flames! flames on the side of my face!
(I'm sorry, I know I've been posting a lot today. I'll cut this; it's basically me ranting about health care and politics in our oh-so-broken system in the US.)
I read the NYTimes vociferously and it's one of my most-visited sites. I like to go there around now in the evening because the new op-eds come out and I like to see them and maybe comment on one or two. If I forget, by the time I get to the comments the next day the section is invariably closed, although I still read them because a lot of times I get more intelligent discourse there than I do in the op-ed. (see also: David Brooks, Ross Douthat, and sometimes Thomas Friedman.)
Anyway, Ezekiel J. Emmanuel has been writing a series of columns for the Times for a while now. He was a health care advisor to President Obama, back in 2009 when folks were talking about the ACA (aka Obamacare). So he has some idea of what he's talking about. I don't always agree with his points; I can't bring to mind specifics but I do remember vehemently disagreeing with him on a few suggestions he had for health care reform in previous columns. Tonight, though, I like what he had to say here. (If you can't read the article due to Times limits and do not have an account, let me know and I can help.)
What he talks about in this column is the Republicans' plan to replace the ACA. They've been saying since it was enacted their plan was to repeal and replace it, and sure enough, the House has voted over 40 times to repeal the damn thing (and wasted millions of taxpayer dollars in the process). But none of them ever said exactly what they'd replace it with, until now.
He goes into more detail than I will about what exactly the "Patient Choice, Affordability, Responsibility and Empowerment" (Patient CARE) act entails. Some of the ideas aren't terrible, to be fair, and some of them might have won cautious Democratic support years ago. But there's one in particular I want to attack in here.
Emmanuel says: "...Obamacare’s absolute ban on withholding coverage from people with pre-existing conditions would be rolled back. Those who remained continuously insured would stay protected, so they couldn’t be charged higher rates or be excluded entirely. But if their insurance lapsed, health insurance companies could charge more or refuse to cover them."
This? This makes me see red. Let me explain why, although I'm fairly certain most of you are intelligent individuals who already get it.
I was diagnosed with anxiety and depression in the fall of 2000 and started on my first psych med, Zoloft, at that time. (I have fond memories of Zoloft. It worked beautifully until it just...stopped. But I digress.)
In November of 2001, I ended up hospitalized for a couple days due to a complicated migraine that apparently the local doctors couldn't figure out even though subsequent neurologists told me it was a classic presentation. (in defense of the local doctors, I didn't actually have the migraine at the time, I just couldn't talk. The migraine came a couple days later.)
Both of these were enough to disqualify me from any future insurance coverage. There are stories of cancer patients who have had their coverage dropped because they neglected to disclose a back injury on their forms--apparently that's a pre-existing condition. Insurance companies in the US don't need a reason to deny people coverage; they'll find any loophole they have to and squeeze through. Someone like me, with mental health issues and chronic migraines, wouldn't stand a chance.
I spent years terrified I'd lose coverage and never get it again. I was fortunate enough to find jobs that had benefits, and the brief period of time I had to buy individual insurance I remember having to jump through a million hoops to prove I'd had three years of continuous coverage so I didn't have to fill out the health history questionnaire. I knew if I'd filled that out honestly, they wouldn't cover me, and if I didn't fill it out honestly, they'd drop me once they found out.
When I was terminated at Large Travel Website, I immediately started paying for COBRA because I had to keep my coverage, and those premiums were a serious bite into our budget, but we had no choice. The day Morgan got his current job and we knew we'd both get coverage under his employer, I almost cried in relief because we could stop spending hundreds of dollars a month. (Also cried because it meant one of us was employed again, but I digress.)
I had conversations with Morgan about the possibility of us trying to emigrate to Canada or the UK or somewhere with universal health care just so I could stop being scared of going without it. (He was not in favor of the idea for many reasons, some of which I agree with.)
And then the ACA passed, and it was like the sword stopped hanging over my head, or at least wasn't dangling quite so precariously. It was by no means a great solution--truth of the matter is it's a crappy one--but it was more than we'd had before. The lack of pre-existing conditions meant I could lose insurance for a short time and still get it back. Of all the changes the ACA made, that was and is the one that is most important to me.
The Republicans want to do away with this, which should come as no surprise to anyone. The Republicans also want me to pay more in general for health care, have more "skin in the game" or some bullshit like that. (Paul Krugman has written some excellent columns on just why this is a stupid idea, for the record.) So let's play this out logically, shall we?
Suppose the Patient CARE (bullshit name, but I digress) gets passed by both houses of Congress. Suppose the pre-existing conditions clause gets repealed. Then suppose that for whatever reason, I lose my job in January. Since I'm not covered by Morgan's insurance currently, I can't get coverage under his plan until open enrollment in November. Suppose I can't afford the COBRA premiums on my current insurance plan. This leaves me with two options: go without insurance or try to find individual coverage. If I am able to immediately find individual insurance I can afford, I'm safe...until I can't afford those premiums and let my coverage lapse.
