Wednesday, January 18, 2012

That Post On The Healthcare System

I realized something today.  I realized that I've been putting off blogging, primarily because I had promised a post on the healthcare system, which I felt unequal to for a number of reasons.  One is a lack of organization, one a distaste for controversy, but primarily I've been avoiding the subject here because it involves going back there, and there is a place I've successfully managed to steer clear of for several years now.

However, I do think what I have to say needs to be said, and luckily it is not up to me to offer the perfect solution to solve all our problems and create a disease and debt-free paradise.  I can only point out the problems as I see them.  Sit back and relax.  This promises to be a longish post.

I was sixteen years old when I was diagnosed with stage three (stage four being worst-case, stage one best) Hodgkins Lymphoma, a cancer of the lymph system.  It came out of nowhere for our family.  Someone later made a remark to my mother, as if it was something she should have done, about how they were "concentrating on prevention" themselves.  Now, my sister and I lived about the healthiest lives possible.  We lived on the side of a mountain, breathed clean air, climbed trees, ran around in fields, not to mention having ballet classes every week.  My mother cooked everything we ate from scratch, we drank soda perhaps once a year.  We were always healthy, and because we were always healthy, when our family couldn't afford health insurance, just about the time I turned sixteen, it didn't seem like a big loss.  I couldn't remember the last time I'd been to the doctor.

My dad was (well, still is) an airborne firefighter.  Not with a silly little helicopter either.  He flies different planes now, but at the time, in fact for the first eighteen years of my life, he flew a WWII bomber (a PBY Catalina for the technically inclined) which had been adapted to carry water.  It was a beautiful plane...but my thoughts on aviation shall be saved for another post.  He was (and is) a hero to many, certainly to those whose homes he saved from the flames.  So much for those who like to imagine that all people who can't afford health insurance are useless layabouts.  Incidentally, both of my parents are also college-educated, intelligent people who don't say "ain't".

So much for the background.  We fell into that larger-than-politicians-like-to-admit category of people who fall through the cracks.  We did not qualify for the state programs, but the cost of conventional health insurance would have drowned us.  We already lived frugal lives as it was, and once I was diagnosed it wouldn't have mattered anyway.  Conventional health insurance companies have a useful little thing they call a "waiting period for pre-existing conditions" which means that, when you sign up for your policy, anything you were diagnosed with when you signed up is not covered for the span of time known as the "waiting period", usually six to nine months.  During that time, you pay your premiums, and they pay nothing.  If we had taken that route, none of my treatments would have been covered, and we would have been paying them premiums on top of my already huge medical bills.  My mother (a true gem among women) spent hours on the phone and online researching our options.  In the end we took the only option that didn't involve us selling everything we owned to pay my medical bills.  My dad took a voluntary pay cut, which put us down to the income bracket where I qualified for the state program.

I want to make it quite clear here and now that I have nothing against the doctors.  I had the most wonderful doctor that anyone could ask for through my whole ordeal, and he fought for me tooth and nail on many occasions.

And now we come to a special pet peeve of mine, called the "amount allowed".  (There really is a euphemism for everything.)  This simply means that when the medical provider bills the insurance company, the insurance company will not pay more than a certain amount.  Then you (assuming you have insurance) pay a percentage of that amount.  I have in my hands an old explanation of benefits from my old insurance company for an office visit a few years ago.  The original charge was $115.  The amount allowed was $37.45.  Of that amount I paid $15 dollars.  If I had not had insurance I would have had to pay $115.  The only people stuck paying the entire bill are the people who have no health insurance and can least afford to pay it.  If you could choose to have no health insurance and just pay $37.45 for that visit, that would be one thing, but the reality is another entirely.  And that is a fairly small bill.  There is a shot they give you the day after you receive chemotherapy, which helps raise your white blood cell count and thus boosts your immune system so that they can keep giving you the chemo.  Because (and I know I've said this before) the whole idea of chemo can be summed up in these words: they're slowly killing you and hoping the cancer dies before you do.  I'm not knocking it. After all, it worked for me.  It just always amazes me that someone thought of it in the first place.  Anyway, that shot, which they give you in the stomach (gross, and painful) sent me into a serious allergic reaction culminating in a blackout, a trip to the ER, a very speedy ambulance ride, and a blood pressure of 45 over 20.  I was the first person on record to react to that shot and I have yet to hear of any other cases.  However, the bill for that shot (not the ambulance ride or the ER or the oxygen, just the shot) was $13,000.  Of course, the amount allowed was much less.

A much more recent experience is that of the dad of a good friend of mine, who recently had a heart attack which led to open-heart surgery and eight days in the hospital.  He had no insurance and his medical bills added up to almost twice the amount of our mortgage.

So yes, there is something horribly wrong with our healthcare system, and it can't be ignored.  Health insurance should not be a for-profit business.  The full weight should not fall on the shoulders of those who can least afford to pay, and that is where it falls.  Not on those who have nothing.  They are covered by federal programs.  It falls on the responsible, hard-working citizens.  Yes, there are people on welfare who abuse the system, or people who lie on their unemployment forms.  My parents were not, are not, those people.  Neither is my friend's dad.  They work hard.  They pay their taxes.  They don't want handouts.  They want their hard work to be enough to pay for the lives of their children.

Whew...there it is.  Done.  Any thoughts, feel free to comment.  To end on a good note, I have just been declared cancer-free for ten years.  This summer: celebratory head-shaving!


  1. Holy COW! I love this blog! The "big wigs" need to read it - Melanie you are a dinamo! love you! -nancy

  2. Melanie, this is wonderful. (But certainly there ain't nothing wrong w/ saying ain't, is there?) If the heads of industry had all been through what you have, their targets would be different and the hierarchy-of-for-profit-needs completely re-arranged. Until that happens it's going to be a nasty, messy slog...the more voices like yours, the less nasty the slog shall be and sooner we'll reach a place where us squishy flesh-vehicles can say "We really used to have a healthcare system that worked like that? Ugh, what were they thinking?" And grandparents will say "Well honey, a lot of people weren't and that's why it was happening." :)

  3. As a medical biller for several providers, I think you are missing an important part...medical providers have HUGE overhead and why don't they deserve to make a profit? Even before insurance companies came about, people still paid their providers, whether it was with a chicken or money. You talk about being a Renaissance girl, but seem to be detached from reality that would have applied even then.

  4. I in no way intended to imply that these things should be free, only that there should not be such a large discrepancy between what the insurance companies have agreed to pay and what the uninsured person must pay. I believe in paying for what you receive, but something is wrong when the cost is so high that ordinary hard-working people cannot afford it without losing their homes. And last I heard they don't accept chickens anymore.