Tuesday, August 03, 2010

Thankful: The Flip Side

To continue with my post Thankful, here are some I purposely left out so I wouldn’t ruin a perfectly good and heartfelt essay:

I am thankful that I have health insurance to pay for good medical care and modern technology.

Unlike other civilized countries like Canada and Great Britain, the United States does not provide health insurance to its citizens—except for some half-assed benefits for the disabled and those folks who are over 65 (Medicare). Americans have to purchase health insurance through private companies, and are at the mercy of those companies regarding cost, coverage, and annual rate increases.

I am thankful that Martha has a job, and a job that pays her monthly health insurance premiums.

I am thankful that we’ve had the $5,688 in cash to pay for deductibles, co-insurance, co-payments, and drug co-pays since January 1. (If you don’t know or understand these terms, don’t ask.)

To repeat a comment Robert the Skeptic made last night on Thankful:

"Yeah I'm marking time until my aortic valve starts giving me 'symptoms', the stenosis is 'severe' so I am on the long countdown. Will probably need to take out a second mortgage to pay the copays and deductibles but as you say, I'd be dead meat if the technology weren't available. Guess we are lucky bastards."

Robert and I may be lucky bastards, but there are millions of Americans who don't have jobs, health insurance, or the cash the insurance companies require (or very likely, they don't have all three).

* * *

GAMES INSURANCE COMPANIES PLAY

From an article in USA Today on July 22, 2010:

"Non-profit Blue Cross and Blue Shield health plans stockpiled billions of dollars during the past decade, yet continued to hit consumers with double-digit premium increases, Consumers Union found in an analysis of 10 of the plans' finances.

"Examples cited include:
Blue Cross Blue Shield of Arizona: A $717.1 million surplus in 2009, seven times the regulatory minimum. The plan raised rates for individual market customers by as much as 18 percent in 2009. Company Spokeswoman Regena Frieden said, 'We believe the amount we have in reserves is appropriate.'

"Regency Blue Cross Blue Shield of Oregon: A surplus of $562.2 million in 2009, about 3.6 times the minimum. The plan revised rates on some plans an average of 25.3 percent in 2009 and 16 percent in 2010. Spokeswoman Angela Hult said the surplus is 'essential to protecting our members from surges in claims costs.'"

Our health insurance carrier is Blue Cross Blue Shield of Illinois by way of Blue Cross Blue Shield of Arizona (don't ask). On January 1, 2010 they ruled it necessary to institute a new co-pay: every time Martha or I visit a "specialist"—Dr. Lung, Doc Potty, Dr. Eyeball—we pay another $50 out-of-pocket to help defray the insurance company's "losses."

Addendum: A chart of ObamaCare changes for your perusal and refusal.

29 comments:

TechnoBabe said...

I am thankful that you and Martha had enough to pay your co-pays too. For me, I am used to no insurance. It has been many years since I had any medical insurance. In six months I will be 65 and hopefully there will still be medicare and I will still receive my social security benefits.

Charlie said...

BABE: Isn't it terrible to have to hurry up to get old? All of us in Blogaritaville are pulling for your 65th.

Pat said...

God knows our Health Service
(Britain)isn't perfect but my experience has been: in emergencies and acute cases it is first rate.
The normal everyday nursing standards would seem to have lowered somewhat since my training days in the forties. But then I would say that wouldn't I?
I thought President Obama was changing the health system to make it accessible for all. Or did I get that wrong too?

DJan said...

I had to wait until I turned 65 to retire from my job so I could have health insurance (Medicare). I still pay for the copays and for the 20% that Medicare doesn't cover, but at least if I end up in the hospital we won't go bankrupt, like so many others have.

Charlie said...

PAT: Obama's "Sweeping Health-Care Reform" does little or nothing to correct the systemic problem of private insurance companies. Insurance will be accessible to those who can afford it.

DJan: Gee, I wonder how many times we'll hear a story exactly like yours!

Sharon Longworth said...

I read this having spent all day at work discussing our new Government's plans for sweeping changes to the health service - we seem to be hurtling headlong towards offering huge chunks of our health provision to private insurance companies in the name of cost-cutting. It wasn't in the manifesto, nobody voted for it.

Kevin Musgrove said...

What Sharon said. [sigh]

Fay's Too said...

I could go on and on about this. Oh, I think I may have done so.
Here's to you for putting words together so well!

Charlie said...

SHARON & KEVIN: C'mon, you two, tell me it ain't so! While the insurance companies get rich and the MPs have a few extra pence in their pockets, the only cost-cutting will be done to you.

But of course you know that already.

FAY: I KNOW this is one of your favorite subjects—maybe it's time for another tirade.

hope said...

I also have "Blues and Cross, hand me a Shield" as well.

