aged off a plan) is up, you are responsible for finding your own health care.

Now, on to Canada. I wanted to do some looking on my own, so I googled Canadian Health Premiums. I came up with the Canadian Health Act FAQ, which is a very interesting document. Especially since it turns out that Canada really DOESN'T seem to have universal health care: according to the FAQ, they have a national health INSURANCE plan, which is different. Interesting stuff.

On the other side of things, like I said, I have a serious health condition. I have Crohn's disease, which requires me to stay on medications for the rest of my life. As of this point, I have a fairly mild disease, and am only on 3 medications. At the most extreme end of this disease, you can go through tons of surgery, ending up with a bag on your side and not being able to eat ever again (it's called "total parenteral nutrition" or TPN). And since Crohn's is an autoimmune disease, it seems to bring along a whole host of other problems.

I'm currently on Pentasa, which retails without insurance for $0.58 per pill according to HealthPricer.com. I take 3 pills, 3 times a day. In an average month, I take 270 pills. That's $156.60 for a month. Without my insurance, if I order it over the internet. (I currently pay $20 a month, because Pentasa is not a generic drug yet).

I'm also on Remicade, which is an infusion drip that I get every 8 weeks. The medication alone is $2000. Just the medication. That doesn't cover the nurse, my hospital stay (I get it done in the infusion suite), or the prep kit (Benadryl and Tylenol). Again, because of my insurance, I pay $20 each time.

I'm also on Prilosec, which I'm not going to link to, which I could get OTC but is cheaper with a prescription ($20 for 90 days vs. $20 for 20 days in the store). That's it.

I went without health insurance for one month, during which time I paid approximate $300 dollars for my Pentasa in the store (this was about 5 years ago too, so that's why the price has gone down), and stopped my Imuran (which I am no longer on) completely because I couldn't afford it.

So what's the answer? Honestly, I don't know. I know I'm damn lucky to have health insurance, and that I'm pouring every penny I can into my 401k because once I retire, I won't have any company-sponsored health insurance (my company doesn't offer it). And since I'm only 33, and Medicare is going to be bankrupt by 2020 (when I'll be only 46), at this point, the only health insurance I'm planning on is what I will have put aside for. Sad, but true. I'm going to do some more digging - see what I can find out about treatments for folks with my disease in other countries. I know that the several Canadians on my email list for Crohn's (off of Yahoo groups) say they don't have access to all the medical treatments and medications that we do here in the States. And one of the comments in the CNN blog mentioned that the US does do a LOT of cutting-edge medical research.

I'm going to keep following this, but I'm curious to find out what the folks who read this think. What's your answer? Links welcome!!! But please - I know this is a hot button issue. Remember my rants from a bit ago? I don't like fanatics - let's have a reasoned discussion.

Where do you stand on health insurance?

Comments

[queenoftheskies.livejournal.com]

I've had both good and bad experiences with health insurance.

I've gone without insurance. I've worked where I had my insurance paid completely. I've worked where I paid 3/4 (or more) of my insurance myself, and currently, I work where I pay half my insurance myself.

Where I work now, though, because of the number of employees split over three divisions, that amounts to less than $200/month, which is a HUGE cut compared to what I've been paying at other places I've worked.

I, too, have some chronic trouble...diabetes and high blood pressure. Both are in check, but kept in check with three medications that I must take on a daily basis. Two have been combined into one pill now, so it's now three meds in two different pills per day.

Last time I was without insurance, I paid about $550+ for a three month supply. (Of the two different pills.) That was hard.

Trying to live without insurance with a chronic condition is next to impossible. If I hadn't gotten insurance shortly thereafter, I couldn't have even tried to pay for more meds, because I'm required to go to the doctor every three months to have blood sugar and everything checked.

Then, there are the EXTRA tests that have to be done at least once a year.

Being in a position (in most of the companies I've worked in) to see how much employees pay vs how much employers pay, I have to say that what I've seen over the past few years is employers shoving the burden of insurance payments on employees.

I consider myself lucky now to be in the position I'm in. I have some good insurance at a reasonable cost. I'm not sure most people are so lucky.

