It’s quite a coincidence that there is a mandate debate going on here again. Special kudos to Eugene for this excellent diary. In March I wrote this diary, talking about a run-in I had with the mandated system here in Massachusetts. Well, I can’t believe it, but it happened again, and this time it’s much, much worse. My situation is not unique, but it is complicated. As a result, I will try to explain everything as simply as possible. I apologize if it's hard-to-follow at times, but it's not something that can really be summed up in three sentences. However, if you're the type that demands a quick summary of things, feel free to jump to the blocked-points I make at the end. That should give you an idea of what we are dealing with here in Massachusetts...
I am a Graduate student at a university in Massachusetts. I have dedicated my life to making my community, my country, and the world a better place, and when it comes to healthcare, I can with no hesitation write that I feel largely ignored by all three. Being involved in community development, I was very excited to move to a state that apparently had set the bar for healthcare policy. But almost immediately upon moving here in the summer of 2007, it became apparent to me that the "healthcare rules" would hurt me financially, not help me.
At my graduate school orientation in August of 2007, they explained to us that the state had mandated health insurance, and that I would be forced to purchase a plan or not be able to enroll in classes. As a student studying community development, this meant that - even though I am a fellow and on a large scholarship - I would need to take out loans to pay for my mandated health insurance and some of my living costs. I was offered two insurance plans, and although one plan was terrible, I had little choice. I simply had to take it. It would have been hard to justify taking loans out (at 6.8% interest) to pay for my insurance and then getting the expensive plan. So there I was, like several other students in my department (and several thousand in the state), stuck with taking out loans for a health insurance plan that did not cover us.
I did everything right. I read the plan front to back, and understood perfectly what it meant. I would pay a little over $1000 and basically get no coverage. Why was I paying for it? Because I was forced to. I had no real choice, and I was told that I did not qualify for Commonwealth Care (the state provided plan), because I was a student and had just recently moved to Massachusetts from Virginia. I saw fellow classmates try to fool the system by dropping the insurance shortly after signing up for classes, or pretending to be unemployed in order to receive the Commonwealth Care. But I thought it best to put faith in the system, and go with the rules. I should have seen it coming; I was being duped from the very beginning.
At first, before I had to go to the doctors, it was no big deal. I'm young and healthy, and even though my plan didn't cover preventive medicine, it didn't scare me. But then small things started to happen that I usually would go to the doctor for, but knew that my plan wouldn't cover it or it would only cover 80%. I did the math and understood exactly what I had gotten myself into. In January I hurt my finger pretty badly. In fact, at an Obama rally, I recall shaking the Governors hand and wanting to scream because of the pain. That time I did go to the doctors, and was referred to the hospital, and so on. Just a finger. No big deal. Well, that cost me several hundred dollars, and after almost a year, it's still not healed. Remember, I'm a student, who has no real income. In fact, the maximum I'm allowed to work at the school is 20 hours per week (hence why I had to take loans out to pay for my health insurance and some living expenses), so trying to pay a few hundred dollars for added health problems is impossible.
A few months later I had to go to the doctor for stomach pains. I knew my plan would cover the costs, or at least 80% of the costs, because it was an illness. My doctor, fearing H Pylori (a bacteria that travelers like me tend to get), had me get a blood test. Well, for some reason, the insurance company refused payment. At first, they told me it was because I didn't submit a claim form (which I had). When I got a bill for $800, I laughed and called my doctors office. Knowing that this charge was far too high for me to pay, they got right on it, and called the insurance company. I received a call back later in the day informing me that the insurance company would pay. Well, they never did, and a few weeks later, I got another bill.
In June, after a strange sequence of events, and an altercation with a bat, I was forced to get treated for possible rabies exposure. I had little choice in this treatment, as the bat may have bitten me, and rabies causes certain death. However rare the disease may be, it was not a risk that the doctor or I was willing to take. The treatment is not cheap. In fact, the first shot (actually 5 shots) cost almost $8,000. At first, the insurance company told me that they would cover nothing because vaccines are considered preventative medicine. Perhaps this is that one unique situation where it's actually life-saving treatment, but even if it is not, I felt that the insurance company's sole role had been to deny payment. They saw me as a vulnerable student, and tried to take advantage of me at every stage.
Fortunately for me, I fought back, and working with the good people at the hospital, I applied for "free care". When I first met with my healthcare financial aid officer, she told me that I would have been far better off not having any insurance plan. Because I already had a plan, I didn't qualify for some of the state plans. So, really the only thing I could do was apply for free care. Long story short, I qualified, and free care was supposed to pay for my rabies shots. Due to incompetence from nearly everyone involved, this has yet to fully happen, and I still have several thousand dollars in bills.
Now, back to the $800 charge for a blood test. When I received another bill for it in June, I called the number on the bill, and was told that I didn't have to pay it because free care had already covered it for me. But here's the big issue. This is not the state or the hospitals bill to pay; it's the insurance company's. Once they saw that I had free care, they stopped paying for everything, and even denied my rabies vaccine on three different occasions. It wasn't until the hospital contacted them, did they even pretend that they were supposed to pay for it. And yes, you read that correctly; the private insurance company (that I was forced to use) essentially tried to, and may have successfully, stolen money from the good taxpayers of this state.
This could go on and on, but I'll spare you the details of my frustration. Basically, if I had to sum up my grievances, this is what they would be:
- Mandated health in this state uniquely hurts students over the age of 25. We are not able to be on our parents insurance plans, and we cannot afford healthcare, but are forced to pay for it. The plan we got was bogus, and didn't cover anything. So we basically were forced to give money to a company that wouldn't give services. And perhaps most frustrating; we will be paying for this through loans for years and years to come. I know and have heard of countless stories of students cheating the system to get by. We shouldn't have to do that. We should all be on Commonwealth Care.
- Once I qualified for free care, my insurance company attempted to not pay for any coverage at all, and as far as I could tell, they essentially tried to put the burden on the state, even though they were contractually obligated to pay for certain things. I'm guessing they thought because someone had paid for it, I wouldn't put up a stink if it was the correct organization. They were wrong.
- We have to invest in our students. In many developed countries college and graduate school is free. That's not the case here. I don't think its ideal, but I accept that. I'm investing everything I have - financially and emotionally - into the future of my country, and my country can not even invest one dime into me. It's embarrassing and it's a sad injustice to say the least. Healthcare for students (and everyone else) should be a priority, and the fact that I had to consider bankruptcy and law suits as a young man, highlights the failures of our state policy. And let me remind you that I am one of the lucky ones. I'm educated, I know the system, I speak the language, I come from a middle class family that could help if I was in serious danger, and my health is in good condition. We've got to make some changes.
Again, I apologize for such a long and relatively complicated story. And in all honesty, it’s actually much wilder than this. In the last few weeks I have received three new bills, totaling over $3,000. The insurance company claimed that they paid out 80% of the bill. The hospital says that they have not. I’m left in the middle, unable to pay any of it, and the state doesn’t even realize what sort of mess is going on.
So what can we do about this?
I know this isn’t popular here in America, but the simple answer is...
...get the hand of the free market off of my body and SOCIALIZE IT.