Wednesday, March 24, 2010

"To your health!" -- An observation on U.S. health care in nine parts

I think everyone may have heard this quote by now, the one made by Durham, North Carolina resident DeCarlo Flythe about the bitterly contested health care legislation Barack Obama just signed in to law: "It's just going to be like Christmas," Flythe said to WRAL reporter Erin Hartness. "It's going to be great. You know, no worries [about] the bills. We are going to go ahead and pay our co-pay and be all right."

I have my reservations about that, but then my love-hate relationship with the American health care system goes back a long way, back to 1996. March, August and October of 1996, to be precise. Let me tell you why.

1. Galling behavior

In 1996, my husband worked for a small flooring company selling carpet, tile, hardwood and the like. The owner of the business decided to retire and made plans to sell the company; all the employees waited in trepidation to see who the buyer would be, and if you've ever been in this position, you know exactly what I'm talking about: depending on the integrity of the new owner, the grand promises of "We don't plan to change a thing; everything will continue just like it's always been" can mean either more or less, depending.

As it turned out, it meant less. The very first thing that happened was that the new owner dropped the group health insurance plan, the one that the former owner had paid the employees' premiums for, allowing them to sign up their family members at their own expense, which is a very standard deal. All of a sudden, the fifty-plus employees were insuranceless and we all started scrambling for private health care.

But guess what? Private health care is hard to get. To hear some conservative talk show hosts, you'd think that you can just walk into the office of an insurance broker and say, "I'd like some health insurance, please, not just major medical, but something with a prescription plan and a mid-range deductible and give me an order of fries with that."

First of all, private health insurance, we discovered, is expensive. And due to my handicap from the car accident I was in at age twenty-one, I was (and am) the personal anathema of the insurance industry with a list of pre-existing conditions as long as your arm. And while we were sadly reviewing this-bad-plan-with-a-huge-deductible and that-bad-plan-with-a-low-deductible-and-no-prescription-coverage, my gall bladder went out.

That was in March of 1996 and one moment I was just perfectly fine and the next moment, I was doubled over, wailing, and burning with fever. My husband drove me to the emergency room and I cried all the way there, not only because of the pain I was feeling, but also because of our lack of health insurance. The next day, I had the surgery and of course it couldn't be the easy-peasy laparoscopic kind; no, it had to be the full-bore cut 'er open and rummage around kind, which left me in the hospital for four days afterward.

I spent those four anxious days wishing that there was some kind of automatic pain-killing drip for the mind like the happy morphine button I was keeping my left thumb firmly planted on to ease the pain of the incision site. Because my right side? It was actually relatively okay. But my worried mind was a mess.

It was a state that didn't get any better as time went on.

2. A nickel for your thoughts

The bills had just started rolling in from my surgery when the next incident occurred: Meelyn, who was three at the time, swallowed a nickel. Now that doesn't sound so awful, does it? I mean, little kids swallow stuff all the time and you just bide your time and wait for it to come back out nature's way. But, no, no....not insurance-free us.

In our case, Meelyn's nickel lodged itself in the tiny opening between her trachea and her esophagus. The county hospital and their emergency room -- the same one that was badgering us daily to pay off my gall bladder surgery in full -- welcomed us with a tight smile when we revealed that we still didn't have health insurance three months later. The limited ER at the hospital didn't have instruments small enough to retrieve the nickel from Meelyn's little throat and the doctor told us that we'd have to take her to Riley Hospital for Children in Indianapolis.

"And we suggest you drive her there yourselves instead of having her taken by ambulance," we were told. "The ambulance will cost you several thousand dollars to make that trip."

We felt so helpless. That was when it was beginning to dawn on me how bad this could actually get. Because yes, every American does have access to health care and hospitals do have to treat you regardless of your ability to pay, but that doesn't mean they have to be kind about it. Or concerned. Or helpful, compassionate or caring. They don't have to give you one iota more than the bare essentials, and other than that, it is a cold process. Probably not everywhere, don't get me wrong. The hospital in my home town had a certain reputation that I'm positive isn't shared by every medical facility out there, but let me just say that I'd been a patient there with health insurance and a patient there without health insurance and the difference in the way I was treated was measureable by miles and fathoms.

And if you can feel the difference in the ER, you can only imagine the atmosphere in the registration office. And the billing department.

And here's an added note of piquancy: When you have hospital bills rolling in from an unexpected surgery? It's really hard to afford the monthly premiums for that private health insurance you were hoping to buy.

