Tuesday, August 11, 2009

We're Already Rationed

I have a friend who has a better insurance plan than I do. She's very overweight and has a host of problems associated therewith, including rampant diabetes. Her primary care physician, after much discussion, recommended bariatric surgery. Her excellent insurance company denied payment. Because she was "non-compliant" with several weight-loss programs. And because she was (wait for it...) "overweight and had food issues." Really? Say it ain't so. I have another friend who has Sjogren's Syndrome - it's an autoimmune disease in the arthritis family whereby all your "moisture producing" glands dry up. She has chronic dry-eye, produces nearly no saliva and doesn't sweat even on the hottest days. HER insurance company denied her Sjogren's meds because they weren't in the formulary they prescribe out of, and they weren't sure that what she had was "really" a disease. I have gone from an excellent insurance company to a sub-par insurance company, because of a change in my husband's job. I am on an anti-seizure medicine that costs about $1100/month. My insurance company has stated that I must begin paying for my neurologist because she's not in the plan. And she won't sign up to be in that plan because this is a sub-par company. One of our local hospitals SUED this company because its "reasonable and customary" costs for procedures were so out of line with Medicare, which is the baseline for these charges. The company that submitted those "reasonable and customary" costs was said to be independent. But (wait for it...) it turns out that it's OWNED by the sub-par insurance company. That company is under investigation by the State of New York as we speak - for conflict of interest and price-fixing. My sub-par insurance company switched me to a generic for my seizure meds. They don't work as well. But, the insurance company says, I can get the brand-name. If I pay the extra cost - they'll kick in the $17 that the generic costs, leaving me with $1083 to pay out of pocket each month. What's my point? The wingnuts are all screaming about "rationing." You've just read about 3 cases of rationing with regular insurance companies. And we pay a hefty price for these insurance policies. And they routinely deny care. And for those who say that they want government out of their health care, I have news for you. If you are of a certain age and eligible for Medicare, you are IN a government-sponsored and government-funded (you can thank me anytime, if you are so inclined) insurance program. I'm paying for you. My kids are paying for you. My husband is paying for you. So when would you like to cancel that Medicare policy and go purchase insurance? You can't afford it, you say? You're a senior citizen or on disability and have limited income? Welcome to the world of many other Americans. Take your government-sponsored and government-funded insurance and be glad in it. Count yourself lucky. You're not in the "donut-hole" where you might have been laid off prior to being eligible and you can't afford COBRA payments. You might be a spouse who's younger than your mate - and he or she has Medicare, but you don't and you're now without insurance with several years to go before eligibility. You can try finding a free clinic or a health department clinic. But the waiting lists are long and while they do their best, there's only so much you can do with limited funds and charitable donations. Be reasonable. There are no "death panels" or committees that will determine your health care based on your productivity. I realize that at some point, some northern indigenous tribes used to set their elders afloat on an ice floe - but we don't do that here. Be reasonable. Read the bill. Contact your representatives. Attend a meeting, with NO preconceptions, and an OPEN mind and listen. Don't let your brain be coopted by nutjobs out to disrupt anything and everything. Volume of the argument doesn't make it correct. Inciting people to riot is a crime. Disrupting the democratic process is un-American. We need a universal health care option so that I'm sure my mom is taken care of. I'm sure my kids are taken care of (they're young men, not yet working in jobs that supply health care, but too old to be covered under our care). To make sure that my mother-in-law and father-in-law are taken care of. We need reasonable discussion. Not disruption. Not fear. Not anger. Not hate. Those are un-American and irrational responses to a very American problem: How to help those who need our help.

No comments: