Health Insurance and the Independent Writer
categories: Bad Advice / Cocktail Hour / Don't Talk About Politics
10 comments
Cobra
When my wonderful five years at Holy Cross were up I was able to take advantage of COBRA health coverage. The acronym stands for Consolidated Omnibus Budget Reconciliation Act, but it’s appropriately threatening, deadly snake, right. All the act states is that employers’ insurance plans must continue to cover employees terminating for any reason for eighteen months after termination. This protects many people, but for an example, think of someone battling cancer: can’t work anymore, gets to keep insurance. For a while. If she can pay. My own COBRA amount was about $2200 a month (a month, yes) for me and my family, which would allow me to keep the excellent insurance I enjoyed via Harvard Pilgrim. But of course, newly free-lance, $26,000 was not a possibility. I lucked out, however, as the Obama administration stepped into the mounting unemployment fray of 2009 with a 2/3 subsidy of COBRA coverage across the board, across the country. So, for a mere $700 a month, my family remained covered, and this was marginally affordable. All the while, news stories came and went: the COBRA subsidy would be ended. It had been saved at the last minute during negotiations over unemployment benefits. It was dropped. It was restored. I remained worried for the entire 15 months of the original subsidy (which was not extended), a time of various health crises for my family.
You may recall I had neck surgery. Or anyway, I certainly recall it. Or before and after it. I tried for over a year to heal without surgery, and may have kept at that foolish enterprise, except my insurance was going to lapse. So, I scheduled the surgery, and when the subsidy ended, no way around it, began paying the full COBRA premium.
In the midst of healing, the 18 months of even the unsubsidized COBRA coverage was up. That is, the specter of no health insurance at all was looming. I had a lot of expenses coming, too, though the surgery had been fully covered, not cheap, and thanks. In the midst of healing, in fact, still pretty looped, I got on the phone. Harvard Pilgrim first, as I loved their coverage. The fellow on the phone was very efficient, very kindly, very articulate. “Yes,” he said, “We certainly do have coverage in Maine, and we certainly do have individual policies.” He put me on hold, called up the relevant figures. “Here it is,” he said. “One price. Very similar to your old coverage. $6800 a month.”
“A year,” I said, not quite delighted, but resigned: we could manage.
“A month,” he said.
I tried to do the math. “That’s. That’s. That’s.”
“That’s $81,000 a year.”
“Who can pay that?” I said, not really incredulous: this is the state of our health insurance system, after all.
“There’s a table,” he said, calling it up. “Okay. The suggested yearly income for this premium is… let’s see. It’s $1,100,000.”
“I won’t even be making $81,000.”
“Try Anthem Blue Cross/Blue Shield.”
Anthem actually does have policies for the self-employed who don’t make millions. I called, got the run-down on premiums. Something fairly comparable to my old coverage had comparable rates to the quote from Harvard Pilgrim. But the Anthem salesperson went over the other options with me. In the end, we came up with a $15,000 deductible plan. (Per calendar year, folks–whatever you do, don’t get hurt at the end of December!) It has some benefits, like free yearly check-up. Plus, you get the rates they’ve negotiated with your health-care providers.
(A particular sin of the “system”: if you have no health insurance, you pay at least double what people with health insurance pay. That is, your health provider skins what he or she or they gave up in strong-arm negotiations with the insurance companies out of people with no insurance, who are generally the least able to pay at all.)
Our rate? $560 a month. For now. Because of course the Maine State Legislature has just given the insurance companies a 12% rate increase. Not too bad, as they’d asked for 39% ahead of the health care act going into effect, as if that act doesn’t hand them 40 million new customers. (Corporate radicalists love state’s rights: states aren’t as powerful as industries. States are easy to push around. Even proudly progressive states like Maine.)
Worrisome. But, we can manage $560 a month, and do. And have enjoyed reduced fees on about $10,000 of follow-up appointments and therapies on my neck, for example.
Gosh, thanks!
In our family, though, there’s a medication that costs $1000 a month. When we moaned to the local pharmacy (don’t forget pharmacies take probably 50% of these outrageous prices…), we were given a $200 break. So $800 a month. Insupportable. (What do people do who have fewer resources than we? Well, they don’t take the meds. They get sicker. They die. They end up in jail, if that’s the sort of med we’re talking about. They use the emergency room for small problems. The use the emergency room for all problems. They cost us all a fortune.) We paid for one month of the medication in question.
