Posted by: CarolAnn | August 17, 2009

Health Care and Health Care Insurance – How it is and how it should really be

My father had just turned 59 years old shortly before his passing on October 19, 2005. But, two years prior to his death, he had gone to a civilian hospital for his scheduled quadruple bypass heart surgery. “It was vital to his survival,” were the thoughts of the cardiologist. At the time, my father had personal reservations about the surgery (who wouldn’t?) because there was a chance that the surgery would not be successful, or worse, that he would not make it through the surgery at all. His life was in dire straits, but luckily, he had government Tricare health care insurance benefits (from his 20-year attachment and subsequent retirement from the US Army) where he could at least acquire some form of health care services.

Please donate to help save your life

Please donate to help save your life

I remember always seeing jars perched atop counters at local shops, gas stations and other convenience stores with little notes attached, “Please donate for Mikey’s heart surgery,” or “Donate to help get Sharon kidney treatment.” Of course these were just minute observations I’d made. Sometimes I chipped in a buck or two, other times the jars were so many that they just didn’t make sense anymore. The jars still pop up every now and then. I couldn’t believe that so many people weren’t (and still aren’t) getting health care treatments simply because a) they don’t have or can’t afford health care insurance, or b) their health care insurance won’t pay for the treatments for whatever reason they deem valid, or c) they had health insurance but just didn’t earn enough money to meet the deductibles or co-pays. Sad, really when you think about it.

Getting back to my dad…at the time, the choice was clear. He either had the heart surgery or he would die. That was it. There were no other alternatives. My father didn’t die from the surgery, but due to presumable inadequate hospital hygienic practices, he ultimately succumbed to a hospital-acquired infection commonly referred to as MRSA. I wouldn’t have seen it coming in a million years. The surgery went off without a hitch. No red tape, no governmental bureaucracy or intervention to prevent his health care services…just a little bug that lead a major and lethal march on my dad’s physical demise. Luckily for him, his government-sponsored health care insurance enabled him to seek secondary health care treatments at an out-of-state heart center. His health care services there, I’m sure, sustained and extended my father’s life by at least another year. In the end, there was nothing any one could do to restore my father’s physical body. The MRSA packed a fatal punch; by the time all was said and done, there was nothing – not even alternative medicine – could do to make my dad well again.

I remember, in his final months, weeks, days…how a hospice nurse came to my mother and father’s home, checking on him. We all knew it was just a matter of time, and instead of trying to fight the outcome, we were resolved to accept the fate that had been dealt him. We involved my dad in his funeral arrangements; as morbid as that may seem. But just like any major life event, we felt that by tap-dancing around the subject and avoiding his thoughts and input on his end-of-life decision would’ve been selfish on our part. My dad picked out his own coffin, even tried to get a small chuckle out of me and my mom by mentioning the fact that he’d probably not be able to fit into the coffin by the time the funeral came. (My father, though skin and bones, had taken on a substantial amount of belly fluid and was bloated from water weight gain.) When my father passed away, after a grueling two years of in-and-out hospital stays, surgeries, medicine, needles, and numerous outpatient treatments and diagnostics, he was finally at rest. He crossed over in the wee hours of the morning, resting gently in his favorite recliner, with family all around him. I’ll never forget that moment as long as I live.

So here I am today, recollecting my thoughts, experiences, and encounters with the medical community, health care insurance, and the senseless fight over these issues while people continue to struggle and die. This brings me to my own experiences. When I was injured on the job back in 2000, I was personally paying for health care insurance through my employer. It was expensive, but I had to have it. Little did I realize, and so I learned, that even having paid-for health care insurance, that my health care insurance would not (and didn’t have to according to workers compensation laws) pay for my health care treatments.  You mean to tell me that after years of paying for health care insurance that my insurance provider did not have to pay for my health care treatment? No. It didn’t and it wouldn’t. I was forced to adhere to strict workers compensation insurance that decided whether or not I would receive a treatment, when I would receive it, and whether or not I’d get a weekly check from the compensation board depending on whether I’d taken the recommended dose of prescription drugs, invasive diagnostics, or otherwise.

