Un-insurance

There was an open cash register (for once) at the local PetSmart, and I hurried over with my purchases–three giant bottles of cat litter crystals. Chinni, my outspoken Siamese, had expressed his deep disapproval of the state of the litter box (I promise you, you don’t want to be on the receiving end of that caterwaul), and I remembered I’d forgotten to change the litter…last Wednesday (it’s Sunday).

Ooops. That’s how I wound up listening to an uninsured checkout clerk on a Sunday afternoon.

I set down a litter bottle and she started talking, out of the blue. “That was my boyfriend on the phone,” she said, (Honestly, I don’t invite these confidences, they just seem to happen) “and he’s got some prescription painkillers I can have for free. Well, that’s ONE down, anyway.”

“See, I don’t have health insurance, and my doctor wants me to go to the hospital for more tests. Every time he does that I have to pay $200 for each prescription, that was $1,000 last time, and each X-ray is another $200 or $300. So I’m calling all my friends to see if they have leftover medicine I can use instead.”

Isn’t that dangerous?

“Oh, no,” she assured me, “I leave messages for my doctor every time I get some pills, so he knows what I’m taking. If I wasn’t supposed to take that kind of pill, he’d call and tell me.”

But…doesn’t PetSmart offer health insurance to its employees?

“Sure,” she said, “But I haven’t been working here 90 days yet, and they won’t insure me until then.”

Well…couldn’t you wait until then to have the tests?

“The doctor says no. Believe me, if I could I would. I’ve been in the hospital three times this summer, with bronchitis and pneumonia and asthma and this stomach thing they still don’t know what it is, and let me tell you, I already owe those guys so much money I don’t know how I’ll pay it back.”

“Oregon Health Plan, they tell you they’ll cover you, but they won’t. Every claim I’ve submitted they say isn’t covered, it’s my responsibility. Well, I take that back, I appealed the biggest hospital bill–$10,000. I wrote them a letter and then I had to write another one when they said no but finally they paid it. But the other bills they won’t pay, and it’s like $9,000 for everything and now the doctor says I need at least five different tests and all this medicine and some of it my friends don’t have.”

I resisted the strong temptation to plow through my medicine cabinet looking for stray medications to give her. But I swear, there’s no better line of demarcation between the haves and have-nots in this country than the state of their health insurance.

When I left Intel, the first thing I did (after doing the shellshock carbohydrate thing for 3 days) was fill out the COBRA form for health insurance, set up automatic payments, and get it going. When Intel screwed up my coverage, I went into high gear, trounced on everyone I could find until they fixed the mistake and I was once again covered.

I have COBRA for 17 more months, am casting around for alternatives and really wondering what health insurance as a self-employed person is going to be like. Intel’s insurance–which pays for all but $15 for medications and doctor visits and covers dental and vision care as well–is very good; I’ve been warned that I won’t find anywhere near that kind of coverage as a business owner, not if I don’t want to pay $1,000/month and accept a much higher deductible.

It’s crazy. My friend Jim took a much lower-paying job, far beneath his usual level, because it offered health insurance he and his partner badly needed. He’s not that unusual, either; several of my friends have left lucrative consulting practices and gone back to being employees because the health and retirement benefits were enough to make up for all the disadvantages of being a corporate drone.

Who knows? I may wind up getting back into harness that same way when COBRA runs out, if I can’t find a better alternative. But at least I had the option, and was lucky enough to be able to pay for it.

My sister’s family of five lost their coverage temporarily when her husband changed jobs. Like PetSmart, his new employer had a 90-day clause. COBRA would have picked up the gap, but at a price so expensive that they opted to “go bare.” Everyone held their breaths that three young children wouldn’t have a medical crisis before the new coverage started.

And even if you are a fully insured employee, it’s not something you can always count on. My friend, an Intel employee and US citizen who’s worked in the UK long enough to also be a citizen there, came back to the States on temporary assignment.She became very ill, but finding affordable, willing care for her was amazingly difficult. Her out-of-country coverage was minimal at best.

My own doctor refused to see her although she’s got signs all over her office saying she’s looking for new patients. When my friend finally did receive care (and a bunch of prescriptions), it proved very expensive. Intel insurance only provided for a $200 allowance for medication…and she used that up with the first prescription. She was out hundreds of dollars by the time she went back to the UK–where all her medical care was free.

At least she could pay for it. My friend at PetSmart doesn’t have that luxury. She is fortunate enough to know she’ll have healthcare insurance in the near future…which makes her one of the really lucky ones.

I grew up in a medical family where our mantra was “socialized medicine is substandard medicine,” but I don’t buy that anymore. I think the healthcare and insurance industries in the US have had every chance to make healthcare affordable for everyone, and they’ve consistently blown it.

Dammit.We have got to fix this.

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