As my dentist likes to put it, "Yes, they do pay some. The problem is I'm using 2010 prices and they're using a chart from 1912."

Ironic they'll pay for "Wellness" check ups, yet drive us batty when it comes to the help we need...paying the bills!

Sorry, stepping off the soapbox now. Carefully. So I don't injure either of us. ;)

Ponita in Real Life said...

Having lived in the US for five years, I understand how things work down there. And being a nurse, I saw some of the stuff patients got charged for. Ridiculous system, if you ask me.

The Canadian system isn't perfect either, but all the basics of medical care (and a lot of specialist stuff too) are fully covered. It's the waiting times that are a killer! If I could afford the $50 - $60K to go south of the border to get my back fixed, I'd do it in a heart beat!

As it is, I am on the waiting list to see the neurosurgeon for an initial assessment... and that list is about 2 years long. :-(

I keep hoping the lottery tickets I buy will produce enough winnings to cover the expenses...

Bibliophile By the Sea said...

DON'T get me started on insurance industry crooks!!!!!

Glad u are doing well Charlie.

Sausage Fingers said...

Many of my friends chief complaint about socialised medicine is the long wait for care, especially emergency care. My last ER visit here in Fla. was 2 hours, the only reason they rushed my in was that I sprayed the contents on my stomach at the nurses station, accidentaly of course.

Charlie said...

HOPE: Don't be fooled by the Wellness check-ups. Yes, they're good for us, but they also alert BSBC of any potential problems that might cost them down the road.

Put a seatbelt on your soapbox and you can stand there all day if you want.

PONITA: I've heard about your long wait times for specialists (same thing in the UK), but if "Obama-Care" was to cover everyone we'd have the same problem. Just not enough doctors, nurses, or facilities to handle the load.

DIANE: Crooks? Did you say crooks?

FINGERS: Welcome to the blog, as long as you don't puke on it.

ERs operate on a triage system (the worst go first), and sometimes they mis-triage . . .

Robert the Skeptic said...

Yeah I neglected to mention that just my monthly premium for my health insurance is $1,200 per month. That is more than my house payment was and consumes about 1/3 of our household income.

To listen to the conservatives rail about "Obama Care" and Socialism you would think the Apocalypse was falling on America. Well the bill passed but there was nothing in it that helped me.

It further encourages me in believing that we have only one political party in this country - the "Republicrat Democan" party headquartered in the nation's capital: Wall Street, NY.

Buzzard said...

Your thankfulness rings true with me. I could run off the same list you lay before us. I had heart by-pass surgery on Dec 29th, and I am still trying settle all of my co-pay issues.

Having said that I am grateful for the skilled surgeons, excellent and caring nurses, and the support of my wife through a very difficult time.

One last comment on large medical bills. If you are fortunate enough to be able to pay your bill in full, you can speak with the billing office, and ask if there is a discount if you paid in full today. My wife was all over this, and one co-pay was $1700 and she was able to get it to $1275. She was able to perform this with co-pays of a couple hundred dollars and still get a considerable discount.

Tiffin said...

Eight years ago, I had an angiogram to detect heart problems in February and then a triple bypass the following July and three month post-op rehab, all totally covered by our health care system here in Canada. Thankful? Infinitely! Yes, our health care system is far from perfect but I prefer it to any alternatives I see in other countries. I won't get into the other health issues I've had. I'll just say that if I had had to pay for them, we'd be living under a bridge somewhere with our clothes in a shopping cart.

Charlie said...

ROBERT: I've known that you pay an outrageous premium and that's why I included BSBC of Oregon in the post (even if they aren't your carrier).

As far as Obama-care, I don't see much in it for much of anyone, except those with pre-existing conditions—and those people will pay dearly like you.

BUZZARD: Welcome back!!!

I don't doubt that the paperwork is still flying on your by-pass. You'll probably end up with 40 consulting doctors, radiologists, specialist this, specialist that . . .

And I DIDN'T know about negotiating cash discounts, even though we debit card everything.

TUI: Long time no hear!

But I hear you about your health system. You pay for it, of course, through various and sundry taxes, but it's easier paying in bites than all at once—especially for the major stuff.

And I'm glad you don't live under a bridge: how in the world would you iron your clothes?

Unknown Mami said...

I contend that insurance is the biggest scam in America. And yet I'm thankful I have it because the alternative in this country is so horrible.

KleinsteMotte said...

