Some Examples of Why the US Desperately Needs Universal Health Care

I'm so fed up with the state of our economy and the health insurance fiasco in particular.  This week, I watched that home makeover show where communities of good folks build extraordinary houses for extraordinary people with extraordinary problems.  In this particular episode, a father of six had resorted to taping up his hernia with duct tape, because he could not afford to get surgery.

Read that again:  taping up his body with duct tape because here, in the richest country in the world with the best-trained doctors in the world, a hard-working, honest guy tapes up his hernia so he can go out at work for his family.

Barf.

Then, I got a call from my son's school.  A mother of three (all of whom go to school with my son) has cancer.  She cannot cover her bills resulting from surgery and chemo and "related medical expenses," so the school is having a series of fundraisers, one of them held at a local pizza parlor and another involving buying raffle tickets.

Oh. My. God.  Schools should be raising funds for buying more music for the music program.  Oh, right.  There isn't one any more. 

Well, schools should be raising funds for buying more art supplies for the art program.

Crap.  I forgot.  That's kinda been scrapped, too.

Goodness, schools should be raising funds for buying better playground equipment.

Oh, right, the kids only have 15 minutes of recess anyway.  Who needs more than chalk and a ball?

The point is:  the woman should have health care.  The man should have health care.  He shouldn't be self-medicating with duct tape and she shouldn't have to rely on the goodness of the community to pay her medical bills (I mean, not without a formal tax structure whereby we ALL contribute to ALL of our medical costs).

Health care is not a consumer good.  You do not "choose" health care problems or their remedies the way you choose whether or not to buy generic laundry detergent, Tide or an expensive organic, locally made brand.  We do not choose whether to get hernias or cancers (YES I KNOW LIFESTYLES MATTER).  We do not choose to fall down and break bones.  Or to inherit poor eyesight from Mom or a predilection to asthma from Dad.  As consumers, we are not able to effect costs the way we can in the marketplace.  The marketplace is a wholly inappropriate word to describe health care.  Doctors and insurance companies have control over costs; patients do not.  


********
I'm so fed up with stories like these two brief ones that I have to share with you a friend's story (with her permission, of course).  I know she is not unique, but perhaps telling you the *details* about her story not only puts a "face" on the experience of "welfare" and "health care coverage" for some of you, but also, hopefully, provokes you (and me) to continue to exert pressure on our political leaders to work harder for greater social equity, more jobs that pay a living wage (!) and a better social welfare plan.

A friend of mine is on the Oregon Health Plan -- health insurance for Oregonians below a certain income level.

It's not great insurance.  For instance, it does not include either dental or vision coverage.

She has both teeth AND eyes.  Imagine that.

She has been vigorously looking for work in this horrible economy.  I could dedicate a whole blog just to her experiences there -- watching her write multiple, beautifully written essays per application for jobs that only pay $11 an hour, for instance.  I swear, she's worked harder on some of those applications than I did on my college ones.   Yet, time after time, she either is the runner up for the position or the company decides it isn't hiring after all, but thanks her for her interest.

The *only* job she's been able to find is a temporary one working in an poorly lit, dirty county office basement for $10 an hour.  She feels *lucky* because the guy working beside her has a college degree and she doesn't.  She is nothing if not grateful to be working and -- I had her as a student -- she's a darn good worker and smart too. Organized.  Dependable.  Creative.  Able to think outside the box.  Literate.  Funny.  Good communicator.  All the good qualities.

She needs the job to pay her bills (duh!).  Her rent (including all utilities) is $825 per month.  She has a car -- it's paid off, but of course there is insurance, gas and maintenance.  She eats, so there's a food bill.  She has a cell phone and she's changed the terms on it so that it is cheaper per month than it used to be.  Still, an Iphone isn't a cheap cell phone.  Personally, however, I think she's lost enough in her life over the past two years (horrifying experience in a bad marriage, resulting in a messy-as-hell divorce) that I am not advocating she give up that little luxury of an Iphone.  (Even if she did, a cheaper cell phone is not going to make the difference between being able to pay her bills and not being able to do so.)

