Who Are the Uninsured?

So the other day I was looking at this sort of small boil thing on my leg (I know, I know, TMI but necessary to the story).  “Do you think this could be a staph infection?” I asked Teddy, figuring he would be the expert since things like that tend to lurk in locker rooms.  “Could be,” he answered.  “Well, if I start to see some necrotizing flesh I guess I will go see a doctor,” I said, and I was only kidding a little bit.
I went with John to his doctor yesterday.  There was no more putting it off.  He hadn’t seen a doctor for any sort of follow up since being diagnosed with diabetes in February.  They called him over the phone to let him know.  They didn’t tell him how to check his blood sugar, or what he should be eating, or anything.  And now he was out of his medicine.  He’d been out of five or so other medications for several months, but knowing so little about diabetes we didn’t know what would happen if he stopped taking that one.  So off we went.
We left $150 poorer, with a lab bill to follow, with a handful or prescriptions that will cost us over $500 every month IF we fill them all every month, and that’s after prescription club card discounts.
The last time I wanted to see the doctor, earlier this year, because my leg was swollen and I was worried about a blood clot, I went to the emergency room.  Yes, I am one of those people.  Why?  Because when I called the doctor’s office where I go when I am sick (which is thankfully never) they said I hadn’t been there in over three years, so I would be a new patient, and they would have to charge me for a check up first, and they wouldn’t be able to see me right away.  And I would have had to pay the whole bill right then.  This also happened to me the last time I got sick enough to need a doctor.  That time (I had walking pneumonia) I ended up at the Walgreens walk-in clinic (I recommend them, by the way.). See, healthy uninsured people don’t get annual physicals.  So they don’t have a relationship with a doctor.  When they get sick, they wait a few days.  Tough it out.  See if it won’t get better on its own.
Emily has student insurance because Spring Hill requires it.  She graduates in May and will enter the ranks of the uninsured unless she finds a job that provides insurance.  Luckily for her she is astonishingly healthy–no antibiotics or doctor visits for illness since the age of two.  The other kids are on TennCare but I’m pretty sure Jake gets kicked to the curb at 19–bad news, since he does take medications that it fully covers.  Teddy will have coverage in college, I suppose, and even if we lose TennCare for the little ones as we have fewer dependents, there is a program called CoverKids for them.
I could write several columns about the failures of TennCare but I won’t because despite all of them I am grateful that my kids have had insurance of any sort.  There were years when they didn’t, when I sucked it up and asked for a bill at the doctor’s office while staring at the sign stating that all accounts needed to be paid in full at the time of service, when we waited a day or two longer than other people might to see the doctor, hoping things would improve on their own, when we paid $100 for eyedrops for a corneal abrasion and used them on pinkeye outbreaks for years in order to get our money’s worth.
So how did we end up here?  Where did we go wrong?  Aren’t those uninsured people, those people who think they are entitled to healthcare, people who don’t work, or who are deadbeats, or who just don’t bother to purchase insurance?
Well no, they are people just like us, which is why I am writing about this very personal topic.  Because I think people ought to know that.
I’m not going to go through the last twenty-plus years and tell the whole sorry saga of our health insurance blues, because it would take too long and probably be boring.  I’ll just hit the high (the low?) points.
Growing up, I never thought about health insurance, and I’m sure you didn’t either.  I went straight from my father’s plan to my husband’s–I got married less than three months after I graduated from college.  I remember how fun it was reading about the plans and deciding which one we should pick.  That was right at the beginning of HMOs, and the Federal Government (where John worked then) offered Kaiser Permanente, which was free but kind of sucked, actually.  But it was a lot better than nothing.
The only problem was that when we moved to Knoxville, Cobra notwithstanding, we were screwed, because there was no Kaiser here.  So with a baby on the way, we entered the ranks of the uninsured.  I got a job at UT that had great benefits, but not for pre-existing conditions!  So Emily was an out-of-pocket purchase, paid off over many long years, as were two of our other babies.
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I was also writing for the Tennessee Register then, and I wrote a long article about the burgeoning health care crisis in this country–something I had never heard of at that time.  All the experts I interviewed said it was only going to get worse.  When I was seeking a position with the East Tennessee Catholic, I showed that article to the then-editor, and he wanted to know what it had to do with Catholicism.  Ah, hindsight.
That was my last full-time job, so I never was offered insurance again.  John was, at his first post-law-school position, but the family plan was so expensive that we couldn’t afford it, plus I was pregnant already and it wouldn’t cover that pre-existing condition–that didn’t stop TennCare from kicking me off though–because I was OFFERED insurance, even though we DIDN’T get it and it wouldn’t have covered me if we had!
Several years later, after John began practicing law on his own (that means no group coverage, people), he found a nice insurance agent who said he could get us affordable private-pay coverage.  He came out to the house and we picked a plan.  A few weeks later, we got the bad news:  because of his pre-existing health conditions, and the medications he was already taking, John had been declared officially uninsurable.
That’s right, folks:  that’s how insurance companies hold their costs down.  They weed out the people who need the coverage most.
After awhile, we did the math.  Paying monthly premiums, the deductible, and the co-pays for people who rarely if ever got sick made it impossible for us to afford the care and medications for the one person in the house who needed it.  We had to drop that insurance and it’s only become less affordable since.
In the ensuing years, there have been times (pregnancies, extended illnesses, excessive medical bills) that we’ve been able to qualify for TennCare in one form or another.  I was able to get my gall bladder removed during one of those times, happily.  In between, John only goes to the doctor for medication refills and we look for patient assistance programs and samples to cover the costs of his medications, or else he goes without “less important” medications.
Something has to be done about the state of health care in this country.  My European friends laugh at our resistance to “socialized medicine.”  They can’t understand why we wouldn’t want what they have.  The Affordable Health Care Act is not perfect, but it’s a start.  I trust the pro-life Democrats’ assurances that they are satisfied with the concessions that were made to them before they voted for the bill.  I may yet read the whole thing (900+ pages) to see what all it includes for myself.   My feelings about the HHS mandate are already on the record but I am still hopeful that it will be overturned or modified.
Reform has to come, one way or another, sooner or later.  It’s coming too late for some people.

