Thursday, December 3, 2009

Unemployment Diary: America, The Joke's On Us

I know this is a political entry, and not about Stella, but what's a blog for if not to spout somewhat informed opinions to the general masses that neither asked for nor desired them?

Which is why I am writing tonight, well that and insomnia.

I am in this state of mind, because I am thinking about our health care system once again, and the fact that as a newly unemployed father I have to do whatever it takes to keep my daughter and wife covered medically. That this is at best expensive, and at worst very expensive and inconvenient makes me not only sad, but angry. I feel we Americans have been sold a bill of goods in this department, and have let the rest of the civilized world blow right by us. As we fret about the ludicrous idea that a public option would somehow lead to a complete government-controlled health care monster that will pull the plug on grannie (even if she's not connected to anything!) the rest of the first world enjoys affordable, easy and efficient health care. Truly the joke's on us.

I could repeat some arguments and facts that are easily obtainable online, but that wouldn't make any sense. PBS' "Frontline" has already done it for me, with its program "Sick Around The World." Here's a link, I recommend you watch it. (The premise of the program is that correspondent TR Reid travels to five other capitalistic democracies to see how their health care systems work. Compared to ours they are all models of efficiency, humanity and excellence. They are also far cheaper than our own system, with administrative costs that are typically fractions of our own. Our so-called "capitalistic" system is revealed to be what it really is: an agreement, or cartel, among the large health care providers to not drive prices down. Hey guys, listen up: our three major health care providers really are just one big company, in effect if not in name. That's why everything here sucks so bad: it's a monopoly. The so-called "government" controlled systems actually introduce competition. Most tellingly no other government wants to even be remotely like us in this department, whereas we were once the envy of the world.)

I guess this topics been on my mind a lot lately because as we all know the majorly scary part about being laid off isn't the lack of money, unemployment mitigates that a little. It's the fear of lack of health care. My company-sponsored plan just ran out, one month after I was laid off. I wouldn't be surprised if the cost of my plan was WHY I was laid off, either.

Two weeks after getting laid off I was given the chance to enroll in COBRA, our national private plan for those who just lost their jobs. In one of the great and terrible ironies of modern life COBRA costs at least $1,100 a month for a family of three, with the main breadwinner, me, having just lost his job. This is expensive. But as we all know, if you think paying for health coverage is pricey, try not paying for it. Another irony: only in America could we have a health care system named for a poisonous snake.

Randi, unfortunately, can't get enough hours at her school to get us on her plan, which we would love. Teachers in NYC are actually totally badass, and fought, and won, a great health care plan that functions the way it should. Low premiums, a wide network of providers. You go to the doctor, you pay your $25 or whatever it is, and that's about it, you're covered.

But the fact is she can't get the additional work shifts at her school to get us on the plan. Why not? I have a theory. My theory is that times are so bad that teachers are putting off getting pregnant (which has been traditionally the major source of open teaching spots) because they are afraid their job won't be there when they would come back. I can't prove this, but things are much, much tighter at the school than they were two years ago when we decided Randi should stay home for the first year to raise our then unnamed baby. I wouldn't be surprised to hear that people are waiting for things to turn around before trying to get knocked up now.

So, I received my COBRA enrollment form from a firm called "Benefits Concepts" I believe. In the package there was at least a modest reason to cheer; of all the stimulus money being spent at least some of it was going to help mitigate COBRA payments. In fact if you qualified, which I did, your payments would be 35% of what they normally would be without this stimulus money. Criticize Obama all you want, but I think this is the one undeniably right thing I've seen from our government all year. Health care costs should not financially cripple those who can afford it least. This is just common sense. Because, guess what America, if we do get horribly sick over here in BBD Manor and we don't have health care/insurance you guys will still end up paying for us, except it will cost more. But we will go through the formality of being bankrupted first.

Cutting to the chase, I filled out my forms, and said that yes, in fact hell yes, I wanted to participate in this program. I mailed in my forms two weeks ago, hopeful and excited to take part in this program. My care still wouldn't be cheap. In fact our family's costs would still be $380 a month, but it would be much cheaper.

Well, I found out that my coverage hadn't started when I went to the pharmacy yesterday and they refused my insurance. Then I called Benefits Concepts to find out that they lost my paperwork and I wasn't eligible for the reduced rate. I went, to put it gently, batshit.

"I am pissed," I hissed to the pleasant-enough woman on the phone. "I sent this in and YOU GUYS lost it, either by accident or on purpose. I need this health care, I have a 19 month old daughter!"

I was so goddamned mad, and my choices were not appetizing. To be sure that my coverage didn't lapse I could pay the full price, and then hope they send me some kind of reimbursement when, or if, they find my paper work. Yea, right!

Or I could wait for them to mail a new form to me, because for some god-forsaken reason they could neither email it to me or fax it! Because, as you all know, we still live in the 19th century. They might even send it via carrier pigeon I suppose.

I told them to get me a supervisor, like now, like five minutes ago. They said they will. Now I had to face a scary thought. Until this gets straightened out, however long it takes, we ARE NOT COVERED AT ALL.