My cancer care was swift once it was finally diagnosed. We have a system that requires a GP to determine what specialist is needed and then you're put on a wait list. i complained of abdominal pain and a lump for over two years. Finally the pain was too bad so I went to the ER. They kept me, operated removing a 15cm tumour and all of the large intestine and then told me the biopsy report said it was late type two stage ( originally thought late type 3 stage). Not sure where the blame lies for the lack of earlier intervention but glad the operation was free. We do have additional insurance through my former employer 'til I turn 65 next year which would have covered the chemo pills price of $1000. for a months' supply but I could not tolerate even 6 days out of 6 months. Check you fire insurance plans. We really got taken because our fire marshall has yet to file his report after 2 1/2 years. They don't know the cause so they won't make a ruling.
Glad we had a savings account with a few dollars but 2008 riddled that too! Still we have to lots (not $) to keep us smiling.

Entre Nous said...

don't want to burst your bubble or anything but....

In the 60's my mother's best friend (a registered nurse) immagrated to Canada, to work in their system she claimed was wonderful. Years later she said it had deteriorated to the point of it being worse than a third word country. (I won't go into how the dr.s were begun to be treated by the government...)

Years later when injured at work I ended up in the ER, speaking to a Canadian intake RN. He was Canadian. Left there due to the horrible healthcare situation, unless one had gobs of private money for private care - meaning not in public hospitals. The last straw for him was, that patients were laying around on stretchers literally dying because there were not enough dr.s - most are here - and if ANYONE, even a nurse, so much as touched that patient to help, and the patient expired, they could be sued CIVILLY. We're talkin lose your house civil.

My distant cousin LIVES in Canada. She says we should have been thankful all these years before OBAMA-CARE threatens to turn this country into Canada, with its horrible health care system. She LIVES there.

Now, since OBAMA-CARE insurance comapnies scrambled to get stuff through.

My best friend has been forced to see a physical therapist since he injured his neck. His insurance company (we won't mention any names but it starts with BLUE-)refused to pay for x-rays, CAT scan, or MIR until he had seen the physical therapist for SIX weeks. After an INJURY.

We were taught even after a SLIGHT blow to the neck, you can be walking around with a broken neck and not know it - without x-rays.

I have no insurance, but it appears that it doesn't matter anymore.

Barbara Bruederlin said...

You and Martha should pack up and move to Canada, Charlie. You can stay with us!

Despite what one of your readers states, our health care system does work and it works well. Sure there are some issues, but nowhere in the universe is there a perfect health care system. Many hospitals are seriously overcrowded, but nowhere is anybody being sued for treating a patient who then dies.

Tiffin said...

I must respectfully disagree with one of your readers who says there aren't doctors because they have all gone to the US, that our health care system is 3rd world, that people are lying around dying in halls and that doctors are sued for even touching someone. (We aren't a very litiginous people, actually.) This is not accurate information. We have excellent doctors, among the top brain surgeons in the world, superb cancer and heart doctors, brilliant medical researchers, etc. Our system isn't perfect and yes, it has been strained through government cutbacks, but it is open and accessible to every Canadian. I happily pay the taxes I do to ensure that the least among us can enjoy that right.

Charlie said...

MAMI: I totally agree with you: My first "thankful" in this post is, "I am thankful that I have health insurance to pay for good medical care and modern technology."

That doesn't mean, however, that I don't bitch about it because I do—frequently.

KM: As a cancer survivor you are a testament to a system that works for millions of Canadians.

Wandering Coyote said...

OK, that Obama chart makes my head hurt so I am just going to skip it.

I am thankful I live in Canada, despite the imperfections of our medical system (and there are many). Compared to what you guys have down there, I'll take it any day, thank you very much.

Wandering Coyote said...

OK, just glossing over some comments here...

I am not getting into the debate about Canadian health care and it's issues etc., but just know that as a person with a chronic illness, I have been very satisfied with the access to treatment, resources, and specialists I have received over the years. Seriously.

Lady_Amanda said...

Hi Charlie,

I totally agree health care in this country sucks. I am one of the forunate people to have a disablity. I pay nothing to go to the doctor and for about five months out of the year I pay three dollars and thirty cents for name brand prescriptions and a dollar and ten cents for generics. Now one thing you do have to remember is that I have seventeen different medicines! However usually by June I might my decutbile and I pay nothing. However, as a Christian I can't let people who work their asses off go without insurance. I know a young woman around my age, who doesn't have a disablity, who work TWO jobs and NEITHER offer her health insurance. Now that just unchristian for me to say well she has to take her own hard worked money and pay EVERYTHING out of pocket. Do you think that Obama will make this better? Just wondered.

Hugs and blessings,
Amanda

MaryWitzl said...

What Pat said about the NHS. In fact, I have to say that if the British National Health Service isn't perfect, it's pretty close. I've lived in five different countries now, and the NHS is the winner, hands down. We've got great hospitals and doctors in the U.S., but you have to pay through the nose for them and wait for hours.

So sad that the insurance companies fatten at the expense of so many. It shouldn't be so hard to provide decent medical care that doesn't financially ruin people.

Syd said...

I am glad that we have health insurance but hope that the rest of the country will have it soon as well.