This is a complicated story, and even some of it sounds fairly dramatic, I’m including those elements not to be dramatic, but to explain the situation fully.
I will start a small amount of history. I had been purchasing insurance through my domestic partner for a couple years, paying a fairly significant sum. When her office changed insurance providers and the price went up, I realized I could do better buying my own directly as a sole proprietor. So I found a plan which costs a little under $5,300/year.
At that point, I was working as a consulting with the state of Vermont, providing training and technical support. It was a lucrative contract that got killed when we had a budget shortfall. Therefore, in May I was informed that my contract was not going to be renewed.
Fortunately, I had seen this coming and was prescient enough to have started saving money. When my contract ended at the end of June, I had enough money in my savings to pay both my health insurance and rent through the end of the year.
This is a very good thing, because my health took a fairly bad turn this Fall and I had to curtail my work search significantly. This story isn’t about the loss of employment, but I include it to provide a full perspective on what’s going on.
Health insurance is something I was willing to pay for, and pay significantly for, for one primary reason: even though I am mostly healthy, I do happen to be diabetic. This means that I am on several medications (one of which is quite expensive) but with my insurance, I rarely have to pay more than $30 for a prescription. This insurance also covers doctor’s visits with a $20 copay for visits to my primary care physician and a $30 copay for all other providers.
But if I, as a small business owner, had to hire anyone else, I never would have been able to cover the cost of it. It’s just ridiculously expensive. Furthermore, the rules of the plan require that I be hiring someone at 30+ hours/week in order to cover them (this includes me, and we’ll get to that part of the story later).
So even if I wanted to cover an employee who only worked 15 hours/week, I would not have been allowed to do so. You heard me right. Under this model, I can buy insurance as a business owner, but I can only cover some of my employees, even if I’m willing to foot the bill myself.
This is all a small part of the story, and just about the economics and the ridiculousness of the nature of those economics.
This fall, three things were going on at once:
- I got very sick;
- I had to apply to get into Vermont’s Catamount Care program because I couldn’t afford to buy insurance any longer;
- I had to find work to support myself while the other two things were going on
I’m going to start with the Catamount story just to emphasize the absurdity of it. I will note that I still work part-time as a teacher, which places my income at the level where I don’t qualify for Vermont Medicaid, which is the state-sponsored medical available to anyone who qualifies in terms of their income, but still at the point where I can’t afford to purchase my own insurance.
Catamount Care is Vermont’s private health care plan system with state support. If you qualify for the plan, you can either pay the full monthly fee or, if you qualify for assistance, you can pay part of it (that’s means-tested based on income).
The Catamount story starts with me trying to figure out (a) whether or not I qualify and (b) whether or not my pre-existing conditions are covered.
I do qualify, but the process of understanding how and why I qualify was maddening. I had to talk to five different people before I got a good answer. One person I talked to clearly didn’t understand the program and was actively rude about it. Another understood the program quite well, but didn’t understand my situation well enough (that was partially my fault, because I didn’t understand some of the specifics).
But what I had to do was figure out how to make sure they had all the information I needed and present things so that it was clear that I qualified.
It turns out the difference between being qualified or not hinged entirely on that factor I referenced earlier of how many hours I worked. When I had a lucrative contract with the state and was working 30+ hours on my own business, I qualified to purchase my own medical insurance through a group plan. When that contract dried up and I no longer had it, I wasn’t qualified to renew my plan.
That was the sole reason I qualified for Catamount. If I had merely been unable to keep up with the payments for the group plan, I would not have qualified. It was because my insurance company was going to drop me that I qualified, which only was the case because I reduced my hours.
Just so we’re clear: if I had continued to do 30 hours of work/week for my own business, even though I wouldn’t have been getting paid for it, I would not have been able to apply for Catamount.
Now: I am a very well educated person. I have a master’s degree. I am not, as they say, a moron. And yet, I had a lot of trouble figuring all this out.
I have trouble imagining that everyone applying for health care in Vermont can follow this bizarre logical process and I strongly suspect that some people who qualify don’t bother applying because they think they don’t. In fact, I can verify that this is the case because it turns out I would have qualified last year. That’s right: if I had understood the program better, I could have gotten into it a year ago, and not had to pay the full cost of my insurance plan this entire year. It would have saved me thousands of dollars to have enrolled in Catamount a year ago, and even though I very much had looked into it, I didn’t apply because I didn’t see in the documentation how I qualified. But, so it goes.
So I applied in early November. I got a call from them fairly soon, asking for more info about my current insurance plan. They needed to know which plan I was on and my group number, etc. so they could verify that the plan was coming to an end, but I was told that once they had that, I’d qualify.
Except that wasn’t the end of it. I didn’t hear anything until two weeks later, but the day before Thanksgiving I got notice that I had to prove myself to be a citizen. Thank you so much, anti-immigration nutcases: it turns out that in order to receive any services that include any federal funding, I have to provide a copy of my passport (I don’t have a passport) or my birth certificate. The note explained that I had four days to do this or my application would be canceled.
So, not having a birth certificate, and having legally changed my name in the meantime, produced a bit of a problem. I called them in a panic, and was able to get an extension, but once again: more stress than I needed an an extra complication. So I finally got in touch with probate court and in touch with the department of vital records from the town I was born in, and found out I could get everything taken care of relatively easily and quickly, but it did cost me about $40 all said and done to get things done fast. So, okay, I now have proof of who I am and I can bring it into one of their offices so they can verify who I am and that I was, in fact, born in this country.
In the meantime, they send me a note saying I qualify for the program which helps employees pay for their own insurance when the employer doesn’t cover it all. This, of course, is not what I applied for. So I called them again and asked what to do, and it turns out because I’m employed part time by the college, I have to get them a copy of a form and get it sent back to the state. This form basically tells the state “we don’t offer insurance to our faculty, so she doesn’t qualify.” I dropped the payroll office an e-mail about it, never heard back and then on a Friday called and got the info for the one person who handles this sort of thing who was gone for the week.
Fortunately, when she did come in on Monday, she was great. I’m qualified and everything, have a decent deductible to pay in the meantime, but after all this… I’m thinking… wow. That was a lot of work to do and it took much longer than necessary.
The employee form that I just referenced, for example: if they’d told me it was a possibility that I’d need to have that done, I could have done it a month ago.
The birth certificate? If they’d just said up front “these are the things we may ask you for in the process of your application…” well, I would have had that all resolved in early November, rather than dealing with them during the weeks that covered preparation for and recovery from surgery.
But I’m also just really lucky that I was able to get this all taken care of, because while I was doing this, I was a mess.
And that is the second part of my story:
The medical issue is fairly straightforward: I got really sick in early September. I mean, sick to the point of barely eating and having significant gastric distress. This included days where I could not keep anything down (and one day where I couldn’t even keep liquids down). Out of the next six weeks, I had maybe seven days where I was fully functional on my own. During a large chunk of this, I could not sleep for more than 45 minutes in a row, and during those six weeks, I never slept for more than 2 hours in a row.
I had five visits during that time to my primary care physician, who was convinced that it was a problem with the intestines. Those visits would have cost me over $700 without insurance. My current bill for them stands at $100. The lab work that was done there would have cost me another grand or so, but there is no fee for those tests at all.
After those weeks of visits, in late October they finally decided they needed to do some actual tests that looked inside my abdomen to see what was going on. They scheduled a scan of my intestine which would have cost over $500 if I hadn’t had insurance, but didn’t cost me a dime.
Turns out the problem wasn’t gastric. It was kidney related.
I got called my my primary physician’s office within a few minutes after the scan was completed and they’d arranged a visit with a urologist who specializes in this sort of thing. Mind you, I was still in fairly constant pain at this point, and had been for weeks, but I trekked over to the urologist’s office across the street from the hospital and he explained the whole situation to me in great detail:
The scan had immediately showed the problem: a kidney stone on my left side which had actually created a complete blockage. This created a large fluid sack around my kidney which had had two dangerous effects: it had (a) ended my left kidney function entirely and (b) served to block my intestines from functioning fully, therefore explaining the gastric problems.
This was serious enough that he wanted to schedule surgery as quickly as possible. The scan was done on a Monday. The surgery was scheduled for Thursday.
This, of course, was terrifying.
My insurance plan covers surgery, but with a large co-pay: up to $1,000 for outpatient surgery and $2,000 for inpatient. So I was basically crossing my fingers hoping that I wouldn’t have to stay overnight and cost myself an extra grand.
This, by the way, wasn’t surgery to remove the stone. This was surgery to insert a stent which would divert the fluid from the one kidney to the other, and serve as a temporary bypass in order to release the pressure on the left kidney and give it time to heal. The stone removal was to come later.