[vg-ford.livejournal.com]

Trying to live without insurance with a chronic condition is next to impossible.

Oh yes. I have tests as well that I need (colonoscopies every other year, and blood tests every 3 months for the Remicade) and the bills were outrageous.

[macfrode.livejournal.com]

while I'll admit that insurance is a quandry, and I don't have the answer, I do have to say however that the Massachusettes law that makes you a criminal for not having insurance isn't the answer. I'm a criminal now for basically being too poor?? I could try to become a burden on society and go on the government dole, but as you can probably tell by my wording that is something I have avoided doing so far. I could see a state insurance plan that provided lower cost insurance due to the large numbers of people on the plan (like big businesses provide) that you could buy into if you CHOOSE to, but not this making people criminals. The kick in the crotch is that for the most part I don't trust modern medicine (I prefer naturopaths and they aren't covered by insurance) and would most likely not use it if at all possible anyway. So I should be paying $500 a month (which I can't afford) for something I don't use? And what about Christian scientists? No one has said if they are criminals now too for not having health insurance. (it's against their religion) Basically I feel like Mass sold it's citizens to the insurance companies and claimed they had achieved universal health coverage. It's like it never occoured to the powers that be that the reason so many people don't have insurance is that no one can afford it, the workers or the employers. Gotta love unfunded mandates, and then they wonder why we're the only state in the country that has lost population for 2 years running. I think Mass is going to get a history lesson, it's no coincedence that this is the home of revolutions and civil disobedience.

[vg-ford.livejournal.com]

I thought that there were lower-cost initatives in process for Massachusetts? Not that I've looked into it, though. But would you be willing to pay higher taxes that didn't cover the naturopathic medicines either?

It's a no-win situation right now, I agree. And I'll be following the Massachusetts situation with interest.

Thanks for the comments - it's given me more to think about.

[macfrode.livejournal.com]

yes there are lower cost alternatives, but it depends where you live in mass how low it gets, in Boston they say it can be cheaper but out this way the lowest i've seen that wasn't state aid funded was around $458 a month. So while I did round up a bit, that IS the lower cost plan as far as i know, hence my issues with it. Now you mention taxes, I don't know if it should be something paid by taxes or not, I've been avoiding using things that are goverment aid. Like I said, I would favor a statewide plan that offered lower prices because of the volume of people on the plan and people could choose to be part of it or not. As it is now there is no official "state provided plan" that does anything like that. There are "State approved" plans that are provided by the big insurance companies, but it seems like all that is saying really is that these plans are seen by the state as meeting the criteria the state is looking for. No it's not a good situation for health care, but it seems like you shouldn't have your health go in the toilet because you can't afford to pay for food and heat due to a goverment imposed health plan you can't afford.

[vg-ford.livejournal.com]

No it's not a good situation for health care, but it seems like you shouldn't have your health go in the toilet because you can't afford to pay for food and heat due to a goverment imposed health plan you can't afford.

Agreed.

[pickledherring.livejournal.com]

I don't have any seasoned intellectual tidbits to offer, just a hug. :(

I don't know what the right answers are, but I know the current situation bites ass for a lot of people, and I've been on the craptastic side of it. We're getting out of the military, which means no more free (for us) medical care, and my husband might have the beginning of Crohn's, we're not sure. I don't know what the future has in store, and it's a little scary. Anyway, *HUGS*.

[vg-ford.livejournal.com]

Well, you're actually pretty lucky - because he's retiring from the military, he'll be eligible for Tri-Care. TAKE IT!!! My folks are on Tri-Care and it's awesome. They pay a minimal amount each month, and their benefits rock. Like $5 prescriptions. As my dad's a diabetic, that's really good.

*hugs* to hubby with Crohn's. If you guys have any questions, definitely feel free to ask me in Chat or email me.

[therealmutley.livejournal.com]

wow you guys really pay heaps for medical insurance hey? I have no idea what it is like here to have a chronic illness and pay for it (without insurance) but at least to get insurance it's not that massive, and one day when I do get it, I will not bitch about it, knowing you guys got it harder. Good luck bud *hugs*

[vg-ford.livejournal.com]

Thanks.

