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Friday, August 21, 2009

Health Care Stories, Austin, Texas


This month Tome of the Unknown Writer is featuring a Health Care Stories Project "focusing on health care stories and opinions from the US and countries with universal health care all this month." Here is my story, fresh in my mind, as my young daughter required emergency surgery a few weeks ago.

The physician's assistant (PA) at the urgent care center diagnosed her with a kidney stone. She ordered a CT scan for later that afternoon, explaining that 90% of all stones are small enough to pass but a scan would alert us if the stone was too large to pass.

As the morning passed into the afternoon and the time of the scan approached, my daughter's pain moved from her back to the lower front of her abdomen and seemed more tolerable. We deduced she was passing the stone.

But let me back up so I can explain our health insurance situation. Husband and I are both self-employed. I'm a psychologist. He's a home builder. Husband is covered under a separate policy from the kids and me. Why? Because no individual underwriter will cover his chronic disease, AKA his pre-existing condition (diagnosed at 18 years old). He has special coverage under the Texas "high risk pool" (subsidized by the state). As a result, we pay two high premiums for two separate plans. We have high deductables ($4500 and $2500) and high copays ($45) so that we can keep our premiums to $1000/month. That makes for a combined total of $12,000 per year, math majors. And with copays that high, we see the doctor almost never only if we think it's absolutely necessary.

Given the high deductable, we knew the cost of the urgent care and the CT scan would be coming straight out of our pockets. Because we believed she was passing the stone, her dad and I considered skipping the CT scan because of the cost. I called the PA and ran it by her. She urged us to go, this time saying she wanted to rule out a few other conditions. We decided to play it safe and take her. But we still wondered if we weren't "wasting" a huge chunk of money.

The CT scan revealed that the source of her pain was not a kidney stone but, rather, a large cyst. At 4:45pm we were told to get her to a hospital emergency room (ER) immediately, that the cyst required removal.

Since then, my husband and I keep thinking, "What if we hadn't gotten that scan?" All because we can't afford a low deductable.

One last note on affordability. We're grateful we're able to maintain our current coverage. The recession has hit our family pretty hard. My biggest fear is that a harder hit will force us to join the nearly 50 million uninsured Americans. I don't even want to think about where we'd be, where my daughter would be, if we weren't able to flash that BCBS card at the medical centers.

But for now we're scraping by and paying our insurance premiums. To say I feel uneasy is a gross understatement. I think its unfair that small business owners have to pay so much more compared to someone working for a large corporation. Supposedly this country is all about supporting small businesses. Not where health insurance is concerned.

So I strongly support health care reform with a public option. Have been holding my breath for it, in fact, since we dropped husband's long held individual policy in hopes of the Clintons promised reform in the early 1990's. But the strong insurance lobby pushed back. And now here we are, more than fifteen years later, trying again.

To all of those congresspersons against reform legislation? Here's a challenge: Surrender your federally funded health insurance and join we hard working Americans who pay out the nose for our supposedly "best health care system in the world." I bet know if you were out here in our world you would pass something quick.

21 comments:

Sinda said...

Yep.

Mary Alice said...

Amen sister

blognut said...

I wholeheartedly agree.

Cheri @ Blog This Mom! said...

*like*

Jenn @ Juggling Life said...

Sing it from the rafters.

Lisa Wheeler Milton said...

Exactly said the woman with a chronic condition, afraid to think what losing coverage would mean for her.

Lee said...

right on!

Sara said...

love this post. I agree. watched a special on pbs last night about a few folks with grave illnesses and no coverage. it was shocking and heart wrenching. there were deaths. and much sadness. it was awful. i'm sorry that it's so expensive for you to be insured but happy that you're still able to make it work.

Magpie said...

Damn. I so fail to understand why anyone wouldn't want the public option, why anyone wouldn't want EVERYONE covered. Just don't get it.

Glad your kid is okay.

JCK said...

I am SO on board with you on this. We have self-employed separate coverage as well.