The ER staff did give us a flannel blanket to wrap Meelyn in as we carried her out to the car and set off on that one hour drive, me sitting in the back seat clutching her and praying that the nickel wouldn't dislodge itself and block her trachea, my husband breaking every law of the road in his hurry to get Meelyn to safety. It was an utter nightmare and I'll never forget how frightened I was.

3. The third time's not charming

Back at home again with the offending nickel captured as a souvenir in a specimen cup, we all drew a deep breath and carried on. More bills rolled in; we were at the six-month mark without health insurance. And that's when the third incident happened.

Aisling, who was then fifteen months old, fell down in our living room and bonked her head on the stone fireplace hearth, rendering herself unconscious. I was in plain sight in the kitchen, cooking dinner, and one moment she was toddling around, babbling, and the next moment, she was on her back on the floor, as white as salt and rapidly turning blue because her tongue was trapped in the back of her throat.

I made that 911 call screaming in fear, trying to talk sense to the dispatcher while frantically groping for Aisling's slippery little tongue. She was rag-doll limp, and up until that point, I'd never known what a deep shade of blue the human face can turn when that human is deprived of oxygen. She had a seizure in my arms and I finally turned her upside-down, which allowed her tongue to fall forward and she finally sucked in a shuddering, life-giving breath. The ambulance arrived and the EMTs burst through the front door to find me, Aisling and Meelyn all on the floor, breathing, weeping and trembling. Bill, our lovely next door neighbor, came in and called my husband, who was thankfully only about five minutes away at work.

At the emergency room, we were treated with a subtle attitude of "Are you back here again?" and Aisling had a CAT scan. There was a great deal of worry because her head didn't have a goose-egg on it. She was conscious and feebly coming back to herself there in the emergency room and it was determined that she had a slight concussion and we were sent home with instructions on how to deal with a brain-bruised baby: they decided not to keep her in the pediatric ward for observation because -- you guessed it -- we didn't have health insurance.

My husband and I spent the night hanging over the rails of her crib in shifts, fearfully checking to make sure she was breathing, conscious and not comatose.

Aisling had a second CAT scan a few days later, just to make sure that the seizure had occurred because of oxygen deprivation and not because of some underlying neurological problem. It came back with no abnormalities, and Aisling was pronounced well and cured.

4. The deluge and then the war

When you have medical treatment with health insurance, you likely never see an itemized list of all the people who are paid by your provider. But when you don't have health insurance, the bills roll in from everywhere. For my surgery alone, we had a bill from our general practicitioner, the surgeon, the hospital, the lab, the imaging department, the just went on and on. Every day was a new bill, none of them less, it seemed, than a thousand dollars, and all nudgingly marked TOTAL DUE UPON RECEIPT.

Any hope of getting affordable private health insurance completely died, right then and life became like the merry-go-round from hell as I talked to different billing offices and made arrangements to pay each one a monthly pittance. I filled out endless papers and made copies of tax returns and mailed documents here and there and even personally visited a couple of in-town offices with my babies in tow, trying to figure out how we were going to pay all these people the money we owed them. My husband sold flooring like a madman, working all the hours God sent in an attempt to gain some ground, and to our favor, the economy was bustling along and he had a lot of success.

This is what's wrong with that "everyone has health care available to them" argument. Yes, you do indeed have the health care. But afterwards? You have the absolutely staggering bills. Those bills are the things that keep people who desperately need health care from seeking health care: they know they can be treated, but can they pay later?

There were several places that were very nice to us as we worked out payment plans. Riley Hospital for Children earned my love forever by reducing our debt to them to zero. Their bill for Meelyn's two hours in their emergency room was $6,000+ and at the advice of one of their billing consultants, I filled out the paperwork they provided for people who didn't have health insurance and they had mercy on us. The day I got that letter in the mail, I sat at the kitchen table and cried with gratitude.

In spite of that enormous reduction of debt, we still owed around $32,000 for our three health incidents in 1996 and the beginning of 1997 saw the local hospital, the entity to whom we owed the most money, becoming increasingly hostile to our plight.

Agents from the billing department of the hospital took to calling me on a daily basis, sometimes being so warm and kind-hearted that I thought we'd reached an understanding of how much we could pay. I'd sigh in relief and hang up the phone, pleased that they finally understood that we simply could not pay them $150 a month because there were about ten other places that were also clamoring for their share of our income. But the next day, there would be another call and a different agent would berate me and shame me for not paying my bills, for being a deadbeat, for my dishonor in demanding medical services that I was "refusing" to pay for.

