Health Activist Soapbox: Health Care Reform Needs Reform! #NHBPM

I'm of the opinion that we rarely get things right on the first attempt.  I think it isn't until we give it a go for several rounds that we finally get closer to what we want, need or envision.

So when I think  about the Patient Protection and Affordable Care Act (PPACA), a.k.a. Obamacare, what pops into my mind is, "First draft, needs a revision."

I already know I don't like the changes the PPACA makes to:

• medical flexible spending accounts
• the medical expense deduction on Federal income taxes
• the tax on the manufactures and importers of medical devices

You might think I'm just complaining, but mark my words.  I predict that once this massive 906 page law is fully in effect, we are all going to encounter an unpleasant surprise or two when it comes to our health care.

As far as I am concerned, this isn't a done deal.  Sure, lots of people are celebrating this as a historic win, but I see this as a work-in-progress and a new advocacy issue, especially since I've been told that the needs of those of us with chronic illness weren't really taken into consideration during the writing of this new law.  With what little I know, I can already see that the PPACA needs changes, revisions and rewrites, and sooner than later.

There is a lot of ground to cover here, but right now I just want to talk about the changes to medical FSAs.  So here is my opinion on the changes that take effect January 1, 2013 and why I think you need to be concerned too if you are covered by an employer-sponsored cafeteria benefit plan.

Medical Flexible Spending Accounts (FSA)

What is an FSA? A benefit program where before-tax money is deducted from an employee's paycheck and placed into an account.  The account is used by the employee and their family to pay out-of-pocket medical expenses.

Why haven't I heard of FSAs before?  According to the Employers Council on Flexible Compensation, only 25% of eligible working Americans take advantage of this benefit.

How does the PPACA change FSAs?  Before, the employee could decide how much to put into their FSA account every year.  Beginning January 1, 2013, contributions to medical FSAs will be limited to $2,500 for an employee and their family.

Why is this a problem? This change will hurt those who have a lot of out-of-pocket medical expenses, like those living with chronic illness, autism or children with special needs.

Why should I care? Out-of-pocket expenses included things like deductibles, co-insurance and co-pays. If you have health insurance, you will be paying these fees as part of cost-sharing provisions in the PPACA.

What you might not know is that the PPACA puts the ceiling on health plan out-of-pocket expenses to $6,000 for individuals and $12,000 for families starting in 2014.  These limits were set based on rates associated with high deductible health plans and, of course, can be raised in subsequent years due to inflation.

Now I just looked and the current deductibles for our employer-sponsored health insurance plan are no where near this high.  Which has got me worried that my husband's employer could decide to raise deductibles to meet their growing costs under the PPACA.  Sure enough, we are in open enrollment right now and our deductible has gone up, not a lot, but still every little bit means less money for other expenses.

O.K., back to why I think you should care...

In previous years, you could put $12,000 into your FSA and you'd be covered.  By doing so, you saved yourself anywhere between 25 to 40 cents on every dollar spent since you were using pre-tax money.  Beginning in 2013, the worse case scenario is you paying out $9,500 of your hard-earned after-tax dollars to pay for health care expenses.  By my calculations, in this scenario you'll be paying an extra $2, 375 to $3,800 in taxes just by paying your medical bills.

What do FSA experts say about this? My husband's employer uses a company called WageWorks to manage its FSA program.  Jody Dietel, the compliance officer for WageWorks, said in a recent interview that, "...it’s not really a health care friendly policy—it was a revenue grab.”

In other words, this is one way working Americans and their families are funding the PPACA.

Are We Going to Pay More for Healthcare?

I guess that is the $25,000 question, isn't it?  Even the respected Kaiser Family Foundation says,

No one knows for sure. Even supporters of the law acknowledge its steps to control health costs, such as incentives to coordinate care better, may take a while to show significant savings. Opponents say the law’s additional coverage requirements will make health insurance more expensive for individuals and for the government.

Like I said, I think we're all in for some health care surprises.


Related Articles

• After The Election: A Consumer's Guide To The Health Law  
• Obamacare Strikes Again: New Limits on Spending Accounts  
• Deducting Medical Expenses in 2013 Will Be Harder  
• How Obamacare's Medical Device Tax Will Stifle Advancements in Health Care  

Me & Hep C: Sorting Through My Feelings as Treatment Is About to Begin

I picked up my Hepatitis C medications from the pharmacy Wednesday night.  When I got home, I inspected them, read the drug monographs enclosed with them and found a place to store them for the next seven days while I wait to begin treatment.

