19 February 2007

The cost of losing your insurance

Promoted from the comments:

Surgeon in my Dreams wrote:


Shadow - many of us appreciate your looking at this side of this extremely "hot" issue.

I won't go into details, anyone who "knows" me knows already, but my husband will soon be uninsured.

We do not qualify for assistance with his medications because of our HUGE combined income. We attempted to purchase private insurance and they REFUSED - several companies not just one or two.

So, do we buy these medications, or do we pay to keep a roof over our heads? They come to about $1300 a month. Does not include doctor visits or lab tests or anything other than prescription medications.

We live very simply - not beyond our means at all. Drive two old, paid for cars, and have a simple small house with a payment that is no more than the average rent in our county.

The uninsured aspect is not his fault -nor can his illness' be chalked up to having "brought it all on himself" - nor am I sure it would matter if he had.

He worked his way through college from 18 until he was 23 or so while paying off his mom's home because his dad died young. Worked all his life and did everything right by the book (according to the commentors here)but still wound up in this predicament.

Some folks have no compassion - no empathy - and for whatever reason are just plain bitter. Whether it be because they have never had to struggle with adversity, or just simply because they have a 'big head' and think it could never happen to them, there is no reasoning with folk like that.

And in case anyone wonders - I am about as non-liberal as they come down here in my little southern world. I'm not even sure I am proud to say I have been a republican most of my life, because it seems to me now, that the very party I have supported is the very one willing to let us fall between those cracks some of you refuse to admit exist.
Is this a straw man?

23 comments:

scalpel said...

I recommend choosing cheaper medications.

ERC said...

Hello. Normally I am a lurker here, but I have to agree with the commentor.

My husband has CHF with an EF=15% and COPD with lung function of 42%. We had BC/BS insurance through my job. The company I worked for dropped BC/BS and went to United Health Care. The hosptial where my husband is treated does not take UHC. Therefore, I had to change jobs. I gave up a job and career I truely enjoyed because of the insurance change. Because of his illness, hubby can't work. What are we going to do when my new company changes insurance providers? What are we going to do when we reach our insurance maximums? We tried to get private coverage through BC/BS and they would not cover hubby because of his illnesses.

BC/BS told us that if we went with private coverage that his CHF and COPD treatment would not be covered for the first year, then after the first year they could drop him. The only reason he has coverage now is because we are a member of a "Group". Once the insurance companies find a way around that, we'll be screwed.

Your response of "choosing cheaper medications" does not even begin to adequately address the issue of patients loosing insurance coverage. As a physician I would think you would be more concerned about patients who, through no fault of their own, loose insurance coverage. I constantly worry about loosing insurance coverage. Do we choose between putting a roof over our heads or keeping hubby alive? This is the USA and people should not have to make that kind of choice.

scalpel said...

It seems like it would have been easier for him to change physicians than for you to change jobs. I'm sure there were in-network physicians/facilities he could have gone to. I have UHC myself.

As I said, uninsured care can be handled at the state level with federal assistance. Further federalization of the healthcare system is not the only answer.

ERC said...

Yes, hubby could have changed doctors/hospitals. However, he is treated at one of the top 10 hospitals in the country and has some of the best healthcare available. The surgeon that performed his emergency quad bypass, is one of the best there is. He has patients that travel in from all over the country. If it weren't for this surgeon, hubby would not be alive today. He spent three weeks on life support after surviving 5 heart attacks. I rather have hubby seen by one of the best, than go to another hospital and not get as good healthcare. Besides, once you develop that kind of relationship, you don't want to give it up.

We're trying to get disability so that we have a "backup" insurance but that costs the taxpayers money.

You're right, having the federal government step in is probably not the best answer, but there has to be another solution. I will do whatever it takes to get hubby healthcare and if I have to support the Fed Govt stepping in, then I will.

Bohemian Road Nurse... said...

