When Danna Walker left the second-floor conference room and returned tearily to her desk ”” where someone had already deposited a packing box for her belongings ”” her first thought was not of the 14 years she had worked for DHL or the loss of her $37,000-a-year salary.
It was of Jake. In three months, once her benefits ran out, how in the world would she provide health insurance for Jake, her mountainous, red-headed 21-year-old son, who had learned three years earlier that he had metastatic testicular cancer?
Since the day she was laid off in October, Ms. Walker and her husband, Russ, co-owner of a struggling feed store here on the outskirts of Houston, have mounted a largely fruitless quest to find affordable coverage for Jake’s pre-existing condition. Their odyssey has become all too familiar to millions of newly uninsured Americans who suddenly find themselves one diagnosis away from medical and financial devastation.
I am not commenting as an expert; but my understanding is that as a 21 year old he would not have been covered under his parents insurance for much longer in any case. Second, a terminated employee can continue medical coverage through Cobra for at least two years ( if they pay the premiums). Third, the son could qualify for Medicaid as long as he does not have significant financial assets. According to the story this is not true in Texas. I don’t know about that but I have never heard of anyone ultimately being refused treatment, although the paperwork can be a nightmare.
I had a friend whose daughter was diagnosed with bone cancer in the three month period between college graduation and starting her first job as a teacher. She was too old to be covered by her parents policy. She is cancer free three years later; all paid through Medicaid.
But I would still say we have a system that is not sustainable.
Jimmy is correct. He probably can’t be covered by his parents insurance at his age. Now think about it: ten years ago there was none of the fancy treatments that cured him and cost two million dollars. We simply have priced ourselves out of high tech medicine. You usually can get doctors who will treat you for little or notheing if you look and ask, but they can’t pay the hugh cost for all the studies, chemotherapy drugs and lab and xrays that the standard of care requires. His best bet is to try to find a teaching hospital that will take him on, but those are under financial pressure also. Some hospitals have social workers that can help him hunt, but many hospitals have stopped that since it is no longer reimbursed. I don’t know what is the answer, but part of the problem is lots of government regulations and legal risks.
In any state I am aware of Medicaid is not available unless the young man is totally disabled under Social Security regulations. Most likely he is not. Many people labor under the mistaken belief that if you cannot afford insurance Medicaid will be available. However, unless you are supporting a minor child, you must be over 65, blind, or totally disabled in order to qualify for Medicaid. Further, it can take months to obtain a disability determination.
As far as people dying from lack of treatment, it happens all the time. Women who can’t afford mammograms die of breast cancer. Men and women who can’t afford regular checkups and expensive tests die of undetected illnesses. Sad? Yes, but as my more conservative friends tell me, that is the price of maintaining a free market medical system. Some must be allowed to suffer and possibly die to instill fear of being uninsured in others. Sometimes, however, I find it difficult to reconcile with my Christian sensibilities.
It is insane (and a total historical fluke) that health insurance is tied to employment. Imagine if, instead of developing a public education system, about 100 years ago employers started throwing “free education for your kids” in as part of your compensation package, and that had persisted up until now. So if you had a good job, your kids went to some fantastic private school, but if you lost your job (unless you could pick up the tuition yourself) your kids got pulled out of school until you could find another job.
Not only is the way we pay for health care crazy, it also causes a total distortion of the market for labor. (And is one of the reasons our car manufacturers are going broke.)
Amen, Catholic Mom!
My state, North Carolina, now has an insurance program for people who can’t get coverage because of pre-existing conditions. I suppose it costs more than private insurance, but then, that’s not really unreasonable, is it? It means that people can sign up for catastrophic coverage to protect themselves from the costs of devastating illness. Sounds to me rather comparable to high-risk auto insurance pools for people with driving problems. I favor a market-based approach to insurance and medical care, and if/when such a system is implemented, something like this high-risk pool is going to be needed because we are at our core a generous people. Nobody can afford to go on the way we are, and I am totally unconvinced that nationalized care will reduce the cost.
Virtually ever state has an insurance pool for people with preexisting conditions. However, it is extremely expensive and if you have lost your insurance due to loss of job, it is highly unlikely you can afford to be in the pool. COBRA coverage is very expensive, but much less expensive than the state pool, so if you cannot afford COBRA you cannot afford the state pool.
I’m not sure what you mean by I favor a market based approach. A market based approach is what we have now. Employers are not required to offer insurance coverage to employees and employees are not required accept coverage from their employer. Insurance is offered as incentive to attract good people. That is a business decision, and a practice fewer and fewer businesses are following. Most businesses now only pay a portion of the health insurance cost, and that portion is decreasing every year. The alternative is a private plan.
I read all the above, including the comments, with a heavy heart for people struggling to find treatment. I know y’all do not like socialized medicine, but the article suddenly made the NHS here in the UK look a whole lot better. The architect advising our parish has just been treated for testicular cancer, and received the all-clear at the 12-month check-up. It has cost him nary a penny beyond of course the taxes that we all pay.
Catholic Mom:
I sort of understand your point, but I believe it is historically inaccurate. Medical care was largely unavailable to the average American in the early years of the industrial revolution. After a while employers began seeing the benefit of providing some health care to assure the health of their work force. The was provided in the form of company doctors and company nurses, who provided emergency and some preventative care mostly to factory workers.
The rise of health insurance occurred with the rise of unions. Unions, seeking to obtain a better life for their members, began demanding access to health care for themselves and family members. The employers responded by implementing health plans as part of the compensation package. This practice spread to non-unionized employers partially as a way to stave off unions, partially because medical care was, at the time, inexpensive; and partially because a healthy work force was good for the employers, who were requiring 10 hour days, 6 days a week.
MCPLAW, insurance as an employment perk has its roots in the very high tax rates immediately post-WWII. Employers can deduct it, and it’s a way to increase wages without increasing tax liability. Before that, you pretty much paid for medical care as you went. We haven’t really tried health insurance offered the way car insurance is for the largest number of people. Are you the same guy who tried to convince me that Medicare is a great deal? It is, so long as our children and grandchildren keep paying more and more for it.
Katherine:
I have never tried to convince anyone that anything is good or bad. You asked if anyone had any good news about Medicare and I responded that I had many clients who received excellent care under Medicare. If you were unhappy to hear that I am sorry.
However in your particular case I believe my point was you were not required to use Medicare, you could buy a private health insurance if you thought Medicare was not a good deal. You seemed to be laboring under the mistaken belief Medicare was mandatory, when it is not. You also seemed to be laboring under the mistaken belief that Medicare somehow restricted your health insurance options, which it does not. Just as you now you seem to be laboring under the mistaken belief there is no difference between insuring ones health and insuring ones car, or that we are not operating in a market based health care system; which we most certainly are; if your are not on Medicare.
I do not know what you do for a living, but I deal with these issues on a daily basis, and if you believe we would all be better off if all of the insurance policies were cancelled and everyone was told to go out an find there own insurance you are simply wrong. As I recall you said you have a preexisting condition, which means you would be one of the people unable to find insurance.
If you don’t like the current system opt out. The system you want is out there. Give up your group policy, buy private health insurance, and insure your preexisting condition through your state pool.