As I put them away, it felt weird to finally have my medications "in hand" and not be starting treatment right away.  All that struggle to get them and for now two sit in my hall closet and one in my refrigerator.

It just doesn't seem quite right...

It was then I realized that this was a watershed moment.  I was in the space between talking about doing Hepatitis C treatment and actually doing it.  It was then that the emotions flooded in:

Feelings	Thoughts
anger	I already had cancer...did I really need Hepatitis C too?!?
annoyance	I have my medications but I have to wait a week to start taking them?  Aargh!  I just want get going before I change my mind and chicken out!
anxiety	What have I gotten myself into?  Am I in over my head?
concern	I know this will be hard for me, but how hard will this be for my husband who has a front row seat to this craziness?
courage & determination	I can do hard things!  I can beat Hepatitis C!  I am going to Fight Like a Girl and win!
fear	Will this work?  How bad will it be? Do I have what it takes to endure this?
gratitude	Thank goodness I have insurance that covers this treatment and a supportive husband and friends who will help me get through it.
hope	If I can do this and if the treatment works, this might improve my overall health status for the better.  And that would be all kinds of AWESOME!
resolve	I am doing this.  I am going to stick it out no matter what.  I will succeed.
overwhelm	Two pills every 8 hours and three pills every 12 hours that must be taken on-time or the treatment might not work.  Can I be this perfect?
worry	Side effects--which ones will I get? can my medical team handle them? will they derail my treatment? how will my level of functioning be impacted?

There is a lot going on inside my head and my heart right now.

So my plan is to feel these feelings and trust in the knowledge that, if I don't resist, they will sort themselves out during this final week of waiting. Plus if I feel overwhelmed, I can distract myself.  There are still plenty of things I want to do before I begin treatment.

Ultimately, the act of starting treatment will silence the doubtful emotions and allow me to take the leap of faith required to plunge myself into this treatment. 

In the meantime, on Thursday I purchased a mega pill organizer able to accommodate the blister pacts of Incivek and filled it with the first week of my medications.  Then I broke out the label maker and labeled the box with my daily medication schedule: 6 am, 2 PM, 10PM and midnight.  I also marked Friday as my Pegasys injection day.

While I worked, I observed that my pills are pretty shades pink (ribavirin) and purple (Incivek.)  Then a funny thing happened.  I began to feel grateful for these new "girl power" pills that are going to help my body do quite an extraordinary thing--beat Hep C!

I can't wait to get started...

Related articles

• Hepatitis C: The Facts (ohmyachesandpains.info)
• Book Review: Free from Hepatitis C by Lucinda Porter, RN (ohmyachesandpains.info)

Can Money Buy You Good Health?

They say that money can't buy you love or happiness, but I am beginning to think that it might actually be able to buy you good health, or at least better health if you live with chronic illness.

I know nowadays there is a lot of talk about the uninsured and those with health insurance.  Correspondingly, you hear a lot about the two different health care systems serving these groups: the publicly funded health care system (think county hospitals and clinics) and the insurance funded health care system (think doctors in private practice, medical centers, etc.)

Having medical insurance and chronic illness, I've spent a good portion of my time and energy access care in the insurance funded health care system over the past eight years.  I've learned a lot of things about how this system care works, enough to write a whole series of blog post.  But perhaps my most perplexing discovery is that there is actually a third health care system that doesn't get a lot of attention, that of the cash-only or self-pay medical practice.

As the name implies, these are physicians and other health care professionals charge up front for their services.  So if you can't pay (or charge the bill to your credit card) you can't be seen.  They don't accept your insurance--in fact many don't belong to insurance networks and have opted-out of Medicaid and Medicare. Most will provide you with a superbill so you can submit their charges to your insurance company, but since their rates are usually above and beyond what your insurance carrier considers "reasonable and customary," you will only be reimbursed for a fraction of what you paid them.

So, in essence, this third health care system is for those who have money, lots and lots of money.

I don't have lots and lots of money, so in the past, whenever I have stumbled upon one of these medical practices, I have steered clear and not given them a second thought.  Which is all well and good except that, as time has gone on and the insurance driven medical system has failed to provide me with adequate care for my chronic illnesses, I now am getting referred to this third system of care because its members provide the services I am seeking.  In this system reside the experts in things like pain management, rare diseases and disorders and novel and cutting edge treatments that pick up where conventional approaches fall short. 

