Modern Healthcare in America: A personal story.

This is going to be a personal blog post. It's about me, my experiences, and my issues. I'm not spouting off about politics, I'm not using hyperbolic examples of what I may think people go through, this is all true. Many people have it much worse than me. I really don't consider myself 'poor' but at the same time it doesn't mean things are easy. It doesn't mean I don't struggle. It doesn't mean I don't desperately hope for some kind of change.

As I've announced, I'm happily pregnant with my 2nd child. The last time I got pregnant was in 2006. Back then I'd only just married my husband, and we both worked low end jobs at Sears. He had a blue collar position as an auto-mechanic, doing back-breaking dirty labor under cars in a barely climate controlled garage. I worked on my feet all day behind the counter, selling customers tires and auto services. I loved my job, but it paid dick. Not only was I paid less than 7$ an hour, but since our dept had no room for 'full time' employees, I was there, 38 hours a week, with no benefits. We finally decided for my health that I'd quit before the baby was born, that way I could be home with her. We just had to survive on less than $36K annually, before expenses. The good news was, we made it work.

Back then with our meager earning and bills, we qualified for State Medicaid (now Medicare), for mothers and children. This left my husband without insurance, while he did the hardest work of all, but my prenatal care, my ultrasounds, even our babies expensive treatment for jaundice, was all covered by our insurance. We got the bills, and we sent them to Medicare, and we didn't pay a dime. It was the least stressful visit to the hospital I've ever had. I saw some of the bills, of course, they didn't want to wait to be paid by the state so they often tried to scare us into paying out of pocket. Thousands of dollars for a special hospital lamp to help a newborn deal with jaundice, thousands more for infant bloodwork. The numbers were shocking.

Fast forward, now it's 6 years later, through careful saving and family assistance we now have a house of our own. We have a mortgage and home owners insurance and property taxes too. These are the commitments of owning a home. We also have one less person living with us, one less person bringing in any contribution to the bills. The good news is my husband has a better job. He sits at a desk for a salary, works tireless (and mostly uncompensated thanks to his salary) overtime, and he commutes a lot farther to get there.
We make about 12K more than we used to. With the new baby on the way, that money has to stretch to cover another person. We also exceed the cap for state healthcare. We barely qualified for 'low income child' coverage, which allows us to keep our daughter on a separate health insurance plan. This is the good news.

The bad news is this, after six years of being able to get by with minimal medical influence, with a baby on the way, now we have to spend a lot on prenatal care. For the first time, I'm seeing the bills, and the bills are real.

Remember I said we make $12K more than when we were young and broke? It's an important number. Now for two adults we pay five thousand dollars annually in insurance premiums. That's just what we pay for the privilege of having insurance, whether we use it or not. We also have an office copay, a specialist co pay, a hospital copay, an Urgent Care copay, and an ER copay. It seems anywhere we might go, we're paying just to get in the door, before we even get treatment.
Having actually had to see an OB and have my first pregnancy checkup, the insurance has generously promised not to charge me a co-pay -every- time I see my OB, but they make up for it in labwork. Any labwork that totals less than $250 a visit becomes my bill.

The insurance promises that the hundreds of dollars I'm currently paying is MUCH LESS than than what I would pay if I was uninsured, but I'm not exactly sure why that's supposed to be reassuring. Since the Insurance is profiting off of me and my premiums  they negotiate with the Doctors/Labs to gouge me slightly less on pricing? Less than if I were... say... a professional writer with NO insurance trying desperately to pay for things out of pocket? It strikes me as a disturbingly incestuous relationship if that's the case, punishing people for the crime of being unable to buy insurance.

But back to the numbers... My Ob's lab wants $250 (out of pocket) an ultrasound, he also recommends getting at least 3, possibly 4, given my health history. (*ca ching*) I also have a thyroid issue, that requires blood work at least once every 3 months, for around $50 out of pocket. So for labwork ALONE I'm paying  $1150 out of pocket. But that means I meet my deductible! I should be home free!

