healthcare and the affordable care act

If you have been following the blog for awhile now, you might have picked up that healthcare is an area of great interest for me. (See the Wisdom Teeth Saga of 2012 for a taste.) I don't think I'm alone in this, either. In many cases, new adults like myself have been used to the college healthcare plan that includes: squeezing all our doctors' appointments into Christmas break; mediocre campus health services; or perpetually self-medicating.

And now things are a little different. We make our own doctors' appointments. I, for one, am eternally grateful that I am now covered by my dad's insurance coverage until I'm 26, and I can say even more confidently that I'm not alone in that! A few of my classmates and friends have been faced unexpectedly with bigger medical issues: traffic accidents, surgeries, food poisoning, and even cancer.

I know that, at least in my circles, a cheer went up when Obama won the presidential election in 2008, and again when the Affordable Care Act (ACA) passed. Affordable healthcare options are a weight off our shoulders, once we've seen our monthly student loan payments, the discouraging job market, plus the cost of a data plan/rent/gas/car insurance (which we need to be able to drive our cars to work).

But this is all theoretical, right? October 1 is now infamous for the launch of Healthcare.gov, which more or less collapsed under the apparently colossal demand. Perhaps that demand in itself testifies to the importance of accessible healthcare options. And now, the December 15 enrollment deadline is rapidly approaching. I thought it was high time I address this topic.

Now, I have gone out of my way to learn about this Obamacare business. I have been collecting intel on it for months. In the summer and early fall, there was a lot of talk about healthcare and insurance marketing to millennials. (My take? Stop messing around and be real with us. We've got an eye for real value. Just tell me: what am I getting out of this? It'd better be good!) Then, after October 1, and after the government shutdown fiasco blew over, it was all about the broken website. There has been a disturbing undercurrent of what I can only see as propaganda, trying to convince young people in particular to defy Big Brother and forgo coverage. And now everybody's in a panic, because we don't really know what's going on, but we know it's important and it probably impacts us in a big way.

So I tried to talk to a bunch of people to get a feel for the personal experiences of the ACA an the changes to the healthcare system. I didn't get to talk to any newly married couples, but I will say that most of us who are under the age of 26 are just sticking with our parents' plans until we can't anymore. My lucky 30-ish friends who already have jobs with benefits are set, and their spouses are also OK. Some of them are batting around the idea of fast-tracking their upcoming marriages to get uninsured spouses covered before 2014. I also have friends who have switched jobs in the past year, with benefits being a major motivating factor. There are a few who don't have insurance at all, don't have a way to get it, and simply can't afford the monthly premiums. That is a real thing, and a problem.



I work for a small company, which hired an insurance consultant to discuss our needs and options with each of us individually. This guy told me about the bronze, silver, gold, and platinum level plans, how much each of them costs, my deductible for each and what's covered under every level. He said the factors that influence the cost are my zip code, my birthdate, and whether or not I smoke. So, my coworkers who live in a different state will have different options. I will tell you that the plans ranged in price from $190 to $330 a month.

I balked at this. To be honest, I just don't have that kind of money left over in my monthly budget. That would eat up my emergency fund - the dollars that would cover healthcare expenses up to my deductible amount, for example. Even splitting that cost with my employer, I would be hard-pressed to keep those payments coming for a sustained period of time.

Now, don't get me wrong; I completely buy into this system. I count it as a victory that people with pre-existing conditions, poor people, and single-parent families now have a shot at being insured, and I would chip in for that in a heartbeat - if I could. For now I am heaving a sigh of relief that my dad's plan will still cover me at no extra cost to him or to his employers. (For the record, this is something I'm not clear about: the healthcare advisor said that under a family plan, each additional member costs extra; but most of the people I talked to said it makes no difference for their family how many people are on the plan. There's a premium and a deductible for a family, no matter how many members are covered by the plan. For this reason, most of my peers are staying on our parents' plans as long as we can.)