Yes, it seems that here in Los Angeles many of the doctors who are at the top of their fields convert to this kind of practice.

Now I find myself wishing I had the money, the golden ticket, to access this third level of care.  I'm drawn by the allure of better treatment that could potentially make a significant difference in my quality of life.  Granted, I don't think they could cure me, but from what I have heard, it seems like these upper echelon providers could reduce my chronic illness burden and help me regain some of the day-to-day functioning I have lost along the way. 

With all the hype, I have to wonder, 'Could being treated by one of these cash-only healthcare providers be the difference between living disabled and living more able-bodied?'

Unless I win the lottery or become the recipient of some fortune from a deceased distant relative, I guess I will never know.

So what do you think?  Can money buy you good health?  What is your opinion of cash-only or self-pay medical practices?  Are you able to access this top tier medical system or is the admission price preventing you from getting the kind of medical care they provide?  

Please share your answer to this Question of the Week below in a comment or over on the Oh My Aches and Pains! Facebook page.   

The Health Care Games People Play: What Should I Do?

It's been a long week.  I attended a plethora of doctors' appointments this week so could be ready to start Hepatitis C treatment.  My week included painful procedures Monday and Tuesday and ending with frustration on Thursday when I learned the new neurologist I saw wasn't a good fit for my needs.  Right now I am tired, grumpy and beyond annoyed.

So take what I am about to say with a grain of salt.  Oh, and I have purposely not named names to shield myself from any venting fallout.

A Really Slow Process

One of the things that is really bugging me right now is how long it is taking to get my Hepatitis C treatment drugs.  I saw my hepatologist on January 10th and I learned from the support staff (see below) that he didn't write the prescriptions until January 20th.  Then it took my call on January 24th to finally get the prescriptions faxed to the pharmacy. 

Unbeknownst to me, my primary insurance information got deleted from the hospital computer system, so my prescriptions got sent to a private specialty pharmacy that bills Medicare, my secondary insurance.  I'm not sure how that happened, since I verify that information every single time I come in to see my doctor.  

Getting the Ball Rolling

As I mentioned above, I called two week after seeing my doctor since no one had contacted me like the doctor said they would.  During my first conversation with support staff, I got a "song and dance" about how it takes 2 to 3 weeks to get things going.  It was after that lecture that we got to the business of checking on the status of my prescriptions and discovered the deletion of my primary insurance information.  I then went on to inform the staff of the details of my prescription benefit coverage, which is a separate entity from my primary health insurance.

I thought we ended the discussion with the staff person saying my prescriptions would be re-routed to my prescription insurance's specialty pharmacy.

Confusion Ensues

A day or two later I got a call from the private specialty pharmacy saying that they couldn't find my Medicare drug coverage.  So I called them back telling them that Medicare wasn't my drug coverage and that I had private prescription insurance.  I told them the prescriptions were sent to them in error and were being re-routed to my prescription insurance's specialty pharmacy.  Then this past Tuesday, the private specialty pharmacy called me again wanting my private prescription insurance information.  I called them back once again explaining that the prescriptions were sent to them in error and asking them to please forward them to my prescription insurance's specialty pharmacy.

I then called the support staff at my doctor's office since I was getting the distinct feeling that things were not happening the way they were supposed to be.

Doing Things Their Way

Sure enough, the staff did not send my prescriptions to my prescription insurance's specialty pharmacy.  No, I was told that working with my prescription insurance was a "nightmare" and they would rather use this private specialty pharmacy than deal with my prescription insurance directly.  When I told them I called my prescription insurance and was told the Hepatitis C medications would only be covered if they came from their specialty pharmacy, I was told that I was given incorrect information.

Yeah, O.K., whatever.  I'm not going to argue.  I figured that their private specialty pharmacy would be told the same thing when they called my prescription insurance.  No sense in belaboring the point when it was clear the staff was persistent in doing things their way and perceived my phone calls as "getting more involved than I needed to be." 

Prescriptions from the Barrio?

