Strangled By Red Tape - Our Journey to Insurance

Permit me to step from behind the notebook  and offer my personal experience. We've been slogging our way through the new health care marketplace, a fetid swamp of rotting bureaucracy populated by malicious trolls and frustrated angels.  The shining goal keeps us dragging ourselves forward. There it is, so bright, so beautiful, just beyond our grasp: health insurance!

I have been uninsured for two years. It was the first time in my life I've had no insurance and it's been scary. I left a state job with a great salary and great benefits to become a freelance writer. It's a long story but bottom line was I had to choose between my wallet and my health. I decided it was better to be poor and not sick. I made the right choice. You won't be surprised to hear that it wasn't long before I had to add another job, but real estate sales doesn't offer insurance either. So here I am, mid-fifties, in great health, but one broken leg or scary diagnosis away from financial disaster.

I looked into insurance. Of course I did - I'm a responsible adult. The cheapest insurance I could find was a terrible plan with high deductibles that was going to cost me a thousand dollars a month. I just didn't have a spare thousand lying around every month. So that meant going without and keeping my fingers crossed that I didn't get sick.

In case you're wondering, no, I couldn't be on my partner's insurance.

My partner is a musician. He's been one all his life. And musicians don't have health insurance unless they buy it themselves.  And the cost was exorbitant.

So the prospect of a government-regulated healthcare marketplace sounded like a great thing to both of us. We got on that website and got ready to enroll.

I actually didn't find the website to be that bad - the federal site directed me to the New York Healthcare Marketplace, where I answered all their questions and got to the point where I could choose a plan. Then I stalled.  I hadn't heard of most of the companies and the options chased each other around in my brain without pausing long enough for me to understand what they were.  So I waited for the smart one in our family to get involved so he could explain it to me.

What followed were two solid weeks of angry howls from his office.  Each day was the same: get on the phone and call the number to which the marketplace directed him. Hold for an hour or more. Finally reach a human and ask simple questions. Get the answers, then call the next number for the next step. Wait another hour or more. Begin the next step, then discover the first answers were wrong. Go back to step one.  Some days, rather than getting the wrong answer, he'd be told that they just didn't know the answer.

He's not a terribly patient man on the best days, but this experience sent him way over the edge. Some of the things he yelled after he hung up the phone were concepts I didn't even know were possible. On the plus side, I've learned a lot of new combinations of colorful exclamations. 

"I'm drained," he told me more than once. "This is the most exhausting thing I've ever done. And I'm getting nowhere."

Chasing your tail will wear you out.

I'd love to conclude this with a happy picture of us both holding our insurance cards. I may yet get to add that to this post. For now, I can tell you that I have been approved, I chose a plan, and I'm waiting to hear about the next step. I'm told that will happen in January. 

The best rate I could find was about $350 for a bronze plan - nothing special, but it's insurance. I just read a New York Times article where they discussed the cost of the health insurance under so-called Obamacare, and they maintained that a silver plan (that's better than bronze, you know) was about $300 or so for the average middle to lower income person. That's not my experience. If you can tell me where that plan is, please let me know.

But I'm not complaining. Bad insurance beats no insurance and $350 is a whole lot better than $1000 a month.

My exhausted partner? He's also supposedly signed up, but he has his doubts. He suspects it's been screwed up.

We're thinking it might be simpler to move to the UK.

Just What Got Passed, Anyway?

My inboxes are flooded this morning. My personal email address has thank you's from the president, an exhortation from the BoldProgressives to "hit the Blue Dogs" for their blocking of a public option, a celebration of the Working Families Party's success in helping get a local Blue Dog to vote "aye", and an email from my guy's mom checking on his recovery.

My work inbox, a nonpartisan address, has a letter from NY's governor applauding the passage of health care, a blistering attack from NOW NY on the president's executive order which they say could be used by a hospital to deny a rape victim contraception as part of her post-attack treatment.

There are letters from all the local congressional reps announcing their vote, with the funny part being that reluctant, late-to-the-game Blue Dog announcing his "yes" vote in an ALL CAPS SUBJECT LINE. He wants you to know he got your emails and phone calls.