It's not a perfect solution, by any means. I have heard time and time again that the success of this new system depends on the buy-in of 20-somethings, and this could be a problem. Because we feel invincible (not me, definitely, but that's the stereotype). Because we are in many cases unemployed, or in the Peace Corps. Because we just can't afford it. Because we don't understand it and how it works, and we don't understand how to look for the information we need.

(FYI, in Delaware, there is a service called Choose Health Delaware created to help people navigate the system. I have no testimonials on whether or not it works, but they're marketing it pretty hard.)


It's not a perfect solution, but it is an answer to a very real problem. The healthcare and public health situation in this country is horribly broken, and we're paying for it as a nation - financially, culturally, emotionally. It has very serious side effects on our economy, and more importantly, on our national psyche.

I have been encouraging my peers to participate in the exchanges, if they can. I have been encouraging them to seek out information. I have been asking questions and trying to understand the strengths and weaknesses of this new system. I believe we need this, as a nation, whether it works or not. Our public health system is sorely lacking in comparison to that of other developed nations, in most areas except one: spending. That should be enough to grab our attention.

I strongly believe that this is a step in the right direction. Our healthcare system is a mammoth monster and it will take time and probably many stumbles for us to overcome it and find a system that works. I quote a friend of mine who is working on a master degree in social work:

"This very imperfect system (The ACA) is a step toward really really important universal coverage. Because the UN and lots of people view universal healthcare as a human right, I think the ACA is an important step forward. I think the Obama admin. (despite handling things like the website horribly) is really trying to offset costs for young people but the insurance reality remains that healthy people subsidize sick people and young people are overall healthy."

All this being said, readers, if you're still with me - I urge you not to give up. Do not be discouraged. Keep thinking critically, as we were raised and educated to do, about the problem that faces our country and the bodies that constitute it, the bodies both healthy and ill. Let's be constructive and creative, and while we do what we must do for the time being, take note of what works and what doesn't, and what we need to be better and stronger and healthier as a nation. It's not impossible. We just don't know how to do it yet.

* * * * * * *
Readers, I'm still curious. I know I still have a lot to learn about our healthcare system and the changes that are taking place. What are your thoughts and experiences with all of this? Share them with me in the comments.

And thanks for reading!

posted from Bloggeroid

love in the time of fists and choler

When you look back on your college years, you won't remember doing homework. You'll remember studying abroad, volunteering, playing sports, participating in student organizations, [not remembering at least a few "last nights,"] and spending time with your friends. 

- American proverb

I woke up yesterday morning on a crinkly bedbug-protected mattress on the floor in a guest room of what I know as Karin's Convent. Audrey rolled over on the mattress next to me, and instead of getting up and booking it over to Brooklyn Bagel, we talked for at least an hour about life, love, and the pursuit of happiness.

And then we got up and booked it to Brooklyn Bagel.

Anyway, somewhere in the course of that conversation it occurred to me that I really don't remember doing ANY homework.

Those who know me might legitimately question whether that's because I really didn't do any homework or if all the papers and projects and case studies and readings just melted into the hectic humdrum of the Life of a Lib Artiste.

Judging by the fact that I did in fact manage to pass college, and by the blank look on Audrey's face that mirrored my own awe at the sudden, tangible truth of this cliche, and the fact that my grandparents are still (for some reason) proud of me and also read my blog, I'm going to say it's the latter.

And yes, I will begrudgingly acknowledge that there are some other, more notable experiences throughout my college career that overshadowed the time we spent doing homework. (I almost wrote, "time spent in the library," but to be honest I don't even remember where I used to do my homework, and I remember the library pretty well. Using the logic I gained presumably from doing my homework, I can infer that my time spent in the library was not homework time. Weird...?)

In the process of writing this post I made a list of a few things I do remember from my college years, which I will not share because if I do then none of you will buy my memoirs in the future, and also because you would get pretty bored pretty quick. But my favorite thing on the list so far is watching "The Bachelor" with a living room full of friends at a house called Huggs.

The name of the house was entirely coincidental; but it is not a coincidence that our driving subject of conversation this weekend was love. Specifically, open-handed love. Inviting-the-fickle-and-fateful-whims-of-the-universe love. Agendaless love.

