Saturday, March 24, 2007

Two overviews of the uninsured.

A comment in my previous post did not ring true to me at all, and I had to do a little reading to try to confirm it. It is true that there are discounts on hospital bills available to "charity cases," and after an outcry and a few class action suits, some hospital chains offered other discounts, but a lot of the uninsured are, as I said, often left paying the full freight of their hospital bills. This article in USA Today sums up my situation if I were to go freelance. The couple in question made over $48,000 a year but had no insurance at the time the husband was struck by an unexpected illness. They didn't qualify for a "charity" discount but couldn't afford the whopping hospital bill. There but for the grace of corporate slavery goes moi.

And the first chapter of this book: Uninsured in America. is available online.

The thing is, a lot of people who are uninsured are not "poor." A lot of employers just don't offer health insurance, and freelancers and contract workers can be making a really good living but still be unable to afford health insurance. Private insurance can be very expensive and even if you earn a good income, if you live in a place where housing is expensive it's often hard or impossible to pay for both. In the priority list, housing and transportation and so forth have to come before a hefty monthly bill for private health insurance. If your employer doesn't offer it, you're basically screwed. My own son is in this situation - he makes pretty good money but is uninsured. He wants to get private insurance, but right now the budget won't allow it. And many of his friends are in the same situation.

This is an issue I hold near and dear - as I said, my husband's illness was an eye-opener, and showed me just how close to the precipice most of us "comfortable middle class" people are every day, and how unaware I was, and how unaware and blissfully ignorant most people are. "The best health care system in the world" my ass.


Donna said...

And that's another thing about us here in Australia. The optional private health cover is relatovely inexpensive. (Though it's a major whining point for many people). Our family pays $130 a month. For all of us. That covers optical, dental, physiotherapy, ambulance as I said before. It also covers us for treatment in a Private hospital with out choice of doctor. We have chosen to reduce the cost of our insurance by electing to pay a gap if we need the private hospital. Big deal! If one of us needs to go into hospital, we pay $50 a day for the first 8 days. And that's only if we choose a private hospital.
And they complain constantly about our hospital system anyway! Yes, there can be long waits if you're going public, but not if it's life threatening. When my Dad was sick, and needed immediate surgery, he was living in the country, was airlifted to a Sydney hospital, had surgery that night and was in ICU for a week. He wasn't billed a cent.
And the other thing is that our prescription medication is partially covered by the government, so our medication costs are relatively low as well.
I used to take our helathcare system for granted, but after hearing about the US system, I *really* appreciate it!!

Catherine said...

There is no US "system," that's the problem. There is little or no oversight of these insurance corporations, especially under BushCo. And it would be one thing if they were really competent and wonderful and the service was worth the huge price, but I could go on for hours about my now deceased father spending hours of the last year of his life on the damn phone and writing letters, trying to sort out billing errors relating to his medical care. And he had "great" insurance! I had to do the same thing during my husband's illness - the insurance carrier would bounce claims and send me a form letter telling me that last $40,000 hospital bill was my responsibility. NOT. It was like a second job, hours of my day on the phone fixing insurance matters. And I knew we were the lucky ones - I'd get it fixed evenually and not have to lose my house.

juliet said...

Crumbs it makes me glad for the much maligned NHS which so many UK people bitch about. The NHS is free at the point of delivery and is covered in your normal taxation. I am so glad you are still here with us

Anonymous said...

I'm so glad you are doing well and rebounding. you are so right about the insurance situation- it's why I still am doing a crushing job of 6 day a week travel and 16-20 hour days. I need the insurance coverage and to keep a roof over my head, although it's only my husband and the dogs living there for now. I come home and wash clothes and vacuum and leave again. Maybe I'll just drop dead on the road, then the business coverage has to pay triple on my life policy. If you follow Girl to B'more I'll take you to my favorite knit shop. Good luck! Kimmen

Mia said...

The other thing about insurance is that you have to work for a fairly large company in order to get the group rates. And the list of pre-existing conditions that they try to exclude is pretty long. When I changed jobs, the new insurance company was the same one as the old one but they tried to claim that I had a pre-existing ear condition because I had had a series of ear infections about 6 months earlier. And because I work for a small company now, my deductible is now higher because I have asthma. They always try to find a way to avoid paying out. lcxbpcq

Paper Tiger said...

And what's at least as cruel and insidious are the new stricter bankruptcy laws that make it harder for individuals and families to get debt relief... because a huge proportion of bankruptcy cases are due to unexpected health costs. lenders claim that they're trying to keep people from frivolously racking up debt and escaping it, but trying to collect from a family who has no money because their child (or, worse, their breadwinner) has a terrible and unexpected disease is just inhumane. As my Dad always said, "You can't get blood from a stone."

Catherine said...

Re the new bankruptcy laws - you got there ahead of me. The new banruptcy laws are monstrous because they do not give a break to someone with a catastrophic illness in the family. I've said it before, but by the end of my husband's life I had put an MRI on my Mastercard and had to sign as guarantor for his nursing home stay of over two months, if the insurance hadn't come through and covered that I'd have been in dire financial trouble - that was over $60,000, and I had no alterative because the Bush administration had quietly stopped hospice care for veterans (husband was a Vietnam vet) who had any assets at all - we weren't destitute and living under an overpass, so who cares about his years of service to his country? Hospice had been one of those guaranteed rights every veteran could count on. We didn't find this out until I was trying to get him into the VA hospice program, and even the local VA office didn't know this and was appalled when we found out.