I too cannot get private insurance, and my employer does not provide insurance. I am in a rural area where there are not any charity/county clinics. Around Podunk, if you get cancer/diabetes/heart disease/or anything else without having insurance---it's too bad for you. I suppose eventually I will have to change jobs in order to find insurance---which means I may have to move away from my beloved home and go to the dreaded "big city"--at least I have that choice in my chosen career as an RN. Many around here don't. That's the breaks...

Anonymous said...

Have you considered contacting the drug companies to see whether you can get the medications at a lowered cost or even free?

Anonymous said...

If this man has multiple sclerosis, that's about what it costs.

Scalpel, there are no cheaper medications for this condition- you've got a few choices, all about in this price range.

And, these medications fall under orphan drug status- they're not going generic. If he buys from a mail order pharmacy in bulk (ie, 3 months at a time), his drug costs will drop a few hundred bucks a month. Of course, he'll need to have the $3k to spend up front.

I know a lot of patients like this. They don't qualify for the pharma support programs because they've got a house, cars, they look all right.

He can stop working and try for SSDI, which gets him Medicare in 2 years, if he can get the SSDI.

I don't think this is a straw man at all. I think this is a real problem for a decent sized proportion of patients.

Would this man be in better shape as a Canadian or a Brit? Probably. But, would it be better to have cancer in Canada or Britain? Almost definitely not. I don't know what the answer to the 'universal healthcare' problem is, but I think this guy's situation is real.

scalpel said...

I doubt that horrendously expensive medications of questionable efficacy would be covered in a socialized medical plan either.

Anonymous said...

Hi Scalpel,

Actually, medications for MS are covered in all the European countries, Canada, Australia, and NZ. I agree these meds are not as effective as we'd like.

If I or my spouse knew we were going to get MS, we'd consider immigrating.

But, if I knew I was going to get a glioblastoma, or breast cancer, or have a baby at 26 weeks, I'd definitely stay put.

I'm not pushing for universal health care, but I think it's reality that folks with some conditions would be better off, as individuals, in socialized systems. And, I think it's possible that any one of us could turn into one of those individuals.

The example Shadowfax put up is a good one of an individual who would probably do better in a socialized country. I think it's just wrong to have to choose between keeping your house and getting your meds or a procedure you need. But, it's also equally wrong to wait twelve weeks for a mammogram, six weeks for a breast biopsy, and then another six weeks for a mastectomy, as you might in Canada.

I don't have an answer, but I do think it's important to openly acknowlege the weaknesses of both systems and that there aren't easy answers.


-Anon9:46

scalpel said...

If someone else is paying the bill, you may have to do without certain meds or procedures. That's just the way life is.

What you are saying is that some people can't afford to buy their medications, so they want "the government" (their fellow citizens) to pay for them. If that scenario develops, there are going to be limitations on the medications and procedures that are covered, simple as that.

If wishes were fishes, then I'd want "the government" to buy me a bigger aquarium too. Or I'd learn to do without some of my fishes.

Mother Jones RN said...

I've been in the same situation that the Road Nurse finds herself in now. When I looked for a new job, I didn't ask about wages. Instead, I asked about their healthcare plan. The cost of healthcare is staggering, and even with insurance, I can hardly afford to go see a doctor or buy my medications. People without insurance are in a very bad situation.

MJ

hannah said...

shadow, you're beating your head against a brick wall here.

I don't think you'll change any minds by arguing ancedotal evidence -- it takes personal experience, watching a loved one suffer or having to suffer yourself before you can really understand the depth of the problem.

ERC said...

I have to agree with Hannah. Unless you've been on our side of the fence, you'll never understand. You don't have to stress over buying medications, paying co-pays for doctors visits, tests and procedures. My hubby will be having a pacemaker/defib implanted soon. Our out of pocket cost for this will be $3000 for the surgery. That doesn't include the physicians fees. That's on top of the money we already owe, plus his meds. That may not sound like a lot to a physician, but to many of us, it is. Hubby takes 7 maintenance meds per day. That's a lot of money in co-pays. For many of his scripts, there are no generics or cheaper alternatives. I make too much money to qualify for the reduced prices offered by the drug manuf. We also have a prescription drug plan so that disqualifies us, yet we pay several hundred dollars per month on meds.