In the end, I was tossed to the wayside with a small settlement that barely covered the expenses I had incurred while facing a life-altering physical dilemma that would still to this day, infringe upon my everyday living. I’m one of the fortunate ones, though. Even after numerous neurological exams, diagnostics, and professional advisement of how I “should get use to it” (a wheelchair), I arose from that chair and am thankfully able to walk.  Call it a miracle, Divine intervention, or maybe just the fact that I’m supposed to serve a higher purpose or another special purpose here on earth, I don’t know. What I do know is that time and time again, paid-for private health care insurance is tied into a strategic bureaucratic monopoly of elite investors and for-profit organizations, which really don’t care about you, me, or anyone for that matter. Bottom line is if you’ve got private health care insurance, you have more to worry about then if you didn’t at all.

cbl-car-wreckIn fact, for the times that I didn’t have health care insurance (including now thanks to a recent financial loss) hospitals will still see you. The cost is higher, and if you can’t pay, the existing costs are shifted to those who do pay for health care insurance. Think of it this way: Do you own car insurance? Yes, you must in order to drive your car legally on the highways and byways. There’s a clause in your insurance policy called, “underinsured motorist coverage.”  Do you know for what that is? That’s the part of your car insurance that pays for ALL the drivers who get on the roads without car insurance. All in all, you’re already paying the dime for the have-nots. But at least you’re protected in the event that you get into a car crash and the other driver doesn’t have insurance. Right? Imagine the price ticket of that medical bill? Speaking of which, do you really believe that your private health care insurance provider is going to pay for your car accident? Nope. Ever get those neat little questionnaires in the mail asking you multiple questions as to whether your health care event was caused by an accident? Where? When? Etc. If the accident was your fault, your car insurance is going to pick up the tab — whatever is left over will fall to your health care insurance provider. Your health care insurance then has the right to sue your private car insurance to reimburse its costs to pay for your health care. Guess what happens next? 1) Your car insurance is going to sky rocket. 2) Your health care insurance provider may raise your rates or even drop you. It gets better. If the other driver didn’t have any car insurance, you’re still going to foot the bill. One way or the other, someone is going to get waxed…and I assure you, it’s not the other guy and it’s not your private health care insurance provider. This, by the way, is based on personal experiences.

When my son broke his hand years ago, I received a letter in the mail from my health care insurance provider wanting to know whether or not my son had injured himself at work (Ha! He was a middle-school student.), or on “someone else’s property.” Strange thing is that you’re afraid to reply truthfully. What if he’d been injured on my porch steps? Would my home owner’s insurance have to pay for it? Or what if he’d been wrestling in a neighbor’s yard; would their home owner’s insurance have to pay for it? People often wonder why there are so many lawsuits and malpractice suits in the legal system. Most average citizens don’t involve themselves in drama or would choose not to get sucked into a major lawsuit; but the reality is that when insurance companies are constantly suing one another to get out of paying for providing health care to the individuals that have been paying them for years on end, what example is that setting?

In my opinion, the private health care insurance industry is a double-edged sword. On the one hand, they claim that they’ll take care of you. On the other hand, when it really counts, they turn a quick about-face to find another source of payment to cover your treatments.

Family is what matters...and health care is important to all.

Family is what matters...and health care is important to all.

So where does this leave us, the average citizens…families, who just want to do the right thing? I don’t have a simple answer to that question. I always thought I was doing the right thing by paying outrageous rates for health care insurance and learned that in the end, it’s all about who foots the final bill. Usually, it’s the people like us, who’ve done every thing in our power to protect ourselves. We’re the ones who are chucked to the coals.

Is a public option the right idea? I can’t really say. But I do know one thing. If we don’t try another avenue to help all people to get adequate health care at an affordable cost, big insurance wins. They win on every level. They win the right to keep suing each other. They win the right to deny your care. They win the right to say that you don’t need end-of-life counseling. They win the right to make you cover the costs of everyone. They win the right to keep raising rates even when the economy is in such poor shape. They win. We lose.

This is one public battle that should never have been waged against the people of America. This is a fight for the American way and treating others as we would have done onto us. If I was a doctor or health care provider and I saw a sick child, a dying man, a lame woman, I couldn’t turn the cheek because the insurance company won’t pay for “specialized treatment.” As a human being, it is my priority to show compassion and humanity in the face of adversity. And that’s the way it should always be. Period.

Just some thoughts…maybe we all need to read the health reform package before we toss it to the wayside.

Health Care and Health Care Insurance – How it is…and how it should really be

OpEd by CarolAnnB – Social Media Sorceress

(CarolAnn Bailey-Lloyd)

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