Saturday, October 12, 2013

why insurance in the U.S. sucks

This may take a few posts because I don't want to do a big information dump. But with the recent debates over the government shutdown and healthcare (the President's Affordable Care Act) I thought I'd share some of my personal experiences to balance out some of the misconceptions that some folk may have about being both uninsured and insured in the U.S.

To begin with, like many 20 somethings in the U.S. today, my kid's father and I were uninsured when we were first married and having our first two children. We were both working, healthy and not making much money (barely enough to pay basic bills and buy food) and the result was that we could not afford healthcare. When I became pregnant I went to the county and applied for help and discovered that we made so little that the prenatal was pretty much covered by Medicaid. My healthcare in general wasn't covered but I was glad to find that the babies births were covered so that we didn't have outrageous medical bills after the babies were born.

The process wasn't a fun one however. In order to prove that you weren't trying to rip off the system, you had to tell them how much you paid each month for every little thing, including toiletries like tampons, toilet paper, etc. And when you're making $1200 a month and living in a city like Denver it's hard to imagine that you could afford to buy anything other than the barest of necessities so itemizing just seemed like a slap in the face. But I sucked it up and we did get healthcare for that little period of time from the federal government. I won't go into the continued marginalization you face when you're on Medicare- suffice it to say that you're treated by the nurses and the healthcare professionals as though you are a drug addict who can't hold a job when that had nothing to do with it- we were just poor (I will add that most of the doctors were exceptions- they did not have the same attitude toward the people they treated for some reason- but I didn't see an actual doctor very often).  Anyway we survived it and I was glad for the care because when I was pregnant with my second child, they discovered I had cervical pre-cancer. After she was born I was treated for it successfully and have not had a re-occurrence but had I not had Medicaid I wouldn't have been able to afford the care I received (I was still covered under post-natal care).

After the girls were born I was a waitress ($2.10 an hour + tips) and the kid's father was a painter ($8 an hour when he was working-weather dependent work) we still didn't have healthcare for our young children or ourselves because we decided we'd rather eat. At some point my oldest got pink eye and a doctor who did occasional pro bono work did see her and gave me a prescription for the medicine. The medicine was expensive but I was just grateful that I didn't have to pay the doctor for the visit itself. This went on for a few years- and there was a point when the kids would get sick and there was no doctor to take them to (the previously mentioned doc had some office problems and shut down) and we just prayed that it never turned serious.

You might ask why I didn't check on Medicaid at this point... good question. I had had such a bad experience with the whole system when the girls were little that when their medicaid expired, I never reapplied. I hated the way they treated me and my kids. I would have reapplied if anything serious had happened- they require you to before hospital admittance but fortunately nothing that serious ever occurred.

Up to this point, it's all been about being uninsured. It was scary and worrisome but we made it through. In fact, I am quite grateful now that Medicaid was there and think my pride was a little overdone. I shouldn't have put my girls through some of the difficulties that I did. Later, when I had foster kids and they had Medicaid, I didn't find it so incredibly insulting. It's not great but it's not as insulting as I made it out to be with my first two children. In retrospect, I was oversensitive because I was young.

So, sometime in 1996-7ish the kid's dad was in business for himself and I was doing home daycare and the income was decent enough that we weren't worrying about where food was coming from. We were finally making enough money to get insurance, so we shopped around and found an insurer that allowed us to buy into a group so that we weren't paying an outrageous figure for insurance- I say it wasn't outrageous but the cost was still $800.00 per month which felt pretty outrageous. I can't imagine what it would cost now. I am not even sure who the insurance was at this point but we got it just in time because I became pregnant with our third child around the same time. It was quite different having a child in a private hospital under the same doctor's care.

I should add right here that we were fortunate that we were healthy at that time and the insurance group didn't reject us. Part of what the ACA does (in states, like Colorado, that are accepting it) is force insurances to accept people regardless of pre-existing conditions. If we had been unable to afford insurance at that time and had had to wait a few years, my son and older daughter were diagnosed with asthma and were both hospitalized for it.  Insurance(in those states who refuse to accept the ACA this will still be the case) is really gambling, companies don't take people that have a risk factor that will cost them money. It made sense for them because why would they want to take someone that was obviously a payout not a pay-in? A few years later and we might never have found insurance and we could have been in really dire straits. Luckily, we got insurance prior to his birth and my daughter was not yet showing symptoms of asthma (that we noticed)

The insurance we had didn't last too long. Rates increased and we had to find something more affordable so we moved to Kaiser Permanenete. the cost still went up but the other was going up quite a bit and there were some benefits to Kaiser. There were some definite downsides to being part of the integrated managed care consortium but I think that is where I will end this part of my discussion about "why insurance in the U.S. sucks" for now. Thanks for your patience and I hope you come back for the rest of it!

How about you? Do you have good healthcare?


