why insurance in the U.S. sucks pt. 2

So great comments everyone! In fact, they are deserving of the Great Commenters award!!

I responded directly to your comments under the post but the comments were so good that I will bring some of what you said onto the main postings if you don't mind...Anyway, onward through the discussion. For those of you who want to catch up, the first post was here.

Having moved from a regular insurance provider to Kaiser Permanente, the kids and I found the first benefit to the managed care institution was that they had a pretty firm grasp on asthma. My 2 year old son had been hospitalized for five days with a severe asthma attack in April 99 and his sister had experienced some issues at school that the family doctor had not been taking seriously. In both cases I found our GP undereducated about asthma and, especially where my youngest was concerned, unable to help and worse seemingly unwilling to admit it. When we went to Kaiser, they were all about preventing asthma so they immediately tested both children for allergies and sent them to an allergist on a regular basis to get help get their asthma stabilized. All the pediatricians we saw were fairly well educated on what the specialists were doing so we never had to worry that the regular Doc would doubt the prescribed treatment. Kaiser was also partnering with National Jewish which is (or was) leading the nation on asthma treatment so they were doing their very best to keep my kids out of the hospital and in fact out of the doctor's office as much as possible.

At this point I think Ian's comment about healthcare being driven by profit is relevant here (I hope you don't mind if I quote you here, Ian!),

"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."      

The reason this becomes important is that part of the reason Kaiser is so good at treating Asthma is that it makes sense to treat a preventable disease such as asthma the way they do. If you keep the kids on the proper medication with a preventative that keeps the asthma in check you will keep them out of the hospital which is far cheaper (duh!). And Kaiser has also been out there pushing good nutrition and encouraging their customers to exercise which of course also saves them money. There are also other ways that seem logical for insurances to operate that (to the person on the outside) one would say, "It seems like it would be cheaper for the insurance to do... [this]" because in the long run the patient is treated more efficiently and given better care. So, profits are great if it's done to save sick costs and to raise the health and wellness of your patients. The problem was that those were not the only cost savings I witnessed at Kaiser and often the "savings" came at the expense of patient care.

First of all, I was working at Denver Public Schools and had by then gotten a divorce. I was getting my insurance through the school system (by the time the kids dad & I split the monthly cost was $1000) but I stayed with Kaiser because I wanted to keep the doctor I had and (more relevant) I couldn't afford the other plan they offered. The plan was almost the same as the one the kid's dad and I had- same co-pay, same emergency, same pharmaceutical pay-outs, etc. but my cost was $50 a month. The employer cost (as I recall) was $100 a month. The family plan was around $500 a month. As you see, paying as an individual/group is a great deal more expensive than paying in real "group".  But that aside, a couple of examples outline the problems with Kaiser.

A friend of mine went on a trip to France and came back with strep which she got on the plane. It was a freakish strain which caused a lot of complications and she had to go to the hospital to the emergency room. She also had Kaiser and it took a bit but they figured out what it was and sent her home with antibiotics. Unfortunately, they did not check her medical chart and see that the type of antibiotics she was on was of the same type that she was allergic to. So she went home and within a short period she had a severe allergic reaction. She was rushed back to the hospital. They switched her antibiotics, kept her for a couple of days and sent her home. The antibiotics were not working and she went back in having developed a staph infection from her first hospitalization and poor treatment. Her body was misshapen and bloated- almost 4 times her regular size! She was there for two weeks and she nearly died. All because they were in a rush to treat her and send her home. It was a frightening time for her and she wound up with scars on her forehead where they had to drain the fluids out. It's graphic and awful, I know. But poor medical treatment is never going to be pretty but at least this story ends with her being okay.