She's been living very simply, stretching every dollar as far as it can possibly go.  No eating out.  No buying organic, fancy food (in her prior life, she was a health nut).  No going out.  No buying clothes.  Not even visiting her two-week-old grandson (the gas is too expensive).

She knew that she had to stay below a certain income level in order to keep her health insurance.  Being the honest person that she is (and not wanting to get caught "cheating" -- you know, trying to have health insurance AND enough money to cover her bills), she told the OHP office that she was working.  She wanted to know how much she could earn and STILL keep her insurance.

$903 per month GROSS.   If you subtract her rent ($825), that leaves a whopping $78 for EVERYTHING for the rest of the month.

She also calculated that, at $10 an hour, and figuring in the $400 a month she gets in alimony, she can only work *12.5* hours per week  in order to still qualify for health care. 

In other words, she can only earn -- through working--  $503 per month and still keep her insurance.

What employer is going to keep her for only 12.5 hours per week?

If she goes over the $903 per month, not only does she lose the health care, but she has to pay back whatever health care bills she incurred during the prior month.

For this month, at least, that would be a REAL problem.  Earlier this month she had an ER visit for an eye infection.  (Remember, OHP has no vision coverage and, though she had known she needed both new contacts and glasses, she could not afford to replace either.)  She'd been wearing her contacts for too long and her eyes finally -- and predictably -- freaked out.  Needless to say, she cannot afford to pay for that ER visit, so she has to choose to stop working in order to continue to get health care coverage.

She's not a person who *wants* to stop working.  She LOVES to work and she's good at her job (her employer told her they've never hired a temp who caught onto the system so fast).  She also really wants to keep her apartment -- where would she go if she couldn't cover her rent?!

She explained to me that OHP does periodic checks on their clients -- you know, to make sure nobody is cheating the system.  Fair enough.  But here's the catch:  if you appear to be living on too *little* money, they suspect you of lying (working under the table and not paying taxes on your income).  You have to justify how you pay every bill.  If, for instance, your friends are helping you out, they have to sign forms saying that their money is just gifts and is not associated with any kind of fair labor (say, babysitting for you).  So, even if you want to work for the money, you have to lie and say you did not.

If you appear to be earning too *much* money than you have to lose your health insurance.

All of this is such a game.

Anybody who thinks we do not need national health care insurance needs to go look at the faces of the people trying to live by the rules -- honesty gets them screwed, but then again, landing in jail for "fraud" is a pretty bad experience, too.
Another way to get screwed is to need prescription medications and not be able to pay for them, thus jeopardizing your health.  Say, for instance, you have serious hypertension.  (Of course, if you didn't have dangerous high blood pressure *before* losing your health insurance or worrying about how to pay your bills or how to keep the creditors at bay, you will eventually.)

Are you not gagging yet? 

My friend's biggest problems are her prescriptions -- she has four that she absolutely has to have refilled every month.  (She has serious hypertension.)  Her other prescriptions are more the kind that are only taken as needed -- for migraines, for asthma and allergic reactions.  (She used to take hormone replacement therapy and, while she was on that medication, she did *not* need hypertension medications.  However, OHP will not cover her hormone replacement therapy and, since having to go off of that medication, she has had several *noticeable* medical problems that have resulted in her taking more medication than she ever did previously.  So, currently, she is *not* on her hormone replacement therapy -- prescribed years ago because she had had cancer and had a complete hysterectomy.)

Arguably, her medications for asthma, anxiety and migraines do not need to be filled as often.  I did a little internet research and found that, out of pocket, her costs for the four monthly prescriptions that she *does* need to refill every thirty days total $60.47.  So, if you subtract that from her whopping $78 per month, she has less than $18 for the rest of the month for food, gas, car insurance, and the cell phone bill. 

Hmmm....I'm speechless.

