An Apple A Day…

16 08 2009

When my daughter’s asthma got bad, bad enough to require hospitalization, I was told to take her to a specialist.  And to do so, I had to have a phone chat with some health insurance representative as to why this was necessary.  Why was her normal doctor not significant enough to fulfill her medical needs?  And I then waited a day for approval, which was granted, to begin seeing this pulminologist.

When my other daughter needed reconstructive foot surgery for a hereditary defect that I myself had to undergo surgery for when I was a child, I had to get the same type of approval for a specialist.  And after seeing that specialist and hearing his recommendations, the request for surgery was denied.  Neither her walking, nor developement were impeded by this deformaty, no matter how painful, so at this time the surgery is not approved by my insurance company.

When I went to my gynecologist to have my IUD changed, an IUD I have had in place for twelve years when the recommended length of use is seven to ten years, I had to wait for my gynecologist to receive my insurance provider’s blessing in replacing it.  And my insurance company wouldn’t agree to the type I wanted to have – installed, for lack of a better term.

I pay for this insurance through the nose.  There have been years where I have paid over $200 a month and never once had to so much as call on a doctor.  There have been other years where I have saved myself immense figures in medical expenses by having insurance.  But at either rate, I am paying for it but I don’t get to make the decisions about my care.  I get to select the best doctor I can find from a list provided to me by my insurance.  I get to still pay a portion of the costs in addition to my premiums.  And for all of this, I still don’t receive carte blanche when it comes to what is approved in my medical decisions.

Considering all of the above, it really aggravates me when I hear the grossly over dramatic reasons against a public heatl care plan and the so called ‘death panels’.  The idea that the government might appoint people to sit back and vote on whether or not my family is deserving of a specific health related treatment isn’t that much different than what I have endured through three different insurance providers over the past ten years.  Treatments outside of the typical check ups and cold cures and mammograms and tummy aches seem to get passed along to some moderately trained telemarketer who guides me through a series of yes or no questions and then with some unknown assistants, decides whether or not I can have my desired treatment paid for in part by the very insurance policy for which I pay!  Where is the difference?

Since my lay off in April, my family has been uninsured.  It isn’t something I am terribly proud of or comfortable with.  I worry each day that my children will suffer from some bang or bump or sickness or break or any other number of maladies that children seem to be magnets for and I will have to debate how badly they need medical care – with no medical education outside of thirteen years of motherhood.  Under the terms of my divorce and child support order, my children’s father is to pay for their medical coverage and a whopping $263 a month in child support.  But this doesn’t happen and isn’t enforced, which is another rant for another day.  Yet due to this, I have been unable to get them enrolled in the state sponsored medicaid programme which is supposed to ensure that all children have medical coverage.  Things were going great in my enrollment until I said yes that there was a child support order in place, now I am back at the proverbial square one and have to work with some interstate agency that again, is another rant for another day.  I would gladly sign up for medical coverage that would give me peace of mind should my children fall down or get sick.

There is a waging arguement about Obama’s plan (which I am pretty sure isn’t really his specifically but rather one put together by either Kennedy’s team or the House Democrats) that states that people who lead healthy lifestyles won’t receive a benefit that they currently might receive in private insurance plans because of the principle idea that each person will be regarded as an equal, the guaranteed insurability clause.  This basically says that whether you are Joe Smith who doesn’t smoke, has no cholestrol issues, no history of cancer or diabetes in his family and runs five miles a day, or if you are Jim Black who smokes a pack a day, is eighty pounds overweight, suffers from diabetes and has a family history of heart disease; either one, you will be insured at the same cost.  As an individual who is permanently injured through no fault of her own and thereby labeled with a pre-existing condition for any pains she may endure for the rest of her days, I am rather relieved at the idea that an insurance company cannot refuse me or charge me more because some ditz decided paying attention while driving was a choice not a necessity.  I’m not Joe Smith and I never will be Joe Smith, so perhaps I don’t relate with Joe Smith’s irritation at not being able to pay less for insurance for being so healthy.

(I’ll continue calling it Obama’s plan, just for the simple fact that he is backing it and it easier than saying the House proposal or Senator Kennedy’s proposal.)

Another aspect of Obama’s plan that I champion is the idea of allowing for importation of medicines and the increase of generic drugs.  My oldest daughter has a bevy of medicines she is prescribed to take and of them, only one has a generic alternative.  The other six are not available in a generic form and at US pharmacies run roughly $80 – $120 for a month’s worth – each.  As I can no longer afford this and have no doctor to prescibe such medicines if I could, this adds to my prayer each day that she doesn’t get sick.  And when generics are filled at a cost of only $4 each, I applaud the idea of allowing competition in the drug making field.

There are so many critics of the ‘government insurance’ plan that find some example of how pitiful Canadians have it in waiting for approvals or such, but the five Canadians I know are very content with their insurance.  In fact one Canadian I know who moved to the US does nothing but complain about how dreadful private insurance in the states is when compared to universal care in Canada.  Their insurance is paid through taxes paid to the government and the highest tax bracket is less than 40%.  The total government tax on a yearly salary of 40k is 15%*, whereas at 40k salary in the states my combined percentage loss to gross pay between my health insurance and taxes is 22%.  Now I don’t know much about Canada and I understand that they do have higher sales tax rates in each province than we do here, but does it bridge that gap of 7% difference in what I pay on my taxes and insurance?

On any plan there are going to be people who fall between the cracks, people who need a treatment and aren’t provided for.  I know I have seen this occur on private insurance plans myself and on military plans with my father, retired career USN.  We spent eight hellish weeks of trying to get military doctors to approve tests for my father as he would lose the use of his legs, but their determination that it was merely due to his weight got in the way until I finally took him to a civilian emergency room where he was diagnosed with a debilitating cancer.  But the idea that the masses of unemployed and underpaid can finally receive the medical coverage for themselves and their families is one that I think our government owes us and it is about time that this issue is falling on not so deaf ears.

*Source Canada Revenue Agency

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2 responses

27 05 2010
Sean Mandolini

Finally a post worth my time. Blogs are just getting so boring nowadays. If only more people wrote like you..! Regards, Sean Mandolini,

29 12 2010
bestmedicalcover2

Great article….!!!Nice to know about new things with helping concept.

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