Not to be dramatic, but if hubby went without certain meds or procedures, he would die.

Your attitued about healthcare seems very apathetic. I find that very disconcerting, considering you are a health care professional. Wouldn't you want your patients to receive long term healthcare, needed meds and procedures?

If your wife was laying in the hospital dying, how would you feel if someone said to you "if someone else is paying the bill you just may have to do without certain meds or procedures". Until you're dealing with a terminally ill loved one, you'll never understand what we deal with. Every day I wake up wondering if this is the last day I'll have with hubby. Every day I worry about paying for his meds, paying co-pays, paying deductibles. I also know, that it is only going to get worse and his disease progresses. How do you look at someone you love and say, honey I'm sorry but you are going to have to suffer and die miserably because we can't afford anything else?

scalpel said...

Just because a technology or an expensive medication is "out there" doesn't mean that everyone is entitled to it. Sorry.

You're complaining about $3000 for an AICD? What if you had to pay $50,000? AICDs are nice to have. They aren't mandatory. We did without them for years and years. Not everyone can afford yearly ECHOs, PET scans, or cardiac MRIs either. The cost/benefit ratio of all of these interventions needs to be examined, and will be.

Anonymous said...

Why put down the physicians for their attitudes? I am sure many of them offer free health care or write off their bills to indigent patients quite often. What about the CEOs of the health insurance companies who are making multi-million dollar salaries? These are the companies who refuse certain patients their access to healthcare just because they know that they will be spending more money on these ill patients rather than making a profit on them. What about the drug companies that make huge profits and bribe our politicians into passing laws that benefit them? What about the medtech companies that make the AICDs and prosthetics that are so expensive - do you think that they do it for the sake of humanity? They reap millions in profits, at the expense of patients. If you have a chronic disease in the US, just realize that its going to be an uphill battle (unless you are poor enough to be on Medicaid or you are wealthy enough to not worry about health care costs).

hannah said...

scalpel -

ah, righto. You must obviously have to take care of your ailing 61 year-old mother with an obviously life-threatening condition and, oh, scrubbing her incontinent diarrhea from the carpet. Right, right?!

When you live with a leg that is two inches shorter than the other leg for 55 years (polio! mind you), and have to deal with the extremely painful consequences, call me up. Or when *your mother* treats her degenerative spinal arthritis with Aleve...or *you* start working minimum wage jobs by the age of thirteen so that you can pay for your mom to have steriod shots in her neck (3 shotsx1,500 plus the 3,000 for the mri and reading) so that she can move her head from side-to-side...

...or maybe her medication should be cheaper?

View from the Trekant said...

If you want a picture of single payer healthcare for the US, look at the single payer health care we already have: the VA.

We couldn't prescribe statin drugs after heart attack or coreg for heart failure until loooong after everyone else was doing it per AHA guidelines. When I asked our head pharmacist about the hospitalizations that these medications would save, he just said "The hospital admits don't come out of MY budget."

We rationed stents every year - limiting the number of people who can have a coronary intervention until the next fiscal year's budget comes out.

Long lines.

Limited access to doctors.

Limited choices for all - regardless of patient motivation or ability to pay.

We need to hold the insurance industry more responsible. I don't think having the government take over the entire thing will improve anything.

scalpel said...

1) Aleve is great medicine for arthritis.

2) Paraspinal steroid shots are a scam.

3) MRIs are overused and most of them don't change clinical management.

ERC said...

This is a very difficult subject and it is near and dear to my heart. I am not complaining about paying $3000 for the pacemaker. If I hadn't of changed jobs it would have cost us $12,000. My problem is that the only reason hubby has insurance is because I work for a large corporation and he is covered under a group policy. If the for-profit insurance companies could figure out how to legally exempt seriously ill patients, they would drop him, and others like him, in a heartbeat. They lose money on him hand over fist and that is not why they are in business. If we lose insurance coverage then the out of pocket expenses would break us. I spend $300 a month on meds, and that is just the co-pays. Believe me when I say this, is not a complaint, but again I don't know what we'd do if we lost coverage. I don't know how people without coverage do it, other than going into debt. If we had to pay full price for his meds it would be over $1000 per month. Not everyone can afford that. So, should they not receive good healthcare because they have a lower income? Should my hubby not receive good healthcare because it is hard on us? All of these patients with serious illnesses are human beings. They have families and friends who love them and want to see them treated well.

As long as hospitals, drug compainies and pharma remain for-profit there will be people who don't get good healthcare. Should patients less fortunate than us not get good healthcare?

We need a system in place that will allow seriously ill patients to get the insurance coverage they need without fear of being dropped, or reaching their maximums. Your points are valid from a business perspective, but what about the human perspective? These patients are human beings, with feelings and family who love them and deserve a chance. Unfortunately healthcare is a business that deals in life or death, literally. There is no other business model like it, the stakes are higher and human emotions play a real factor.

scalpel said...

What difference does it make if it's the incurance company or some hypothetical socialized universal health system paying the bills? You are still wanting more healthcare than you are paying for.

You are not wanting "good" medical care for your husband. You are wanting the very best medical care available in the world today at one of the best medical facilities in the world. But you can't pay for it yourself, so you want someone else to do so.

Those suggesting a nationalized healthcare system ignore the fact that if we try to provide healthcare for all, they may have to settle for "good" healthcare. Not super-excellent top -of-the-line healthcare.

In all honesty, the mortality difference probably isn't all that significant.

hannah said...

1) Aleve is great medicine for arthritis.
For the first five or ten years of it, yes. As I've watched my mother age, I've also noticed that things tend to get worse. But that could also be complications from polio, as well. For the most part, she lives with the arthritis; certainly, her mother and grandmother and so on lived in such the same manner and without the help of Aleve. Pain management is mostly about life-style changes, as my mother tells me. She leaves the house twice a year on Thanksgiving and Christmas. Unless I have to drag her to the hospital because her potassium levels tend to drop precariously low and when that happens, her legs and arms stop functioning. I think that being able to move your legs and arms might be a basic necessity - and your heart is kind of important? - but I could be mistaken. God knows that we can't afford the two-three week ICU stays, but since she doesn't qualify for government assistance, nobody's tax dollars are keeping her alive! Thank god!

2) Paraspinal steroid shots are a scam.
Probably, but she was able to turn her head from side to side after she got them. I mean...I think turning your head from side to side might be important? I could be mistaken? She's pretty much homebound, so really, all she *needs* to see is the television screen.

3) MRIs are overused and most of them don't change clinical management.
True, but they would not give her the damn injections until she got the MRI. An x-ray would be significantly cheaper and affordable, as we argued, but I also understand the "must cover my ass" dilemma that many physicians face. My father is an ER doc and has been sued several times.

scalpel said...

"I think that being able to move your legs and arms might be a basic necessity - and your heart is kind of important? - but I could be mistaken."

Potassium is very inexpensive, fortunately. Often hypokalemia is caused by other medications (especially diuretics).

Ridwan said...

The Center for Media Research has released a study by Vertical Response that shows just where many of these ‘Main Street’ players are going with their online dollars. The big winners: e-mail and social media. With only 3.8% of small business folks NOT planning on using e-mail marketing and with social media carrying the perception of being free (which they so rudely discover it is far from free) this should make some in the banner and search crowd a little wary.


www.onlineuniversalwork.com