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.
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Sick With Worry
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Luckily, we live in New Jersey, a guaranteed issue state where we can't be denied coverage for preexisting health conditions—even cancer—and we won't face exclusion periods imposed on our health-insurance policy as long as we follow certain rules. For example, if my husband lost his job, as long as we kept up our COBRA payments, roughly $1,500 for a family of four, for up to 18 months, we can't be denied coverage down the road. And now the government is chipping in up to 65 percent of such payments for many people laid off this year.
And yet, I still worry. I've heard plenty of health-insurance horror stories from other patients and survivors that give me pause: there was the woman I met at radiation therapy who was denied insurance because she was diagnosed when she was between jobs and, therefore, between insurance plans. Unemployed and single, she couldn't afford her COBRA payments. Then there was my mentor from the Leukemia & Lymphoma Society, a mother of three with no health insurance, who was told that the only way to get government assistance for her medical bills was to divorce her husband.
And then there was the Canadian on an Internet cancer forum who praised her country's socialized medicine: "We just got a third PET scan machine in Ottawa!" she sang. Three PET scan machines for the entire Candadian capital? There are more PET scan machines than that in the Manhattan radiology center where I get my scans. And PET scans are now considered the gold standard for identifying the kind of cancer that I had.
I listened to their stories and realized how very lucky I am to have such good insurance. And yet I know that just one layoff or one cancer recurrence are all that could be between me and a health-care crisis like so many Americans are facing today.
In March, my husband's company issued 5 percent pay reductions to stave off layoffs. As long as he still has his job, that's fine with me. It's his health insurance that's so invaluable for us. Perhaps my life depends on it.
Jen Singer is the creator of MommaSaid.net and the moderator of the Parenting With Cancer boards at Planet Cancer.
Editor's note: In an earlier version of this story, Singer incorrectly identified Canada's capital city, Ottawa as a Canadian province.
© 2009
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