You do not want to be NOT COVERED AT ALL, in America, the land of the free the home of the heartless. Where I guess we're all supposed to hold charity car washes and bake sales to make up for the shortfall in coverage for our citizens in this once-great nation. No, should lightening strike, figuratively or literally and someone in this house get very hurt or sick until this clears up we are screwed, we are people in the next Michael Moore movie, we will have fallen through the cracks. How quickly I felt the difference now that my ass was on the line, and my daughter's ass and my wife's. This is what America has become. A place where you better pray you don't get fired, because you literally live and die at the mercy of your health care provider. It's not nice, but it's a fact.

No supervisor called, a shocker. Randi and I discussed what to do. She was calm, cool and magnificent. She said we will work it out, and that if I wanted I could put her on the phone with "them" and she would get all southern on them. Trust me, she's not kidding. When rising to the defense of her brood Randi is the fiercest creature in nature, worse than a mama polar bear, honey badger or wolverine. I thought about this, but wanted to do my best first. And I can be pretty fierce myself.

In addition to letting me know she would be happy to put the fear of god into them, Randi also reassured me that health-wise we will be fine for the next few days until this is cleared up. I said okay, okay, you're right. Let's just take this one step at a time.

I called back and spoke to a second person at Benefits Concepts, Joel. He told me that yes, they could fax me the form, and they would, but they had to be sure that they hadn't lost our paperwork first. As for the supervisor, who still hadn't called, he said they will get back to me within 24 hours. Because this is how they express urgency.

He was a nice enough guy, and seemed to listen to my issues, even if he couldn't do much about it. So I said, okay, look, and then call me.

Then we waited. About two hours later, when I was playing with Stella right before dinner the first person I spoke to called back. She told me they'd found the paperwork, and I could in fact GET the reduced government-sponsored rate after all. I asked where the paperwork had been. She said she didn't know, it just kind of turned up. She then said I could even pay for our coverage now, over the phone, to ensure it didn't lapse, as long as I had a checking or savings account.

I did, and we did the business over the phone, much to my relief. Let me tell you, I was never so happy to spend $380 as I was right then.

But can I also say ... how stupid, utterly ridiculous and inhumane all this is? Why should I have to beg for the "bargain" price of $380 a month at all? Why can't we simply live in a nation where we understand that even as our right-wing brothers continue to blather on about the right to life that providing health care insurance for all actually does more to guarantee that right than ANYTHING? Why do we continue to bow to the anti-government zealots, who are either in the thrall of big business or simply professing an ideal that has passed its sell-by date?

Okay, MAYBE you could make the claim in 1994 that a government sponsored plan, as proposed by the Clintons, would be relatively inefficient and pricey versus private industry. Maybe. But back then a visit to your doctor probably would cost you $70 out of pocket if you didn't have insurance. Today it is multiples of that. Hell, I've had tests that have cost multiples of that.

The truth is our health care system as it currently slouches is making America LESS competitive with the rest of the world. If you were a smart, qualified, coveted white-collar professional from, say, Britain why oh why would you come here? If you lose your job once you get here you are screwed big boy, whereas if you stay in safe, sane England you and your family remain covered for pennies on our dollar? Even greed can't trump family, most of the time at least.

I've spoken to a lot of people in our financial services industry about this, because that's what I did for a living before getting laid off. NO ONE likes our current system. It's bad for doctors, bad for patients and bad for our nation. You know who likes it? Health care providers and the various middle men that make money off the fat margins this cartel generates. That's it, them. And they have controlled the entire debate, and they're still trying to control it. And yet somehow they get nice, middle-Americans to worry about chimerical scenarios and "death panels." You know what a death panel really is? It's the insurance company board that decides your new disease is a "pre-existing condition" and then cuts you off. It's Tom DeLay and his cronies kowtowing to big pharma in 2005, guaranteeing the government's right to NOT negotiate prices with these firms. As a result they've pocketed $500 billion in profits, and counting since then. Seriously, how can you believe in a capitalistic system and ensure that the government, which has more leverage to negotiate than ANYONE, not be allowed to bargain to drive down prices?

Again, I say our current health care system has to be reformed, it is hurting America too much. The best and brightest are not going to want to come here any more when they see that other nations offer them far more protection should something bad happen, like, say the world's economies melting down. Their own desire for material gain is not going to trump the fear of their kid getting a terrible disease. It's just not. (And it's not just people from other first world nations that are leaving. I spoke with one financial services pro who said an acquaintance of her's moved back to not Western but EASTERN Europe after being laid off from his white collar job. Why? For better health care. Meaning that not only is the US system not the envy of the world, it's not even the envy of the former Eastern bloc!)

We've rested on our laurels for a long, long time in this nation. We've been brainwashed since we were children to believe that America is the best nation in the world, with the best of everything. When it comes to health care this is true. We do have the best health care system in the world. The third world. Because that's basically how our system functions, it is the world's largest and most expensive third world style plan, where the wealthy are totally covered with the best of everything, and everyone else had better scramble and pray they don't lose their jobs.

