Monday, March 19, 2012

Falling through the cracks

As the Supreme Court draws closer to deciding the fate of the Affordable Care Act, and people either deride the act as Obamacare or draw blanks on its oft-confusing language, those of us in the individual market continue to endure gigantic increases in our premiums even while listening to people complain that they don't want the government to come between me and my doctor. I'm as disappointed as the next person in the healthcare act, insofar as it made deep compromises with the insurance industry and didn't go far enough to ensure healthcare equality. I believe in universal healthcare coverage, however flawed, but I know this will never happen in our country given the current political climate and the level of ignorance we see every day. I have resigned myself to paying for 15% plus increases in Sophie's healthcare coverage every six months to a year (over 150% increase in the last three years). I have researched and done due diligence, deciding to downgrade the boys', The Husband's and my coverage to catastrophic coverage, still expensive and ever-rising as well. I'll continue to grit my teeth in resentment toward those who believe the United States has the best healthcare system in the world and hatred toward those who support the insurance industry in any way.

When I publish this post, I'll call Anthem Blue Cross and begin another fight with them over coverage of Sophie's medication. I won't bore you with the details, but a drug that she's been on for years, that we got from Canada through a pharmacy in New York was just approved for use in the United States by the FDA. I am now able to get the drug at our local pharmacy through insurance. Unfortunately, even with insurance, the drug costs three times as much as it did when I bought it from Canada. That's just messed up and indicative of the bullshit that is the insurance industry, the pharmaceutical companies and American healthcare, in any form.

Here's an excerpt from economist Paul Krugman's column in today's New York Times:

To understand the lies, you first have to understand the truth. How would ObamaRomneycare change American health care? 

For most people the answer is, not at all. In particular, those receiving good health benefits from employers would keep them. The act is aimed, instead, at Americans who fall through the cracks, either going without coverage or relying on the miserably malfunctioning individual, “non-group” insurance market.
The fact is that individual health insurance, as currently constituted, just doesn’t work. If insurers are left free to deny coverage at will — as they are in, say, California — they offer cheap policies to the young and healthy (and try to yank coverage if you get sick) but refuse to cover anyone likely to need expensive care. Yet simply requiring that insurers cover people with pre-existing conditions, as in New York, doesn’t work either: premiums are sky-high because only the sick buy insurance.
The solution — originally proposed, believe it or not, by analysts at the ultra-right-wing Heritage Foundation — is a three-legged stool of regulation and subsidies. As in New York, insurers are required to cover everyone; in return, everyone is required to buy insurance, so that healthy as well as sick people are in the risk pool. Finally, subsidies make those mandated insurance purchases affordable for lower-income families.
Can such a system work? It’s already working! Massachusetts enacted a very similar reform six years ago — yes, while Mitt Romney was governor. Jonathan Gruber of the Massachusetts Institute of Technology, who played a key role in developing both the local and the national reforms (and has published an illustrated guide to reform) has surveyed the results — and finds that Romneycare is working pretty much as advertised. The number of people without insurance has dropped sharply, the quality of care hasn’t suffered, and the program’s cost has been very close to initial projections.


  1. I have been an advocate of some sort of "socialized medicine" since I took my first ethics class in college, over twenty years ago. I continue to rail against the culture that doesn't believe each and every person ought to have access to healthcare and refuses to acknowledge that half (or more) of the reason we are in such financial trouble in this country is because we are spending astronomical amounts of money on a system that doesn't work in any capacity. GRRR!

    Good luck with the insurance company today.

  2. last night while it was steadily snowing i was dreaming. in my dream i was holding sophie close to me and somehow.....we were comforting each other. it was as if we shared a similar horizon and could not face it alone. so we held each other wrapped so close, sophie sitting in my lap like a small child. but she was not small and neither was our challenge.
    we both exist on a treatment that is impossible to afford without insurance approval for coverage.
    we both are hanging by a thread.

    what is the price of a life?
    sad that we must be very careful who we ask.

  3. I read that Krugman piece this morning and thought of you. Fight the good fight, Elizabeth. My prayer is that you will win. Sophie will win. All of us.

  4. What is so unbelievable to me is that anyone could say that universal health care is a bad idea. I just don't get it.
    But then again, I don't get a lot of things. Homophobia, racial prejudice, the tea party. You know.
    I loved rebecca's comment.
    I love you.

  5. I'll second Ms Moon above. How can people think that universal healthcare is an -ism? Socialism or communism? The only -ism it is is humanism. Thanks for another measured post, although I know that there's a volcano seething under your skin now. Good luck with everything.

    Greetings from London.

  6. Elizabeth, I'm glad you're saying all this, because attempting to do so makes me flustered and frustrated and inarticulate. I read an article in Forbes recently that might interest you. It was on Santorum and how apparently he's been claiming Obama's health care will harm his daughter's benefits, when in actuality it will apparently ensure she receives benefits for the rest of her life.

  7. Mornings that I don't want to go to work my husband reminds me of the beauty that is corporate sponsored insurance and I go. And I will never leave. But surely being locked into a job for the next 30 years (I'm grossly exaggerating my retirement, not my current age) is not what the right wing had in mind? What if I had wanted to open my own business and be a "job creator"? Do only the wealthy & healthy get that privilege?

    But on a brighter note, I'm going to do my part for your premiums - I have a lunch date at the mistress on Friday! I'm so excited! Well, for lunch AND for four days in SoCal without the kids, but lunch will clearly be the highlight of my trip.

  8. Blue Cross has just raised our premium by 30%. I am so disappointed that the insurance commissioner in California hasn't been more effective in regulating their excesses. And where is Gov Moonbeam, anyway? I think it's quite likely the SCOTUS will not agree with the POTUS, but why can't California under Brown do as well as Massachusetts under Romney?

  9. There's just too much money to be made by the medical-pharmaceutical complex for them to allow lawmakers to pass universal health care. Someone's making big bucks off that medicine that's so much cheaper in Canada.

    It IS ridiculous that a country as advanced as the United States has such a primitive and patently unfair system of care for its citizens.

  10. I pay for BC/BS because I am independent contractor with the local early intervention program. My premiums are 457/mo and rising with a 2,500 deductible. I am the only one covered as the kids have Medipass due to their adoption. I have never met my deductible yet the premiums go up and up. In November when i had surgery it covered nothing. The only benefit I had was the doctors could not charge me what they would charge an uninsured person due to their agreement with BC/BS. Surgeon if uninsured $2,500. BC/BS allotment $645.00 of which I am paying off200.00 a month...I have never in my entire career as a nurse struggled with such insurance messes as I have in the past decade. All of the above illustrating my theory that the middle class have become the "new indigent."



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