Sunday, January 15, 2012

Is it class warfare after all?


I hate to even ask this, I really do. But, after looking back over my journey for the past 14 years, just passed this mark on New Year's Eve, I have to answer a resounding yes. Is it class warfare after all?  What class warfare you are asking by now?

Medical class warfare I scream! And what is even more disappointing to me, I can't seem to see a resolve to it all...not at all.

Let me explain a bit further of where I am coming from with all of this. My son, now thirty, has a half way decent job and a typical middle class salary with it. And yes, I know that even keeping employment right now is a God send. He also has insurance for health care. Unfortunately he also seems to have inherited some of my autoimmune genes as well. He has been diagnosed with sjogrens recently. Now having insurance one would think that one could go to the needed doctors, receive the needed prescriptions (copays expected) so that one could continue to stay gainfully employed and hopefully give back to society as well.

Well, that just isn't the case. I would scan in the document he unearthed in his health care plan but I am afraid that may cause too many problems but I do have a copy of it. Apparently they have an exclusionary list of ailments that are not covered. This has nothing to do with pre-existing conditions and excludes all insured on this plan. Now, when did all of this happen? I am not talking pre-existing conditions but refusal to pay for any care for over 36 diseases or conditions. Some included on the Uninsurable Conditions list are:

AIDS
Alzheimer's disease
ALS (Amyotrophic lateral sclerosis)
Anuerysm
Acoustic Neuroma
Cardiomyopathy
COPD
Cirrhosis
Collagen diseae
congential heart defects
congestive heart failure
Chrohn's disease
Emphysema
Hep B and C
lupus
muscular dystrophy
polycystic kidney disease
rheumatic heart disease
stroke
sjogren's syndrome
tay-sachs disease
transplants

Wait, I am not yet done. And now add something called Ratable Risks. According to this document "the following medical conditions are uninsurable for specified time frames and ratable risks thereafter. Whether they fall into an uninsurable or ratable category may depend on time frames, severity of conditions, treatment, stability, and prognosis. This is not an all-inclusive list but a reference of many conditions of questionable insurability. Some listed conditions may require a rating that exceeds our risk tolerance, and coverage will be denied indefinitely."

Some on the list include (63 conditions total listed):

addison's disease
adhesions
agoraphobia
alcoholism
amputations
ankylosing spondylitis
anorexia nervosa
atrial fibrillation
cancer
chronic fatigue syndrome
colitis (ulcerative)
diabetes mellitus
encephalitis
hypertension
lupus
multiple sclerosis
obstructive sleep apnea
pancreatitis
parkinson's disease
peripheral vascular disease
rheumatoid arthritis
TB
etc.

Yes, this is indeed class warfare! If one has lots of money, one can pay cash for their doctors, medications, etc. or even buy insurance at a very high premium to cover these conditions but if one has this insurance(and I am afraid almost any insurance of late), is middle class or lower class, one can't afford to get sick at all!

I was wrongly under the assumption that insurance in this country should cover something but it behooves me, or anyone reading these lists, to exact what precisely they are covering at all.

I welcome a discussion on this as although I don't want to get political on my blog, I am starting to realize that perhaps at some point we need to get political. I for one value human life and I will clearly state that I do believe we should provide healthcare for all and for all conditions. How do we resolve the insurance issues, cost of prescriptions, and medical care currently ravaging not just our economy but humans as well? If we don't stand up for healthcare coverage for all, many will die in this country (and many have already died). We need to ask ourselves precisely what values we hold dearly. Do we believe that life and health are a cost that should be shared by all? Do we believe that it is the individuals responsibility to acquire their own treatments, even if this ultimately leads to their own death due to lack of money? This is truly the bottom line and yet I have not heard this mentioned on the national news media in these terms.

How much are we willing to pay for a "healthy" life?
$5,000
$10,000
$20,000
$30,000
$100,000
$1,000,000
$2,000,000

And more importantly, how do we as individuals begin to make the changes we believe are so desperately needed in this country?



9 comments:

tharr said...

I wished I knew Deb. It seems that anyone that is in a position that could make changes chooses not too. I am starting to look for a new rheumatologist because my insurance provider had slipped a clause into the new contract and the network of doctors that my rheumatologist belongs to would not sign it until they took it out. So, I'm having to look for a new doc because of my insurance provider. It's frustrating ... they want to be relieved of paying all of the specialists charges but what happens if you don't pay all of the premium to them? Bottom line, it's all about money, they don't care about you or me.

abcsofra said...

Tharr...my heart goes out to you. I was on that roller coaster of constantly having to change ra docs when I was under my hubby's insurance as a secondary. In the end I just stayed with the doc from my plan and paid the additional copays. But it needs to be fixed. Bottom lines shouldn't apply when health and life are involved. I think this issues speaks strongly to our values in the US and it worries me alot. I have seen this slippage onset since 1980's and maybe even before. And I have worked on managements side all my working life. It is a tragedy unfolding and I can only hope that we as citizens wake up and at the very least put our bucks where our hearts are. I was happy to see the BOA "riot" over the additional fees, the withdrawal of massive amounts of customers from Netflix when they doubled their fees. It is high time we do what we can with what we have left. I know this doesn't resolve the healthcare crisis here but it is a good start in my book. I will refer to it as the trickle up effect :-) I hope your care stays consistent with this new doc. Got my eyes crossed for you :-) ...never my ra fingers.