The kind of love my mind doesn't like to wrap itself around.

But, as Audrey so wisely and beautifully put it, "You have such a range of motion when your hands are open. When they're closed, the only thing they can do is punch."

I would like to add that closed hands tend to grab things. Like a baby who gets hold of a chunk of your hair. Infant vice grip = pain.

Closed hands don't really facilitate the most love-inspiring activities.

And as I discovered this sunny Sunday morning, I struggle to understand and accept open-handed love. Which is ironic since as a baby I used to sleep belly-up, hands fallen open at my sides. Now, though, they spend most of their time in various degrees of curled up. But throughout the course of this conversation Audrey gently took my hands (literally and figuratively) and opened them up, smoothed out the crinkles and the clenched knuckles and the terse palm.

And just in time, too.

By evening I was back at home and on my way out the door to see Jason when I noticed some dental insurance letterhead sticking out of the pile of mail on the kitchen counter. I pulled it out, expecting the relief I'd been promised the week before my surgery, but what I saw shook my hands and closed my throat and churned my stomach. I felt like I was going to puke. Covered by insurance: 0.00. Patient responsibility: Over $2,500.

Now, this is really getting to me. I am upset that the original estimated amount I would have to pay, and a condition of me going ahead with the surgery, ended up being less than one third of the final amount that now falls under my responsibility. I am upset at the fact that it will take me months to pay this off, even if I give up every penny of my paychecks until I'm out of the red. I'm upset that at the very least I will have to give up some things I wanted to do this summer and into the fall because of this outstanding balance. These are my selfish complaints.

On a fundamental, societal level, though, I am angry that a fairly routine and preventative procedure is so financially out of reach for me, someone in a stable financial position, to say nothing for the millions of people in this country who struggle to make ends meet. I am angry that nowhere in the surgery office is there a posted list of prices: anesthetic, single tooth extraction, extra dose of anesthetic, stitches, markup for skill and precision. Nowhere in the pharmacy nor the GP's office are those costs posted either. I am angry that income influences so many doctors' decisions to enter the medical field, and that income influences so many families' decisions to stay out of those doctors' offices at all costs, until they can no longer put off a trip to the emergency room. By this time it is too often too late.


[Note: For an easy, enjoyable read that addresses a lot of these societal factors, check out T.R. Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.]

I'm angry for the people I know bearing the burden of exorbitant medical bills on top of the burden of pain and illness those bills could not cure or even ease. I'm angry for families left with tens or even hundreds of thousands of dollars of medical bills to fill the void left by the death of a loved one who couldn't have been saved with millions. I'm angry that health insurance is so expensive, so exclusive, and so apparently worthless (if my personal experience in the last 8 months is any indication). I am angry that business owners oppose healthcare reform because of the added cost it will place on their straining bank books. (I understand the threat this added cost can pose, but where does the cost come from? Something is wrong here.)

I'm angry that this country is growing increasingly obese, increasingly over-medicated, and increasingly polarized in political debates about public health. Public health. The very title indicates an issue that affects every constituency in the nation. People in every party die of cancer, stroke and heart disease. People in every party get colds and break bones and live with chronic diseases.

I am saddened by all of these things, and perhaps most of all saddened by the fact that there is no easy fix, that there is something broken in our system that I can't pinpoint, cannot package into the perfect legislation, cannot encapsulate in a widespread activist campaign. There is something broken in our system and it is too broken to fix itself. And I don't know what to do about it.

Anyway, I tried to contain this wave of anger and sadness and general unrest by fleeing to the basement to gather my things and my thoughts. But it wasn't going away. It's not just going to go away.

A few moments later my dad came down the stairs after me, and my impulse was to push him away. But I thought of Audrey opening my hands, and tried not to resist.

"You're not going to have to pay that," he said. And I launched into all the health-related angers and sadnesses and general upsets I just spelled out here. And his reply was something along the lines of, "Yes, but don't lose hope yet. Don't lose control. Just go there tomorrow and try to sort it out."