I'm sorry, but the jokes on us. As we've patted ourselves on the backs the health care firms have built a cartel system that has become extremely hard to break up. And they were aided and abetted every step of the way by right wing zealots who care more for their rhetoric and partisan victories than their fellow man. Oh, and the cash from big pharma that keeps the wheels moving. They care about that too.


rachel leah said...

I think they "lost" your paperwork on purpose, as a matter of course and then made you fight for the cheaper rate for that reason as well. A lot of people would have given up and that is what they were hoping you would do. Am I a ctnic? I think I am a realist. I have fought with these bastards too many times. I have never mjade a dental claim in my life that has not been incorrectly denied first. And we are talking regular cleanings, nothing fancy.

When G was born, Seth filed all the paperwork to add him to our plan and faxed it and it was "lost." We were told that they had no record of receiving it (though we called constantly to follow up and they told us that they had received it and it was fine) so because we did not make the 30 day window, G could not be covered under Seth's plan. We had a newborn with no health insurance. However, because they were being "sensitive," they would take it out of Seth's check post-tax. I came up with a better solution that involved a sworn and notarized statement made by Seth about sending the paperwork on time and them sucking it up because they were being asshats or else face the fact that they just found out the person who they were trying to fuck over had a lawyer as a spouse. So, they added G.

Kellygirlnyc said...

Well put, Dave. This is a great entry. I have/had a GP who would make me COME IN TO the office every time I had a test result to receive. I would visit for negative urine samples, just fine blood samples, etc...EVERY TIME I went in they would try to weigh me (denied) and take my blood pressure and listen to my lungs. EVEN if I just was coming in for test results, EVEN if it was the second time in 2 weeks. I found out that this was so they could bill my insurance for an office visit. They would receive more money and since I had insurance, no big, right?

Well, a couple of months after the last visit I had with them I got two letters saying I owed them
money. I called them, they said I owed them. I called our insurance and they said, we paid them that money. I finally put the two parties on the phone with each other and they worked it out between the two of them.

You are right. In this country you have to totally jump through hoops even when you HAVE coverage because the people working in the industry, doctors, insurance billers, insurance representatives don't want to make it easy for you to submit claims even when you have the insurance to pay for them.

After talking with the Dr.'s office, the insurance lady clicked back over to her call with me and told me it was resolved and that I wouldn't be receiving any more letters from the Dr.'s office. She also told me that it was good that I called because most people would just send in a payment thinking that it wasn't covered and you can bet the office wouldn't have sent the check back. I told her I felt that office abused the insurance and she made a note of it, and I'll certainly not go back to that office.

It makes me worried for all the phone calls I'll have to make when we have kids.

I guess my point is every single part of the system is indeed broken, like you said, and we're all paying for it in every way possible. I hope it can get improved soon, or we'll seriously consider heading to Australia. Whew!

Anonymous said...

Hi David!
This is Julia, Jakob's mom.
Thank you for this entry, it's very well to the point written.
This is really unbelievable sad. I am very sorry that you had to go through this.
You're so right, this so not humane health care system is making America less competitive, just because it lacks this human right.
We know many expats living in the US, mostly from Europe, and they all want to return to their home countries, just for this reason. What a brain drain for the US.
I for myself really really enjoy living in the US, life is so much easier for the most parts. BUT not for health care and retirement. So, my decision (and also my husband's decision) is clear: we want to return back home.
I really hope that America (or Obama or the politicians) find a healthy solution for their people.
Maybe it's cynical, but I hope sometimes that more Americans get angry about their health care system: only because, if more people get angry, there is a bigger need for change.
I could tell you stories from Germany, where friends of mine or family members had chronic illnesses and they didn't have to pay a single dime (except their premiums and their co-pays of course). God damn, having cancer is already enough of a burden...So, tell me one good reason, why a person battling with cancer should have to fear loosing its health care insurance.
Just the term "health care insurance" is driving me crazy. You don't need this insurance, when you are healthy. You need it when you are ill. In German, we call it insurances for the sick people. Maybe we have to introduce this term to the American vocabulary, so that people get the sense, what this is all about...
Let's hope that Stella and Jakob, when they are grown ups , won't have to go through these struggles anymore.

David Serchuk said...

These comments are truly astonishing. I will address the last one first.

Julia, this is horrible and sad news. That you and Tomas are likely leaving the US simply because of health care, or the lack thereof, points to everything going horribly wrong in this nation. You guys are honest, hard working, talented, skilled and raising a family here. You are what America needs to get stronger. Even just 20 years ago it's almost certain you would have stayed. I am so sad to hear about this.

You and Letham are the flipside of Julia and her husband Tomas. An American couple (more or less, although Letham is of course from Australia) giving serious thought to leaving here due, again, to health care. God, this is terrible, and I am so sorry to hear about all the work you had to do just to get reasonable care. And, you're right, the needless medical testing is insane. But thank god you fought for your rights.

Umm, can you be my lawyer? :-)

Anonymous said...

There's a movement to radically change California government, by getting rid of career politicians and chopping their salaries in half. A group known as Citizens for California Reform wants to make the California legislature a part time time job, just like it was until 1966.