I decided I wanted to learn more about this private specialty pharmacy the staff is so in love with.  So I Googled the number they called me from and the first link was to their website--which was down.  So I went back to Google to search the other name the staff used for the pharmacy and this is what I found on Google maps: 

My prescriptions are coming from "Rx Farmacia"?
Where is the front door?
And is that crime scene tape on the street in front of the pharmacy? 

Is it just me, or does it seem ________ (insert an adjective here) that a big university medical center rated "Best in the West" is sending my prescriptions for Hepatitis C treatment here?  And O.K., so I shouldn't judge a book by it's cover, but I certainly find it odd that this book's title is in Spanish.

What Should I Do?

In all seriousness, I feel incredibly uncomfortable with my medications coming from here.  I mean, I have seen other private specialty pharmacies and none of them looked like this.  I am praying the my prescription insurance gave me the right information and will deny coverage because I admit the look of this pharmacy conveys the messages "counterfeit medications," "money laundering" and "fly by night."

I mean, I hate to admit this, but based on appearances I trust my prescription insurance's specialty pharmacy way more than this place.  Plus I did some more research and discovered that my prescription insurance's specialty pharmacy can have my medications delivered to my local chain pharmacy location.  The pharmacy pictured above is in East Los Angeles, which is nowhere near where I live or could get to on my own.  So they have to ship my medications and I have to wait around to receive them so I can get them into the refrigerator ASAP.


This all begs the question: if you were in my shoes, what in the world would you do???

I can't wait to read your answers...

ADDENDUM: 6:01 am--After I posted this, I called my prescription insurance's specialty pharmacy and I am happy to report that they received my prescriptions for Hepatitis C treatment.  Not sure if they came from the private specialty pharmacy or the doctor's office; either way I don't care!  I am so pleased with this outcome!  I am now eagerly awaiting a call from Brittany who will facilitate the process.  Because I am worried about the "nightmare" comment (see above), the first thing I am going to do is ask Brittany to call me every time they need something from my doctor's office so I can keep in top of them.

WE FEEL: Fibromyalgia Is a Burden

We really need more research on the impact fibromyalgia has on a person living with it.

So when I learned about the WE FEEL survey (Women Expressing Fibromyalgia's Effects on their Everyday Lives), I knew I needed to share an overview of the results here as well as spread the word about this study on Twitter.

While the results certainly don't surprise me, I think it is important for health care providers, family member and friends to read these results.

• For many, life with fibromyalgia is burden of moderate to severe symptoms that interfere with quality of life
• Many patients feel their symptoms are not taken seriously
• Many patients suffer for years before they get a fibromyalgia diagnosis
• An early diagnosis can often mean a better outcome
• Having fibromyalgia makes it difficult to do things like household chores or work outside the home
• Persons with fibromyalgia enjoy less quality time with family and friends
• Positive social support and adequate coping resources are often limited
• A combination of medical treatment and social support was found to be helpful in decreasing fibromyalgia symptoms and increasing the ability to manage day-to-day life
  

I also found the following results about treatment modalities interesting as well.

• Four in ten patients (42%) who take prescription medication said that their drug therapy was successful in improving fibromyalgia symptoms
• Exercise (46%) and alternative therapies (43%) like massage, meditation, and chiropractic care were identified as treatments that improved fibromyalgia symptoms
• Just over half of the respondents (51%) said that lifestyle changes helped improve fibromyalgia symptoms
• Those participants who reported receiving more support from their spouse (56%) and/or children (61%) also reported more positive benefits from treatment
  

The take-away message for me is that people living with fibromyalgia need more support from medical providers, family and friends. Better drug therapies that do an improved job of targeting symptoms are needed. Health insurance needs to cover proven alternative therapies and occupational therapy programs that teach lifestyle changes so that patients have a chance to obtain better symptom management.

Let's Stop Selling Health Insurance...

Image by SavaTheAggie via Flickr

I'm really not an expert on health care reform, but something clicked when I starting writing about it on Monday and I find myself with more to say.

This post is inspired by the graphic you see at the top, the image of the house on fire. The caption reads: PRE-EXISTING CONDITION--"Hello? My house is on fire and I'd like to buy a fire insurance policy. 911? Nah, the government says insurance companies must cover all pre-existing conditions now. It's not like I should have to pay for it."

This illustrates the problem with calling health care coverage "health insurance."