"But I don't have TIME!" I broke down.

"I do," he said. "I don't have to work tomorrow. Let me go for you."

I shook my head. "I don't have time or money to deal with this right now!"

"I have time!" he said again, more forcefully this time. "Let me do it."

"But I want to take care of it MYSELF!" I wailed, collapsing like I was 6 again and feeling like the world was caving in on me.

At which point my dad just burst out laughing, and squashed me into his arms. "You've been taking care of everything yourself since you were 15," he said. "You've been taking care of some things since you were 2." (That's the year my brother was born.) "I want to help you. I want to take care of some things for you. We are a community and a family and that's what we do. We help each other and take care of each other. You don't have to bear the weight of the world on your shoulders, all by yourself."

And suddenly I felt my hands unclench. Literally and figuratively. I felt this wave of universal whim swirl around us and it made me dizzy, so dizzy, but in that corkscrew I caught a glimpse of love sans agenda. Hands spread wide, flat, open. Reaching out toward my fists and waiting. Just waiting, so patiently, for my stubborn flailing fists that might just keep pulling farther and farther away forever.

I'm still terrified of this. I'm still working on faith and I'm still working out the kinks in my palm, tied up in there from years and maybe even decades of clenching and punching and pulling. I still cringe when someone approaches me open-handed. But I am starting to understand. I am circling closer every time, and I am finding it easier to resist biting the hand that feeds me. Open. Agendaless. I know that I am very lucky to have many sets of open hands around me, despite my thorns and bristles. There are too many hands to count.

medicine and memoriam

Happy Memorial Day, dear readers! I hope you all are spending your national holiday outside, preferably poolside, with a cocktail and some sort of grilled meat (or faux meat, for my veg friends). Or perhaps more reverently, placing bouquets on a loved one's grave.

I have spent mine so far in bed, or weeding out my email inbox, still full of "unread" messages transferred from my stolaf.edu account. The irony here is that they have ALL been read at some point, but still are marked bold for attention. I suppose this is a somewhat fitting way to spend Memorial Day, as I am unearthing a ton of messages that start me reminiscing about countless group projects in college, hilarious web videos, stumbleupon suggestions, emails planning meetings to plan spring break or interim trips. It feels like a barrage of time capsules catapulted into my present from another dimension.

That being said, it is one day short of one year since St. Olaf's Class of 2011 walked the stage in commencement of this next year of our lives. And therefore one day short of one year since I have been writing on this blog.

I don't think that's real.

Best of luck, though, to the Class of 2012, who yesterday embarked on the same journey I and my classmates have taken by the horns over the past year, and will continue to conquer in the months and years ahead.

That being said, I don't plan on sitting here all day. It's apparently 90 degrees outside, and I have plans to hit up a barbecue later this afternoon. I will not be eating burgers and drinking Summer Shandy this evening, however, because I got my wisdom teeth out on Friday and have spent the holiday weekend recovering. Which mostly entails watching tons of movies, planning my day around taking meds (although I have happily avoided the hardcore painkillers), trying to avoid busting my stitches by being perpetually unsatisfied on the hunger front, sleeping all day and then feeling restless and guilty about it. My ancestors are the type to break their hips and get back on the ladder a mere 6 weeks later, but I have apparently inherited the recessive whining and moping genes.

I hate sitting around.

I also hate not being able to distinguish the taste of blood from salt water, having to make that distinction in the first place, and not being able to open my mouth more than I need to put a spoon between my lips.

It gives me an appreciation for good health.

Also, it's upsetting how much I've spent on medical bills this year. Between me and my car, my medical bills easily outpace my student loans--which is particularly upsetting since I just looked at them yesterday and, although I've been making payments for 6 months, they have hardly a dent in their individual amounts. I would love to be able to skip getting my wisdom teeth pulled and instead direct that money to knocking out a couple hundred off my highest-interest loan.

