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My interests include veganism and vegetarianism, health, ethics, politics and culture, media, and the environment. I have three kids; I teach college part-time, study piano and attempt to garden. I knit. I blog on just about anything, but many posts are related to my somewhat pathetic quest to eat better, be more mindful of the environment, and be a more responsible news consumer. Sometimes I write about parenting, but, like so many Mommy bloggers, my kids have recently told me not to. :) Thanks for reading.

Monday, January 24, 2011

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.  


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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.

9 comments:

  1. Beautifully written. I am so 100% with you. Thinking about this gives me a headache and a sinking feeling in the pit of my stomach. Soooo much injustice, and the pundits can't shut up and think about someone else for 10 minutes. It's a disgrace.

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  2. The Silent Scream...I am grateful to Elaine for giving voice to The Silent Scream... and for those of you who follow Elaine's blog - I am the face; and it is my silent scream that you are hearing. I love my job albeit temporary and without benefits of health care or job security. I am ineligible for unemployment benefits when my 520 contract hours end. I made a conscious choice to leap "hoping" *NO* PRAYING that the net will appear. I remain steadfast and determined that very soon with the efforts I continue to put forth, I will have a sustainable income with health insurance. Today, I wrote a six-page employment essay and hit the send button. For those of you wondering how at my age I have become the face; know this, I am not alone. There are many, many Americans just like me whom never imagined that one day their voice would become the SILENT SCREAM.

    *I fled an abusive marriage almost two years ago and am gratefully safe; never looking back and ever hopeful ~ Kendall

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  3. This should run as an Op-Ed in the Wall Street Journal or NY Times!

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  4. The system is long broken Elaine. It's the same way here in UT, the help is all or nothing. They don't want to do a thing for anyone who is taking whatever job they can right now.

    So, the only people who are really benefiting from the assistance here are those who refuse to work at any job. They've learned to play the system.

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  5. In A Gadda Da Vegan -- I know it's long broken (and so does Kendall, who, as you see above, is willing to have me use her name). This post was worth writing to underscore yet AGAIN exactly what "broken" looks like, up close.

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  6. Update from Kendall: In order to remain on the OHP for the month of January (otherwise, I repay all of my RX $$$.$$, hospital $.$$$.$$, and diagnostic exams (echo cardiogram/vision/etc) I have limited my work hours to comply. Work hours: *drum roll please: 50 hours total. This is my last month on the OHP plan. It is scary at the very least to now be without ANY health care coverage and have a temporary job that will matrix me out of the workforce in about 400 more hours. I have canceled an appointment with a cardiologist that has been scheduled since late last fall and with a neurologist. Both appointments were to address my hypertension and migraines. I had an injection this week for a migraine along with a medical appointment. The physician prescribed a medication that has been very successful in staving off migraines. Out of pocket cost each month: $50.00+. As someone who had her first migraine at the age of ten, YES, I have tried EVERY alternative medical treatment available, and been a part of the Mayo Clinic study, AND YES, I limit dietary foods/beverages that are known triggers. Ummmm the physcian's words to me included, "You know, "stress" can be a big trigger for migraine sufferers. Are you under a lot of stress?" (It was our first meeting) I guess electronic chart notes do not include *patient is under stress. GOSH, what could I POSSIBLY be s-t-r-e-s-s-e-d about?

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  7. I am in the same boat. My husband and I have been either unemployed or underemployed for the past couple of years. We currently do qualify for state medical insurance, thank the gods, as
    I have health issues that I've managed to juggle for a long time, but they are slowly getting worse, and I am now on several medications, and forsee a time in the near future when I will have to attempt to apply for disability. Despite that, I do work part time and also have to tread a fine line... if I work a little extra one month, I may be penalized for it by the welfare system. We do have a teenaged son, which is the only reason we are currently qualifying for welfare... he turns 18 in October, and I am worried that I will lose my state-sponsored health coverage at that time, because instead of a three person family, my husband and I will be considered a two person family (even though my son will still be living with us while going to college) with the same (miniscule) income, and we'll probably be over the poverty line. Arizona is also in the process of cutting medicaid, and my son (who will be considered a "single adult" at the age of 18) probably will not qualify, which means he'll join the ranks of the uninsured. Thankfully, he has no medical issues, but what if an emergency were to come up? We are considered homeless (as we have no permanent address and live in an RV), and every six months we have to go in a "requalify" for welfare... it's a nightmare of paperwork, and it's also very stressful, as we wait for our fate to be decided by some social worker with a guideline.

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  8. Ang -- Thank you so much for contributing your story to this post. I wish you and your family the best.

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Politeness is always appreciated.