My husband and I were such pitiful little greenies, we didn't realize that this is the common practice of bill collectors, kind of a good-cop-bad-cop scenario. One agent would agree that one hundred dollars a month was a reasonable amount, considering that we had one hundred dollars a month promised to about fifteen other medical entities, but then a second agent would call on another day to coldly tell us that we were going to be sued and living on the streets in a cardboard box if we didn't pay the complete total by the end of the week, or at least five hundred dollars a month.

We didn't know that these tactics were illegal and I, raised by my parents to be honest and forthcoming, answered the telephone every single time it rang. It simply never occurred to me to just let it ring. I would protest to the agent of the day that I had just made an agreement on Tuesday with such-and-such agent to pay one hundred dollars a month and the inevitable response would be "I don't see that marked in your file, Misssssssssuz McKinnnnnnnney" as if it was some lie I'd come up with in order to....get myself into trouble? It made no sense at all, but then IT WASN'T SUPPOSED TO MAKE SENSE. The problem was, my husband and I thought that everyone, including billing agents at county hospitals, knew that we were anxious to pay our debts and were eager to do so in a timely and civilized manner.

They weren't. Oh, the hospital wanted us to pay the bill, all right, but they had absolutely no intention of being civilized about it. Harrassment was working just fine for them.

5. Off to the market

With chronic acid eating out the linings of our stomachs due to the increasingly belligerent antics of the hospital, my husband and I discussed selling our house and using the profits to partially pay off the hospital and get them off our backs.

"We don't have much equity," my husband said, worry lines creasing his forehead. "I mean, how much equity could we have built up? We've only lived here for two years."

"There's not been a chance to do much improvement to things," I sighed. We'd purchased our home as the shabbiest house on a nice street in a great school district: We had the location, location, location thing down. The house did need some work, mostly just in updating the 1970s decor, replacing the carpet, painting and the like. It didn't need anything major, except for maybe a second bathroom....

My husband called our real estate agent and told her that we wanted to put the house up for sale. She was horrified. "Oh, please don't do that!" she cried. "You're going to lose so much and gain so little. Let me help you get this mess figured out."

Her name was Susan and she was a truly lovely person. Real estate wasn't just her job, it was her calling. She was passionate about home ownership and she really took a great deal of her personal time to sort us out with the conventional wisdom of the industry. What my husband and I didn't perceive at the time was that the conventional wisdom of the real estate (and banking) industries was not the the same wisdom that a financial counselor would have offered us, but we didn't find that out for about seven more years.

Susan's advice was that we take out a home equity loan. At the time, my husband was in a profit-sharing program with General Motors (he'd moved over to car sales by then and we were all safely enrolled in his company's group health insurance plan, a huge relief) and was getting a lovely big check every February. Susan suggested that we use this check to remodel our one enormous bathroom into two nice-sized bathrooms: one accessed through the hallway, and the other would be an en suite attached to our master bedroom.

Once we'd done that remodeling, we could have the house re-assessed. As Susan pointed out, the comps for our neighborhood showed that every other house on our street had at least a bath and a half; most houses had two, and some had two and a half. We'd have a lot more equity at our fingertips if we made that improvement.

The second upgrade we made at Susan's suggestion was to have the driveway paved. All the other houses on the street had cement driveways, she pointed out, and our gravel driveway wasn't in keeping with the comps. We couldn't afford cement, but we did have asphalt put down and it made a huge difference in the curb appeal in our house.

Another change we'd made the previous year with my husband's profit-sharing check was to have a new gas furnace installed to replace the 1970s total-electric plan the house originally had. Along with that, we'd put in central air, which was another amenity all the other houses on the street had.

Susan felt that with those improvements -- new gas furnace, central air, paved driveway and extra bathroom -- we could get a very tidy sum if we applied for a home equity loan and refinanced the house to take advantage of the rates that were just beginning to drop. When we bought the house, we had signed on at a fixed nine percent, but we were able to refinance for seven percent and that made a huge difference in our monthly payment.

We felt we were seeing the light at the end of a dark and scary tunnel. The equity in our house had received a pleasing boost due to the improvements we'd made with cash, the refinancing had freed up more of our monthly income due to a lower payment and soon we'd be able to pay off all that medical debt in one fell swoop.

6. Blessed relief

The day I went to the hospital's billing department and wrote them a check for tens of thousands of dollars was one of the happiest days of my life. Seriously. The day I got my college diploma? Happy! My wedding day? Happy! The births of my beloved children? Happy!

