Something's Gotta Give

One of the things we missed while living overseas was watching the Sunday morning public affairs talk shows.  In the DC area we get about four hours of roundtable discussions and interviews based on the previous week's beltway shenanigans.  I'm a politics junkie, which is an especially fun thing to be when you loathe the current administration to the core of your being. 

This week I'm particularly incensed by the shrub's veto of the SCHIP bill while uttering the words, "Poor Children First."  It's not uncommon for the prez to display twisted, faulty logic, but when you're funding a pointless war in Iraq and at the same time denying 5 million poor kids healthcare coverage, the subterfuge seems much worse than usual. 

George "Clinton Traitor" Stephanopolis did a good job this morning sussing out the facts of the bill while pitting Health & Human Services Secretary Mike Leavitt against New Jersey Governor Jon Corzine.  It seems that NJ gets a waiver to offer SCHIP to children living more than 200% above the poverty line (the federal limit for the program) because cost-of-living is so high in NJ.  Leavitt came off as a total lackey muttering endlessly about private healthcare and all the millions of well-paid Americans who are going to leave their private insurance scheme to mooch off the government. 

I know that those of you who read my blog probably have a nice package with your employer.  You tell me, would you leave that plan for a government funded and managed system?  I can barely type the words through my hysterical laughter.  Like you can get time off to go sit in some bureaucrat's office to even fill out the paperwork. 

Health insurance coverage is top-of-mind this week as B and I navigate the gator-infested waters of the US healthcare system.   I'm very lucky in that I used to have comprehensive coverage at work at a reasonable price to me.  But millions and millions of people who earn an honest living in this country don't have that luxury including me and B at the moment.

If you ever wondered how one could be, well frankly, mid-to-upper middle class and be completely screwed, here's how it happens.

1.  Group healthcare plans are so vastly different from individual healthcare plans as to be completely incomparable.  Aspects of coverage that you assume are available across the board are, in most cases, completely unavailable to individuals seeking coverage.  

As a result, we will have very large gaps in our insurance coverage, particularly if we end up starting a family in the next year.  We were able to find one plan that would cover maternity costs, which we decided we wanted "just in case."  We're not actually planning any activity in this area in the next year or so, but it seems prudent to take a cautious approach.

Here's the rub: even though we'd start paying an additional $167 per month for the coverage right away, they won't actually cover us for 12 months.  If stuff happened before 12 months, the entire 9-month she-bang plus whatever birthing procedure happens would be covered by our own cash savings.  Out of curiosity, I did some research.  The labor costs alone for a very normal, natural birth with no epidural would cost about $5k.  The epidural costs an additional $5k.  Then it just balloons from there if there are any complications whatsoever.  You could quickly run up hospital bills to the tune of $50k or more. I didn't even count all those pre-natal doctor visits and well-baby visits that also wouldn't be covered.  Would a baby be a pre-existing condition?

2.  Individuals cannot avoid deductibles.  B had a pretty crappy healthcare plan at the World Bank, but I have been lucky enough to have really excellent ones that didn't require one to pay anything after the co-pay.  Individuals, on the other hand, have no choice.  Some plans won't charge you deductibles for regular office visits, but you're in for a world of pain if you have to visit the hospital or need andy kind of procedure.  We could be liable for up to $5k in medical costs annually.

We're looking at paying more than $400 per month in premiums.  That's nearly $5k already.   That's potentially $10k per year for healthcare.  The most I ever paid as an employee of a company was $1450.  We could probably swing the $5k if we had to, but it's easy to see how a family of four would be boot-strapped even if both parents earn good incomes.  Note that this deductible would increase with each family member.  In our case it's $2500 per person.  That's be a $10k deductible for a family of four.

3.  For individuals, a pre-existing condition is not covered for 12 months regardless of whether another provider was covering it before.  In 1996, congress passed the Health Insurance Portability and Accountability Act (aka HIPAA).  Most of us know this by the waivers we're always signing at the doctor's office.  Aside from making you waive your privacy  rights so they can compel your insurance company to pay your bill, the HIPAA does a couple of really good things for people in group healthcare plans:  a)  prevents insurance companies from denying you coverage for pre-existing conditions if you switch jobs or your employer changes providers and  b)  it outlines the guidelines for COBRA insurance in case you lose your job.  This is great because when you rely on health insurance through your employer, you have no choice in your provider or a choice in whether a change is made.

HIPAA does not cover individuals seeking insurance.  At all.  Which means all the shady tactics used by insurance companies pre-HIPAA are still used against individuals like me and B.  Thankfully we're very healthy and don't really have any pre-existing conditions, except B was mysteriously sick enough last year to be in the hospital for a week.  They never knew what caused his illness, and we have to disclose this when we apply for insurance.  The company could overlook this information as a strange infection that probably won't reoccur.  They could agree to insure us, but at a higher premium to cover their perceived risk.  Or, they could outright refuse to cover him at all.  We'll know this week. 

Obviously, additional costs on top of the $400+ we're already going to pay will be most unwelcome, if not a show stopper.  When my dad initially retired from the Army a few years ago, he and my mom sought out individual insurance to cover them until he found a new job.  Because my mom had had a heart attack, they were offered a monthly premium that they literally couldn't afford.  Both of my parents are college grads and earned a good income prior to retiring.  My dad could fall back on VA benefits if necessary, but my mom went uninsured (with a heart condition) until my dad found a job with a group healthcare package.  

If B is denied coverage completely, we'll be teetering on the edge of financial ruin until his company hires additional US staff.  If he doesn't get sick, no problem.  If he does, we're toast. 

This is bullshit.   We earn well above the poverty limit, but like most people we're in a position to be barely to able afford to pay for our own, inadequate, healthcare.  I haven't had a chance to see "Sicko" yet, so forgive me if this is the theme of the entire movie.  If it is, I'm here to tell you that I'm living in this quagmire. 

I see this as a full-circle testimony against the whole of Republican ideals about the traditional family and the free market.  We're encouraged to get married and have children.  Indeed, this is put up as the ultimate goal of every American.  Yet, they actively (and without shame) rail against any program or system that would ensure that every American child has a chance to grow up to be a healthy and productive member of our society.  Yup, it's better to bankrupt a family than give them a helping hand.

They think the "free market" will compel private insurance companies to behave appropriately.  But when profits are the entire motivation of a business, there's no chance that's going to happen.  The industry isn't completely unregulated, but it remains under-regulated.   You shouldn't have to get screwed if you're a small business manager (B) or a self-employed entrepreneur (me). 

The sad part of this story is that we're more than willing to buy private insurance.  I'm not sad that I can't draw on Medicaid (even though I've paid into that system *cough*).  What riles me is how completely shitty my options are, and how much I'm going to pay for essentially nothing. 

And to be completely childish about it, all I feel empowered to do is heartily wave my middle finger at the White House when I drive by.  Fuck You, Mr. President.