The Adventures of a Curmudgeon in Healthcare

CALL ME ENGLISH but—, methinks ‘tis the season of the anarchist curmudgeon.

Curmudgeon – (somebody who is irritable or stubborn)

I know, I know. I am a US Citizen now, but remember the judge did say to bring my ideas and culture into the mix.

Traditional territory for curmudgeons would be local weather conditions. Well here up the Twisp River we are only beginning the mud season which should be almost done by now —meaning that the three or four feet of snow that has traditionally been on the ground for the last three plus months is on the permanent melt-out, leaving a serious mud-fest (excess of slutch)* in the dirt road driveways of these unpaved parts. As it happened this year we hardly got any snow at all until mid-February, by which time we had all given up on the idea of a winter. Then we got pounded with six feet in a two week period. In terms of actual snow falling it  was way more because given the longer daylight in February,  it was a “dump snow/half melt out, dump snow again/half melt out again” cycle, meaning a pretty rapid snow accumulation, despite the more unfavorable-for-snow-sticking-around, tilt of the Earth’s axis in relation to the sun in March. Don’t get me wrong. I love the snow. And this late snow has been of some respite to those of who like to ski and to local winter based businesses who had taken a hammering this year because of the lack of snow, but it really is all out of whack (messed up),  for the time of year.

(*English sub-titles in parentheses).

I digress. In curmudgeonly terms I am not so much thinking about local micro-climate. This time of year brings far worse ills, like the onset of ‘tax season,’ pretty much reminding me of everything that is rotten in the United States of Sellsomemore. From going through medical receipts and Health Insurance statements and doing the math (adding up the sums), I am most cruelly reminded of  the exorbitant costs of having access to health care in this country.

For my English readers then I present, a Health Insurance 101 (a basic crash course in), with a view to you guys (people) resisting —with every ounce of moral fiber your aging bodies can muster— the same scam being implemented in Britain. And perhaps, for my US readers, as the judge said looking at things with the different perspective of my cultural background, it might shed a little new light upon it for those who suffer it for granted.

First things first. Let’s make no mistake about this. The United States punishes we-the-people when it comes to having health care. And guess what, the older you get, and the more naturally you likely you are to succumb to ill health —with an aging body, that does not repair itself as well— the more they punish you. Presumably this is based the utter falsehood that the older you get the more you will be rewarded for the fruits of your labor.

Three years ago we got a family health plan, for two adults and two children, costing $500 a month, with a $6000 deductible (I will come to this particular abhorrence all in good time).  As the senior member of the family, then a late fortysomething, $250 out of that $500 is for me alone. At six years younger than me, Mom (the mother of our children) comes next at about $150 a month and the then pre-teenage children cost $50 a month each.  Three years later the monthly cost of insurance has risen to $754 a month, (a fifty something percent increase that is way above the rate of inflation).

Half this increase was justified by our insurance company as resulting from the extra costs to them of implementing “Obamacare.” From where I stood the extra cost of Obamacare to the insurance company is nil, because they passed all that cost on to me and other consumers. The other reasons for a 50% hike in monthly health insurance costs are because the insurance companies claim that, on top of implementing Obamacare, the general costs of providing health care naturally increases over time. Some of this part of the equation doubtless translates as the unstated punishing-people-as-they-get-older financial penalties. In other words the operating costs of overseeing the transfer of wealth from ordinary people to the corporate coffers is forever escalating.  And boy have they had a bonanza this last couple of years because they have in effect billed me, and millions of others, twice for “increased operating costs.”

Don’t get me wrong. I am not in league with the right-wing thinks tanks who advise corporations to set up fake grass roots front groups, to bombard us with annoying animated ads every time we open our e-mail, warning us that Obamacare is driving the country to financial ruin. No. I simply come from a country where the ordinary people of my grandparents’ generation gave pretty much everything they had to establish basic human rights and then had the good grace to throw in defeating Hitler to boot. And for those who lived to tell the tale, they were justly rewarded with free education and free universal healthcare, for themselves, for their children and their children’s children. Growing up in England I was one of those grandchildren. It is ingrained in my bones, and it will be detectable in my DNA, hundreds of thousands of years hence when future archeologists find my remains in the fossilized long goodbye of a mud season to crown all mud seasons, that free universal healthcare is the mark of a civilized society.

