She is lucky that her husband's company did not cut costs by getting a cheaper plan that may have been no plan at all. The "mom and pop" small business my brother in law worked for did just that, but when he discovered he had brain cancer, their insurance coverage proved to have more holes than Swiss Cheese. Not long afterwards, unable to work due to the disease, he had to quit work and of course that ended what little coverage there was. Faced with exploding bills, his only recourse was to "spend down" his family's assets to a ridiculously low level to qualify for Medicaid. This was a terrible blow to the self esteem of a man who had prided himself on providing for his family, thought he and his employer were doing that, and ended up pauperized by the system.
The article and this story illustrate several points worth deep consideration:
We need to uncouple employment and insurance, so that a change or loss of the former does not make for a loss of the latter. Make coverage a feature of citizenship, more akin to accessing fire and police protection or public education. This alone would eliminate many inequities in the system, where one's quality of care is dependent on which policy they are lucky or unlucky enough to have.
For any public options, we need to make sure that the rich and the poor are served by the same system. The rich will ensure that the system has good quality and does not destroy those it is supposed to be helping. But if only the poor are in the system (think Medicaid), it is vulnerable to shoddy quality and political opportunism ("Cut costs there -- they're just lazy welfare bums anyway.")
Current proposals to mandate either individuals to buy or employers to offer health plans provided through the open market need to prevent the proliferation of low-cost but essentially worthless "Swiss Cheese" policies. They may provide the appearance of coverage and a false peace of mind, but only enrich the insurer.
Finally, remember that any system will have it's horror stories -- some structural, and some the result of carelessness, ignorance, or malice. So don't let the fear of there being horror stories attached to possible solutions prevent us from seeking solutions. Don't let the Perfect be the enemy of the much-better-than-current.
Sick With Worry
I dealt with cancer. But it's the possibility of losing my husband's health insurance that really scares me.
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Please, God, don't let my husband leave me. Not that he's planning to—as far as I know. After all, he's stuck with me through so very much, including the discovery of a cancerous tumor the size of a softball in my lung. And through my monthlong hospital stay, while he took care of our kids, oversaw housewide construction, and handled the insurance bills. And through months of chemotherapy and, later, weeks of radiation treatments where the other women in the waiting room and I confessed that we feared that our husbands would leave us … without health insurance.
My therapist told me that it's normal to fear abandonment when you're at your most vulnerable, and I'm grateful that my husband has stayed with me in sickness and in health. Yet I'm grateful not just to have a good man, but to have a good man with good health insurance.
An employee at a midsize IT firm, my husband has access to a Preferred Provider Organization (PPO), a flexible health-insurance plan with many choices of doctors and medical facilities, from a large insurer in New Jersey. It covers most of our medical bills and pharmaceutical costs, and even provides a modest vision plan for my husband, our two kids, and me.
During my treatments for non-Hodgkin's lymphoma two years ago, our insurance carrier paid for almost all of my medical bills, which totaled upwards of a quarter of a million dollars—and counting.
Naturally, we've paid into this insurance plan from my husband's paycheck. And we've paid our $3,000 annual family deductibles, my $1,000 individual deductibles, copayments and out-of-pocket costs all along.
But even my oncologist was surprised at how good our coverage was—until he dropped our plan last year, citing a low reimbursement rate. Still, our insurance company not only covered the costs for most of my cancer treatments at a topnotch New York City hospital with some of the best doctors in the world, but also my posttreatment scans and tests, including last month's $12,000 biopsy, which assured that my cancer is still in remission.
The truth is that we are one layoff and one positive PET scan away from health-care-related economic troubles. I can't help but worry. My husband's work—developing the online presence for banks, credit unions, and credit-card companies—is not exactly a stable business these days. So we are socking away money just in case. We use coupons and shop at discount stores. We're hanging on to our cars as long as we can—my 2002 minivan has 112,000 miles on it; my husband's 1999 Pontiac is approaching 90,000 miles. Vacation this summer will mean traveling to our community lake.
It feels all wrong to rely on my husband's employment and our marital status to be able to continue the kind of quality cancer treatments and tests that saved my life. As a self-employed author and blogger, it would be difficult for me to get affordable health insurance with the kind of coverage that my husband's corporate job allows us now. If I became a single mother, it would be even harder. And now that my oncologist is out of network, our out-of-pocket costs are higher. Plus, our investment portfolio has, of course, taken a hit, and most houses for sale in our area have been sitting for more than a year.
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