It's one of those "It depends," over here, re: insurance. I don't pay that much, for example - it's $35.77 a week out of my paycheck for medical insurance for hubby and I. Not bad at all. But were I to go on Cobra, my payments would be approximately $800 a month. That's a lot of money. And that's JUST medical - doesn't include dental.

[tambowrites.livejournal.com]

We lived without insurance for about a decade. We didn't have any chronic illnesses, thank God, but we also couldn't afford to get really sick or injured. When the 'bad things' do happen, if your income is low enough - like ours was - hospitals, doctors and emergency rooms will work with you to set up an affordable (ha!) compromise, at least here in Iowa. Like 2 years ago, when I had a major rupture and nearly bled to death, needed emergency surgery RIGHT now... it came to almost $8k, outpatient. I actually had to pay about $850. Took a lot of paperwork, copies of our tax records, and a bit of running around and making phone calls, but they WILL help you find a way to pay what you can.

Doctors do too, at least here. When we were sans insurance, our physician billed us her lowest rate for office visits ($35) even if they were lengthy, and almost all of our medicines were free samples and/or VERY inexpensive generics. Like 2 weeks worth of a generic amoxicillin capsule was a bit over $5 through Walgreens. That helped a LOT.

We're insured now and surprisingly enough, there are more tests done, more little procedures, more 'options'. I know that when I hurt my wrist and they found that non-cancerous bone tumor, if I didn't have insurance they would have taken a 'wait and see' approach instead of actually going in to fix it. We had often been marginalized for not having insurance, essentially given a band aid to get us out of an after hours clinic so that our regular doc could deal with us later. We've had to ignore problems that probably should have been dealt with, like my husband's acid reflux and my depression. It ain't fun living sans insurance, but it's done every day by millions of people, especially the working poor. Too much money to qualify for state aid, too little to afford paying for insurance coverage.

Fwiw, I have friends in Australia and Britain, and they're astounded that we get treated quickly, that we don't sit around for hours/days/weeks waiting for a doctor or a hospital room. A friend's father NEEDED intestinal surgery badly or he would die. It took them 2 weeks to find him a 'slot' and he was so septic by then they doubted he'd survive. He did, but here in the midwest he wouldn't have had to wait. With or without insurance, he'd have received prompt care. I've heard similar stories from my british friends, how they might have to wait weeks to see a doctor and then receive minimal attention and care. From EVERYTHING they've ever told me, it sounds like a worst case scenario of visiting our local charity hospital, where most of the folks on public assistance go. Lots of waiting, little attention, crowded wards, and bare-bones care.

FWIW, our system isn't perfect and sometimes it sucks, but if we get socialized medicine or a national plan it won't be any better for the insureds than it is now for the non-insureds. Perhaps someone should focus on the bazillions spent on needless tests and procedures, the folks who go to ER for a little scratch, and who take their kids to specialists every time they get a runny nose. There are both extremes, you know. Those who receive little to no medical care, and those who suck it all up like nectar when they really don't need to.

[vg-ford.livejournal.com]

FWIW, our system isn't perfect and sometimes it sucks, but if we get socialized medicine or a national plan it won't be any better for the insureds than it is now for the non-insureds. Perhaps someone should focus on the bazillions spent on needless tests and procedures, the folks who go to ER for a little scratch, and who take their kids to specialists every time they get a runny nose. There are both extremes, you know. Those who receive little to no medical care, and those who suck it all up like nectar when they really don't need to.

Agreed. I have a friend in Canada right now dealing with ruptured disks, and it's been hell for her trying to get in to see people. She's flat on her back, can't do ANYTHING really, and she's waiting 3-4 weeks for an MRI.

You're right about the people who overuse it, too. My GI recently chastised me for not seeing my primary in over a year, for a checkup. I looked at him and said, "But I see you every 3 months for a checkup. Why should I see her for anything more than my annual?" I mean, she's going to do the exact same blood tests he's doing. So why should I waste her time?

Then again, I have a friend who's in the emergency room once a week, convinced he's dying of "something." Talk about abusing the system.

Thanks for the comments - it's definitely given me more to think about.