I've had one of those cysts. Ovarian? They are scary. Hope she recovered quickly.

katydidnot said...

isn't it amazing how none of us has to think that hard to come up with these examples.

Jason, as himself said...

Ugh. This subject keeps coming up in real life and in blogs I read and it just frustrates me so much.

I'm so thankful for my employer-paid health insurance, even if it is just a mediocre HMO.

I would hate to see you have to join those 50 million. Very scary. Good luck.

Kathleen Scott said...

I was fortunate to have good insurance coverage when I was treated for breast cancer. I couldn't have afforded treatment otherwise. And without coverage, treatment might not have been available. It's unconscionable for people to languish for lack of care.

I agree that people should not have to be homeless and die for lack of care.

I don't know how to reconcile the idea that we all have the responsibility to live healthy--exercising, eating right, maintaining weight, not smoking, etc. But it need to be in there somewhere.

Reinvent Dad said...

Broken system. I believe everyone should have access to affordable healthcare, but at the same time everyone needs to take responsibility for their own health and contribute monetarily.

Becca said...

I grew up in canada and I just don;t get what scares people about "socialized" medicine. it works. yes, you pay higher taxes, but you get good care, free for it.

imom said...

Preachin' to the choir!

g said...

Thank goodness you had the scan.

I will go read the link.

My story - hope to be brief - I have great health insurance, being a public employee.

At 9 months my son choked on a twig at day-care. The caregiver saved his life and called 911. In the next weeks after that, we noticed he had a cough. It was winter, and colds were going around. The cough continued, and our caregiver kept bugging us about it - so I took him to the Dr. We took him several times over the next month or so - always told it was "going around" etc. He stopped growing, and at one point frightened me because he appeared too weak to crawl - finally the doctor performed a test that was painful to a baby (which is why she delayed until absolutely no other alternative)

turns out he had aspirated part of the twig, and at least 1/2 of one lung was blocked completely. They rushed him into surgery, and thankfully, he is now a strapping 21 year old.

But I think about it. I took him to the Dr. about 5 times before it was diagnosed, I was actually kind of a pest, because each time they really didn't treat him. And my Dr. finally referred him to the test because she knew his history.

What if I had been reluctant to go to the Dr. because of paying the fees? You have to understand - we rationalize things when it comes to money. It's winter, the baby has a cough. Do you go to the doctor or wait for it to "clear up?" two weeks later, another cold - pay for a visit, or wait for it to "clear up"? Pay an office visit to a doctor that doesn't know what you've already been through? Or, God forbid, take him to an acute care clinic and get a random doctor? Your baby just has a cold, it'll clear up.

If we hadn't had health insurance, I don't know what would have happened to our son. He would probably not have died, but he would have been a sickly child, with respiratory problems all his life.

I always think what it would be like to be a mother in my situation, and have to make that decision - is it just a cold? How much will it cost? Is it money well-spent?

And in families like yours, who have insurance, the same decision would be agony. Me - I was lucky. I had gold-plated insurance, and there was no question about making an appointment.

We really need to solve this problem.

Maggie May said...

Damn this story made me really upset. For everyone who doesn't order the test. I'm so glad your daughter is OK.

Jocelyn said...

Your family's story is so powerful. I'm serious here: send a copy of this to all sorts of legislators. It makes the important points.

Agent X said...

I completely agree with you. To throw in my own two cents, I work for a very large company and still have a $2300 deductible to pay before my insurance covers anything beyond preventative visits. I only pay $45/mo. for my son and I and am lucky on the pre-existing condition thing though. Still even for the large corporation employed the cost has risen exponentially.

brigit said...

Here in Australia we complain about our health care system too. It hasn't kept up with population growth, when it comes to things like elective surgery, but for those needing medical attention, it is always available.

For the uninsured, like me and my daughter it still provides care fairly efficiently. When my daughter was twelve she had an illness that wasn't diagnosed for 8 months. In that time we went from one specialist to another, most of it covered by our public system. I guess we do still live in 'the lucky country.'

So glad your daughter is OK.