The surgery went extremely well. I didn’t need painkillers, but I did have to pick them up just in case, which placed me as part of the State of Vermont’s tracking system for anyone who gets any schedule C narcotic via prescription, which is just oh so peachy.
The difference was immediate: no further pressure on the kidney, but with some minor unpleasantries that lasted the next week or so but I was able to sleep better and after that first week, I was able to sleep through the night. This brought us to early November.
The total cost of that surgery, I found out, was $4,935.58. My portion of that bill was $929.34.
My insurance had almost paid for itself entirely with that one surgery, and I still had a 2nd one ahead of me.
The 2nd surgery was ten days ago: it also went extremely well, though it was a longer surgery and I had a harder recovery time. I got motion sickness heading home that day, and (I never have motion sickness), but after a day or two of recovery, I was doing okay, still not needing the painkillers.
I haven’t been billed for that surgery yet, and if I am, it won’t be for more than $71.66, which I’m good with.
So I’m good now: the second surgery removed the kidney stone and left me in a lot of short-term pain, but I’m beyond all that now and doing well. In the meantime, the function has started to return to the left kidney, but I won’t know until next month whether it returns to full function or whether it sort of lingers permanently at the half-function level it was at a couple weeks ago.
I’ve got a long recovery ahead of me: I have to get used to exercising again, and I have to get back in the hang of, well, everything. This took a small chunk of my life from me for a time, and put me in the position of having been forced to place my life in the hands of strangers.
Don’t get me wrong: once diagnosed, I was treated with the utmost respect and dignity, but this was a horrible experience. I’m not out of the woods yet; we don’t know how or why the stone developed, or whether or not I’ll develop any more in the future, which means that having health care is a fairly big deal for me in the future as well.
And even with health care, I was misdiagnosed by my primary care physician, and misdiagnosed to the point where things got really bad before they started to get better.
But I’m writing this because we talk about health care and we talk about the need for it, but we don’t spend enough time saying exactly how important this is. This isn’t an extreme case. This is something that happens to lots of people all the time, and some of us have health care and some of us don’t.
I took a look at my records from my insurance. They break everything down by what the provider charged, how much the insurance paid, and how much I’m expected to pay.
I summarized this for the year (this does not include the prescription plan), and found the following:
My health care providers charged $23,820.97 for care I’ve receiver this year.
My insurance company, which places limits on payment charges for certain procedures, paid out $10,052.62 of that.
I’m expected to cover an additional $1,699.34 on my own.
If I hadn’t had insurance, I’d have been royally screwed. Even as things stand, I’m not sure how I can afford the surgery, but I’ll find some way to cover it.
But through this whole process, I was thinking about something that happened to me about 15 years ago, when I didn’t have insurance: I developed an ear infection one winter.
I never treated it. I never went to a hospital. I never went to a doctor. I just hoped it would go away.
After a month, it did.
I got lucky.
Ear infections can do really bad things to you. They can even lead to brain damage.
I was lucky.
Can I imagine someone in kidney distress doing the same thing because they think it’s a virus or an illness that just needs to pass?
Yeah, because that’s what my own doctor thought: take some antibiotics, let the problem heal on its own, and everything should be okay. I had to push to get approved for the abdominal scan. And I have insurance. How much motivation will there be for people to push when they know they can’t afford the cost of it?
I also think about something that happened back in 1992: I had a bicycle accident. I lost my breaks going down a steep hill and had a choice between ramming into some bushes or heading into traffic.
I chose the bushes, not realizing there was a hard metal fence hidden inside them. I rolled over onto a spike on top of the fence and it impaled my neck, leaving a hole the size of a quarter, but I was lucky enough that it missed all the major stuff.
When I went to the emergency room, however, they told me they were going to do surgery right away.
Then they found out I had no insurance.
They they had a little huddle where I couldn’t hear them.
Then they came back and told me that they thought surgery would be unnecessary.
The minute they found out I didn’t have insurance, I fell to the bottom of the queue. I was ignored, left to sit for hours at a time. My hands were all scraped up from the accident and it took seven hours before I could clean them. I kept asking for something to use to clean my hands, and finally the doctor showed up and threw me a washcloth and a bottle of bacitracin and told me that they were for my hands and left.
Having insurance matters. Having insurance can be the difference between being treated like a person and being treated like a burden. Having insurance can be the difference between health and disability, between survival and death.
This is why it’s necessary. This is why it’s relevant.
I just didn’t realize until recently just how necessary and relevant it was.
Now that that’s all done, I think I need to go find a job.