Our Broken Healthcare System

Blue and Moist

My sister Katie writes about her travails with America’s broken healthcare system, and her insurance provider, Aetna:

I don’t let Lupus define me. Most of the people I encounter everyday don’t know I have it. But, I do, and for the first time since I was diagnosed 10 years ago, I am speaking up.

The fall of 2000 and the beginning of 2001 was a busy time for me. I was planning a March wedding, in college full-time, had both an internship and a part-time job. For most of that time, i was feeling run down and achy, which I attributed to my hectic life. However, I then developed what looked like a rash on my legs. After a week or so, when it didn’t go away, I had it checked out by my family doctor. He referred me to a specialist, a hematologist. The hematologist examined me, ran several tests and since the “rash” was actually inflamed blood vessels, he gave me a prescription for a corticosteroid (Wikipedia: prednisone). A few days later, while with my brother picking up his groomsmen tuxedo for my wedding, my Dr. called me with the results. All the test results pointed to Lupus (Wikipedia). He told me to enjoy my wedding and I would see him again a few weeks later. That was the first (of many) occasions where I told myself to bear up and focus on the positive. 

Over the years, I have seen the specialist at least twice a year and have controlled a fairly mild case of the chronic disease. I have had two, healthy children, hold a full-time job that I love and lead a fairly normal life. However, there have been many days of pain. My joints are arthritic and achy. I run low-grade fevers often. I can’t spend much time in the sun and I sometimes am so fatigued that I can’t get enough sleep. Recently, I have had new symptoms that include pain and a heavy, tingly feeling in my legs. This may be from arthritis in my spine. (I’m waiting to get some lab work back.)

Besides a handful of short rounds of prednisone over the years, the drug that has given me the most relief has been Celebrex (Wikipedia). Celebrex is classified as a Cox2 inhibitor non-steroidal anti-inflammatory drug (NSAID). It suppresses the inflammation, so fevers, arthritis, and fatigue aren’t a problem while I am on the medication.

I was recently denied coverage of Celebrex by my health insurance company, Aetna. When the nurse called me with the news, I was shocked. My first thought was: how can I live the rest of my life in pain? My doctor’s office is still fighting the insurance company, but I am starting to lose hope that the drug will ever be covered. The out of pocket cost is $180/month. Aetna has specific criteria the patient must meet for the expensive drug to be covered. One of them is having documented gastrointestinal bleeding. In other words, I have to be bleeding internally from taking cheaper medications, in order to be on a more expensive one. Make sense? No.”

I would describe our healthcare system in one word: broken. Why should anyone, including the health insurance companies, make a profit from people being sick? Why aren’t more politicians trying to change this? I don’t want to fight this problem for the rest of my life. People who are really ill don’t have the time (and many don’t have the resources) to do so.

While I know that this blog post won’t change the system or make my pain go away, it feels good to put it in words.

Insurance Companies Pour Money into GOP’s Hungry Craws

Surprising to nobody, yet still somehow depressing. Funny how the Tea Baggers don’t care that the GOP is bought and paid for many times over by the insurance corporations, and others of their ilk. Talk about corruption of the elites…

Treasure Chest - Nadeau

— Faced with wide-ranging new requirements in the health care law, the insurance industry is pouring money into Republican campaign coffers in hopes of scaling back regulations while preserving the mandate that Americans buy coverage.

Since January, the nation’s five largest insurers and the industry’s Washington-based lobbying arm have given three times more money to Republican lawmakers and political action committees than to Democrats.

That is a marked change from 2009, when the industry largely split its political donations between the two parties, according to federal election filings.

The largest insurers also are paying hundreds of thousands of dollars to lobbyists with close ties to key Republican lawmakers who could be shaping health policy in January, records show.


(click to continue reading Health insurers: Insurance companies pour money into GOP campaigns – chicagotribune.com.)

The other thing is, how do insurance companies have so much profit anyway to piss away on lobbyists? From insanely high premiums, right? If their profit is regulated at 15%, suddenly the money spigot dries up.