There a note from an insurance conference pointing out the incredible importance of the health insurance industry to New York's economy. There's a vitriolic letter from the National Republican Committee Conference lambasting one of those local congressmen, referring to him as a " loyal lapdog" who put politics first and his constituents second.

It has become such a mess, such a muddle, that I doubt any of us outside of Washington fully understand what was being debated this weekend. I'm going to try to figure out the big picture.

Here's what I just found on The Daily Beast: "Health-care reform may have been historic, but many of its biggest reforms won't take place for at least a couple of years. So what does the health-care bill change right now? Crooks and Liars has assembled a handy list of immediate changes. After President Obama signs the bill, children will be able to stay on their parents' health insurance until their 27th birthdays. No child under 19 will be excluded from plans because of preexisting conditions. It will eliminate caps on how much care you can get in one year. Adults with preexisting conditions will be able to start shopping online for a plan in a national high-risk pool while waiting for insurance exchanges to get started. Small business can deduct as much as 50 percent of employees' health benefits for tax purposes in 2009 and 2010. It will fill in the "donut hole" of Medicare prescription drug coverage with a rebate. Insurers will have to post their balance sheets online, listing administrative costs, executive compensation packages, and benefit payments. And you can no longer be dropped from your insurance plan just because you get sick."

And there's a letter from Michael Moore to both addresses, explaining what he believes the new bill means. He sees it as a victory for US citizens over corporate interests and a good start on a decent health care system, but far from perfect. In fact, before endorsing it, he admitted this was one pretty weak piece of legislation. But it's a foot in the door.

Here's what the NRCC says...and I quote (eliminating the attacks on the guy who voted for it): This is..."a bill that fails to lower the cost of healthcare," ...creates " hundreds of billions of dollars in new taxes, Medicare cuts, runaway spending and unprecedented government control,"..."this toxic bill will negatively impact small businesses that are struggling to hire in the midst of a tough economic climate."

Here's Michael Moore's letter (with some of the GOP bashing cut where it adds no information - you can read the whole thing at the link): "Thanks to last night's vote, that child of yours who has had asthma since birth will now be covered after suffering for her first nine years as an American child with a pre-existing condition.

Thanks to last night's vote, that 23-year-old of yours who will be hit one day by a drunk driver and spend six months recovering in the hospital will now not go bankrupt because you will be able to keep him on your insurance policy.

Thanks to last night's vote, after your cancer returns for the third time -- racking up another $200,000 in costs to keep you alive -- your insurance company will have to commit a criminal act if they even think of dropping you from their rolls.

If it's any consolation, the thieves who run the health insurance companies will still get to deny coverage to adults with pre-existing conditions for the next four years. They'll also get to cap an individual's annual health care reimbursements for the next four years. And if they break the pre-existing ban that was passed last night, they'll only be fined $100 a day! And, the best part? The law will require all citizens who aren't poor or old to write a check to a private insurance company. It's truly a banner day for these corporations.

So don't feel too bad. We're a long way from universal health care. Over 15 million Americans will still be uncovered -- and that means about 15,000 will still lose their lives each year because they won't be able to afford to see a doctor or get an operation. But another 30,000 will live. I hope that's ok with you.

If you don't mind, we're now going to get busy trying to improve upon this bill so that all Americans are covered and so the grubby health insurance companies will be put out of business -- because when it comes to helping the sick, no one should ever be allowed to ask the question, "How much money can we save by making this poor bastard suffer?"

A Daily News poll online this morning asks if you believe America is better off today than yesterday. The No votes are edging the Yeses by six percent. But Mike Lupica wrote a stirring column lauding the fact that when push finally came to shove, the president stood on his principles, telling House Democrats that this was a moment when they could do what they came to Washington to do, vote for a change that makes things better. I believe that is the aim of this bill.

It's not a great bill, not by any measure. But it moves toward reforming a system that is going to bankrupt us. It moves toward assuring health care for every citizen which is, in the long run, not only the human thing to do, but the fiscally responsible thing to do. We cannot afford to care for the growing number of uninsured by forcing hospitals to treat them in emergency rooms. We need to create a system that reflects reality. I believe this bill is a step toward that.

