Thursday, September 03, 2009

Our family's health care story

Wow, two posts, two days in a row! Can you stand it? Although this one's gonna get political, so if you're looking for yarn, you can leave now. :)

I've been meaning to blog about this for awhile. Health insurance was something I went for decades without ever thinking about. I got a good job right out of college and had great coverage for like $35 a month. After I got married and we had kids, I worked off and on but still had good coverage, either through my own employer or Bill's. Both of the kids were basically born for free. It was great. I've been treated for post-partum depression (still on regular medication) for years, basically for free. Fortunately, depression doesn't seem to be a pre-existing condition (or at least one insurers can deny coverage for) here in Oregon.

After Owen was born four years ago, I made the decision to start my own business (this little pattern company called Gardiner Yarn Works). Last year, we finally became profitable, to the tune of about $4000 for the year. This year we'll do a bit better, but we're not going to be eating caviar at the Christmas party. The business at this point is self-sustaining but not providing any kind of contribution to our household expenses.

Two years ago, Bill made the decision to take a new job with a company he'd previously worked for. It was a sales position, commission-only, but he was an employee and so we had the normal employer-provided benefits, like health insurance. A few months after he'd changed jobs, his employer suddenly informed all the sales consultants that their positions were being converted from employee to independent contractor. Guess what - no more health insurance. Suddenly, Bill was self-employed along with me, and since we're both extremely small operations, we're stuck finding individual insurance.

The kids and I had no trouble finding a decent plan. We had a couple to choose from, in fact, and the three of us are covered for around $350 a month (we do have high deductibles, which we discovered when we took Owen to the ER with a severe case of croup and got a $1100 bill for it). We don't have dental or vision coverage, but so far, we're fine with our coverage.

Bill, on the other hand, had seen a doctor a few times a couple of years ago (right before his employer-based insurance got yanked) for a knee problem. The doctor couldn't really diagnose anything and told him he'd just have to live with it. However, due to the fact that he'd been seen for this condition, he's uninsurable. Nobody will sell him private insurance. Fortunately, in Oregon, we have a state plan for people who can't get insurance anywhere else. Without this plan, he'd be out of luck. And it's expensive - he pays over $600 a month just for himself, making our family's insurance bill around $1000 a month.

We're lucky that we can handle $1000 for our insurance payments, although it's not terribly easy. We've given up our cable TV and shop the 2nd-hand stores. We grow a lot of our own vegetables and don't eat out very often. The kids don't have lots of expensive activities, like piano lessons or private ballet/gymnastics/soccer - it's Parks & Rec or nothing for them. Still, we have it pretty good, I know. For now.

One of the things that's so terrifying about the current health insurance system is that we could lose our coverage at any time. It's also very frustrating that so many decisions in life have to be made in order to keep your health insurance. My mom would like to retire next year, but she needs to figure out how to bridge the gap from her current age (62) to Medicare (65). She could go on my stepdad's insurance, but he's a contract academic and with public university budgets what they are right now, he has to worry every year about not getting renewed (and if he doesn't, there goes that health insurance option). I can't imagine how people wanting to start a small business manage if they're not in perfect health. Are we really all supposed to throw in the towel and go work for someone else, just because we need health care coverage? Aren't small businesses the backbone of the American economy?

So much of the debate about health care reform makes me livid. People who have good insurance through their employers don't want it messed with, and that I can understand. However, don't they realize that these days, employment is not a guarantee? What happens when you get laid off, despite your glowing performance reviews? Or your company goes bankrupt because the CFO has been embezzling funds? Or they decide to outsource your job to India, or Mexico? Absolutely nothing is guaranteed these days. Just because you have a good job and good insurance doesn't mean you will tomorrow.

Additionally, insurance just keeps getting more and more expensive. What happens when your current employer-sponsored plan gets chucked for something cheaper, because your employer just can't afford to pay 50% of your premiums anymore? Employer-sponsored health care has been around for so long, people take it for granted, but don't get too comfortable. The current system is unsustainable.

The thing that really makes me see red is the folks that somehow think that insurance reform is "socialist" (using socialist as a dirty word) or is requiring them to pay for people who are unwilling to buck up and support themselves. Guess what - low-income people already have coverage. It's called Medicaid. It's not perfect by any means, but if you're on welfare, you've probably got some health coverage. The people who really get worked over are the people who are working low to middle-income jobs with employers who are too small to afford employer-sponsored health care. Or those of us who are self-employed and have no choice but to get expensive, risky (as in, there's no guarantee you won't get kicked off at any moment, for any reason) individual plans.