The day I finally pried that evil hospital off our backs and off our telephones by writing them a check covered by money based on the equity we'd built up in our home? HAPPY! HAPPY! HAPPY! My feeling of triumph was immeasurable as I handed the check to the cashier and swept out the office door in what I felt was a totally appropriate manner of haughty scorn.

We entered into a totally new phase of marriage, money and home ownership. My husband was selling cars like nobody's business. He had enjoyed selling flooring, but cars really resonate with him and he absolutely loved his job. We made a lot of money and for the most part, we spent it wisely. We set up a payment plan to get our house paid off in fifteen years (we had a thirty-year mortgage.) My husband, who is one of those strange people who prefers the saving of money to the spending of it, socked away three months' income in a savings account. We cut up our two credit cards and worked on a debt-reduction plan to get them paid off.

Our "big" splurges were things like eating in restaurants every weekend, something cheap like Arby's on Fridays and someplace nicer like Chili's or The Outback on Saturdays. It was fairly inexpensive to do that back then, with the girls being so small that they always shared one meal from the kids' menu.

Other than that, we we lived a very simple life although my husband trembled with fear every time I walked through the doors of Wal-Mart. Things were good. Meelyn went off to our lovely, highly-rated neighborhood school for kindergarten, first and second grades. After her second grade year, we decided to home school both of the girls and embarked on that new adventure with excitement.

7. And then....

September 11, 2001 happened. Car sales stopped like a faucet turned off in Detroit as the country sat poised in uncertainty, wondering if the immediate future would take us back to prosperity and peace, or if more terrorist attacks threatened us.

Then the economy fell apart and our income fell with it. Factories in the area, this area known for its production of car parts, began to fold one right after the other. If church bells had been rung to announce the death knell of the auto industry in the midwest, central Indiana would still be resounding with the echoes.

Our income went from $82,000 to $37,000 in the space of one year and the bell rang for us, too.

By January 2005, we were sunk. Our income was so low, it was impossible to carry on with our mortgage payments and the home equity loan and the this-and-that of monthly bills. It's not that we were bad at budgeting - quite the contrary, we were very good at it. But it's kind of hard to make a budget when you have no money to work it with. Slowly but surely, we were crushed under the weight of what we owed. The lawyer who handled our bankruptcy was compassionate as we sat in his office filled with Indiana University memorabilia and I cried, plucking tissues out of the box he'd thoughtfully placed on the corner of his desk.

A lot of people were going down with us, he said. In all his years in the legal profession, he'd never seen anything like the number of bankruptcies he was seeing in 2005. His great worry is that there were still many more to come.

I was somewhat relieved to know that it wasn't just us: We weren't filing for bankruptcy because we were shiftless losers who blew their money on lottery tickets, drugs and drink. We were just caught in the same vortex that was catching so many other people. In spite of that, however, there was a nagging feeling that dug at me constantly, driving sleep away from me and keeping my jaw permanently clenched.

The hospital, I felt, had won in the end after all. Indirectly, they got our house.

8. Five years on

As you know if you read this blog, we're still home schooling. We hung onto it with both hands white-knuckled for the girls and I often think that my husband and I and others like us are either the bravest and most stalwart of parents, or possibly the stupidest for voluntarily resigning ourselves to nearly constant financial struggles. Maybe both.

My husband is still selling cars. He has changed dealerships, and the one he works at now is a profitable one even though the economy is still so bad. The one he worked for when we had to file for bankruptcy? It is, as Margaret Mitchell would have it, gone with the wind that swept through Detroit. Our income has recovered somewhat, but not by much. We are at least making over $40,000, the national average, and I suppose in these tough times, that's not so bad.

The dealership he works at does offer a group insurance plan, but unlike the good old days when one's employer paid for the employee's share of the monthly premium, we now pick up the whole tab for ourselves. My husband and I are the only two people on this group insurance , which includes medical, dental and vision plans; we had to take the girls off the plan about eighteen months ago because the premiums went up to $1,200 a month for the four of us.

Removing them from our health insurance was one of the scariest, hardest things we've ever done, especially since about two weeks after we did it, Meelyn came down with an unwelcome strep throat/ear infection combo. It was a weekend, the prime time for kids to get sick, so we took her to the urgent care facility here in town since the doctor's office was closed. It cost about $120, but it was right after Christmas and we were flush with money.

The doctor wrote two prescriptions for her and we drove to a couple of different pharmacies to see which one had the cheaper prices. The costs at both of them were similar -- around $90 for the antibiotic and the stuff for her ear -- but guess which pharmacy we didn't spend our money at?

