Friday, 2 October 2009

Adventures in Health Insurance

I don’t have health insurance.  I haven’t for this entire century.

I was never one for doctors, possibly because I spent a good deal of my childhood riding in the backseat of my grandfather’s Cadillac while he and my grandmother went from doctor to doctor to doctor.  Mostly I just sat in the waiting room of the chiropodist, the optometrist, the gp, reading the same Highlights magazine over and over and over.  Occasionally it got ugly, like the time my grandmother chose to explain to me her entire cataract operation – how they removed her eye and put it on her cheek – when I was about 4 years old. 

There were lots of hospital visits and funeral homes, too.  The smell of the cherry-scented bathroom air freshener that covered the smell of the formaldehyde at the funeral home in Canarsie is etched in my brain.  As I’d descend the scary stairs into the bowels of the funeral parlor, the smell would get stronger and stronger until inside the empty tiled bathroom it was overwhelming and unbearable.  I always ran back up the stairs and into whichever room we were in that night for yet another Irish or Italian wake.

I put up raucous fights when told I was going to a doctor or dentist.  I remember from my earliest visits how much I hated the doctor.  How I had favorites and if I didn’t get them, I’d use all my force of will to make it impossible for the ones I didn’t like to examine me.  I remember the misery when my mother decided that my amazing and wonderful dentist, who looked like Mister Rogers and painlessly filled two cavities when I was in kindergarten, should be exchanged for a slimy adult dentist who was polite until parents left the room and then pointedly rude and patronizing from there on out.

As a teen, when I said I didn’t want to visit the doctor, and made it abundantly clear that I would put up a fight, I pretty much got my way.  I figure my parents probably didn’t have health insurance and would be just as happy using the money for something else.

The only time I remember going to the doctor was when I was too sick to care.  I was running a crazy fever and completely ill at 18.  I was diagnosed with mono just as I got better and then quarantined to the house for 3 more weeks in the summer right after graduating high school with nothing but a Woody Allen marathon on Bravo. 

My experience with doctors as a child was pretty basic:  people who went to doctors a lot got sick a lot and people who went into the hospital died; every time I went to a doctor, whatever I had would either go away with time or wouldn’t, and there was nothing they could do about.

I’ve pretty much been about nutrition and activity ever since.

As a college student, I had university health services.  When I got out, I was able to be on my mother’s insurance for a while.  When that was ending, I had a full time job in New York that came with health insurance.  It came with health insurance – we paid into it, we filled out forms – and we never once got reimbursed.  I was working for Menahem Golan’s post-Cannon company, 21st Century Films, and the rumour was that Menahem was diverting our health insurance money and funneling it into the budgets of his films.  If you knew Menahem, this wasn’t a big surprise.  But if you thought you were getting 80% back on that gynecologist visit, you needed to think again.

When that job ended, so did my pretend health insurance.  I went on unemployment, then went to grad school, then got back into production in New York.  The golden year – a job that included Oxford Health Plans.  An early HMO model – Oxford was a dream health insurance company.  My chiropractic was covered; all my preferred doctors were on the plan, and pretty much every other thing you could want was covered.  It was fantastic.  When I left that job, I had Cobra, and was still living the dream – albeit expensively.

A move to California left me high and dry.  Oxford didn’t operate there.  Cobra found me on a plan that was somehow affiliated or comparable, but I could never get a doctor.  When Cobra ended, I had joined a media organization in order to take advantage of their group health plan through the HIPC – health insurance plan of California.  It took me a while and a couple of seminars to wade through the options, but I finally picked a plan and got it going.  Continuous coverage.  It was a great plan.  It was 100% more than I was earning at the time, but I was covered.

The only problem was, I couldn’t find one doctor accepting new patients.  Not one.  The best I could do was a nurse practitioner in an ob/gyn practise 3 towns over.  A really condescending and annoying nurse practitioner.  For the two times I went there, I think I was paying over $200 month.

But health insurance isn’t about the monthly cost – it’s about the catastrophe, right?

Like the car accident I was in after my first year of grad school – a grad school that didn’t offer any health coverage, and the job I’d started a week before the accident (and would lose two days after when my bosses’ deal went belly up) wouldn’t offer me health insurance until I’d been there 3 months.

When I left Northern Cali for Southern Cali the health plan went with me.  Sort of.  Only here, the plan I was on had no reach and there were quite literally no doctors or practices available to me.  Pretty soon the monthly cost, plus the yearly membership fee seemed ridiculous.  I was working freelance and that kind of expense became impossible.  I let it go.

Freelancing would surely lead to Union membership and the amazing carrot of benefits.  Right.  Each time Union membership got close, something went wrong, until I suspected it just wasn’t going to happen for me.  Add to that the 400 (soon 600) hours you needed to qualify for health benefits, and the banking system for these hours and the way the hours are not at all translatable to hours worked and the fact that you’re still kicking in and Union initiation and dues….lose lose lose.

So, I am without health insurance.  It’s true.  And the truth is, I don’t make enough, and haven’t in some time to buy my own.  And it’s never seemed worth it to me because I’ve never really utilized this health care system and hope that remains the case.

And while somewhere in the back of my mind, I hope for some kind of coverage, it’s never been something I could shell out several thousand dollars a year for.

I sincerely hoped Obama got it.  I really thought he did.  I thought he got it sufficiently not to dilute it.  I thought he got it enough that I didn’t have to regret that Hillary wasn’t the candidate.  I thought he got it enough that I didn’t have to regret Edwards’ early exit.  Hillary knows health care and John Edwards knows poverty.  I believed either one of them would fight tooth and nail for health care reform.  I believed they had gotten through to Obama.  I believed that he knew this was where we wanted to draw a line, stand up and be counted, and join the ranks of the rest of the civilized nations of the world.

I’m afraid I was mistaken.  He never took the gloves off.  Single-payer health insurance already exists.  It is out of reach for most people.  Brokers exist who will find you insurance, plans exist that will offer you individual or family insurance.  Organizations exist that you can join and get health insurance for nominal annual fees.  But again, those fees, or broker’s fees, plus the costs of the insurance are out of reach for most people.  If Congress has its way, though, I may now be required to pay for what I could never afford before.

Someone somewhere needs to say out loud that there is a difference between health care and health insurance.  That health insurance does not guarantee health care – in fact often impedes it – and that what we need for our citizenry is available and highly subsidized access to health care.

The UK has this and it works just fine.  It works better than our current system, in fact.  People are starting to buy private health insurance there for additional coverage and perks, but it is still not at the point that you need to do that in order to get basic care.  That may change. In the meantime, any resident of the UK can just go to a doctor whenever they feel they need to.  The long waits and delays of the 70’s and 80’s seem largely eradicated.  It’s true – the buildings are not state of the art and they may under-prescribe where American doctors tend to over-prescribe, but overall, if people get hurt they get help and if they are sick they get treatment. 

It’s a shame we can’t manage this.  It’s a shame people are terrified of losing or changing jobs because the health insurance industry has such a lock on things.  It’s a shame that people make huge life choices about how they live and what they do with the majority of their time based on something so ancillary to that.  Of course health itself is extremely important, but getting access to care should not be the reason you choose your occupation or the company you work for or how you live your life.

Just writing all this probably means I may never get access to health insurance again.  Is that how we should be living, as a citizenry, in the 21st century in the wealthiest nation the earth has ever known?

But hey – transparency is the new privacy, right?


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