I went to the pharmacy to get some regular prescriptions refilled. Hubby has a new employer, which means we’re under a new insurance plan, which means sharing the newest insurance information with every one of our regular doctors and with the pharmacists. Oh the joys of paperwork – not. This time instead of a co-pay for prescriptions we have a (really, really big) deductible to meet before the insurance pays for things. I can sure vouch that the co-pay system with the previous insurer was a lot less stressful on my blood pressure. OMG the sticker shock!
My $9 blood pressure medication was no big deal. Getting just four migraine pills for $89 was alarming, especially as the kid takes two at a time, but the pharmacist explained that this insurance company only lets them fill four pills at a time. A month’s supply of ADHD meds was $109. (Yes, I’ve tried going without, and were I coping with just ADHD things wouldn’t be as bad, but you don’t want to hear about all the forgotten appointments and scorched pans et cetera; meds are just a part of my coping strategies.) Dang, that was a big check for all that.
Then a couple days later I went back to pick up some meds for hubby. I’ll refrain from details except to mention that when the pharmacist began to ring up his meds, she paused to ask “Do you still wan to fill these ‘scripts for the asthma meds — as the pills are $101, and the inhaler is $250?”
I was stunned, and stammered, “Y-y-y-yes, they’re his asthma m-m-meds …” As in, of course the guy needs them so he can BREATHE okay! And I wrote a check for $486. OMG — this is not helping my blood pressure. Polysyllabic expletive!
The hell of it is, we’re lucky — we have medical insurance. We can pay for our necessary medications (by getting them filled at approved pharmacies), and when we need to we can go see a GP or specialist (ditto from the insurance company’s approved list of “service providers”).
For those of you from abroad, the medical insurance situation in the US truly is a horrifying and baffling mess. It’s not about “managed health care” but rather “managed health care COSTS”. Each insurance company views their subscribers as accounts receivable, and subscribers who draw more resources than they pay in, or who could potentially could do so, are considered to be liabilities to be avoided. “Pre-existing conditions” are important because they can prevent a person from being accepted by a new insurance carrier. Yes, that’s correct — that means that sometimes people are denied medical insurance because (gasp!) they need medical insurance because they have health problems. (Hence one reason why people are hoping that GINA, the Genetic Information Nondiscrimination Act, will get passed.)
But we’re still thankful — if not downright lucky — that we have health insurance. Like many people, we have stared down that darker road, and scrambled to avoid it. The week after I got pregnant with our first child, hubby was one of many to lose his job in a company downsizing. He was the only one of the two of us who subscribed to a medical insurance plan; because I had a minimum-wage job, we had previously deemed that there was no point in reducing my income by subscribing to a second policy. Per the usual arrangement, employees paid something like half the monthly costs at his place of business.
Getting insurance coverage was the issue — he had that “pre-existing condition” of asthma, for which he must take daily medications and which before the advent of better meds, landed him in emergency care now and then. (And of course, there are minor things like hearing aids and batteries so he can hear, and eyeglasses so we both can see. I don’t think our insurance covered those much, if at all.) Fortunately my maternal “pre-existing condition” had not yet been documented by a doctor, so officially it did not yet exist.
I was still employed, so we wouldn’t have qualified for state assistance. The good news was that we were able to have medical insurance (to pay for his medications and my maternal care and future pediatric care) by continuing to pay for the plan wholly on our own (meaning both the employee’s and employer’s costs), under a COBRA arrangement, which fortunately had come into existence just a year before. Twenty years ago that was some $500 per month — half our annual income of $12,000! We literally had to sell our house to continue medical coverage. (Given that we’d only had the mortgage a few years, we had little equity, but we were lucky to have even that.) The prenatal care, labor & delivery and neonatal pediatric doctor care ran close to $2,000, and my obstetrician had to argue with the insurance company to let me stay a second day after delivery, which was just as well because Baby needed a little time under the Bili Lights. Nowadays uneventful prenatal plus L&D runs about five times that much.
Like millions of others, several times in the past 25 years hubby has been unemployed due to company downsizing layoffs. Each time we go through the same ordeal of figuring out where our health insurance coverage will come from.
You might wonder, Doesn’t the US have some kind of health care plan for its citizens? Well, there’s Medicare, which serves people over 65 years of age, and the disabled. Unfortunately, Medicare coverage is limited in what it will cover, and there are still premiums, deductables and co-pays that must be paid out-of-pocket. There are also the various Medicaid programs that are run by each individual state (with some federal assistance) for very impoverished children, parents, seniors and disabled people. Each state has its own elegibility rules and types of coverage. Some people can get both Medicare and Medicaid, but the laws governing what is or is not covered by which program are labyrinthine. There are an alarming number of low-income people who make “too much money” to be covered by their state’s Medicare programs, yet are not able to afford insurance or who are denied coverage by various insurance companies.
The Institute of Medicine (part of the National Academy of Sciences) reports that:
Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage.
Die-hard patriots will strenuously assert that the US is the “greatest nation to live in”, but the World Health Organization would beg to differ:
The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th.
England’s National Health Service was established when the NHS Act was passed in 1946, coming into effect a couple years later. Over here, the United States National Health Insurance Act was introduced to Congress in … 2006. It died. Although a “free and appropriate public education” is considered to be necessary for every American school child, once the subject turns to free and appropriate medical care, suddenly people start screaming about “creeping socialism”.
Not surprisingly, ensuring medical coverage does something positive for the overall health of a country’s citizens, be they in France, Canada, or England. As Michael Moore quoted, a JAMA study found:
“The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer.”
“Level differences between countries are sufficiently large that individuals in the top of the education and income strata in the United States have comparable rates of diabetes and heart disease as those in the bottom of the income and education strata in England.”
Banks, Marmot et al., “Disease and Disadvantage in the United States and in England,” Journal of the American Medical Association, 2006; 295:2037-2045
Of course, no plan is perfect, and each country’s health care system has its unique problems. The British Medical Association describes the £6.85 cost of non-exempt medications as a hardship,
“There are many people with chronic conditions who are not exempt and those on low incomes find it very difficult to pay.”
I don’t doubt the difficulties faced by people on limited incomes. But even so, that £6.85 for a prescription sounds a whole lot better than $250 … especially as the new year looms and we have to start on a whole new deductible all over again. Here’s to hoping a change in presidential administration helps things change!