Don’t get me wrong a second time, I have received excellent medical care and attention in the US. I just object to the way we-the-people have to foot the bill, so that middle-men who, for no other good reason than to profit at our expense, siphon off oversized chunks of the pie. I think we could still have the great medical care and pay for it in a more equitable-to-all-the-people kind of way, not least by cutting out the middle man.

Okay. So for $500 a month, climbing steeply to $750 a month you would think that that would cover me for any time I need any kind of medical attention.  No. No. No. Not so fast Nobacon.

Here is how getting medical insurance works. It is very similar to the way you might book a flight: you pump in the parameters, where you want to go, what dates you want to fly etc., and within a minute or so, you get all the options of routing and what different airlines are charging for their flight. It is the same with health insurance only the parameters are, as we have discussed, your family size, your respective ages, AND by how much and how much you are prepared to gamble to have a lower monthly fee. Of course the throwaway sales perks attached to booking flights (allegedly cheaper deals on hotels and car rentals) apply to health insurance dressed up as the number of ‘free’ doctor’s visits you might get and the co-pay i.e. the percentage share of other medical care needed, that the health insurance will pay, until the deductible has been payed off, when the insurance actually starts paying the full cost of medical care.

Speaking in riddles? Of course. Such is the language of miasma capitalism when dreaming up ways to make us pay for things that should be part of the good grace a country bestows upon its citizens for simply being reasonably reliable citizens, who in the most part have a genuine human feeling of naturally working for the greater good of the community they live in.

So here is what having health insurance really means and costs. There is no free health care for my family (going off the 2013 figures) until we have paid out a minimum of $13,140.  Last year that was about one fifth of gross household income. In the lean year of 2012 — due to the erratically fluctuating income of being artists— it was almost one third of gross household income. Yes that’s GROSS … in more ways than one. To someone who grew up with free universal health care it is daylight robbery.

Rising even more steeply from 2008 prices

How so? It’s the deductible thing I was telling you about. We maybe get four ‘free’ basic doctor’s visits (one each a year) and the insurance pays a 10% co-pay of other medical bills, but not until we have actually shelled out the $6000 deductible for medical costs does the insurance actually kick in.

Health Insurance Plan                   $9000

plus deductible                                $6000 = $15,000

minus 10% co-pay                                             – $1500

minus 4 doctor’s visits                                      – $360

_____________________________________________

actual cost of having health coverage

per year for a family of four                    =      $13,140

This kind of ‘deal’ is what is referred to as ‘emergency cover,’ which means the only health insurance you can afford, is that which offers you some respite from potentially ultra-expensive kinds of care, that would otherwise bankrupt you and your family. This is insurance against major things that might befall you, such as requiring surgery and/or long term medical care; or multiple-broken bones; or heart surgery and any of the long term debilitating conditions which may come upon you out of the blue, and through no fault of your own.

There is a way to avoid deductibles, and that is when you punch your parameters into the search engine, you opt to pay a higher monthly premium. The more your monthly premium, the less the size of the deductible, but to have no deductible at all, or a very small deductible, you have to pay upwards of  $1200 a month for your premium, which means a) you have to be able to afford $1200 plus a month in the first place, and b) you are in effect paying out $14,400 plus a year before the insurance company will pay for your medical costs. People who can afford this kind of plan opt for it because it alleviates the knowing-the-doctor-is-going-to-cost-you-money-stress. That is the kind of stress that affects we-the-poorer-people, by making us reticent to go to the doctors, to the point of, and often beyond the point of, endangering our own health, because we know it is going to cost us money that we simply do not have. So,even though our family pays $9000 for health insurance, we still have the knowing-going-to-the-doctor-is-going-to-cost-you-money-stress,  because we still have to pay the next $6000 of any medical bills, which if met in full is a big chunk of our family budget.