Then got to work, looked into buying via mail from Canada, a legal ploy. 1/10th the price! Same exact prescription! And for a foreigner!
The Affordable Health Care Act made some inroads into the health insurance disaster. Very much more is left to be done, especially for those who don’t work in the benefits culture. If you’re thinking about going freelance, well, keep thinking. If you’re thinking about voting for a corporate radicalist candidate next vote, please.
Because this bad system costs all of us a lot, and not just saps like me. Or actually, not all of us, just the ones who pay taxes, who are, more and more emphatically, not the ones profiting from the healthcare disaster that continues to bloom all around us.
Flip the coin over. They very causes of high health care costs are controllable. Society’s attitude of “do everything and give me meds” for my heart disease and bypass sugery, diabetes, high blood pressure, congestive heart failure……oh, but don’t take away my cigarettes, unhealthy foods or sedentary life style.
Those in politics and government are only addressing half of the issue-healthcare costs, including insurance premiums. Largely by cutting payments to providers and hospitals. It’s time to start talking about the white elephant in the room-our unhealthy lifestyles which burdens the entire healthcare system and drives costs up.
I couldn’t agree more: a sane health policy would emphasize wellness care and prevention, including healthy environmental policies. I would disagree that those in government are only addressing half the issue–I think they’re addressing about .01 % of the issue, which though vast and difficult is under control in most of the world, not here in the USA. And let’s not forget that a lot of health issues have nothing to do with lifestyles, just bad luck and the human condition, which since we share, we do best when we share the costs. And I don’t mean with the huge corporations who consider their profits more important than any of the real issues. Private health insurance costs us all a lot more than the premiums some of us pay…
Great post, Bill! If you really want a sleepless night, think of how nightmarish it would have been if health care reform had not passed – you may have been essentially locked out of buying health insurance altogether. The good news is that health reform is taking place over a period of several years, so hopefully you’ll have improved access to decent and affordable coverage by 2014, and will not have to depend on such band aids as Canada’s generosity. Also, the Keep ME Well website (http://www.keepmewell.org/toolkit_search.htm?SUBMIT=Yes) has info on how to obtain low cost services. Stay well (and cool!). Dora
Dora, I hope you won’t mind if I point out that you’re Maine’s Public Health Director. I agree that health care reform was a great achievement, and my complaint is not about what passed but about what was prevented from passing. My sense is that by 2014, self-employed people will have more choices and might even be able to enter a competitive market for coverage, and that what was passed was only the beginning of what’s going to get done as expenses escalate and the corporate activists are exposed. I mean, greed shows through the finest cloth. Sadly, though, a lot of lives are going to go off the rails in the meantime. I can afford both the premiums for my all-but-non-insurance and the cost of meds and care that go uncovered under the absurd deductible. The worry is for those who can’t, and whom we all pay for, and dearly.
This post must sceen for all caps, obscenity and bad attitude as this is my third attempt. I’ll make it brief.
Bill you bring up many important and troubling points. I am so glad that you were able to have a successful outcome with your surgery.
Insurance companies and greed are the root of the American medical crisis. Doctors account for only 7.5% of healthcare dollars so people shouldn’t waste too much time hating us, the insurance companies have that covered.
A single payer system was a viable option but that ship has sailed.
Obama has tried to correct some injustices but it’s like trying to run in mud.
Make your voices heard and save Medicare while you can. Privitized Medicare is an insult to the poor and elderly. Many of my patients don’t even know how to wrap there heads around Medicare D or the “doughnut hole”. Give them a voucher and they will not be able to afford insurance, medical care or their medicine.
Only the rich, stupid or hypocritical believe in privitized medicine. Ayn Rand used her Medicare for her lung cancer treatment. She explained that she was a writer and did not make much money.
We don’t screen, we’ve just been having some access troubles. Apologies to one and all. I don’t think the single payer ship has sailed, though it was pushed off the pier by an angry mob. Vermont has joined all the enlightened nations of the world, which is nearly all nations, and instituted their own system. This is a long-term battle against the forces of greed on the one hand, complacency on the other. I do think we’ll get there!
Sorry Bill, I was kidding about being screened. Insurance companies make me crazy. I probably deleted my own posts while throwing preauthorization forms at my key board.
Hope all is well.
