Not helping my blood pressure

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 medsas 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!

7 Comments

  1. 1 December 2007 at 15:20

    It must be awful to live in a country where healthcare is ridiculously expensive. You have my sympathies. And of course, I know how lucky I am to have to pay only £6 for a prescription, regardless of what it is. I get my (very expensive, and quite life-altering) Lyrica incredibly cheaply, and all the painkillers I need, and so on. That’s wonderful, and I’m grateful for it.

    However, don’t be too quick to jump to the defence of the NHS. Their ‘specialists’ have denied me treatment countless times; done the wrong thing repeatedly and worsened my condition in the process; ignored my (fairly obvious) condition from the age of 2, when I first developed some quite serious symptoms, to 29, a 27-year gap of mistreatment and lack of treatment that has left me with a much worse impairment than I need have had; called me all manner of names and generally acted abusively towards me; and have screwed up my health in more ways than I can count.

    It’s only a theory that everyone in this country is eligible for any healthcare they need – I now can’t get physiotherapy, possibly ever again, because I’ve already had my quota of six sessions (six! for EDS!), so will be paying £80 a session for that for as long as I need it. As an example. As another, we have NHS wheelchair services that everyone is supposed to be entitled to, according to need. I don’t use a wheelchair inside the house, partly because there’s no space, and partly because I’ve never had one that I *could* use properly in the house. This loses me my eligibility and all I get is a voucher for a tiny, tiny proportion of the cost of the kind of chair that I need, and ultimately I couldn’t afford what I really needed. I’m on a nine-month waiting list for CBT – some people with mental health problems have to wait eighteen months or more for urgent treatment – and I’m not even sure I’m *on* the waiting list yet, because a psychiatrist seriously screwed up and left me off it for several months – my complaint about this has been ignored. I’ve needed an assessment for dyspraxia since I was school-aged, but I can’t get one, so I can’t advice on dealing with it.

    I look at my friends in the States who have had state-of-the-art wheelchairs, the best of consultants, homecare services, and all manner of other things paid for by insurance, and I have to say that I’m quite envious. I know it’s not nearly that good for a lot of people. And I know that people can lose everything over an unexpected operation that their insurance won’t pay for. But I don’t know that our system is necessarily the best example of one that works. Neither system is great for everyone.

    Oh, and the NHS is notoriously un-disability-friendly. Every month they find another way to tell me to get out of my wheelchair/off my crutches. I quite quickly learned to ignore this ‘professional advice’, since it ends me up in bed for weeks at a time. But I still get treated like a malingerer for not listening to advice that they’re convinced would have me running around like a happy non-disabled person in a matter of months. Knowledge of my condition and attitudes towards my rights and choices are rather lacking. It’s worse for other people with impairments that the NHS is even more prejudiced against…

  2. Tysyacha said,

    26 November 2007 at 15:16

    I have a disability (cerebral palsy), and I have come face-to-face with the ugly truth that not all people with disabilities under 65 can be covered by Medicaid. I have tried to buy my own insurance policy, but a broker that did a lot of research for me out of the goodness of his heart said that no company would cover me because CP (and depression) are pre-existing conditions. I would basically have to quit my job to apply for Medicaid.

    My job is also grant-funded, which means it lasts from year to year and is not guaranteed in any way, shape or form (not that anybody’s job is guaranteed anyway). I’m a “full-time temp”–I work 40 hours per week with no benefits. I make too much money to qualify for Medicaid, anyway.

    I guess if I get sick, I’m on my own, so that’s why I’m praying and gambling that I stay healthy. Heaven knows I can’t afford huge medical bills right now.

  3. Grace said,

    25 November 2007 at 5:48

    Mine was definitely beyond the “hope it clears up” stage. My whole foot and ankle got red, hot, and very swollen. I sure learned my lesson about making sure to clean and bandage cuts, though.

  4. qw88nb88 said,

    25 November 2007 at 4:13

    I too have an infected place on my foot, and despite some three weeks of daily cleaning with hydrogen peroxide and trying to us an antibiotic cream, it’s not getting any better. So yesterday I called and made an appointment with my GP — but I can’t get in to see anyone until Tuesday, four days later! Well, maybe I’ll get lucky and it’ll decide to heal up now … or maybe he’ll decide that something cheap like old-fashioned amoxilcillan will be effective.

  5. Grace said,

    25 November 2007 at 4:02

    I am self-employed, so no insurance for me. I recently had a cut on my foot that got infected and between two doctor visits, anti-biotics, X-rays, and shots, it ended up being about $500 total (which all had to go on the credit card, as we are barely scraping by and certainly didn’t have an extra $500 laying around). That was going to a local walk-in clinic for the medical group I used to belong to years ago when I had insurance. The emergency room probably would have been double that if not more. There is a very good free clinic in my area, but it’s not for emergencies, so when I called in, the soonest appointment I could get was for about two weeks later…not something I was willing to risk with an infected foot! The doctor’s office gave me a discount when I said I had no insurance…I think 80% off the visit and a free X-ray, and it STILL was $500. Ridiculous. :(

  6. 24 November 2007 at 21:04

    COBRA has now gone up to at least $750 per month for a couple … except that was a few years ago for my partner and me, so I suspect it has probably gone up still more since then.

  7. bullet said,

    24 November 2007 at 17:44

    I know the NHS in the UK gets a lot of grumbling, but I’m extremely grateful for it.


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