Health Care Reform Will Affect Your Wallet

Seems like a reasonably non-partisan analysis. The new, welcomed Health Care Reform might have a small effect on a few of our unreimbursed deductions it seems. For years, our business has paid for our health insurance out of our heretofore1 meager profits, and despite nobody actually using the insurance to pay for anything, our premiums have skyrocketed each and every year. Last year alone, our Blue Cross Blue Shield premiums went up over 30%. Yikes.

Calvary Cemetery

  • Couples earning more than $250,000 a year, and individuals earning more than $200,000 a year, will see an increase from 1.45% Medicare tax to 2.35% starting in 2013.
  • Those with the higher income listed above would also see a 2.8% tax on unearned income (interest and dividends).
  • Starting in 2018, a 40% excise tax would be imposed on the portion of employer-sponsored “Cadillac plans” that exceeds $10,200 a year for individuals and $27,500 for families.
  • The threshold for deducting medical expenses (unreimbursed) would be raised to 10% of income from 7.5%, so many will lose the current tax deductions they tax advantage of.
  • Starting this year, those who make use of indoor tanning facilities will pay a 10% tax.
  • Starting in 2013, your tax-advantaged flexible spending account contributions will be limited to $2,500 for medical expenses.

[Click to continue reading How Will Health Care Reform Affect Your Wallet?]

the only real change I see is the 2.5% reduction in deducting health care costs we pay ourselves, which doesn’t translate to much real money, at least in our case, but I’m still scouring the details to see if there is anything else to worry about.

  1. we are still optimists – this year will the year we can set some aside for a rainy day. Yeah, this year []

Insurance Companies Not Automatically Included in Exchange

How badly do insurance companies have to be to their customers before they are banned from participation in the new insurance exchanges? General Electric bad? Monsanto bad? or Halliburton bad? Curious if the rules have been defined yet.

A second Hypnotic Mosiac - Garfield

A couple of hours after President Obama signed the health-care bill, an elated House Speaker Nancy Pelosi met with a group of columnists and commentators, issuing a warning to insurance companies…

Asked if insurance companies might raise their rates on health coverage and blame the increases on the new health-care bill, Pelosi said that the insurance companies should be aware that they’re not “automatically included” in the new health exchanges the bill creates.

“Unless they do the right thing, they’re not going in,” she said. “They will be relinquishing the possibility of having taxpayer-subsidized consumers in the exchange,” she said.

Under the new law, the health exchanges Pelosi referred to will be created in 2014. By pulling customers together, they will give individuals and companies a better chance of bargaining when they buy health insurance. Because the exchanges are expected to serve millions of new customers, insurance companies will want to be part of them.

[Click to continue reading PostPartisan – An ebullient Pelosi: watch out insurance companies, and Rahm is a ‘softie’ ]

Via Susie Madrak of Crooks and Liars.

The Walking Miracle

Perhaps you read of this tragic incident1

Perhaps the most tragic part of Jen’s story is that she falls into a loophole where she currently has no medical insurance.
At the time of attack, Jen was just four weeks shy of securing medical insurance from her new employer, and just 3 months away from marrying Joe, which will entitle her to spousal insurance through his employer.
Jen’s medical bills are likely to skyrocket to the hundreds of thousands of dollars. Now, coupled with the impact of her recovery, Jen and Joe have the unimaginable anxiety of how to pay immense medical bills for treatment that saved her life.
Jen, a Chicago native who loves to bike and is engaged to a Marine Corps Veteran hero, is an everyday American. This tragedy could have happened to anyone. Jen is just like you, just like your sister, just like your best friend – just like the lady who manages your favorite local restaurant. It happened to Jen…and she needs your help.

[From The Walking Miracle]

the story itself:

On Monday, August 25, 2008, Jennifer Hall was brutally attacked by two homeless people on the South Side of Chicago. Out celebrating her 36th birthday with fiancé Joe Hoffman, Jen was viciously kicked in the head until she became unconscious… an unprovoked altercation that left Jen lying in a pool of her own blood with only four teeth left in her mouth.

Medical experts familiar with Jen’s trauma said that nine out of 10 people in her condition are brain dead and don’t survive.

But Jen is fighting the odds.

  1. though, not from me, as I inexplicably failed to publish this post. Doh! Probably because I wanted to say something about healthcare in this country being so horrible []