Oh, and if that were all that there was to it. When I first moved to the United States I didn’t realize why people held fund-raising benefits for families to cover the medical bills of one of their family members. Surely the individual had some kind of health insurance. In most cases yes. In most cases it was the kind of ‘emergency cover’ that we have, where in addition to barely paying out until the deductible has been met, insurance companies have an upper limit clause, after which they will not pay out any more. The cheaper you monthly premium, the lower the upper ceiling of how much in total the insurance company will pay out. So if you can only afford a cheaper monthly premium then the upper limit may be $250,000 or $500,000, but if you are in a car wreck that leaves you paralyzed and requiring multiple operations and constant care, the insurance will cut you off way before your actual treatment needs have been met.

The average American family, of which we are one, takes home around $50,000 a year, meaning thirteen grand on health insurance takes a huge chunk out of the income, and from either not being able to meet that annual outlay, or because the upper ceiling has been reached, the risk of personal bankruptcy caused by medical bills is high. According to a 2007 Harvard study 62% of all personal bankruptcies in the US were the result of medical costs, and of those 78% people had some kind of health insurance at the onset of their illnesses. In 2013 personal bankruptcy due to medical costs still resulted in 60% of all personal bankruptcies.

As a newcomer to the Land of the Free, but never free healthcare, I obviously fell into the health care trap by double default. In 2010 I broke my leg in a skiing accident (a triple break spiral fracture requiring surgery and the insertion a titanium rod into my lower left leg) and if you think that was painful … wait until you see the bill. We did not have insurance so I was liable for the full $22,000 in hospital and surgeon’s bills. I got great medical care and an itemized bill, listing everything in minute detail: from the cost of titanium hardware; to the $1000 plus it costs to stay in hospital overnight; to the jacked up price of morphine; to every last bandage and over-priced plastic throw-up bowl. I went home with the bowl and a carrier bag full of bandages, which the nurse insisted I take, otherwise they would be thrown into the dumpster (the skip) out back.

Of course there are concerned people who have long realized the unjustness of the American system. Washington State is one of the few states which has a Charity Care law, which “requires hospitals to provide free inpatient and outpatient care to very low income patients who have been treated in the hospital. It also requires that hospitals provide discounts to other low income patients,” the funding for which comes from state and federal taxes. So in accordance with due process, the money person at the Omak hospital where I was treated said, ‘you know if you are low income and especially if you don’t have insurance you can apply for charity assistance.’  So I spent the few hours it took to fill out the paperwork and showed my 2009 tax return, and because we had had a lean year in 2009 I qualified for a 40% reduction in the bill, so the actual cost of my care that I paid was $13,200.

Did I feel bad taking the charity aid? In a word, no! I pay state and federal taxes and I contribute many unpaid volunteer hours to my community. And I felt good paying what I paid directly to the hospital and not a middle man insurance company. And in my morphine induced state in the hospital I thought if me taking charity aid means the country has less ready cash to spend on war, then good. In that cloud of bliss-full pain release, I envisaged a sort of general strike in my imagination, where all the poor people who had not sought out the medical attention they needed, because of knowing-going-to-the-doctor-is-going-to-cost-you-money-stress, swamped the hospitals en masse and simultaneously filed their charity care applications,  drawing on the tax dollar budget, draining the government of its resources to spend on war, and forcing a sort of almost free universal healthcare on this uncivilized nation, by default.

Alleviating “knowing-going-to-the-doctors-is-going-to-cost-you-money-stress”

Back in reality, had I had health insurance at 2010 prices, after having paid out my premium and I deductibles and after my perks, I would have shelled out $10,140. Thus, if I had had insurance for my broken leg I would have saved $3,060. Of course if anyone else in my family got sick their care would be covered ‘free’ by the insurance company as long as we did did not go over the upper limit. We are generally healthy and beyond a couple of prescriptions no other costs were incurred by other family members that year.