Insurance implies that there is a risk from which you need to be protected. So, you take out insurance to hedge your bets and guard against the bad thing from happening. That's why homeowners' buy fire insurance, motorists buy car insurance and people worried about providing for their families in the event of their death get life insurance. The insurance companies aren't stupid. They hire people to figure out the risks of offering such coverage to you with an eye on the costs and the goal of making a profit. So obviously, no one is going to sell you insurance if your house is already on fire, you just got into a car accident or your spouse just died.

I guess some people view health care the same way. For those who consider themselves healthy, "health insurance" is something they have "just in case" they get sick. So I can see someone with this point of view on health insurance putting together a poster like the one at the top of this post.

Then there are people like me. I admit that I really don't need "health insurance." I already have health problems, so insuring my health, i.e. gambling that I am going to stay healthy and not need medical care, is literally like closing the barn door after all the animals have escaped. What I need is ongoing access to health care. Without it, I have no support for all the things I need to do to manage my multiple chronic health problems.

If your house burns down, you have choices. You can walk away. You can rebuild. You can tear down what remains and leave an empty lot. You can sell what is left.

People are not like houses.

When we become ill or injured, we need medical care. The whole profession of medicine exists because of our societal commitment to the treatment of the sick and infirm. We do not abandon people when they are ill, like animals do when a member of the herd becomes sick or injured. We stand by them, help them and do what we can to help.

So why do we denied people with pre-existing medical conditions the ongoing access to the means to manage their health problems and ease their suffering? Why do we forget that some of people who utilize the health care system the most are people who live off disability checks and therefore not in a position to pay more to access health care?

Clearly there are multiple problems. There are also disturbing reports in the news that health insurers are already looking at ways to skirt the new provisions to end the denial of health insurance coverage to those with pre-existing conditions. This is why, in a nutshell, I think the emphasis on "health insurance" in the health care reform bill is not the smartest choice of words or concepts.

I know I am probably not qualified to solve these problems, but may I humbly suggest perhaps one small step towards fixing this problem?

Let's start by acknowledging that we all need to go to the doctor, even those of us who consider ourselves healthy. Let's agree that health care services need to be part of everyone's lives, from birth to death, in sickness and in health, to prevent and treat illness and disease. Let's stop selling "health insurance" and start asking everyone to pay for access to the health care system. Then let's talk about making it so that everyone can afford access to health care. Let's agree that health care for all is a goal our enlightened and compassionate society strives towards and is willing to pay for, together, as one united nation of people.

That said, I'm not sure what our health care solution should look like. Philosophically, we seem to be torn between "united we stand" and "pull yourself up by your boot straps" when it comes to solving our social problems. I feel if we could just get over the first hurdle and agree that health care for all is our goal and that we all need to be in this together, we can figure out our own uniquely American solution to this problem.

Agree? Disagree? I want to hear what you have to say so leave me a comment.

Linky Love: On Health Care Reform

Image via Wikipedia

I'm no expert when it comes to commenting on health care reform, but I traveled the blogosphere and found some experts in the subject. Fortunately for me, many of them just participated in the recent edition of the Grand Rounds blog carnival posted at the blog See First. This blog carnival features both doctor and health care/patient bloggers, which makes for an interesting mix of perspectives and opinions. You can read all the submissions by clicking here: Grand Rounds: Health Care Reform Edition.

My favorite post comes from health and patient blogger Laurie Edwards at A Chronic Dose. Laurie has been dealing with chronic illness since the day she was born and talks about how having pre-existing conditions has effect her relationship with health insurance. I have to say, she and I are on the same page in many ways, and her post echoes many of the same sentiments as my post from yesterday: No More Pre-Existing Medical Conditions Exclusions. Click here to read Laurie's take: Where's the Patient in Health Care Reform?

Today's post is short and sweet as I want to get back to reading all the great posts from yesterday's edition of Grand Rounds. I'll be back tomorrow with more of my own thoughts on health care reform, this time inspired by the caption on a picture. Intrigued? Come back tomorrow and check it out...


Sponsored Message: Looking for affordable health insurance? Look no further that Anthem Tonik. Offered by Anthem Blue Cross and Blue Shield, Tonik provides coverage in California, Colorado, Connecticut, Georgia, Nevada and New Hampshire. Tonik might be better known to college students or recent graduates, but Tonik plans are available to anyone under age 65. With three levels of coverage--Thrill Seeker (Tonik 5000),the Part-time Daredevil (Tonik 3000) and the Calculated Risk-taker (Tonik 1500)--there is bound to be a plan that fits your lifestyle and your budget. But don't just take my word for it, check out Tonik yourself and apply online by clicking here: Anthem Tonik. Anthem Tonik, a great option!