But as I said, I was "lucky" because I worked for a big corporation with the "good insurance" and I was able to get them to pay for these things. Pure luck. I could just as easily have been with a small law firm with less flexible insurance, and I would have had to file bankruptcy. This is insane.

KatyaR said...

Since your "incident," I've been thinking more than usual about insurance and my situation. I have a good job that pays well for the type of work I do, but we have lousy insurance. We pay a pittance premium to get a $5k deductible and no drug coverage, which basically means if I can't get an RX in generic form, I don't get it at all. No well-woman checks, either, unless I can pay it all out of my pocket. I've need to see a podiatrist for about 6 months, but I can't afford to go--I guess I'll have to hobble along and hope that I'm not permanently crippled. Most everyone at my work subsidizes the QuickClinic that's owned by a buddy of our CEO, and that costs $75 a shot, and you don't see a doctor and can't get a RX for more than a week.

We aren't allowed to carry more than one week's earned leave over each year--anything else goes into short-term disability. That means that if you are lucky enough to take 2 week's worth of vacation during the year, you don't have any leave left to transfer into STD, and if you take less than 2 weeks, you don't have anything to transfer either.

Oh, and our employer-funded HSA? This year they've decided to fund it quarterly instead of once a year because we've had so much turnover, so we get shorted on that, too. The bank we have our HSA with always runs the 'minimum balance' of your account as $2 more than the actual balance so they can charge you the $2 fee each month. Total thievery.

Basically this means that we're all screwed--but hey, we have insurance, so we should be grateful, right?

Insurance and paid leave are fast becoming luxuries in this country. When will we learn that we need to separate employment and insurance coverage?

Glad to hear you're doing better!

ikate said...

Ah, the health insurance issue. I recently got pretty passionate about this during my pregnancy. I'm even more so now that the little one is here. I choose to go "out of network" for my birth - a much closer hospital, better facilities, and most important, where my midwife had practice rights. Yes, she and her office were covered by my insurance but the hospital was not - makes no sense!

Anyway, I was told I could negotiate with the hospital to discount the difference I would be paying OOP since I was out of the network. My dad is an HR guy for a small college and gave me tips on what to do, who to call and asked me to log my experience for his information. Long story short: I spent 17 hours (SEVENTEEN!!) working to get that discount (saving me $2760 - that was the pre-negotiated "discount" the give to "in-network" insurance companies, an amount I would have had to pay OOP). I am college educated, had help from a HR professional and this was confusing as all get out, not to mention a HUGE pain in the butt. I'm lucky that I even had time to do this - my boss was very understanding as I would be on the phone at work for 45 minutes at a time (since the hours at the hospital were like 9-3:30!).
Oh, and when I got the bill? They didn't give me the discount. Thank god I had that log of who I talked to and when, had kept EVERYTHING they sent, even form letters. It took another 3 months for them to take the discount off the bill. Finally, I had a natural birth, no medications, no doctor (midwife only), no complications and I still paid $2350 OOP after insurance and discounts.
I work for a private school with 80 employees; we are part of a larger group of schools for our insurance, bringing our "group" up to about 700 employees. Our rates have gone up 15%-22% each year for the last 3 years. I pay about $3k a year plus co-pays of about $2k. I live in the Detroit area and we have unions bitching that they might have to pay something into their insurance, or have their co-pays raised from $5 to a whopping $10 in the coming years. I can’t believe there are people out there who still have “free” insurance from their employers.

Catherine said...

My insurance is free for me, and we have less than 300 employees. However, if I had to pay to insure dependents it would be very costly - employee coverage is free, family coverage is not and it's expensive. And the rest of the company's benefits are stingy, so don't hate me because my insurance is free. :-)

ikate said...

Oh, I didn't mean it that way - what I hate is when these people get on the news and act like the world is coming to an end because the company is "gasp" thinking about making them pay a co-pay of $5-$10 on office visits and Rx. Or, that the co. wants them to pay in a few $100 a year as a preimum - it's still pennies compaired to what most people pay for a health care plan. And, for christ sakes, don't complain about paying $5 a visit when there are plenty of people who pay $25+ per visit or have no coverage!

I didn't mean that as directed to you - I haven't seen you on the news saying your company is evil lately :)

Catherine said...

That's only because I swear too much to be allowed on television. ;-)

I was struck, when reading the comments to my rant, by how inconsistent and crazy the "system" is - everybody commenting here would qualify as "middle class" and I think we're all employed, and yet all of our insurance is different. We pay different premiums, deductibles, co-pays for the same services. If I paid $1.50 for a gallon of milk and my next door neighbor was charged $7 for the same kind of milk at the same store, she'd scream bloody murder and it would be the subject of investigative reporting. But when it comes to health insurance, we just shrug and say "What are you gonna do?"