Health Care Stories: Orange County, CA

Kristen doesn't want to piss anybody off, but she just has to tell her story.

Assuredly Uninsurable


I've been wanting to write about healthcare reform for a while now. I feel really passionate about it, but I have so much to say that I end up getting overwhelmed and then say nothing. I've also been a little hesitant on what to say and how to say it, because it is such a divisive and polarized political issue. I know my views are sure to tick a few people off. But my unwillingness to choose a side in the conservative/liberal identification game, along with my tendency to blather on about my personal political agenda, basically means that somewhere along the lines I am sure to piss off EVERYONE I KNOW. Especially my mom, but probably more so for saying the word "piss".

Anyways, there are a million things I could say on this issue, but for now, I want to start with just telling our story. The reason I think our story is important is because I think that most people who are against healthcare reform have some notions about the "uninsured", and also about what government-run healthcare is really like. In our family, we have struggled with private insurance, but we have a child who is on a government-run plan. I will talk about Jafta and our experience with his insurance another time. But today, I want to give a face to the problem for an average American family like ours.

Mark worked at a church for the first ten years of marriage. He had decent insurance at this job. During this time, I didn't really know much about the health insurance crisis. We had insurance, and so how other people were affected wasn't really a huge concern of mine. Like a lot of people today, I assumed that people who didn't have insurance just needed to look for a different job with better benefits, or just pay out-of-pocket and get it on their own. But it wasn't my problem, so mostly I just didn't care.

My first brush with the systemic problem came when Mark was in a major car accident. It was a freak accident - something you never expect will really happen to you, and one of the reasons insurance is so important. Had we not been insured, we would have lost everything to this accident. Thank God we were. We had an HMO at the time so most everything was covered. But when we saw the bill, two things stuck out. First, there seemed to be a serious game of "name your own price" when it came to the bills. The hospital/doctor/ambulance would state their price, and then that price would be considerably reduced to the contracted rate. Which begs the question, WHAT IS THE REAL PRICE? When you buy something from a street vendor in Tijuana, you expect that the first price thrown out is just a high-ball starting point for bargaining. You don't expect it from healthcare professionals, but that is exactly what happened on every bill received. Usually the "contracted price" was about 25% of the initially requested price.

The other systemic issue we noticed, which is no surprise to anyone, was the exorbitant cost and low quality of care Mark received in his month in the hospital. He went days, literally days, without seeing a doctor. I had to chase nurses down in the hallway to ask for help when Mark was struggling with basic functioning. As a family, we felt we couldn't leave him at all or he would be ignored. We had to advocate constantly for him, and often took to doing things ourselves (bathing, toileting, etc) because it was so hard to get someone to respond. It took days for someone to notice that his brace was on incorrectly, and the result is that his bones healed incorrectly which led to two later surgeries. He was booted out of the hospital way too soon, and came home completely and totally dependent on 24/7 care. I literally don't know how he would have survived if he didn't have family to care for him. And the hospital bill for four weeks of substandard care? $500,000. Then another $190,000 for two subsequent surgeries to fix the crappy job that was done in the hospital. And do you think the hospital offered a refund for their shoddy handiwork? No.

There is a lot more I could say about that experience, but I am already digressing from my point, which is to talk about how we became an "uninsurable family". When Mark left his job at Rock Harbor to do private practice, we knew that insurance would be a factor, but I was completely ignorant as to how big it would be. I had seen commercials on tv for insurances plans "starting as low as $90 a month". I figured we would just buy our own insurance, and that it would just be something we added to the budget. I knew we would have some pre-existings, but neither of us had cancer, right? Mark's accident was in the distant past, and while I figured we would pay a higher premium, I had no clue that some people just can't get insurance no matter what they are willing to pay. We called broker after broker. We filled out forms and answered honestly. Because of Mark's car accident, he was considered UNINSURABLE. He wasn't given a higher premium . . . he was flat-out denied. And surprisingly, so was I. A string of miscarriages (that required no medical intervention whatsoever) also rendered me uninsurable, and we found ourselves with no options, even if we were willing to pay. The church did not offer COBRA, and we talked to numerous underwriters, all of whom told us the same thing. We won't insure you, and NOBODY WILL.

Now, Mark and I did manage to find a way around this. We were able to form a corporation and gain insurance as a company of two people, since we are in the same field. But not everyone has the education, savy, ability, or money to do something like that. I know there are many people out there without insurance because of health conditions. And these are the very people that need insurance. Why we would want the government to stay out of offering this right to every person, especially the sick, is beyond me.

We are very fortunate to be insured, but this is still a broken system. We pay $1000 a month to insure the two of us. That's $12,000 a year, and doesn't include our kids. This is only catastrohpic insurance. We have a $5000 deductible every year. I got pregnant in August, so we paid that deductible in 2008, and then it started over in 2009. And once I had Karis, we had to pay the deductible again for her hospital stay. Even after the deductible, our plan only covers 75% of a hospital stay. So my delivery bill was $1900 after the deductible.

So, if you do the math, my pregnancy cost us:
$9000 (9 months of premiums)
$5000 (deductible in 2008)
$5000 (deductible in 2009)
$5000 (deductible for Karis)
$1900 (hospital stay)

= having Karis cost me $25,900.

And I have insurance.

Please know I'm not saying this for a pity party. Mark and I are fortunate, we're scraping by, we don't need anyone's sympathy, yada yada yada. We may have to lay off the Starbucks and eating out for a while, but we will manage. The point I want to make, though, is that some people can't. This kind of expense would put some people into bankruptcy. People WITH insurance cannot afford bills like this. That is not okay. And these numbers are for a pregnancy. I can't imagine what a serious accident or illness would cost.

I share all of this in an effort to put the insurance thing into perspective. Regular, hard-working people are struggling. This is not a problem that just effects illegal aliens or the unemployed. (Although those people are deserving of sympathy, too). This is a problem for many average Americans.

There is so much more I want to say about this . . . I want to talk about how we are already paying for the uninsured, about how government-funded health insurance does not mean socialism any more than libraries, public parks, or schools do. I want to question why we think money-hungry HMO's are managing our health with any more benevolence than the government would, and how 0ur current system has most of the very issues we fear about countries like Canada and England (long waits and crappy care). I'm hoping I will get around to talking about that, but for now, I would really encourage everyone to look at this issue with FRESH EYES. Move beyond the political, because this is not a political issue. This is a social justice issue, and our level of compassion should not be defined by our political alliances.


Kristen
Orange County, CA


This post originally appeared on Kristen's blog, The Howerton Family. Check it out.


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