No More Pre-Existing Medical Conditions Exclusions

Image via Wikipedia

In response to my blog post from yesterday, Health Care Reform Won't Affect Me, a friend reminded me that a big part of the heath care reform bill dealt with pre-existing medical conditions. And all you need to do is look at my blog header for a pretty complete list of my pre-existing medical conditions. Can it be, for once in my life, I temporarily forgot about them? I guess being on Medicare can do that...

Truth is, in my recent past, choices in my working life centered around my mission to always be covered by health insurance.

But let's start at the beginning. I consider myself absolutely lucky that when I received my cancer diagnosis at age 22 I was still covered under both of my parents' health insurance policies. That's right, I had double coverage. I also consider myself fortunate that I continued to be covered under their insurance past my 23rd birthday because my cancer diagnosis, with its 33% chance of survival, qualified me as a disabled dependent. I remained on my parents' insurance until I secured my first full-time job as a social worker with full medical benefits after I completed my undergraduate and graduate degrees at age 27.

Once I became employed, all my career choices included health insurance as a rule-out criteria, i.e. no health insurance benefits meant I would not consider the job. That criteria changed a bit after I got married in 1998. As long as one of us had access to health insurance through an employer, the other was free to pursue work that didn't offer it. We came a bit close to catastrophe in the early '00s when we were on COBRA benefits and neither one of us were working jobs that offered health benefits. But somehow everything worked out in our favor and we both landed in jobs that offered both of us medical benefits once again.

The bottom line is that once I finished my cancer treatment, I accepted the fact that I could never qualify for an individual health insurance policy. I resigned myself to the fact that as long as I was single, I needed to work for an employer with a medium to large workforce. Being married opened the door to expanded possibilities, because now my husband helped share the burden of obtaining health insurance. But even with a little wiggle room, health insurance always colored our job decisions.

Certainly becoming disabled skewed my quest for health insurance in my favor. Never did I think I would be on Medicare at this point in my life. No, my plan was to work, build up a career, gain experience and go back to school to earn a PhD and teach social work. I would qualify for MediCare when I reached 65 (or is it 67 by then?) and was enjoying a semi-retired life with some work, some travel and some more time with my spouse.

Ah, but life is what happens to you while you're busy making other plans.

Let me acknowledge how truly lucky I have been when it comes to being continuously covered by health insurance. I do not take it for granted. I need to add it to my list of lucky breaks, which also include finding good parking spaces and great places to live. I realize not everyone in my situation finds themselves in such good fortune, which is why I honestly and truly hope that the new health care reform bill provision ensuring health insurance coverage for children and adults with pre-existing conditions takes effect as intended.

If I am ever able to work once again, I would relish the opportunity to walk down my career path without being held back from certain opportunities because of considerations around health insurance. What a world that would be!

Health Care Reform Won't Affect Me

Image by leoncillo sabino via Flickr

I am not making this up. I actually went to the Washington Post website, entered in a bit of information about my current health coverage and was told that health care reform will not affect me. I admit I feel a bit disappointed.

After all, this is the legislation that inspired Vice President Biden's on-microphone gaffe, "This is a big f***ing deal."

To be fair, when Congress writes a bill purported to be as big as the novel War and Peace (which, by the way, had 1225 pages in the original edition and 1475 pages in the most recent reprint), it obviously is going to take some time to read all the provisions and even longer to figure out how to implement them. One sound bite I heard was that most of the provisions won't take effect until 2014. I know from experience that a lot can happen in four years.

Still, if health care reform is going to cost the US $1 trillion dollars (that's 12 zeros), I'd like to think that I am going to get some benefit from it. Then I realized that, as long as I am disable and receiving Medicare, I won't get any direct benefits from this legislation. More than that, I realized that anyone on Medicare, Medicaid or covered by employer-sponsored medical insurance won't get anything tangible. That includes the disabled, elderly, welfare recipients and those working adults and families receiving medical benefit from an employer.