This is a notable part of post-grad life. Like more than a few college students, I would imagine, I literally did not go to the dentist for over 4 years. Nor did I get any regular checkup by a GP or family doctor. I went to the health center on campus a few times, until I realized I rarely left there feeling more confident about my health than when I went in. I went to the eye doctor maybe once or twice, but only because I had to if I wanted to order more contacts. Which I definitely did. I still wear the same shitty glasses I ordered online freshman year of college, and I wear them as infrequently as possible.

I'll tell you why this is upsetting. The bill for getting my four wisdom teeth extracted, even after 80% of the surgery was covered by my insurance, still exceeds what I make in two weeks at work. That's after taxes, but not counting bills I have to pay, and gas three times a month. And I have a good job, and my dad's insurance, and I live at home. I know that there are families in this country who get no benefits, possibly don't have health insurance at all, and whose mediocre wages must cover food, rent, and healthcare for multiple children. My wisdom teeth were already starting to give me headaches and to make my jaw hurt. I have no doubt that if I left them in much longer my life would get a lot more miserable in a hurry.

And yet it's probably going to take me at least a month and a half to pay off that surgery plus my hand, and I need to get the timing belt replaced in my car ASAP, and definitely before the summer's over. There are other things I need to pay for as well, and I would love to knock some off my loans, and I was hoping to move out by the end of the summer. My social life has already taken a bit of a hit from these financial straits, because I've had to prioritize, and this is something I will need to keep in mind moving forward.

Medicine and healthcare is a capitalist system, at least in this country, and in my opinion they are not widely considered as such. Public health falls into an odd crack between services and industry, although it's not alone down there. In an ideal world, we could all take care of ourselves, and take care of other members of our communities, and we could avoid getting into sticky situations with our health, and get out of sticky situations when they do arise inevitably. Money wouldn't play such a giant role in whether or not we can afford to get care right now, or whether we are taking the appropriate steps to care for ourselves before an issue comes up. Not to mention the real and apparent impacts of money worries on our health itself, and the fact that this type of stress can, at the very least, slow our recovery processes.

I know finances are a bit of a touchy subject, and for many reasons you don't want to know too much about mine, but it's a big part of post-grad life, one of the many ever-present factors we have to think about as we navigate this territory. And it has been on my mind a lot this weekend, and last week leading up to the extraction.

That, and are the gaping holes in the back of my mouth bleeding, and what can I eat.

I am so unamused.

Also, I still look vaguely like a chipmunk.

Today I have not felt like eating at all, which is not a good idea because I really need to keep my energy up if I am ever going to heal... But I suddenly got a hankering for Bon Apetit's cold strawberry soup. I used to wait for this every spring, and it was all I could do to resist the urge to consume at least one entire tray of cups, bowls, and mugs full of the stuff.

I didn't quite pull off a perfect imitation of the caf version, but it was close enough.

Cheers to you, dear readers. Happy Memorial Day. Be safe, be happy, be reverent but not too reverent, appreciate your good health and, just for today, shove the ledger out of sight, out of mind.

My best wishes to you and your loved ones, and congratulations as we "commence" living the next segment of our lives.

healthcare

I’ve been in college.  I’ve been insuranceless.  In the past few years I’ve visited the campus health center a few times, particularly in the midst of my General Unwellness of 2009, until I realized it was holistically unhelpful.  Other than that, I’ve pretty well stayed on the personal side of healthcare.

But then my dad got back his insurance plan from work, and I graduated college, and I thought it wouldn’t be a bad idea to start off my adult life in verified good health.

Now, my Grandfather the Missionary Doctor has bestowed a good bit of medical wisdom upon me over the years.

Our version of Norman Rockwell's Doctor and Doll

Once, I called him from the bathroom floor of a Quito hotel room, undoubtedly facing my death at the hand of some Amazonian parasite.  I was delirious from fever and, as I said, propped somewhere between the tub and the toilet.  I choked an account of my symptoms into the phone, and in a slow, even tone he told me to sleep, and call him back in two hours, at 1am, with a status update.  “Our bodies are pretty well designed to take care of themselves,” he said, “but sometimes they just need a little help.”