No, reading further, the insurance specifies that after meeting my deductible the insurance will INCREASE the percentage of bills they pay for... After I meet the 250$ for labwork and pay my copays. So all that means is until I pay another $4000 out of pocket, I will continue to pay a large chunk of any further labs, bloodwork, testing, office visits, and even after all that is met... I still pay my copays, I still pay my premiums.

To summarize the numbers, I make approximately $10K "too much" per year to qualify for state assistance, yet in the course of a year, I will pay $5K dollars in premiums, more than likely I will pay at least $5K dollars in out of pocket medical expenses, and that's not even touching all the non-medical expenses that come with having a new child. Diapers, bed, bottles, blankets, and finding some kind of insurance for the baby.
This is all assuming no one actually gets sick this year. This is assuming there are no injuries to me or my husband, no complications with the pregnancy. For two perfectly healthy people to bring a perfectly healthy infant into the world, I'll be spending as much as I would no buy a brand new low end car.

Oh, and did I mention that we are lucky to have this insurance? It's provided through my husbands employer. If we needed to pay for a plan as individuals, we'd probably be paying twice as much for a much higher deductible! This generous insurance plan also offers a family plan. I could add my children to the plan for the low low cost of.... doubling my premiums. So instead of 5K annually, we'd be shelling out ten thousand dollars, just to say we have insurance.

Over 6 years of working, hard qualifying for promotions, and living as frugally as possible to avoid debt and keep the bills paid, one year of medical bills can pretty much wipe all that progress away.

I am lucky. I know most of you reading this probably pay much more. Maybe you pay twice as much and still can't see the doctor you want to see because the HMO won't let you. Maybe your copays are okay, but the one medication that actually works is denied by your coverage. Or maybe they just want you to pay hundreds more for medication that you need.
I am lucky because we have some savings, we have a tax return coming, we have family and friends who can donate all the non medical needs, like baby swings and cribs and toys and clothes. I'm lucky because probably, after all these damn bills are done, I will still have the means to feed my children.

It just kills me that it has to be this way in the first place. I know people who make hundreds of thousands more per year... And subsequently wind up paying tens of thousands more for insurance plans and pills. At the same time I have a friend who's father died, at home and in pain, because his small business didn't allow him to have insurance, and even after a devastating accident, he simply couldn't afford a hospital stay.

The system is broken. Every pill should ultimately cost the same, whether its handed to you inside a hospital by a nurse, over the counter at Walmart, or purchased in bulk over Amazon. Every prescription costs the same to manufacture, why does the cost vary so much to the consumer? Every blood test is the same. Every Ultrasound machine uses the same amount of voltage and costs a flat fee to purchase, even if an ultrasound tech is more experienced, it's shouldn't cost that much more per hospital per visit just to wave a wand around and correctly read the picture.

Yet we're all unable to combat the system. The friends I know who are so much richer, what do they say, "Oh it's always been like this." Why? It feels like madness, a rigged system. People are ruthlessly profiting off the sick and the dying and everyone who just needs a prescription. I rage at the insurance companies, but I can't even be sure they're the problem.

I just wish I knew how to fix it.

I'm posting my story, because I feel trapped. Mostly because I know for all I'm struggling, there are thousands of people telling the same story. Worse stories. People who are suffering and at their wits end because they have to choose to live with untreated pain and illness, or be unable to pay their bills. I've been there.  I'm also telling this story for all the people who are delightfully above this problem, people who are happily insured and happily making money and haven't ever had to weigh the cost of of a prescription against the cost of groceries. If you are that lucky, I envy you. I also hope this might be a story that makes you realize real people, who may not seem 'poor', have to fight each month just to pay for healthcare we need.

If you don't believe me when I say the system is broken, I'm not the only one writing about it. Time magazine has this to say: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/
It's long, and detailed, but worth a look.