Just for fun, I went ahead and looked at the out-of-pocket costs of ALL her medications, assuming that there might be *one* month during a year where she might need to refill all of them.  The grand out-of-pocket total for ALL her medications (asthma, migraines, anxiety, hypertension and, if she could ever get back on it, hormone replacement therapy) is...

Drum roll please...

$404.01. 

Since some of you will want to know:  I obtained out-of-pocket costs for all but two of her medications from the website healthwarehouse.com.  I used generic costs for all but two medications - two were only available in non-generic form.  Two other medications were actually not available from that website at all, so are not included at all in this calculation (both were asthma meds, by the way).  In case you are wondering how much is saved by buying generic:  one of her medications, monthly, is only $3.04 if purchased in generic form but is, according to healthwarehouse.com, a whopping $116 per month if purchased in its non-generic form.

The point here is not whether or not I have the *exact* number right, but to make one point very obviously:  she needs prescription coverage. 

Don't. Get. Me. Started.

OK.  Tell me.  HOW, if she chooses to work and give up her OHP, is she going to cover her rent, her bills, and her prescriptions without health insurance?  There's not even a guarantee that she'll be able to find a job after this temporary one ends, either.

Some people like to contrast the "lazy" people who want government to "take care of them" against the "hardworking" ones that "take care of themselves".

If this example hasn't at least partially convinced you that that argument is -- to state it politely -- baloney and exaggerated, I don't know what will. There should be jobs for every person that wants one.  Policies should encourage people to work -- it's good for their mental health and self-esteem, if nothing else.  And health care should be a RIGHT and not be attached to a job.

By the way, she decided to keep working and give up her health care coverage.  She has coverage until Feb 1.  Today is January 24.

Working to pay your bills -- simple bills like shelter, gas, and food -- shouldn't disqualify you from taking care of your body.

Eyes and teeth and hormones included. 

Duct tape optional.

Battle Hymn of the Conflicted Parent

If you've been reading the Wall Street Journal, or even just little ol' Twitter or your Facebook feed, chances are you've run across this article, an excerpt from the author's upcoming book, Battle Hymn of the Tiger Mother.

I'm not going to reiterate what the author says, except to say that she holds "Chinese" parenting up as superior to "Western" parenting.  Predictably, many responses have appeared, including this one by a Chinese mother who realized that her adopted child was not able to live up to "Chinese" parenting expectations, causing her (the mother) to adjust accordingly.  Similarly, another article has praised what it labels "laissez faire parenting", which is what Chua would call "Western" parenting.  There was also a very sad article from a woman who felt that, in hindsight, her parents' "Chinese parenting" contributed to the sister's suicide.  While I personally doubt you can draw such a straight connection between suicide risk and parenting style (if you could, strict parenting would undoubtedly be touted as a public health risk), I ache for this woman's loss and for her pain at remembering how harshly she and her siblings were raised.

There is also a response of sorts to these responses from Chua herself.

Despite what I didn't like in Chua's article -- her arrogance over the "superiority" of "Chinese" parenting, her not allowing her children sleepovers or play dates, her description of making her daughter practice HOURS a day, and denying her daughter bathroom breaks until she learned a difficult piece of music -- there are a few points she made that strike me as undeniably true.

1.  Children are not as fragile as we often think they are.  Crying over having to work hard on something is not going to "ruin" them.  "Western" parents are often too concerned with "self-esteem" and not empowered enough in their relationships with their kids to INSIST that the children follow through (with respect!), despite the difficulty of the math, the music, the reading, the writing, etc.

2.  Nothing is "fun" until you are competent at it.  And to get competent at ANYTHING you have to put in the time.  Children need to understand this.

For me, the discussion of "Chinese" and "Western" parenting reminds me both of the dangers of essentializing (certainly, not all Asian -- or even all Chinese -- parent the same way) as well as the political nature of parenting, which I've written about before.  There is nothing we do as  parents, really, that is not judged -- if not by others, than by ourselves.  I shudder to think about what Chua would think about my parenting, but then again, I'm not asking for her opinion.