Then I'm screwed. I have no insurance because I can't afford the premiums and even if I could no insurer would have me, I have miniscule unemployment benefits because the Republicans slashed those, too. I can't afford my medication or my doctors' appointments because I have no income and no insurance, and without my meds and my doctors to prescribe them, I get paralyzed by anxiety, depression and migraines and become unable to work. I file for disability, which I probably don't get because that's damn near impossible, and end up a "taker", a drain on society that the Republicans scorn already.
The above scenario may be a bit hyperbolic, but there's also a lot of truth in it. For contrast, if I lose my job in January under the ACA, I still can't get coverage from Morgan's plan until November. I can pay for COBRA, as I could under the Repub plan, but if I can't afford those premiums I can find coverage through the health exchange that--given my drop in income--will likely be subsidized to a large extent, and I won't be charged more for having chronic conditions. I could also, as I mentioned above, take a risk and go without coverage entirely for a few months and not worry that I'd never get covered again.
(The whole part about miniscule unemployment benefits stays true, though, as does the inability to qualify for disability, because our society sucks at helping people out when they need it most.)
And I've said before--I am lucky with regard to health care in the US today. I have coverage that's actually, by most standards, very comprehensive and covers almost everything. The most I should have to spend out of pocket in a year is about five thousand dollars, not counting dental and vision, and it would be less if Morgan werne't on my insurance. My employer subsidizes most of my deductible, which is actually fairly low as HSA plans go, and covers either all or the majority of my premiums (I don't remember which this is, as whatever I contribute gets automatically taken out of my paycheck pre-tax and I don't notice it. I want to say they pay all of my premiums but I pay something for extra dental coverage).
I am incredibly fortunate to have good benefits as they currently stand (although god I miss my PPO plan) and that was actually one of the main reasons I really, really wanted a job with the $Evil_Empire as an FTE. It's well-known in this area that they provide stellar benefits and always have. No one's happy about the change to the HSA plan, but it could seriously be a LOT worse. I have a friend who has an HSA plan in Los Angeles. Her deductible is I think around 5k, and her employer only pays about $500 of it, for comparison.
But if I, a fortunate person with good benefits, am still this scared of losing my job because of the loss of insurance, the system is broken. If friends of mine can't afford their regular, needed medication because even with insurance they can't afford the co-pays, the system is broken. If I know people who simply can't get covered because they can't afford individual premiums but can't qualify for Medicaid, the system is not just broken, it has failed.
The number one cause of bankruptcy in the US is medical debt. Think about that for a minute. Then wonder how the hell we still have the nerve to call ourselves a "civilized" society.
This entry was originally posted at http://blueraccoon.dreamwidth.org/1226125.html. Please comment there. |
comments
I read the NYTimes vociferously and it's one of my most-visited sites. I like to go there around now in the evening because the new op-eds come out and I like to see them and maybe comment on one or two. If I forget, by the time I get to the comments the next day the section is invariably closed, although I still read them because a lot of times I get more intelligent discourse there than I do in the op-ed. (see also: David Brooks, Ross Douthat, and sometimes Thomas Friedman.)
Anyway, Ezekiel J. Emmanuel has been writing a series of columns for the Times for a while now. He was a health care advisor to President Obama, back in 2009 when folks were talking about the ACA (aka Obamacare). So he has some idea of what he's talking about. I don't always agree with his points; I can't bring to mind specifics but I do remember vehemently disagreeing with him on a few suggestions he had for health care reform in previous columns. Tonight, though, I like what he had to say here. (If you can't read the article due to Times limits and do not have an account, let me know and I can help.)
What he talks about in this column is the Republicans' plan to replace the ACA. They've been saying since it was enacted their plan was to repeal and replace it, and sure enough, the House has voted over 40 times to repeal the damn thing (and wasted millions of taxpayer dollars in the process). But none of them ever said exactly what they'd replace it with, until now.
He goes into more detail than I will about what exactly the "Patient Choice, Affordability, Responsibility and Empowerment" (Patient CARE) act entails. Some of the ideas aren't terrible, to be fair, and some of them might have won cautious Democratic support years ago. But there's one in particular I want to attack in here.
Emmanuel says: "...Obamacare’s absolute ban on withholding coverage from people with pre-existing conditions would be rolled back. Those who remained continuously insured would stay protected, so they couldn’t be charged higher rates or be excluded entirely. But if their insurance lapsed, health insurance companies could charge more or refuse to cover them."
This? This makes me see red. Let me explain why, although I'm fairly certain most of you are intelligent individuals who already get it.
I was diagnosed with anxiety and depression in the fall of 2000 and started on my first psych med, Zoloft, at that time. (I have fond memories of Zoloft. It worked beautifully until it just...stopped. But I digress.)
In November of 2001, I ended up hospitalized for a couple days due to a complicated migraine that apparently the local doctors couldn't figure out even though subsequent neurologists told me it was a classic presentation. (in defense of the local doctors, I didn't actually have the migraine at the time, I just couldn't talk. The migraine came a couple days later.)
