Healthcare is a Bitch

I went to doctor on Tuesday. No, not the gynecologist. I know, I know. Must do that. But those oh-so-joyous plans were preempted by a more pressing need. At the start of my last cycle, I took some Advil for my always-wicked cramps. I found that it gave me a pretty painful stomachache, even if I took half the adult dosing, so I stopped taking them and the pain receded. This month, at the start of my cycle, I took one solitary Excedrin before bed. Just one. And I woke up at 5am with a belly full of fire. I woke up and ate a muffin and it seemed to soothe it, but an hour later it was killing me again. I ate crackers. It soothed it. 20 minutes later it was killing me again. This went on for several days, although I had only taken one solitary Excedrin. It was clearly no longer an upset stomach irritated by a medication.

I had the suspicion that it might be the start of an ulcer, based on the type of pain, the frequency of it, and the location. It felt like strong hunger pangs, although I was not hungry, coupled with burning. So, I made an appointment. I do not have health insurance. In making this appointment, all sorts of things ran through my head. Diagnostic tests, lab fees, medication costs. It could be pricey. I went to google for information and found this.

Here is a sampling of the provided examples:

Sore throat, office visit:
Your throat hurts, you go to the doctor. Price includes visit with physician and Strep test. Test was negative. $109

Tubes in ears
Your child has had chronic ear infections. The decision is made to insert tubes his ears. Price includes office visit 30 days before procedure and 30 days after, day surgery charges, antibiotics, drops and decongestants. $2,719

Chest X-ray
You go to the clinic with a bad cough. Your physician thinks it may be pneumonia and orders a set of X-rays to help make the diagnosis. Price includes clinic visit, X-ray and reading of the results. $183

GI Endoscopy
Conducted by a specialist. Scope exam of the gastro-intestinal track on an outpatient basis. Includes conducting the test and reading the results. $1,398

Broken arm
Your child jumped off the swing set. Price includes ER visit, X-ray, simple cast. $2,523

KayTar has insurance, BubTar and the rest of us do not. Do I understand the risks? Yes, I believe I do. Do I like having to take those risks? No, I do not. You see, the insurance Josh's employer provides is extremely expensive. We pay between $800-$1000 per month for his company provided insurance, plus the co-pays are ridiculously high, therefore not helpful for everyday needs. We do not have that sort of money available to pay out monthly. No matter how tightly we adjusted our budget, which is very tight to begin with, we could not squeeze that much money out on a monthly basis. And so, when we found out what was happening with KayTar, we squeezed out that extra money to get her on an excellent plan. It is expensive for an individual plan, but the benefits are amazing. Her plan ends in February. They said that the co-pays were too high and they haven't seen enough interest in their plan, which basically means they are canceling it because they are not getting THEIR money's worth out of the "product".

Now we are faced with multiple issues. KayTar's perfect insurance is ended, so we must find her a workable plan. This in itself is no easy task. Every plan I have checked into does not cover her therapy needs, at all. There is no coverage for developmental-based therapy after the age of three, unless you qualify for something called "High Risk Pool" insurance. I'll come back to this later.

Her insurance started in August 2006 and will end in February 2008. HIPAA's protection of pre-existing conditions is effective only if you have been insured for 18 months prior to your current enrollment. February will put us right at 18 months, but I do not know if her enrollment DATES matter in this case. I am not sure that it will truly be a full 18 months, based on start and end dates and that makes me very nervous. If her pre-existing conditions are not covered, that means anything related to hearing loss, gastrointestinal problems, neurological problems, genetic problems, feeding issues...basically anything we have fought through for the previous year WILL NOT BE COVERED. Tell me, if none of that is covered, WHY DO WE NEED INSURANCE? We will be paying them for absolutely no reason, because they will not be paying out in any of the areas she has need of. Does that make sense to you?

Part of the reason we've fought so hard for a diagnosis recently, is because we know this window is closing; we know that if her pre-existing conditions are excluded we are sunk; we know that "High Risk Pool" might be the only way we can go. Here is the kicker, "High Risk Pool" only covers certain diagnosis from what I understand. What about kids like KayTar, who are medically needed, who need good solid coverage, but they aren't one of the "lucky" kids who have a label to attach to their symptoms? If KayTar, had diagnoses seizures, then we would be in! But bizzare neurological episodes accompanied by EEG abnormalities, brain lesions, developmental delays, feeding issues, and hearing loss? Try again. And it is also astronomically expensive. Basically once they are in the high risk pool, normal insurance will never cover them again, even if they "outgrow" their issues. They are a health risk, and insurance companies can't really make money off of those kids.

Did you know that our state provides an SCHIP program through the very company that KayTar currently has insurance through? With identical benefits? Did you know that we are eligible for this program if you use our net income, but if you go by our gross income we are just over the line? Just over the line! We don't even receive any of that money! Do you know where it goes? Taxes. We are paying the government to provide services like this for people in need and the TINY bit of money that we give is what keeps us from not being eligible for the programs ourselves. How can that be right?

The bill President Bush recently vetoed would have provided insurance for my kids. Not some faceless huddled masses. These kids. MY kids.



He can ask for $200 million to go towards the war, but we cannot spare $35 million for our children's healthcare. How is that right?

We are responsible parents, trying to make the best decisions in a situation that is not ideal for a number of reasons. Would things be different if KayTar's level of need wasn't so high? Yes, it likely would. But that isn't OUR reality. A lot of things would be very different in an ideal world, but that isn't where we live. We live here, mired in these challenges and I can't understand how our government can continue to hemorrhage money into this war and refuse to put a fraction of it to help children in need. It isn't even about socialized medicine, which I suppose is the big Republican fear. It is about the very real problem created by a healthcare system that is more geared to making profit margins grow, rather than actually provide affordable, worthwhile care. People suffer in that sort of system. People who don't have enough money to be a worthwhile investment for these companies to cover. People who need the coverage too much are denied. "Sorry, you will use this insurance too often. We only provide for people who will pay us ridiculous sums of money to provide peace of mind. We really try not to pay out in the event of actual medical needs." It is not a good system. It is not a HEALTHY system. Sure, there are people who function within it just fine, people with enough money and low enough levels of needs...but what about the people who fall outside those parameters? What do they do? What do WE do?

I went to the doctor on Tuesday. My doctor knows I do not have insurance, so rather than send me for diagnostic tests and lab work to confirm the ulcer suspicion, he called it gastritis and gave me a months worth of medication to help an ulcer heal. He also told me to come back after the month if I am still experiencing pain and we will go ahead with testing. The visit cost me $40. The medications were free. There are good and helpful doctors out there. Doctors that will help as much as they can when they know you are in one of these situations, but the system shouldn't be so broken that they are necessary. If our kids were eligible for SCHIP, Josh and I could take the money we put towards KayTar's insurance and get ourselves on an individual plan. Everyone would be covered. We could afford it. We could live with it. But unfortunately that is not the case, and it might never be. So we have to find a solution right now, in this system, and I don't know that it will be possible.