And so I slept.

Lo and behold, by 1am I no longer felt as though my brain was the 10^th tier of the Inferno, and could keep enough crackers and water in my system to give me hope that I might actually see the morning.  When the sun came up that day I felt the Pit of 2009 bottom out and start the upward climb toward sea level.

At least a year before that, Grampi, M.D., was telling me some of his (incredible) field stories.  I won’t share the stories right now, but one thing he said has stuck with me ever since: “You know, people in a lot of parts of the world never know what it is to feel good, they never know what it feels like to be in good health.”

I understand what he was getting at, but as I get older I’m starting to think that most people don’t feel good most of the time.  At least, I usually have at least one minor ailment on my radar at any given time, and I consider myself a relatively happy, healthy person.

That being said, I went to the doctor 2 months or so ago with a short list of questions about mildly annoying but not incredibly worrying issues, and emphasized that I’d really like to avoid taking any medications if I could help it.  I just wanted to make sure I didn’t need to be particularly concerned about anything.

So, the doctor checked my ears, throat, height and weight, asked me a few questions and prescribed me a month of allergy meds and an antibiotic, “just in case” my symptoms were indicative of a bacterial sinus infection.  (She also mentioned that a lot of patients were appearing with sinus infections, but that unfortunately most of them were viral.)

There’s something wrong with this situation.

Somebody, please, show me a doctor who will talk to me honestly about my health, and more importantly about my life.

If this mythical doctor could manage his or her accounts efficiently and transparently, that would be a major selling point as well.  Because, to add insult to injury, I’ve received a bill for every appointment with pre-approved physicians, informing me that my visit was not covered by my insurance and demanding that I pay in full.  Several hundred dollars a pop.  For someone who doesn’t give a shit about me to write two pointless prescriptions I never planned to fill, and take my (eternally normal) blood pressure.

Although I wouldn’t be surprised if it’s nearing dangerous levels as I write.

Fortunately I have had some excellent customer service fix the billing issues and charge me only one-third to half of the original rate.  So that’s… positive?

I could wax political about the state of “healthcare” in our country/world.  I could rant about the inefficiency and unfairness of the billing system, about the moral erosion of health insurance under force of market competition, or about the myriad frustrations and limitations of healthcare and medicine.  I could go on for years (and in fact I have, to various audiences) about how overmedicated our society has become, about cultural hypochondria, about our skewed modern perception of health and illness, about pathological epidemiology and epidemic pathology.

But I’ll direct you instead to a great article that calls Americans “anxious wimps,” and move on to a more interesting/constructive discussion of health.  (I have a South American uncle who once laughed at me for freaking out about an obviously cancerous spot on my toe and said, “You North Americans worry so much.”

Point taken.)

And true to form, I’ll finish with my personal outlook on healthcare.  Aside from the fact that I need to get my wisdom teeth out, and the unfortunate side effects of missing a few days of work, taking medications, and shelling out a couple hundred for a procedure that doesn’t even pretend to be covered by insurance, I’ve basically decided to avoid most medical professionals for awhile. (Excepting gynecologists – for some reason I’ve had overwhelmingly positive experiences with that particular branch of medicine.  At least with the specialists.  Again, won’t speak for campus health services.)  The dilemma I’m faced with then is that I forsake the opportunity to build a relationship with any particular healthcare practitioner, but I’m mostly too disgusted to be interested in that right now anyway.  And then, if an emergency happens and suddenly some biomedics are saving my life, can I in good conscience accept their help having publicly shunned the profession?

So maybe I’ll hold healthcare at arm’s length and focus on self-care.  (Ha, ha!)  I’ve substituted long-distance phone calls, blogging, and journaling for my monthly chats with a personal counselor back at good ole Boe House.  I’m creating a lifestyle.  Lifestyle goals: Boost my immune system.  Be physically fit.  Foster healthy relationships.  Nurture my spiritual side.  Like myself.  Breathe.  Laugh.  Feel good.