That would be the one where the pharmacist assistant, when he asked what prescription plan we were using, said in contemptuous disbelief, "YOU DON'T HAVE HEALTH INSURANCE FOR YOUR CHILDREN?"

My husband, already stressed out, invited him quietly to do something unnatural to himself and we drove quickly to the second pharmacy, where the money was paid and the medicine was handed over with no back-chat from the help.

I was relating this story to a gathering of my home schooling friends a few weeks after that and one of the mothers told me about a program called Hoosier Healthwise, a state government Medicaid program for -- *gulp* -- the indigent. She and her husband had applied for health insurance for their four children when her husband's hours were halved at his job, she told me. And it was such a relief to know that their kids were covered, especially since the insurance was affordable, with monthly premiums based on the family income.

Oh, please don't be mistaken. I have my pride. The idea of applying for government-subsidized health care was unpleasant, to say the least. I'd never applied for any government assistance before and I wasn't particularly anxious to start. But my worry over the girls trumped my outraged sensibilities -- it wasn't too hard to remember that trip to Riley Hospital with Meelyn cradled in my arms, a coin precariously balanced between air and suffocation. And the ambulance ride to the emergency room with my white, dozy Aisling strapped to the gurney while the paramedic tried his best to comfort us both. I was willing to sacrifice my pride and dignity to protect both their health and our precarious financial existence.

The girls were accepted into the Hoosier Healthwise plan, and we pay an affordable monthly premium. It is such a huge relief to be able to take them to the dentist every six months, to be able to take Aisling, whose vision is simply dreadful, to the optometrist for new glasses every year; to know that if they get sick, which they rarely do, I can whisk them to the doctor's office without worrying about a $90 office call, plus the charge for prescriptions. It is a blessing, and I mail off that check each month, sealed with a kiss.

My husband and I are still on the group plan through his employer. For the two of us, one hundred and twenty dollars PER WEEK is taken from his pay. Yes, you read that correctly: $120 per week.

9. Obamacare

While I would like to be as optimistic as DeCarlo Flythe, the man I quoted in the first paragraph, I can't bring myself to think that national health care is going to be anything like Christmas. Oh, trust me -- I'd like to believe it. It would make me happy to believe it, but I'm just not all that great at trusting the government to run programs. I mean, look at the post office. It costs more and more money every year and provides less and less service; as I type this, the postmaster general is considering halting Saturday delivery across the United States. Medicare and Medicaid are bankrupt and unsalvageable.

Cash for Clunkers, that bloated trade-in-the-old-car-get-yourself-a-new-car government-funded monstrosity of last summer was a wretched exercise in just how badly the government can screw things up in just a matter of weeks. Complete with a constantly crashing website, volumes of impossible paperwork, slow paybacks and other assorted idiocies, Cash for Clunkers, from the point of view of those in the car business, was an adventure of breathtaking stupidity that could have been better managed by a group of kindergarteners with an abacus.

How could any reasonable person suppose that government-run health care would be any different? Especially a program that was pushed through against the will of the majority of the citizens, one that seems to violate the Constitutional rights of the very voters who elected the people who stubbornly ran it through anyway; a health care plan that is so great, members of the United States Congress have exempted themselves from it?

For right now, we all seem to be in a holding pattern. Conservative talk show hosts continue to spout off about how we have the best health care system in the world without government-funded health care, available to everyone who needs it, and I can't say I agree with that. I've been in the position of getting that emergency room care that has to be given, regardless of your ability to pay, and I know where it leads: to tens of thousands, if not hundreds of thousands, of dollars in medical debt. Ours may be the best health care in the world, but it sure isn't perfect by any means. I feel that sting of that particular truth every time I drive past the house I used to own.

That's one point of view, which allies closely with the idea that everyone should be able to get health care when they're sick. I firmly believe that, but I also believe that it shouldn't bankrupt them to do it.

The other point of view? I've already expressed it. I don't think the government will do this well at all. I believe it will be a huge mess and it will bring on greater financial burdens for families as taxes are raised to pay for it. I think it will make the economy worse. I'm all for health care reform and I think that needs to be taken care of, like, yesterday. But not like this. Never like this.

Meanwhile, it's being said that the premiums for people with private health care insurance, the kind my husband and I have, are going to increase significantly in January 2011. That should tell us a lot about how things are going to go, but it's going to be some nervous waiting until then.


Amy said...

Shelley -- Thank you for your thoughtful and amazingly honest comments on this health care mess.

Kayte said...

WHEW...what a lot of things you have to deal with over there. Thoughts and prayers for all of it.