Theresa said...

This saddens me beyond belief. I've shared your post on my blog - I hope that everyone who visits reads it. It is difficult to remain hopeful in times such as these - to remain compassionate and not full of anger. As I said in my sharing of your writing - the question begs an answer - so what shall "I" do? Compassion must be coupled with action. The first step, I believe, is to be informed. Writing what you did, risking being "political" - is doing exactly that - informing. We need to hear more personal experiences so we can realize that we are united in this very systemic problem. No one is without responsibility.
Thank you Deb, for going out on a limb with this one. I appreciate it greatly.
And I am so, so very sorry about your son. Please wish him well and let him know there are many praying for him.

Theresa
OneMomentOneLife.org

Cathy said...

For years I have been frustrated that any alternative treatments I have tried, especially working with a naturopath on diet, has never been covered by insurance, but this is ridiculous with your son.

I have always felt that the information that my naturopath gives us as a family has contibuted to my children not having to see our family doctor in over ten years and me only having to go for RA issues in the same length of time. I would say we have saved the insurance companies a ton of money. My husband has worked for three companies now that pay for a RX he needs in order to work and then they stop paying. To pay for it ourselves out of pocket would mean losing our house. So, we have looked elsewhere for this RX and found it at a fraction of the cost. I don't know, the whole thing really frustrates me especially when our premiums and copays keep going up and the services provided keep going down.

Good luck to your son and I hope to read more on this issue here.

Deb aka AbcsOfra said...

Theresa...I have so often wanted to become involved but I find that my physical problems truly limit me. I have researched about how to be heard and find that online is limited (meaning emailing your political reps). I have read that going face to face is better and makes a bigger impact. And my heart breaks for those without insurance at all! I can't tell you how many fall through the cracks because they make over the limit (which is a really low limit at that) to qualify for state/fed programs for assistance. And yes, I truly believe this is a MORAL issue we are discussing here. If one believes that one is responsible for themselves including healthcare and said person can not afford it...what are we truly saying. "You life isn't worth anything?" Because in fact this is what is being said and said very loudly. And then try to touch in any sensible way the opportunity to reduce healthcare costs and corporations which do protect their bottom line, pay millions to lobbyists to combat any changes at all. I am not professing I have the answers but I think it is high time we add life into these discussions and question politicians specifically about how they value life.

Deb aka AbcsOfra said...

Cathy...don't even get me started on this one. I sooo agree with you. But I feel alot of why we can't deduct these expenses goes back to lobbying efforts but once again. How did you save so much money on the RX? It needs to be screamed from the roof tops to others as many have had to stop taking meds due to the cost. Recently I had this very discussion with my endo doc about whether he would agree to me using generic thyroid meds. He and two other endo docs in the past as well have said I need to stay on the brand as generic fluctuates from pill to pill too much with the thyroid meds. He was kind enough to give me one months free of brand thru a sample...bless his heart. I have written a blog post already about how to save money on meds but would love for you to add how you guys saved so much. Spread the love around...so to say.

Wren said...

This is surely one of those "hot button" issues, Deb, and one that is unfortunately political. I believe we've made a good start toward quality healthcare for all Americans with the Affordable Care Act (Obamacare), though it's far from perfect. I'm not sure how the AFA addresses the kind of limits to health coverage your son is facing right now. It appalls me that a health insurance company--that takes all those premiums from those it "covers"--can simply make a list of illnesses and chronic conditions they will not cover. And other illnesses and diseases that they reserve the right not to cover if they don't want to. That's not ethical. In fact, it's robbery.

How can we change this? I think by defending the changes we HAVE accomplished so far and not allowing the big money interests--including our fat cat politicians--to take quality, affordable health care away from us. And we need to speak up and continue to improve what we have.

My heart goes out to you and your son, who surely never asked to get Sjogren's, just as you never asked to get RA. Shame on his health care insurance provider.

Deb aka AbcsOfra said...

Wren...this issue has been on my mind for years as I have often heard from others with ra and chronic illness with worse situations then my son. At least he has a job. I really believe that if we could get money out of politics we might have a fighting chance. I know that Occupy Wall St. has finally found a common ground with many other groups and this is the very ground...to get money out of politics and elections. I soooo look forward to that day. I believe if that ever happens alot of the garbage that really makes no sense at all...common sense has been over run with money...we might then get back to business and what the majority of this country thinks is important and needs to be fixed. I just hate that my son has an autoimmune disorder. I was diagnosed after I had both my children. And yes, this issue is most definatly a hot button. But in reality it shouldn't be. If politicians could once again negotiate like they are suppose to and listen to their consituents, things would change for the better here in the US. Thank you kind thoughts about my son.

Candee said...

It truly sickens me Deb. How many of us have been "divorced or fired" by docs/rheumies? I saw a young mother of 3 tell doc oz on tv that she has no insurance so she was seeking his advice on his television show!

I'm one of your biggest fans deb, thank you for thought provoking posts like this one.