In my family, we have experienced the spectrum of health care, from uninsured, to underinsured, to full-on socialized healthcare.
Considering the trial-balloon Sebelius sent up for President Obama today, saying they would throw a public option under the bus just to get some rethugs on board, I felt it was important to be part MinistryofTruth's call to put out our stories. Jerome a Paris also has a great diary on his family's experience in France.
My husband and I are self-employed and pay for our own healthcare through Blue Cross. It is killing us, and they just raised our premiums by another $150 per month. We used to be uninsured, partially because we couldn't afford it, and partially because we were 25 and thought that we were healthy and didn't need it. Well, 2 minor surgeries later, we were swimming in debt, had gotten $15,000 worth of credit cards just so we could max them out (otherwise, we would've had to have declared bankruptcy)
These days, we struggle to pay for our own healthcare, because we are scared to death to be without it. If two minor surgeries when we were 25 and otherwise healthy could nearly bankrupt us, what could happen now that we've hit 40?
Even so, we constantly are denied the medications and tests prescribed by our doctors. Here is just one example of the pettiness of our insurance company's bureaucrats: My husband has severe acid reflux that causes irritation and then tumors to grow on his vocal chords. He has already had one surgery to remove tumors, and if his reflux is not totally controlled, his voice starts going scratchy within a week. This is more than a case of heartburn from too much pizza-- If my husband wants to retain his ability to speak, he needs to keep tumors from growing on his vocal chords. So, when a stronger medication was released, my husband's doctor prescribed it, knowing that it would work much better for him. Guess who decided that it was too expensive? Yup, one of the pencil-pushers at Blue Cross, who probably got a commission off denying my husband the medicine that will help him keep his voice. At $200 per month, it is too expensive for us to afford, so we have to make due with over-the counter prilosec, at double the recommended dose (which will not be so great for his liver, but Blue Cross apparently doesn't care about that)
Now, speaking of livers, on to my mom and dad. Five years ago, just at the moment my dad retired from working 30 years for the State of Indiana, thereby losing his insurance, my mom very suddenly found herself in the ICU, with most of her internal organs shutting down, and no one knowing why. They had bought some kind of interim insurance, since they were not quite eligible for Medicare (two years shy). Since they had been generally healthy up to the point that my mother landed in the ICU, they hadn't really paid that much attention to what insurance was covering them while they waited to get onto Medicare. Sadly, it was like most other profit-driven insurance: bound and determined to NOT cover my parent's health needs.
After several days of liver, kidneys, pancreas and spleen shutting down (blood was actually flowing backwards through my mom's spleen) the doctors determined that my mom's problem was that her liver was totally dead, and her other organs were struggling to deal with it. My mom could barely take 3 sips of a beer or wine all her life, and now we knew why: her liver had been slowly dying all the time, with her own immune system destroying it from within. Funny thing was, for the last 10 years, her doctors had been saying, "Hmmm, your liver count seems off". It had been written off each time though, and no one put the pieces together until my mom was delirious and near dead in the ICU.
Amazingly, miraculously, she was put on the list for a liver transplant, and before 24 hours was out, a perfect match was found from a woman who had died in a motorcycle crash (and please, make sure your families know that you wish to be an organ donor when you go! It is the greatest gift you can ever give!)
All seemed fine until my mother started picking up her prescriptions for the immune-system depressants that keep her body from rejecting the new liver (all transplant patients must take this kind of medication). Of course, it is outrageously expensive, approximately $2500 each month, but without it, she would die very quickly. The crappy interim insurance they purchase DENIED paying for the medication. HUH?!?! Yes, they denied it and my parents made "too much" money as retired people to be eligible for Medicaid for the next year or two while they waited to get on Medicare.
Take a guess what they were counseled to do by the people in the Medicaid office? After 45 years of marriage, they were told to divorce, so that my mom would be poor enough to qualify. Not kidding.
My mom's transplant doctors were incensed, and took it upon themselves to petition the insurance company. They told them that the medication was not optional, that the medication was considered part of the surgery itself, and that before my mother (or any transplant patient) was allowed to have the transplant, she had had to sign legal paperwork saying that she would take the medication without fail and that she would not live a lifestyle that could hurt the new organ (like drinking too much, which she would never do anyway!). Finally the insurance company backed off and paid for the medication, and now that my mom is on Medicare, she is doing fantasically. She loves Medicare.
Now, for my sister, who lives in Japan (her husband is Japanese) and has 3 kids. Japan has nationalized healthcare, and with 2 of her kids being extremely active 7 and 9 year old boys, she has had her share of doctor's visit and broken bones. Her 7 year old also has strabilism (a crossed eye) which has meant regular visits and surgeries to correct it (just last month, his eyes finally are equal in strength, so maybe by next year, he'll be just fine!) She doesn't have to pay a penny. She makes the appointment, goes in, shows her card, done. Even when the oldest broke his arm, she simply called for the ambulance (like many city dwellers there, they don't have a car and use public transportation, so calling the ambulance is expected), showed the card, got it fixed, done.
My husband and I had personal experience with Japan's system when we went to visit my sister a few years ago. My husband had hurt his thumb before we left, and had been prescribed a steroid for swelling, without realizing that he apparently is highly sensitive to steroids. Anyway, on the airplane, his heart started racing and he began to sweat and shake and feel nauseous. With a family history of heart disease, he worried he was having a heart attack, which only made the symptoms worse. By the time we arrived in Tokyo 10 hours later, he was even worse, and we went to my sister's place so she could help us navigate the hospital system (mostly for language barrier issues, since she is fluent).
My husband first went to the local clinic's emergency room ( a 5 minute walk from my sister's apartment), where he was seen within 30 minutes by the heart specialist on staff. He was prescribed one medication and told to return if it didn't work within 2 hours. It didn't work, and when he returned, he was seen within 5 minutes and given a referral to a different specialist at the next train stop. We walked into a room full of patients, but were called in ahead of them all. The specialist was a kindly older lady who patted his hand and told him he would be ok. She then prescribed a combination of 5 mild medications to combat each of the problems he was having, and told him to quit taking the steroid. We walked downstairs to the pharmacy, and then across the street to get some food. By the time we finished eating, my husband felt 90% better and by the time we got back to my sister's apartment, he was fine. The specialist made him come back 3 days later so she could double check that he was ok, which he was, thanks to her.
Total cost for foreigners not on the Japanese nation health care system? 2 emergency room visits, 2 specialist visits, and 6 medications: $95. $95, and every person along the way apologized for having to charge us at all.
What a difference. If it had been here, we would have gotten to the pharmacy and been told that the insurance company was refusing to cover it, and we should just take some aspirin and lie down.
Sorry my story was so long, but I thought it was important to show how we have experienced health care in so many different ways.
I am also counting down the hours until I can call the white house and ask what the heck they think they are doing by saying they'll drop the public option!