  1. Interesting, I will continue reading with intrigue !

    Here in Finland if you go through the public health care, it is mainly free of charge (some fees for examinations may apply, but they are apprx. $ 20 a pop). I'm currently unemployed and using the public healthcare - the downside is that the waiting times are long, the doctors overworked, and sometimes you feel mistakes happen. I was referred to a local Womens' Clinic for further examination in July, and my actual appointment is in November...
    You can also use private health care - this doesn't mean you need to be insured, you just pay out of your own pocket. When I was working, I chose to use private - as an example I can tell you that a visit to my ObGyn for pap smear and an ultrasound cost me $ 200 last year.

    1. But fortunately you will be seen. If you were here, you would have no healthcare!

      Sounds like your private healthcare is somewhat expensive- like ours. You'll have to weigh in more later when I talk more about what I am paying and going through now. Thanks Zella!

  2. Great discussion! We didnt have insurance until we were in our forties. Somehow we managed to stay healthly and safe. Lucky.
    I dont think it's so much an insurance cost-problem but a healthcare-cost problem. Let insurance companies compete across state lines and there'd be more competition and less cost. Tort reform would cut doctor's fees. Lawyers seem to get a big cut of our money in litigation.
    Ah well. Typing this on a Kindle is a one-finger process resulting in many errors :)
    Again, great post!

    1. I agree that there is an insurance cost-problem but I am not sure tort reform would solve any problems. Right now the only recourse people have against poor medical care is to sue- otherwise the system is stacked against the little guy. If insurance costs are high for doctors, then I think we have to ask ourselves how having a system that is driven by revenue and profit is working for us? I would contend it isn't. But more on that later.

  3. Up until last year I had decent health insurance paid for my by employer (I know, lucky me). But then I lost my job last November and tho I finally got another job in August I now make about half what I did and my new company doesn't offer insurance so I am currently uninsured. I've also had a lot of health problems this year but unfortunately can't get a referral for any of them because I don't have insurance. So, if perhaps I have cancer or some other sad disease, there will no early detection and even if I have something that can be treated there's no way to know because I can't get a referral for any diagnostics. Too bad for me and everyone else who isn't insured. meanwhile our elected reps are still getting paid and have their pricey excellent insurance for which WE pay for while they try to defund the program that might help me and others like me get insurance. I have two words for them but like Dorothy's aunt said, I'm too much of a lady to say them. Okay, that's a lie, but since this is your blog I won't :)

    1. Go ahead and say it!!! :)

      I hope that as the ACA gets rolled out that you are able to find something Marcy. I know that people here in CO are finding healthcare affordable (meaning free in some cases) for the first time. I have no idea what Maine is doing in response to the Presidents healthcare act- CO is at the forefront. Maybe you need to move here? (I kid)

      I am with you about the bastards in WA still getting their paychecks though. It steams me to know end that they're playing these games while the American people suffer. I don't believe in capital punishment but if there were a revolution I might be okay with hanging and quartering the current political establishment. ;)

  4. I'm lucky that both the UK and Canada have state-run medical programs, which have similarities and differences. UK is funded through general taxes; in Canada there is a mandatory Medical Services Plan contribution. Basic healthcare is covered by MSP, and both my wife and I have additional private health insurance through our employers that goes further.

    All the problems you refer to in the US model seem to stem from the fact that both healthcare and insurance (and the pharmaceutical industry, which you haven't touched on) are run as businesses to make a profit. Their motivation has nothing whatsoever to do with the health of the patient - that just happens to be a by-product of the business.

    The free market and entrepreneurship makes sense in many situations, but I think there are some things that define us as a society that should not be driven by profit. If we want a healthy and well-educated society, we should be measuring the health and education of our population rather than revenue, and behavior should be driven by that. We need to steer clear of hysterical paranoia about "socialism" and other meaningless "isms" and simply ask ourselves what kind of society do we really want to live in?

    1. I am coming to both things Ian! That's why this will take me several postings. I wish we had a system more like yours so that people like Marcy could get healthcare and so that I would not be in the situation I am in- which I will also deal with later. Thanks for the great response!!!

  5. I've been fortunate that I've always worked for a company that offered health insurance. The rates have jumped over the years, but they're nothing compared to the $800 you once paid. It's a shame insurance isn't more affordable. It's high because doctor and hospital costs are so high, and a lot of that ties into liability and malpractice suits.

    1. I think you'd find that some of the doctor and hospital costs that are so high are tied to profit margin not necessarily malpractice suits, Alex. We are told that over and over again but I don't think the numbers hold up. In other words malpractice insurance may be expensive but does it have to be? Does the number of actual suits warrant the cost? Insurance is a scam- I hope I am not being too harsh here- in many cases. They tell you need it but they are trying to make a profit not help you. Malpractice insurance is no different.

  6. In Australia, my health insurance for me as a single person costs $86 a month, and I used to pay about $56 or something. The smaller figure was for very limited healthcare, but the one I have now covers me for things like remedial massage, as well as more "accepted" health care services like chiropractic. But my health insurance doesn't cover me for "normal" doctors - that is covered with Medicare, for which I have a separate card and don't have to pay.


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