My medical management experiences are a labyrinth. My childhood medical was military clinic, dispensary, and hospital. My adult medical, early years sometimes health insurance coverage through employment, sometimes none, sometimes catch as catch can. Later adult, I lost touch with the grid due to employment circumstances changing because of unrecognized health issues.
So now I’m self-underemployed below the poverty line and have been for two decades. Because I lost touch with the health insurance grid, I’m no longer accepted by mainstream insurance companies. My preexisting chronic medical conditions disqualify me for coverage. There are optional programs though. Navigating them is riding over icy watefalls on an innertube.
One plan that’s really no help is optional state sponsored alternative coverage. It costs more than I make, though there is some financial assistance available. It’s not a comprehensive plan anyway, not for what I need. And there’s a severely limited panel of treaters who will accept the plan. They are few and far between location-convenience-wise. The nearest treater on the panel to me is eighty miles away.
My medical maintenance costs more than I make before expenses and taxes. I was eligible under free clinic policies for total medical assistance, prescriptions, clinic visits, doctor visits, physicals, laboratory tests, and imaging, and so on. The meds are provided by the pharmaceutical companies under prescription assistance progams. The labs and imaging from pubic and private charities. The nurses and doctors and staff volunteers volunteer their time. It was a godsend. I’d be in worse shape but for it.
Lately, I moved to go to graduate school. New maize of predicaments and falling between the cracks. Health insurance is now required for on-campus students, not distance education students. My program doesn’t allow any online classes. Period. The health insurance disqualifies me for free clinic medical management. The municipal health department here doesn’t treat chronic conditions like the one did where I moved from, which also provided management but at a reduced cost compared to private, for-profit clinics. The health insurance plan has a one-year waiting period for preexisting conditions, of which I have dozens. Okay, I understand, the health insurance is for newly emergent accute conditions, not ongoing chronic conditions at first. So I’m paying for coverage I can’t use but need, and the management I had before I’m no longer eligible for.
I’ve had several episodes of accute conditions that meant I had to go to the emergency room by ambulance. One’s total bill was $30 grand, though the condition resolved itself over a year’s time. One’s total bill was $60 grand, though it too resolved itself over a year’s time. A so-called indigent patient program picked up the hospital portions of the bill. The doctors and radiologists’ groups’ bills I had to pay. $10 grand in the first case, $15 grand in the second. The radiolgists’ bills were unspeakable. One simple $75 X-ray would have done the job like follow-up treaters’ did. But no, they were taking pictures like Japanese tourists. I’ve since had several similar accute episodes without medical intervention that took care of themselves over a year’s time each. Actually, one a year since, though this year looks like a free pass. I learned on my own what the underlying cause was and am now treating for prevention, prevention that no one else cared to address. There’s no profit in prevention when treating accute and chronic conditions is what drives the medical adminstration’s livelihood.
Falling between the cracks. The story of my life.
Bill,
This is great, the nitty gritty. Our nation has been and is covertly cruel to the poor and the self employed. Our nation would be MUCH more productive if everyone were covered, as well as more civilized, kind, and democratic. Our worship of unfettered capitalism is the cause, and capitalism must be buffered or we’ll have a wrecked environment and a threadbare, shabby society.
Apropos of nothing, except you, I just today finished The Smallest Color. Wow, what a book. I love love love threaded narratives, and have always loved them in essays and movies, maybe one book–Into the Wild–but can’t remember a novel offhand with two such compelling parallel narrative arcs. I hope you will write about threaded narratives, which seem au currant, but must be very old. I got caught up in both of your stories and marveled at how the two threads came together. It was fascinating when, having been in the past thread, I found Coop ruminating on those past events. Deeply satisfying.
Our system is just plain crazy! It offers an incentive for people to go on Medicaid, but is extremely expensive for anyone who is self-employed. What happens when a self-employed person gets cancer, can’t work, and still has to pay $6,720/yr. for a $15,000 deductible policy, plus the costs of drugs, bills up to the deductible, and the inevitable increase for having a pre-existing condition? Very few people, even many well-to-do ones, have a large enough cushion to cover every potential medical disaster or an unfortunate series of medical problems.
We really must insist that ALL legislators be covered by any health insurance acts they pass. Then, they would have a clue what life is like for the rest of us! Thanks for offering an inside look at a difficult subject. So glad your surgery was successful and covered by insurance.
P.S. I think COBRA is a fancy acronym for highway robbery.