Health Care Hunkered

Alright. Now I'm mad.

What do I do when I'm mad? Why, I blog, of course.

The Health Care crisis in America has long been a hot button issue for me. I've been an advocate for socialized medicine for years. I realize it's not a perfect system, but nothing is.

So I've sorta kinda had a piece about it on the backburner for a while. But I never really dug in and tackled all facets of what is, ultimately, a very complex issue. It hurts my brain to think about it. Health Care reform is a huge undertaking. Gargantuan. Herculean.

But now it has come to bear in a very personal way and I find myself angry all over again. And feeling very helpless, hopeless and scared.

Recently, Husband's company changed hands, and with it, our health insurance. Our benefits under the old company had gradually become less and less comprehensive, while our premiums, and our co-pays, of course, increased. But, I was ludicrously grateful, because they would cover 12 visits with a mental health practitioner per calendar year. Because obviously anybody who needs more than that is just being melodramatic.

While his boss shopped, we had an entire month where we had no insurance coverage. We did not pay for Cobra, as all but the most dire illness and/or accident would have cost less out of pocket than the premium for a family of four.

When he finally chose a carrier and our benefits were restored, the first thing I did was to check to see if all our family health care providers were included in their provider directory. Our family pracitioner was on their list. The boys' therapists and the ADHD specialist that had been recommended for Diminutive One were not. Nor was the Orthodontist or the Dentist.

Diminutive One's therapist graciously agreed to obtain a provider exception on the basis of continuity of care. She did this despite her misgivings about this carrier; misgivings based on professional experience in the past. She then jumped through hoop, after hoop, after hoop on Diminutive One's behalf. It was enormously frustrating. Calls were not returned. Erroneous information was given. She was passed off from one person to the next, none of whom seemed to know what the hell they were talking about.

It was then that I began to be really afraid.

She is still tryinig to gain the exception, and Diminutive One has not seen his doctor for 3 weeks. We can only afford one visit per month out of pocket. The results are showing. She was a calming influence on all of us. We need her.

Today I went to pick up a refill on Pre Pubescent One's Strattera. Our old copay was $45. I thought that was bad. Now, it's $60. AND...they will only cover one pill per day, per month. He has been prescribed a twice daily dose, and that is what he has been taking for three years. Now, some insurance yahoo, who has never met my child or reviewed his medical records, has decided that he only needs one pill a day. Because that's "standard". I could perhaps save some money on doctor's visits and just consult them directly regarding our health issues.

Of course, I can obtain 30 more pills at my own expense. For $150. Yes. That's a combined monthly total of $210.

To say that I was livid would have been a massive understatement.

I cannot obtain a generic equivalent. Some ADD/ADHD meds do have generics available, but Strattera is a fairly new drug. And because a drug must be on the market for fifteen years before generic producers can challenge the patent, it will be quite some time before one is available for us. Sometimes the big drug companies pay these producers to drop their challenges. They make it worth their while. Everybody benefits. Except the poor bastards that need the medicine.

And here's where a large part of the problem lies.

Capitalism and health care do not make good bedfellows. In fact, I think it's a gross and egregious conflict of interest. When profit margins become more important than people, the quality of care is always compromised. When we take medical decisions out of the hands of doctors, and put it into the hands of actuaries and accountants, we are pandering to a bottom line rather than a patient's needs.

That's a failure of the system in every conceivable way.

Unless you're looking at it from the perspective of the insurance and drug companies, in which case, everything is coming up roses.

I have two children seeing mental health professionals for attention deficit disorders. My youngest also has anxiety issues. Right now, I have one child on medication, but soon it will be two. The combined costs of prescriptions and therapy will quickly become too much for us to handle on one income.

Despite the fact that my husband makes a very good living (good enough that we do not qualify for any government subsidized assistance for health care costs) I anticipate having to go back to work to make sure my kids have what they need to be healthy, happy, productive.

That's wrong. Not just for me, but for everybody. And the really crappy thing is...we are one of the lucky ones. My children don't need this medicine to live. And I have resources. I can and will get what they need.

But people in America are going into debt to pay for prescription drugs. They are going into debt to pay for diagnostic tests. They are getting second jobs and second mortgages to manage the cost of chronic but treatable diseases such as Diabetes, Epilepsy, and IBS. People are not seeking treatment for mental health issues because those services are not covered and the expense is astronomic.

Why are we allowing this to happen?!?! Why is the issue of health care reform not at the top of every candidates political platform? Why do let our health and that of our families play second fiddle to the almighty dollar? And why are we allowing the drug companies to form monopolies on drugs that our children, our grandparents, our friends and neighbors and the mailman NEED to maintain their quality of life; sometimes, to sustain life itself?

The pharmacists, who is also the proprieter of the small independant drugstore where we buy our meds, was, bless his heart, completely outraged on my behalf, and the behalf of all his customers. I asked him if he had much experience with our new carrier, and if so, were they particularly bad.

"They're all CROOKS!" he thundered. "Every last one of 'em! I don't even know why I stay in this business. I'm just putting more money in their damned pockets!"

He looked me straight in the eye and said "I'm sorry sweetheart. If I could, I'd give you the damned things for free and screw the insurance!"

"I know. I know you would. But you can't afford that either."

He shook his head sadly..."No. No I can't."

We left in posession of 30 pills. Two weeks' worth of medicine for Pre-Pubescent One. I don't know what we'll do when they're gone. We do not qualify for any assistance.

I hear the Cheetah III is hiring. I wonder if there's a niche for slightly older women with lots of personality and plenty of....back. Yo.

Well, that might solve my problem, but what about the greater issue? We have to do something. We have to make health care reform a priority. If we don't, it's only going to get worse, and pretty soon, we'll be back to the days when only rich people can afford medicine, and the rest of us have to rely on folk remedies, mustard plasters and leeches.

Write your congressman, your governor, your state insurance commissioner...hell, even your president. We've got to start somewhere.

Here are a few link that I found interesting, helpful and sort of heartening. There are people who are trying. We just have to try harder. And bigger. We have to combine our voices and make ourselves heard.

American Health Care Reform

Baby Boomers Revolt

Alliance For Health Care Reform

Health Politics with Dr. Mike Magee

Footnote: "Hunkered" is a Southern colloquialism that means sick, or weak, or ailing in some way. Can also mean beaten down, depressed or sad.