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.