For my part, I was having migraines and they continued to get worse. I had a sympathetic doctor and she was prescribing me Maxalt and Imitrex for my pain. She said there were a couple of preventatives I should try, which I did. One did nothing but the other was a blood pressure lowering medication. My blood pressure is already low so as soon as I went on it, I felt my blood pressure just tank and I felt miserable. I told her and she immediately took me off but said that was it, there was nothing else she could do. They did a CT to make sure there was no brain injury but when I asked about any other doctors I could see, she said there was no one. That was it.

As the years passed, I was having 2-3 migraines a week and there seemed to be no end in sight. At one point I was sitting in the Kaiser pharmacy waiting on my prescription and the pharmacist was clearly working on my prescription, I heard him say, "She can't take this much of this medicine!" It was really loud and if I'd thought that everyone knew he was talking about me, I'd have walked out. A few years ago I was talking to a different and equally passionate pharmacist about my migraine medicine. He told me that Imitrex and Maxalt are triptans and essentially what they do is constrict the blood vessels (if you've ever had a migraine you will know that it feels as though every vessel in your head is going to explode- especially if it's a bad one) but that it can't, obviously, differentiate between the head (where the pain is) and the other vessels in the body. So if you take too much you could throw a clot and have a heart attack or stroke. Nice. That's why the Pharmacist had been so concerned about how medication I was taking but unfortunately it was going to be some years before I would get any preventative to help with my migraines. At my high point (or low- depending on how you look at it) I took 4 in a day (1 beyond what it said I should take- at least then I think it's lower now) but when you are in so much pain that you are throwing up and immobile because of the pain and dizziness in your head, unable to drive, get to work or... do anything for that matter, you will take that extra pill to get the pain to go away.

Another friend who was a teacher in a college also had Kaiser- had an 18 year old son who was still on her medical plan, He became ill his freshman year in college and they discovered he had a rare form of cancer. He came home expecting to be treated but Kaiser told her that the cancer he had had a high mortality rate and they did not support treatment. She had to sue to get Kaiser to get him the treatment he needed. To my knowledge he is still alive and well. That was in 2002 or so.

I don't mean to scare those of you who have Kaiser. If you have it and it's the only insurance you can afford, it's better than nothing but I think you should be aware of the realities. Kaiser is a business that does not like to spend money and like all big corporations wants to cut costs in order to make a profit. My daughter is an EMT and she hates dealing with Kaiser. She has only negative things to say about it and it's because they will not give their patience the care they need when there is an emergency.

I also don't want to sound like I am denigrating the doctors there. I was quite friendly with many of the doctors that I had while I was there but it seemed that they were quite stretched to the limit. They were caring and gentle for the most part- some good doctors! But they were mostly on overload and they did not seem to be very well paid for their trouble. That's why, when I got a new job and went to work for Denver Public Library which is a city agency, I switched insurances FAST.

But there are troubles coming my way with that and we'll get into that later...

So how will things change for those who have an insurance like Kaiser under the ACA in the future? It might get a little cheaper so people who want to opt for another healthcare company can afford to- at least for those states who are actively working to participate fully (like Colorado! YAY US!!!) with the entire population forced to find insurance, there will be more of a pool to even out the costs. I'm not entirely thrilled by that change. I think, like Ian that it would better to not have healthcare be a for profit institution but if the best we do for now is work in the system we have, then this is better than nothing.

So have you had any issues like that where the insurance companies have denied you coverage?

NaBloWriMo day 13

I'm posting at Key West TV for my NaBloWriMo post today. You can catch me there (although if you don't know or care about Key West you may not want to) or you might want to catch up on Why Insurance in the U.S. Sucks. I'll be blogging on it some more tomorrow. Have a great day!

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?

pumpkin fields

I decided to grow pie pumpkins (they make THE BEST pumpkin pie and yes, they are different than regular pumpkin) this year and discovered that my wee bunnies ate them before they ripened (don't bunnies get tummy aches?). I have three green ones on the patio that I should probably just leave for the bunnies to finish off but I thought I'd see if the sun would ripen them.

 

I wonder how they kept the bunnies out of this field?