According to a San Diego political commentator, the only impact this will have on us, the regular people, is creating a state-based exchange with subsidies for insurance..in four years. A separate exchange will be created for small businesses.

People and families with income over 250 thousand dollars a year will pay an extra 3.8 percent tax on investment income. And in 18 years, insurance companies will pay a hefty 40% excise tax on insurance plans over 27 thousand dollars. I'm not seeing a problem here yet.

What I see as the result of this bill is a step through a door that has, until now, been closed. With the passage of this bill, there is opportunity to fine tune it, to tailor it, to create a plan that not only stops the devastating escalation of insurance costs and health care costs, but extends basic health coverage to every American.

I won't argue compassion to Conservatives. That's not what moves them. I will argue fiscal responsibility.

I listened to David Walker, the author of Comeback America: Turning the Country Around and Restoring Fiscal Responsibility during one of my drives back and forth the hospital last week. He's a sane man. He's knowledgeable and he knows government from the inside. He was Comptroller General of the United States and CEO of the U.S. Government Accountability Office (GAO) from 1998 to 2008. And he is convinced that, without significant reform, health care will bankrupt us. Of course, we're doing plenty of other things that will bankrupt us, too, but health care as we've been doing it is number one.

So the door is open. We've got something to work with now. And the motiviation to work on it.

Screaming about a government takeover of health care, spreading fear, will not contribute to improving this bill. Of course that's what will happen...screams, lies, fear...no doubt that horrific "death panel" garbage will rear its disgusting head, too.

I give up on hoping for civil dialogue. That's not how Washington works. But I demand progress from my elected officials, I demand the very best health care reform they can design that benefits the public, does not unrealistically enrich the corporations and reverses the growing debt load we're handing off to our children and grandchildren.

That's your assignment, Washington. Congrats on doing something. Now shut up and get to work.

A Typical American Hospital - Overworked

There's a medium sized hospital where I've just been visiting the past couple of days.
My guy had to spend a couple of nights and he's fine now, but it was an educational experience.

I don't handle hospitals well now - I spent too much time there with both my parents and I imagine a psychiatrist would tell me I've got some lingering emotional trauma. I'd just say I'm not happy in a place I now associated with so much sadness.

I don't hold the hospitals or the staff responsible. My experiences with my mother were sometimes remarkable and sometimes nightmarish. I remember the young nurse who ignored my mother's complaints that her "arm was burning." She paid attention when I went to get her two hours later in the middle of the night. A vein had collapsed and the IV fluids had backed up; mom's arm was three times its normal size.
Other nurses visited every day when my mom was in a coma, talking gently to her, wiping her face, smoothing her hair.

My father was lucky enough to die at home.

I've spent some time in the past year with another loved one who recovered nicely and was treated very well, but this latest visit was the first one in the midst of this economy. And there's a difference.

Nurses are working long hours, working hard and being asked to work more. The ones we dealt with in this small city hospital were wonderful; kind and caring. They treated their patients like people, not like ailments.

But I heard more than one nurse tell us that she'd be with us all day, through the night and into the following day. And I heard some RNs and LPNs discussing phone calls asking them to work an extra shift.

It's become like a police or firefighter schedule; put in an entire week's worth of hours in one long stretch, then go home.

How do they do it? And how long can they last even if they manage to stay alert, make no errors and continue to treat their patients with compassion and patience?
What's the burnout rate?

The most telling example for me was an elevator ride home late in the evening. I was joined by a young nurse who was holding a sandwich wrapped in plastic.

"My dinner," she said ruefully.

"You look beat," I said.

She nodded. "I'm completely exhausted. All I want to do is go home and fall into bed. I doubt I even eat the sandwich."

The elevator reached the lobby and we said goodbye. And I realized that this is her life; work hard to make ends meet, take care of people who desperately need care, and sacrifice yourself in the process.

Like so much else today, it's not sustainable. And no one will do anything until there's a tragedy or a massive crisis. Maybe this is one time we should be talking about the problem before the crisis.