The Great American Myth

I’m sick and tired.  Of medical bills.  Of insurance companies. Of selfishness.  Of  excessive corporate profits.  Of people dying needlessly.  Of selfishness.  Of people dying because of excessive corporate profits.  Of insurance companies denying claims.  Of selfishness.  Of Congress. Contrary to the great American myth that this country values individualism and families, when it comes to health care, it is not good to be creative, independent, and family centered.  Don’t count on it to get you ahead.  Choose to work for a large corporation, or better yet, the government.  Get the great group health insurance, you know, the one that requires small co-pays and includes great prescription coverage.  Aspire to the gold standard of health insurance that is offered to Congress.  Who cares if you don’t love your job.

Unfortunately, my husband, Mark, and I got suckered into believing the myth.  We chose to be self-employed with home offices, he an award winning management consultant, and me, a life/executive coach.  While they were growing up, our kids always came home from school to one of us, and usually to both.  Our family joked that our kids envied latchkey kids; on the rare occasion neither parent was home after school, our kids did a jig.

All was fairly peachy until last year when our son got very seriously ill with what was diagnosed as Crohn’s disease, an incurable autoimmune disorder of the digestive system.  He withdrew from his freshman year of college and came home to a difficult and painful year of rebuilding his health.  When he got down to 108 pounds, he was too weak to walk without help. One year later, after four surgeries, countless doctors’ appointments, multiple medications, intravenous infusions, and many months of pain, Ethan resumed much, but not all, of his previous life.

So far, this story sounds like it has a happy ending, which is partially true.  The shout-it-from-the-roof-tops happy outcome is that Ethan is alive, a fact that Mark and I celebrate daily.  Our bright, funny, loving son has a future because he survived.

In any other western, industrialized country, our story would end here, but not in the good ol’ U.S. of A.  Ethan’s two main doctors were “out of network” in insurance-speak.  Neither doctor, his colorectal surgeon or his gastroenterologist, accept any health insurance.  I don’t blame them.  Why go through the hassle of mounds of paperwork only to be reimbursed a ridiculously low percentage of their true value?  These two brilliant doctors saved Ethan’s life, and we will forever be grateful to them.

Why didn’t we choose “in network” doctors?  When we brought Ethan home from college, a difficult feat in itself because he was getting sicker by the day, we quickly researched the best doctors for him.  We talked with friends, neighbors, doctors, neighbors who are doctors, and the same names kept coming up.  As it turns out, they were all correct, and now we pass on Ethan’s doctors’ names to other people.  I tell everyone that not only did these doctors save Ethan’s life, but they saved parts of his digestive tract as well.

When the smoke cleared, we were left with $40,000 worth of out-of-pocket medical bills for the last 4 months of 2008.  Didn’t the insurance company pay anything?  Yes, they paid what they thought was the “usual and customary” amount.  For example, the insurance company believes that a reasonable Washington,D.C. doctor’s fee for a colonoscopy is $300.  When the doctor charged $1,400, our insurer paid 75% of $300, or $225.  We were left paying $1,175.  That was just one doctor’s bill for a single procedure.  Toss in a few surgeries, anesthesia, hospital rooms, and you see how quickly the tens of thousands pile up. And then 2009 began, and the bills started all over again.

If you haven’t gasped at these medical expenses yet, let me toss out one more important piece of information.  Our health insurance premiums were $1,830 per month.  Yes, you read that correctly—per month.  Our annual cost just to have insurance was nearly $22,000 per year.  Oh yeah, this plan didn’t include prescription coverage, which cost us several thousands of dollars annually.

Now, Mark and I are not stupid people.  In fact, we met in graduate school.  At a minimum, we are literate and numerate. We do the research and the math, comparing plans and options.  Our problem was this was the only health insurance plan available to us because, and here is the key, we are self-employed.  People in large insurance pools, such as that available to Congress, have far more options and better coverage.

Over the years, particularly when our premiums seemed to escalate hourly, we shopped around for different health insurance.  Inevitably, one member of the family would be turned down for “pre-existing conditions.”  We were stuck with our overpriced insurance that played “gotcha” with every claim submitted.  This is the same insurance company that quadrupled our premiums since 2001 by hiking our premiums an average of 20% annually.  We received notice that our premiums will jump to $2,195 beginning January 2010.  Has your income quadrupled since 2001?  Ours hasn’t.

Ironically, it wasn’t until Ethan developed a whopper of a pre-existing condition that we were able to get a bit of insurance premium relief.  Fortunately, we live in an enlightened state that has a true public option for people who are uninsurable due to specific pre-existing conditions.  Lucky for us, Crohn’s disease is on that list.  Ethan now has his own health insurance plan that costs us only $245 per month, or nearly $3,000 per year.  Our daughter, who recently graduated from college, has obtained her own health insurance.

And then there were only two needing health insurance, Mark and me.  We were recently “approved” for a new health insurance policy with premiums a mere $607 per month, or nearly $7,300 annually.  Before you shout “hallelujah,” there is a catch:  our deductible, meaning our out-of-pocket costs before our health insurance pays a penny, is $2,700 each, or $5,400 per year.

As we work our way through our medical bills while putting nothing new toward retirement, we know we are not alone.  Too many Americans are in exactly our position.  For whatever reason--they lost their job, are self-employed like us, or can’t get insurance because of pre-exiting conditions--they, too, are drowning in mountains of medical bills.

You might think that I blame my insurance company, but I don’t. I don’t like them, which is putting it mildly.  But for-profit insurance companies act rationally; their job is to maximize profit for their shareholders by raising premiums as much as they can while paying out as little as possible.  That they can cold-heartedly and immorally deny claims is another matter.

The real blame goes to Congress, for they are the only ones who have the power to protect families like mine by putting the kabosh on a for-profit health care system.  In a single stroke of a pen, Congress can enact legislation providing all Americans access to high quality medical care.  Canada does it, as doesFrance, Great Britain, Germany, Denmark, and every other western industrialized country.  The United States is alone in putting corporate profits ahead of the lives of its own citizens.

We elect our Congressional leaders to represent our interests, but we, the voters, aren’t their only constituents.  If we were, then we would have a single payer national health insurance system that covered everyone unrelated to ability to pay.  The truly powerful Congressional constituents are the corporations that contribute to political campaigns, especially the insurance companies, pharmaceutical companies, and other health related corporations.  The heck with the 45,000 people who die annually because they could not afford sufficient health insurance.

I am discouraged that Congress will pass meaningful health care reform that will fully side with people over profits.  A national health care system will remain a pipe dream until we reform our campaign financing laws to permit only public financing of campaigns.  Doing so would give every politician an equal chance of being elected and no one would be owned, yes owned, by private corporations.  Contrary to popular belief, the problem isn’t “special interests” or lobbyists because everyone in a democracy should have access to their elected officials. Talk is cheap.  Campaign financing takes big bucks.

So, this leaves me exactly where I began, sick and tired.  I’m sick and tired of selfishness and warped priorities.  I’m sick and tired of a political campaign system that relies on private contributions.  I’m sick and tired of living the great American myth that creativity and independence are rewarded.  I’m sick and tired of we, the people, getting crumbs.

Most of all, I’m sick and tired of being sick and tired.


Perfect Storm