The more you need health insurance, the more you see how ableist it is.
Once upon a time, I was a carefree boy. I lived my life, and did stupid shit, as carefree boys are liable to do. I grew up in Canada, with a socialized health care system. I never saw or heard about an Explanation of Benefits (EOB). Similarly, I never needed to calculate what my care would cost to me. Even when I had my heart attack, the system worked. I did not become destitute, nor was I oppressed by it. The delays in care I experience there were not any worse than the delays in care I experienced in the USA.
One year after my heart attack, I moved to the USA, to live with the woman who was going to become my wife, and is now my ex-wife. For most of my time in the USA, I did not need to use my health insurance all that much. My ex-wife and I were receiving EOBs, but they were rather sparse, and easily understandable. My high cholesterol was under control. I saw the doctor a bit more than the average guy. My heart attack I did not leave me with a disability, or special needs, other than being on medications for it, or requiring periodic checks. When you get one EOB per month, you can easily relate the charge to the doctor’s visit.
I was blissfully unaware about the utter shittiness of our health care system.
This changed, dramatically.
At 48, I had cancer. I had my oncologist, the man responsible for guiding me in my treatment. However, each round of chemo required hospitalization. When you’re hospitalized, the doctor who is your oncologist may visit you, but your ongoing care is entrusted to another oncologist who works with your oncologist. Then consider that there are 24 hours in a day, and that this person will at some point end their shift and pass the baton to someone else. Additionally, if you need a specialized procedure done, you need more doctors. I saw a good deal of the ophthalmology department at Johns Hopkins, for instance. I was becoming more dependent on our healthcare system, and on health insurance.
When you are dealing with a condition like cancer, or anything that requires ongoing doctor’s visits, the EOBs multiply. The first sign of how awful our system is was the reams of EOBs that were mailed to us. I would have had to take up a second job in forensic accounting to figure out what each statement meant. Diagnostic codes and abbreviations do not make for easy reading. I vowed never to look at an EOB again, unless I thought I was being asked for money that wasn’t my responsibility. The government and the insurance companies hope that you will scrutinize those EOBs to find fraud. Fuck ‘em! I don’t want to take up a job in forensic accounting, thank you very much.
Then there is Medicare, which is a poisoned gift.
I was put on disability after my stem cell transplant. Thus, I became eligible for Medicare. In theory, it sounds good. Since you are disabled, the government takes care of your medical expenses. So far, so good. See, for a great deal of my time on Medicare, I had a secondary insurance. Eventually, however, my ex-wife and I divorced. The honeymoon period with Medicare would soon end. I’m disabled, and I do not make enough money for private insurance, or enough money to require a reduction in my disability benefits.
Medicare comes with choice.
Although it sounds good in theory, choice is sometimes overrated. Choice, as far as health insurance goes, is definitely a burden. Most people don’t really get to chose dozens of possible health plans. They have one plan, or a small number of options, provided by their employers. When you are on Medicare, and are disabled, the choices multiply by the dozen. You have basic Medicare (Parts A and B), but you also have Medicare Advantage (Part C), and Medigap, and Part D of Medicare, which covers only drugs. When you lose your secondary coverage, you may want to consider buying Medicare Advantage, Medigap, or Part D. You start shopping, and quickly realize that there are dozens of options for each.
Which option is best for you is impossible to tell ahead of time. See, your costs depend on how much you use the healthcare system. Now, the problem is that medical crises are impossible to forecast. I wasn’t warned about my heart attack or my cancer. You can go from having to go to the doctor once every few months to needing hospitalization very quickly. Which plan is the best? Well, you might as well ask a seer, or bring out your crystal ball.
That’s when the estimates that you get from the government system are actually accurate. I’ll give you an example of how they can be quite inaccurate. I’m taking a PCSK9 inhibitor. It costs me $35 per month. That’s $420 a year with insurance. Now, the best Part D insurance plan on the Medicare.gov puts my PCSK9 inhibitor cost at about $1000 dollars per year. Others can easily go into the $3000. I’m not convinced that these costs are realistic. In fact, I now know that once I get on a Medicare drug plan, my PCSK9 inhibitor could cost me nothing at all.
It gets worse. When you shop for a drug plan, you can get a breakdown of how much each drug is going to cost you. However, this breakdown is most likely bullshit. How do I know? I asked Medicare.gov for the total drug costs of a plan. I got $1,527.91. Then I went to the plan’s page, on the insurer’s website. There, I plugged in the same information, and I got a drug cost of $1,333.27. Why the difference? The government’s site wasn’t taking into account some specifics of my situation. You also always have to consider whether the numbers quoted include or exclude your additional premium.
The point here is that with all the stupid choices that are thrown at our face, it is impossible to determine for sure which plan is the best. We shouldn’t have to do this dance… but here we are.
If you are not on Medicare, the picture is not rosier. Remember the reams of EOBs that were tossed at my head. This happens no matter what plan you are on. You moreover still have to fill in the gaps in coverage. Mental health is often on the chopping block. Vision and dental are next. You also have some fine print about what is covered and isn’t. During my cancer, there was a possibility that I’d have to find temporary housing near the hospital. However, I had no coverage for this. If I had been required to travel by plane, however, I would have been covered for some of those expenses.
No matter how you cut it. The US health insurance system, and the health care systems, are made for the rich. If you are rich, it does not matter if you pay more here or more there. When you are poor, it makes all the difference. Since the fractures in the system come to light only when you are sick, these systems are in addition ableist. I have all my marbles, and I have a hard time making heads or tails of it. I dread to think what happens to people who have cognitive issues.
As long as you are young and healthy, you do not see these problems, but sooner or later, we all need health care, and the factures become visible. The more disabled you become, the more these fractures are oppressive. Consequently, the health insurance system and the health care systems in the USA are made for the rich, are ableist, and are predatory.
The more I’m exposed to the American system, the more I hate it.