Our family is definitely not looking for a handout, or any kind of support from other people. We work our butts off, but just happen to work for ourselves. I would much rather have our $1000 a month go into a tax pool with the rest of the country's taxpayers to make sure that we, and our parents, and our kids, and our neighbors' kids, all have the health care we/they need. I don't understand where all this selfishness comes from. Why is it so terrible to pool our resources to make sure that everybody gets a piece of the pie? Why is socialism such a dirty word? Quite frankly, I enjoy the socialist aspects of our society like my daughter's public elementary school, our local library, our interstate highway system (which we just enjoyed quite thoroughly), the myriad public city parks we stopped at to let the kids run off some energy, and our local police and fire departments. It would've been a bummer to have to go through a tollbooth every 5-10 miles all the way across the west because our interstate highway system had been privatized. Since we got rid of our cable TV and Netflix, our library's DVD section has seriously come in handy. And how much would it suck to have to pre-pay before the fire department would come to your house?

If you support health care reform, and particularly a public option (which would ideally work something like the insurance that Bill gets through the state of Oregon, enabling people who can't get coverage anywhere else to join a pool instead of trying to go it alone), please write your congresspeople and talk to everyone you know about it. The opponents are loud and well-armed with misinformation and lots and lots of money. If you're afraid that a public option will lead to the downfall of American civilization, do some research into Ronald Reagan's opinions of Medicare. And the things that were said about Social Security when it was first being proposed. Talk to some small business owners about their insurance situations.

It's sometimes hard to see the other side of an issue like this when you don't know anyone who lives it, which is why I wanted to share our family's story. I hope it was a least a little educational, and not too snippy! It's really hard for me to talk about this and stay rational since it hits so close to home here. I'm off to do some letter writing...


Blogger Corrina said...

Well spoken!

6:43 PM  
Blogger Sharon said...

I applaud you for putting your point of view into a personal context. It may help folks who are opposed to a public option understand why it is so badly needed.

7:01 PM  
Blogger FugueStateKnits said...

I am so with you! We have six kids and have been through unemployment and poverty - and this was before our state had that Chips thing going on. It's really hard to see your husband not go to a doctor when he's sick, but it's even worse to play russian roulette with your kid's health, lemme tell ya!
What really ticks me off is the morons who are fighting this reform don't get that they are ALREADY PAYING FOR IT - except that they are doing so in a far less organized fashion that is dictated by the insurance industry who cares Jack Sh*t about anyone getting healthy. (Sorry, the fumes are showing as they come out of my ears!)
Thank you for sharing your story - it could happen to anyone. Most people WORK. The lucky ones have health insurance, but that is NOT an indicator of some sort of moral superiority!
Take care,

7:30 PM  
Blogger Scarlet said...

If Bill's employer provides a work space and dictates how he performs his job, I don't think they're legally allowed to consider him a contractor? Especially if they were all employees before, it seems like there would need to be a substantial change in how they interact with people who perform work for them.,,id=99921,00.html

I lost my benefits through my employer about 1.5 years ago because my hours were reduced. Then my kiddo and I were covered under my husband's employer-provided insurance ... but that got eliminated in June. After some lost paperwork got straightened out, we finally got coverage through Regence Blue Shield, but I was freaked out for my uninsured month. If anything happened, I could have applied retroactively for COBRA, but I was still sweating it the whole time.

9:14 PM  
Blogger knittinmom said...

It's actually a really good thing that Bill's now a contractor instead of an employee. And it does make sense for his position (plus he gets paid a lot more, and he works out of a home office). The only bad thing was the health insurance stuff, which we didn't expect to have such trouble with.

I was trying to head off the Monday-morning quarterbacking comments like "well, he shouldn't have switched jobs, then, if you knew you'd lose your insurance", which seem to be all the rage amongst the anti-reform folk. Never mind that his old job was soul-crushing and sucky and he loves his new one.

Thank goodness we live in Oregon where the state government has had the foresight to put in a group plan for the uninsurable!

9:21 PM  
Anonymous akabini said...

Beautifully said, C.

I just had a chat with my hairdresser this evening about this... she's had hip replacement surgery, and is therefore "uninsurable," according to one of our state insurers.

Here's an entrepreneur, who had hip replacement as a way to deal with a congenital arthritic hip - bicycles to work most days during the clement season, vegetarian much of the time, could armwrestle a sailor under the table (all that hair wrangling), and she's "uninsurable," trying to get insurance for less than $500/mo?