Both my husband and I were raised in houses that fell somewhere between the "laissez faire" style and the one Chua upholds.  Our kids are probably raised in a slightly more laissez faire household than either of us were, but then again, they are also being raised -- let's be honest -- by schools, aftercare programs and babysitters too.  They have, IMHO, *plenty* of structure in their lives and I think of their home life as being the place where (hopefully) they can relax a little.  Often, they are in school and aftercare for  a total of 10 hours a day.  The last thing they want -- or need -- when we pick them up at five is for their parents to tell them they have hours of practice to finish or extra math homework that we think they need because the schools aren't hard enough.  (A topic, obviously, for another post.)

Reading about Chua's incredibly strict methods with her children, as well as the responses of the other authors, I ponder how *I* parent and whether I've been strict enough.  While I keep a fairly tight watch on my kids' homework -- and come down fairly hard on them if they don't get the grades I think they are capable of -- I leave their free time choices pretty much alone.  One kid reads voraciously, listens to lots of music and writes stories, draws and plays soccer.  Another watches more TV than I think is preferable, but also devours books and loves sports and is particularly talented at baseball.  The little one still spends lots of time in his imaginary world, but is well-liked by his peers, plays well with all children (something I am immensely proud of), and enjoys drawing, being read to, and playing soccer. He also sings in a kids' choir.

The older two used to take music lessons but, after three years of hating it, I let them quit.  I certainly know Chua would not have allowed THAT.

When they were taking lessons, the expectation was to practice an hour A WEEK.  (Chua discusses multiple hours a DAY.)  Often, the kids did far more than that.  But an hour a week -- 20 minutes three times a week -- was my minimum requirement.  My goal was to get them to WANT to play, not to associate practice with fighting with their mother (which happened anyway, a fact that perhaps underscores Chua's point that you might as well harangue them with even higher expectations).    In the end, they both took to sports and not to music.

You can tell me I failed at parenting them in music.  I would respond that part of that "failure" was the result of a tension between me and my husband.  Music is important TO ME, but he really doesn't give a rat's ass (though if they had wanted to be musicians and worked at it without our having to prod them, he would have enthusiastically supported their interest).  He didn't want to be involved at all in making them practice (or in taking them to lessons), but then he wouldn't back me up when I tried to make them do it.  While a friend of mine has told me privately that she thinks it's NOT important for parents to have a united front, I disagree.  Particularly in issues of education, if the parents aren't on the same page, the children will have a hard time knowing which parent to follow.  I ended up giving into a reality that saddens me:  the kids didn't want to practice and I had no "back up" from their other parent, so turning them into musicians failed in part because it was so exhausting for me.  

That smarts a little, in large part because, in this instance, I was the "Asian" parent and my husband was the "Western" one and, in the end, his view won out (though more by default than by vigorous debate).

However, that was a story of parenting them when they were younger.  Curiously, my oldest (just 14) is now asking to return to piano lessons.  We've had several heart-to-heart discussions about this; I am more than willing to spend the money IF I don't have to harass her to practice.  If I do, then the music education is not worth it to me.  I don't want to spend my time  having to convince her to practice, particularly when I know there will be no Amen chorus coming from her Dad.  But I suspect, since this time it is HER asking to take the lessons, rather than MY introducing them, we may have a more successful experience this time around.

So, she'll re-start at 14, obviously "behind" her peers who have slogged through 8 or 9 or 10 years already on the piano.  But here's the beauty:  the ability to learn does not "expire" as quickly as people think it does.  She still CAN learn the piano if she wants to, and she can do it without a parent having to spend time sitting next to her while she cries over the keyboard, or without one parent telling the other she's being "too harsh".

Sounds like a win-win to me.

Thank God, because even if I have a *slight* tendency toward an "Asian" parenting style, I'm married to somebody who is firmly in the "Western" one.

I suppose I can thank Chua for helping me realize the diversity in my marriage. :)