Both of these were enough to disqualify me from any future insurance coverage. There are stories of cancer patients who have had their coverage dropped because they neglected to disclose a back injury on their forms--apparently that's a pre-existing condition. Insurance companies in the US don't need a reason to deny people coverage; they'll find any loophole they have to and squeeze through. Someone like me, with mental health issues and chronic migraines, wouldn't stand a chance.
I spent years terrified I'd lose coverage and never get it again. I was fortunate enough to find jobs that had benefits, and the brief period of time I had to buy individual insurance I remember having to jump through a million hoops to prove I'd had three years of continuous coverage so I didn't have to fill out the health history questionnaire. I knew if I'd filled that out honestly, they wouldn't cover me, and if I didn't fill it out honestly, they'd drop me once they found out.
When I was terminated at Large Travel Website, I immediately started paying for COBRA because I had to keep my coverage, and those premiums were a serious bite into our budget, but we had no choice. The day Morgan got his current job and we knew we'd both get coverage under his employer, I almost cried in relief because we could stop spending hundreds of dollars a month. (Also cried because it meant one of us was employed again, but I digress.)
I had conversations with Morgan about the possibility of us trying to emigrate to Canada or the UK or somewhere with universal health care just so I could stop being scared of going without it. (He was not in favor of the idea for many reasons, some of which I agree with.)
And then the ACA passed, and it was like the sword stopped hanging over my head, or at least wasn't dangling quite so precariously. It was by no means a great solution--truth of the matter is it's a crappy one--but it was more than we'd had before. The lack of pre-existing conditions meant I could lose insurance for a short time and still get it back. Of all the changes the ACA made, that was and is the one that is most important to me.
The Republicans want to do away with this, which should come as no surprise to anyone. The Republicans also want me to pay more in general for health care, have more "skin in the game" or some bullshit like that. (Paul Krugman has written some excellent columns on just why this is a stupid idea, for the record.) So let's play this out logically, shall we?
Suppose the Patient CARE (bullshit name, but I digress) gets passed by both houses of Congress. Suppose the pre-existing conditions clause gets repealed. Then suppose that for whatever reason, I lose my job in January. Since I'm not covered by Morgan's insurance currently, I can't get coverage under his plan until open enrollment in November. Suppose I can't afford the COBRA premiums on my current insurance plan. This leaves me with two options: go without insurance or try to find individual coverage. If I am able to immediately find individual insurance I can afford, I'm safe...until I can't afford those premiums and let my coverage lapse.
Then I'm screwed. I have no insurance because I can't afford the premiums and even if I could no insurer would have me, I have miniscule unemployment benefits because the Republicans slashed those, too. I can't afford my medication or my doctors' appointments because I have no income and no insurance, and without my meds and my doctors to prescribe them, I get paralyzed by anxiety, depression and migraines and become unable to work. I file for disability, which I probably don't get because that's damn near impossible, and end up a "taker", a drain on society that the Republicans scorn already.
The above scenario may be a bit hyperbolic, but there's also a lot of truth in it. For contrast, if I lose my job in January under the ACA, I still can't get coverage from Morgan's plan until November. I can pay for COBRA, as I could under the Repub plan, but if I can't afford those premiums I can find coverage through the health exchange that--given my drop in income--will likely be subsidized to a large extent, and I won't be charged more for having chronic conditions. I could also, as I mentioned above, take a risk and go without coverage entirely for a few months and not worry that I'd never get covered again.
(The whole part about miniscule unemployment benefits stays true, though, as does the inability to qualify for disability, because our society sucks at helping people out when they need it most.)
And I've said before--I am lucky with regard to health care in the US today. I have coverage that's actually, by most standards, very comprehensive and covers almost everything. The most I should have to spend out of pocket in a year is about five thousand dollars, not counting dental and vision, and it would be less if Morgan werne't on my insurance. My employer subsidizes most of my deductible, which is actually fairly low as HSA plans go, and covers either all or the majority of my premiums (I don't remember which this is, as whatever I contribute gets automatically taken out of my paycheck pre-tax and I don't notice it. I want to say they pay all of my premiums but I pay something for extra dental coverage).
I am incredibly fortunate to have good benefits as they currently stand (although god I miss my PPO plan) and that was actually one of the main reasons I really, really wanted a job with the $Evil_Empire as an FTE. It's well-known in this area that they provide stellar benefits and always have. No one's happy about the change to the HSA plan, but it could seriously be a LOT worse. I have a friend who has an HSA plan in Los Angeles. Her deductible is I think around 5k, and her employer only pays about $500 of it, for comparison.
But if I, a fortunate person with good benefits, am still this scared of losing my job because of the loss of insurance, the system is broken. If friends of mine can't afford their regular, needed medication because even with insurance they can't afford the co-pays, the system is broken. If I know people who simply can't get covered because they can't afford individual premiums but can't qualify for Medicaid, the system is not just broken, it has failed.
The number one cause of bankruptcy in the US is medical debt. Think about that for a minute. Then wonder how the hell we still have the nerve to call ourselves a "civilized" society.
This entry was originally posted at http://blueraccoon.dreamwidth.org/1226125.html. Please comment there. |
comments