Give me a break.

9:27 PM  
Anonymous Anonymous said...

Its like Obama said
"I mean, if you think about it, UPS and FedEx are doing just fine, right? No, they are. It's the post office that's always having problems."

What happens when the post office has problems?
It downsizes and makes cutbacks on services.

Essentially a government run health care system would involve a lot of triage.
This is useful for medics in war and other awful situations... but it really shouldn't occur to everyday people.
The government shouldn't say who lives and dies. And it will if Obama gets his way.

The current system stinks too. But if the Gov. can't run the Postal service...

10:02 PM  
Blogger lamazeteacher said...

What you said about the fact that we are already paying for those people who don't make enough money or are unemployed, is so true. It IS called Medicaid (in Massachusetts it's called MassHealth). Here it is mandatory that everyone have health insurance and if one can't afford it, the state will subsidize you. I work in a doctor's office and there isn't one patient with MassHealth who complains that the state is picking up the bill. In some cases, they get better health insurance than the private insurers offer.

10:34 PM  
Blogger knittinmom said...

Well, anonymous, out of curiosity - do you send personal letters via UPS or FedEx? In nearly every case, the USPS is a huge bargain compared to the private couriers. It's always having trouble for the same reason every gov't agency is having trouble - people are always complaining about taxes.

OTOH, I use the PO all the time (I can ship a box of books across the country via Media Mail for $12, half the cost of FedEx Ground and it takes about the same amount of time). I can't remember the last time we didn't get our mail on a regularly scheduled day, and I can count on one hand the number of packages I've mailed out (and I mail a LOT of packages) that haven't arrived at their destination. The PO argument just isn't going to fly with me.

7:39 AM  
Blogger knittinmom said...

PS - I'd rather have a gov't bureaucrat whose salary doesn't depend on denying the most number of claims decide on my coverage than someone who's going to get a big bonus for saving an insurance company lots of money.

The insurance companies already decide who lives or dies, and they're beholden to shareholders, not voters...

7:41 AM  
Blogger Cindy said...

Amen! I became an independent contractor in 2003 after abruptly being laid off (shortly after I received a letter of commendation and added stock options from the company president). There are no guarantees in jobs these days.

I'm a person who has been "above the curve" on height/weight charts my entire life. I've never been in the right range on any BMI chart and probably never will be. So despite the fact that I've had very few health problems, no chronic conditions, and no weight-related health issues EVER, private insurance companies refuse to issue me a policy.

Fortunately, I found the NASE and got onto one of their group policies, so at least I have something. But it's a $5,000 deductible (which, as a self-employed person, is a fortune) for which I pay $350 a month -- a premium amount that rises at least once a year.

If, God forbid, I develop a health problem, I will be relegated quickly to the bottom of the priority heap. A routine colonoscopy (preventative check when you're over 50) cost me $1,000 out of pocket before they'd even let me in the doors of the hospital for the procedure.

I simply don't go to the doctor except for annual mammograms (the only thing my insurance DOES pay for). I'm glad I have some coverage, but the older I get, the more I worry about not getting more thorough checkups and missing something important that could be fixed if caught early.

Something has to change, soon. I don't have the perfect answer -- I don't think anyone does -- but doing nothing is not an option.

7:54 AM  
Blogger thursday said...

Wow - I don't think we could swing $1000 on month. Currently, I don't work - I stay at home with my son - I'm not sure if going to work would help, though, because I'd have to make enough to pay for child care (which is unlikely). Of course, I did just pay an absurd amount of money to hospitalize my cat. Obviously my pets need insurance now, too.

At my last job (pre-baby), I had fairly good insurance. We had a problem, though, in that very few psychiatrists were accepting it. I needed to get my husband in, but we couldn't find anyone to take him within six months! Sucks when you have insurance, but you can't even use it.

10:10 AM  
Blogger Lavendersheep said...

I think the big worry, at least for me, is that government insurance will remain an option and not become a requirement. Right now we have wonderful insurance and I would hate to see that go away. I am all for insurance that is well managed and available for those that have no other options. I just want to make sure government insurance doesn't become the only option.

10:32 AM  
Blogger Karen said...

I agree 100% with you!! It seems to me it's the people who don't need to worry about insurance who are so against the reform. But do they understand that insurance could become a very real worry for them at the drop of a hat?