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  1. Helga says:

    Leslie, I don’t know what the answer is. Letting government run the health insurance in this country makes me cringe because they administer everything else so poorly. I work a lot with the SSA (don’t get me started), so I can just imagine being sick and having to deal with that. On the other hand, my dad in Germany just entered the hospital for some tests. He has supplemental insurance that guarantees him to be treated by the “head” surgeon, gets a private room with all amenities, etc. Yes, there are different classes in socialized medicine (at least in Germany) and if you want access to better treatment, you still have to buy private insurance. Anyway, just wanted to give you my 2 cents worth.

    • lesliesholly says:

      Thank you, Helga. I agree that our government doesn’t have a good track record of administering practically anything. On the other hand, the track record in Europe shows it can be done, so we shouldn’t give up on ways of trying to do it. I think it’s sad that we have such a superiority complex in this country that we cannot admit we might be able to learn something from the success other countries have had in this area.

  2. As someone who is self-insured because my husband and I are both self-employed, I feel your pain. I have good insurance but with a ridiculously high premium. I’ll never be insured by another company because of a pre-existing. Luckily, my kids are insured by their father who works for a large company. I don’t know what the answer is but something has to change. Especially with those with pre-existings.

    • lesliesholly says:

      Exactly. “Obamacare” is not perfect but at least he did something. Honestly I’d be for something on the European model but realize that is highly unlikely at this time.

  3. Maggie says:

    This is awesome, Leslie, a great and detailed testament. I’m adding it to my People In Your Neighborhood reads this weekend.

    • lesliesholly says:

      Oh, Maggie, thank you so much for including me!! I have been wanting to write about this for a long time. And already I am hearing other people’s stories because of it.

  4. In Canada, we have universal healthcare. While it’s not perfect and has been portrayed negatively in some US opinion pieces re: this election, it ensures that anyone who needs medical treatment will get it.

    • lesliesholly says:

      I envy your system. Here in the U.S. people make fun of it, saying you have to wait a long time, and that we have the best health care in the U.S. Whether that’s true or not, it doesn’t matter how good the doctors are if I cannot afford to see them! Thank you so much for stopping by!

  5. Lisa says:

    I’m right there with you Leslie. My kids have insurance through their dad, thank goodness, but I’m uninsured. It terrifies me, especially when I need to go to the doctor but can’t. There has to be a better way.

  6. Grant Scalf says:

    It seems to me the problem, and the problem most frequently addressed in this piece, is the cost of health care, not the need for mandatory universal health insurance.
    What happened to insurance being a hedge against catastrophic events that would require supplemental funds?
    When a single serving carton of orange juice served to the new mother post-delivery costs $300, there is a major flaw in the system. And that flaw is the lack of market forces driving health care costs down.
    Can we agree that the AHCA is just addressing a symptom and not the problem? Your eye drops should not have cost $100…

    • Grant Scalf says:

      Also, sorry for the necrophilia. I’ve awakened an old post. But it was a good read and I had some friends on Facebook sharing it.

    • lesliesholly says:

      I am far from sure that the AHCA will solve all the problems. So I am with you there. I watched a great video the other day that touched on the multiple problems, ridiculous costs being one of them. Drug companies surely bear a large share of the blame. But even alleviating the symptoms is going to help those of us who are suffering without health care now. Thank you for your thoughtful comments and tune in later–once I get signed up I think I will probably do a follow up post to this one.

  7. Heather C says:

    Thanks for sharing this. It’s such a personal topic. My husband has been without health insurance because of a pre-existing condition involving a stroke and a degenerative vascular disease. Our son, born with a congenital heart condition was denied coverage before Obamacare. It is a long and exhausting road to navigate and I hope Obamacare, while not perfect, will help us feel safer. Good luck to you and your family!

    • lesliesholly says:

      I hope it helps you too, Heather. It’s so screwed up that people who need healthcare the most can’t get it. Have you been able to get signed up yet? I got an account but the site is so glitchy I haven’t been able to get any further.

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