So it would have obviously been worth it if I had had the health insurance, because I would have saved three grand. But that is like saying I am saving money when I fall for every last twofer (buy one get one free) con-man ‘deal.’ The twofer is based on the fact that the seller still makes a profit on you buying their product at half price, because you have been induced into buying a product that you don’t really want. The real meaning of a health insurance policy like ours is that the consumer only gets their moneys-worth for the product if they or one of their family members breaks their leg on an annual basis. Health insurance is like a twofer. It is essentially a product I do not want. What I want is free universal healthcare.

Of course, after breaking my leg, we made it a priority to get health insurance. And herein lies the second part of the default. In 2011 to have the operation to remove the titanium rod from my leg, which cost pretty much cent for cent, what we paid out as a family in health insurance plus the deductible. I got my money’s worth right. No, because I am still paying out $12,000 plus for something that my country, had it got its priorities right, would gracefully give me for free of financial charge, as a recognition of me being a worthy citizen.

The killer blow came when I was being prepped for surgery for the rod removal and the nurse took my pulse and said: “Oh you know you’ve got a heart murmur.” No, but I remembered another nurse when I was on pain meds a year earlier saying the same thing. She had said it was probably nothing and I kind of spaced it (went into denial about it). Being reminded of this, and having paid out all I was going to pay in 2011,  I decided to go get my heart checked out with none of that knowing-going-to-the-doctor-is-going-to-cost-you-money-stress. As it turned out I had a congenital bi-cuspid aortic valve, which in all probability will require six-figure surgery for valve replacement at some time during my life. And my son has the same condition. As it turns out my condition is moderate and stable and there is no surgery on the horizon for me in the near future, and my son will probably have decades ahead of him before he even has to worry about it. But you guessed it, I have a few new kind of health insurance stresses now.

Despite paying $9000 a year for a family of four ($4200 of which, for me as the oldest family member is my cost as an individual) I still have to pay around $800 a year for my annual heart check-up. I now have the don’t-ever-default-on-the monthly-health-insurance-payments-stress, as they could cut me off from health care, like mortgage companies repossessing your house you are a late payer. And, I don’t know if I  will I ever be willing to gamble to change insurance companies (as Obamacare theoretically allows without penalty) to get a better deal, but having now to declare my pre-existing heart condition to the new company. Which begs the question, how far, if any distance at all, have insurance companies got beyond discriminating against people with serious pre-existing conditions, by punishing them with astronomically crippling monthly premiums?

Don’t even get me started on dental bills, which are not covered by any of the above, but know that because my heart condition increases the chances of my getting heart disease, which in some instances travels from the gums to the heart, I have to pay through the teeth to keep my teeth in good shape.

Of course, by luck of birth, I could just put the parameters into a search engine and buy a flight to England when I need the heart valve replacement. That is if the increasingly intrusive corporate influence of British government has not by then, removed the free universal health care there, as it has so insistently been trying to do at least since Tony Blair first came to power.

The tax season sting in the tail is not that we pretty much shelled out most of the deductible for actual health care in 2013, plus paying the spiraling monthly premiums, but rather that the idea of free universal healthcare is not even on the agenda in the United States. Instead we have the pantomime of the petty internecine squabbling over Obamacare, which remains the modus operandi of the Republican Party, and is designed like the government shutdown was to abort the fetus of the germ of an idea that we could and should take things like health care away from the corporate sector. And, whilst we balance our books as individuals, you can rest assured that despite some of the same mock theatrics over proposed 2015 budget cuts for the military both Democrats and Republicans stand shoulder to shoulder in keeping the $500 billion plus (and that’s just the parts they declare) rolling full steam ahead, which is the real reason for the lack of free universal health care in this country.