I've been a Type 1 diabetic for almost 30 years. That said, I am extremely healthy with no sign of complications. My biggest fear is what we would do if Pete got laid off and we lost our insurance. I could not afford to pay for my many medications and medical devices out of pocket- and without them I would die. I'm not laying it on thick or being dramatic - it's a simple fact - without insulin, I die. I worry of being turned down for insurance due to my pre-existing condition. You know what, it's not my fault. My body's immune system "got confused" and saw my pancreas as a foreign virus, and destroyed it. I didn't decided to get diabetes. Why do I have to be penalized for it???

I'm not complaining about my high co-pays for my insulin pump, insulin, sets and reservoirs, sensors, test strips and maintenance medications. I have diabetes, I have to deal with it and with the co-pays that come along with it. But the thought of being without insurance - yes, I would complain about that. I believe we desperately need a government insurance reform to allow everyone who needs insurance to have it.

12:40 PM  
Blogger Yarnhog said...

Amen, Sister!

My husband got laid off from corporate America two years ago, and we've both been self-employed since. We pay nearly $1000 a month for insurance for ourselves and our two kids. Going without is not an option, thanks to my medical history. It's a struggle to remain insured, though, and we're both lawyers! I don't know what people in lower-paying professions do. If universal health care is Socialist, then call me a Socialist and paint me red, but give me some decent, affordable insurance coverage, damn it!

12:54 PM  
Blogger *Michelle* said...

Thank you for having the courage & patience write this. I get so frustrated with the short-sighted & self-interested views of (seemingly) most Americans, that I just don't want to discuss it. My dh works for the dod, so we have decent insurance, but the profit-driven "insurance" system that is allowed to continue in this country is beyond criminal. Only in America would the all mighty dollar be defended over the health of her citizens. The politicians who are waffling on this issue should be hanging their heads in utter shame (as they cash their campaign checks!).

9:13 AM  
Anonymous Lisa said...

Not snippy at all. The state of the country is so divided and heated right now that I am worried for our country. I am also angry at the President. He needs to stand up and fight for you (and me & everyone else).

1:49 PM  
Anonymous Anonymous said...

I will wholeheartedly agree that there needs to be insurance reform in this country big time. I just have one word for the gov't healthcare plan: England.

9:04 AM  
Anonymous Anonymous said...

Be careful, what you think you may want..Socialism, you are not free, you are told, when you will be allowed to see a Doctor, when you will be eligible for surgery, you could die first..
Don't ever sail Democracy down the is free. What is being ask is that you take your health very seriously..TAKE CARE OF YOUR LIFE...then you don't need to see a Dr. that often.. many illness can be taken care of with home remedies or over the counter drugs. The Internet furnishes many remedies..Your Grandmother made and so can you...

1:44 PM  
Anonymous Susan Voegtly said...

Thanks for your well considered and very well written article. I agree completely with you. Thank you for being brave and putting yourself out there in expressing this strangely volatile issue. How can so many seem to not understand at all?? Bless you!

7:04 PM  
Blogger Mel said...

We have a similar story, and the medical bills to prove just how easily depending on employer medical coverage can provide a false sense of security. I would love it if everyone could be cared for, regardless of their financial situation, and I would love it if Obama and our Senators were given a chance to prove they can do it.

To naysayers who think more people would go uncared for by the government rather than private insurers: you're dead wrong. Try living it.

12:46 PM  
Blogger Dolores said...

I agree wholeheartedly!!! Bravo!!!

12:41 PM  
Anonymous Anonymous said...

Couldn't agree with you more.
Everyone should be able to see a Dr. when they are ill, and it should be a given that all children get proper medical care. I think using names like "socialism" is just a way to cast the issue in a bad light and undermine what people deserve as a minimal standard of living.

7:30 PM  
Anonymous Anonymous said...

Hear, hear.
I am sorry to hear about your PPD. I am very familiar with the condition, sorry to say... But bad days are always followed by good ones. Always.

8:22 PM  
Anonymous Anonymous said...

Is it possible to get to get catastrophic insurance and bank the bulk of what you have been paying in order to pay for "normal" medical bils? Also, I applaud your stand, since you are willing to do it on a blog attached to your business and are willing to piss off some potential customers over a political debate.
I was without insurance for my family of 7 for five years and thank God we didn't have anything major happen. But, I don't want government meddling in yet another area of my life.

4:41 PM  
Blogger Donura said...

Thank you for being so honest about the state of healthcare. I went without it for 10 years after I quit my job to stay home and raise 4 girls. I was the only one in the house uninsured but it was not cool. I just happened on your blog through Ravelry because I was looking at your sock patterns for next month's Sock Knitters Anonymous. Love how this internet works!!

10:55 AM  

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