This legislation supposedly helps people get medical insurance. It is supposed to provide subsidies to those who can not afford insurance. Has anyone mentioned yet how they are going to determine who gets subsidized and who doesn't? How much new paperwork and bureaucracy will be created to help make this determination? If it is anything like the process for qualifying for other public benefits, like disability or welfare, this is going to be a nightmare.

What does making health insurance mandatory mean for those who now must purchase insurance? I wonder if it just opens the door to medical care only to have it slammed shut again when the newly insured are overwhelmed by out-of-pocket expenses (co-pays, deductibles, co-insurance and out-of-network reduced coverage) they can not afford. So will the newly insured use their plan if they can not afford the associated out-of-pocket expenses?

Which brings me to the question, does medical insurance = health care?

Plus how many people are going to actively avoid getting insurance. After all, car insurance is mandatory for all drivers here in California and yet there are still uninsured drivers. Will there by a self-pay option that allows people to opt out of getting medical insurance?

For me, the biggest unanswered question is whether making for-profit health insurance coverage mandatory really the way to go here. I still think that health care needs to be non-profit, patient-centered and evidence-based. I believe that the money generated in health care system needs to be reinvested into things like medical research, practitioner continuing education, patient supportive services like social work and upgrades to medical equipment.

I fear that this heath care reform doesn't get to the heart of the matter. After all, having health insurance doesn't insure that people will be healthy. Personally, I'd rather see Congress invest $1 trillion dollars into improvements in agriculture and food production to make fresh, minimally-processed, healthy and nutritious foodstuffs affordable and available to everyone. With so many health care costs tied to what gets put onto the American dinner plate, it seems to me ensuring that everyone eats more healthfully would be a better way to spend my tax dollars than supporting the for-profit health insurance industry.

Which makes me wonder, did we just do this ass-backwards?

Yes, I am disappointed that health care reform won't affect me and seems to do nothing to make the health care system more accessible, effective, affordable, patient-friendly or efficient.

O.K., I've share my two cents, now it is time to tell me what you think. How can you let me know your opinion? By leaving me a comment of course!

Related articles by Zemanta

• 'No Cussing' Crusader Takes on the Vice President (abcnews.go.com)
• Biden "Big f*cking deal!" Gaffe Inspires Internet Entrepreneurs to Cash in (mashable.com)
• WTF Did Biden Just Say? A brief history of bad language in Washington. (slate.com)

Playing the Health Insurance Game

Image via Wikipedia

I just watched the PBS Special Report: Heath Care Reform and highly recommend you watch this program too. The report devoted a whole section on the issue of pre-existing conditions and for a few minutes afterwards I sat and scratched my head. I live with multiple health problems (just look at the description I use to introduce you to my blog above.) I scratched my head because, after viewing the program, I was left wondering how I avoided getting into trouble with my health insurers about my pre-existing conditions.

Needless to say, it took me several hours to come to the following conclusion: it appears at first glance that I played the "health insurance game" successfully. My fear of not having health insurance after my cancer diagnosis at age 22 spurred me to make absolutely sure that AT NO TIME was I ever uninsured in the past 21 years.

Then I realized the sacrifices and calculated choices I made to achieve this goal.

For starters, while I was working, I didn't apply for and turned down jobs that didn't offer health insurance. This automatically meant that working for small employers and starting my own business (like a private clinical social work practice) were never options for me. I avoided leaving a job without securing another position beforehand. In the event I wasn't able to make this kind of transition, I ALWAYS paid for extended COBRA health insurance coverage, which is very, very expensive.

I admit that in the past 10 years, my worries about having medical insurance decreased after I got married. For the first three years of my disability, I relied exclusively on my husband's health insurance, which prompted occasional worries about what would happen if my husband's employment situation changed. In 2007, I qualified for MediCare, which eased those worries a bit but brought new frustrations with my medical providers' inability to make the transition to billing MediCare as my secondary insurance.

I guess for all my bad luck with health problems, I have been blessed with good health insurance mojo. But don't let that fool you; watching this latest report on how health insurance excludes people with pre-existing conditions fueled another round of health care worries for me. I will always be obsessed with getting, having and keeping my health insurance: I will always be playing the health insurance game.

Related articles by Zemanta

• Health-Care Reform: Uninsured Young Adults Are a Problem (time.com)
• Will Illegal Immigrants Get Insurance Coverage with Health Reform? (blogs.wsj.com)
• Morons like us (thehealthcareblog.com)