Saturday, February 20, 2016

My Log 504 February 20 2016: A Guest Article: My son Ben, now a permanent resident in the United States, tells the truth about the improbable cost and trouble in dealing with health care in our southern neighbour, and it ain’t pretty!

English: Barack Obama signing the Patient Prot...
English: Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)
English: Supporter of a single-payer health ca...
Supporter of a single-payer health care plan demonstrates at an April 4, 2009 "March on Wall Street" in New York City's Financial District (Photo credit: Wikipedia)
by Ben Richardson
of Austin, Texas

I am getting really sick of people telling us that single payer healthcare is a pipe dream.  It has worked so well for so many countries.  The people who are against it really want to maintain the status quo.  I’m not shitting on Obamacare because it is so much better than what came before it, but it is basically flawed without the single payer option.
After ten years of living in the US as a non resident alien on assorted work visas, I met my wife Natalie we were married in 2014.  Natalie, while generally healthy has a number of health problems that need attention from time to time.  
I got my Permanent Resident status in 2015 in time to sign up for Obamacare.  As I am a self-employed musician/touring soundman and she is in the service industry we average  between $20,000 to $40,000 a year taxable income (depending on how much work I can drum up).  So when we signed up, we picked a Silver Plan from Humana, which seemed like a good deal.  $6900 a year is the cost of the plan, but with the subsidy we only had to pay $1440 a year.  For this we got Primary Care doctor and urgent care visits for a  $35 co-pay, Specialists $50 co-pay.  For anything extra we had to pay 100% till we reached a $1400 deductible and once over that, we had to pay a coinsurance of 20%.  Once we reached $4500 in additional spending the insurance would cover 100% from then on.  Drugs were also cheaper through the plan
It worked fairly well for the first few months until I got an unanticipated job for quite a bit more money.  Once I had corrected my projected income through the Obamacare website our subsidy dropped and our yearly payment rose to a total of $3840.
The coverage was good. Humana had lots of urgent care clinics in their network.  While we never got around to using the policy to its full potential (finding a primary care doctor, having a physical etc..), whenever Natalie had a problem, we would go to the appropriate provider and for $35 she could see a doctor.  A couple of times, I got small bills in the mail for tests and such for around $100-$150 which I paid with no problem.  
This year when I went to renew, I found that the Humana plan I was on had raised its rates by about $150  a month.  So I went on the website and tried to find a similar Silver Plan.  I found one from Ambetter that was about the same cost as the Humana plan had been in 2015.  It seemed similar, although i had to admit the whole process is quite confusing and not set up well for comparisons between plans.
A few days ago Natalie got sick at work, and the next day I went on the Ambetter website to find a doctor to take her to.  The first couple of clinics that came up were both less than a mile away from our house.  That seemed like a good sign, but it was not to be.  The first of the two clinics turned out to be inside the Del Valle Jail, the second was the children's clinic inside the Delle Valle Primary School.  The next two places I called, only took appointments and didn’t have anything available till next week.  On the third call a woman registered us, then had a consultation over the phone with Natalie.  After spending a good thirty minutes on the phone, she told us that no one was available and to go to the emergency room.  She was extremely insistent that she should go right away.  I asked her if she could recommend any urgent care clinics and she kept insisting that we go to emergency.  I finally searched urgent care on the Ambetter website and was directed to the only one in Austin. It turned out to be inside a CVS drugstore.  When we got there, the nurse said they didn’t have any doctors there and that Natalie should go to emergency.  I finally got a guy from Ambetter on the phone and as it was getting late, he said  he would find us a doctor early the next morning, and he did phone back
The next morning he called back with the primary school and prison phone numbers. At that point I lost my cool and asked him sarcastically if the $6900 the Plan was costing me, really entitled us to a doctor.  I then posted my story on the Ambetter Facebook page, telling them that they sucked.  I soon received a call from an Ambetter lady who, after I took her to task on the lack of walk-in clinics in their network, promised me that she would get me an appointment in the next hour.  She called back and gave me the number of a doctor who could fit us in at 2:30PM.  Talk to Betty, she said.  So I called Betty right away, only to be told in a most unpleasant manner that the doctor had NO openings that day.  By this time, Natalie was starting to feel a little better and we both basically gave up exhausted and frustrated.  
The only silver lining in this whole mess, is that a couple of weeks before the end of the enrollment period, the Health Alliance for Austin Musicians had called me to tell me about a Silver Plan they were pushing that turned out to be a bit cheaper, so they signed me up with The Sendero Silver Plan that is slated to take effect March 1.  They apparently have a lot more urgent care and walk-in clinics so we have our fingers crossed that it will be more like the Humana plan from the first year.
“So why didn’t you just take her to the emergency?” I hear someone ask.  Well I am pretty suspicious of hospital emergency rooms in the US, based on my experience, and also that of Natalie, who always went to emergency rooms before she met me.  I was on travel insurance for the first ten years here, when I went to the hospital one night with a sore abdomen.  Four hours later I walked out with a diagnosis of a strained abdomen.  They presented me with a bill for moe than $12,000, and tried to get me to pay for it and get reimbursed by the insurance company, even though the insurance rep had told me that that hospital could direct bill them. I didn’t pay them, and when I later followed up with the insurance company to make sure that the bill had been paid, they told me that they had asked the hospital for a detailed accounting of all charges.  The hospital had responded by sending a bill for $900 which the insurance paid and that was the end of it.  Can you believe they tried to rip me off for $11,100?
One time, on the road, Natalie had terrible stomach pains and I took her to the hospital for a three-hour visit.  I later received a bill for over $4,000.  
On another occasion she was rear-ended by another driver and had to go to the hospital that night, returning the next day feeling worse, requiring a second visit.  I had decent car insurance, the other driver had none. My Insurance company covered the repairs to the car, and assured me that they had taken care of all the medical bills to the tune of almost $3000 (the maximum they were legally obligated to pay).  Imagine my shock six months later to get a bill from a collection agency for more than $14,000 for the second hospital visit.  I think this is because the doctors just cavalierly order the tests and not once in my experience have they ever mentioned that these tests are costing you thousands of dollars.  Even when I would question the need for so many tests, the nurses would just cheerily brush off your concerns by saying “the doctor has ordered them”.
After we had signed up for coverage, and Natalie feared during a Caribbean holiday she had caught some kind of infection from a biting insect. We were driving from Dallas Airport back to Austin late in the evening and she called a hospital in Waco and asked them if they took our Humana Insurance, which they assured us they did.  We were there for two hours but after an examination they gave her a clean bill of health.  I specifically asked them if there were any charges as we left, and they said no the insurance has got it.  A month later I received two bills, one from the hospital and one from the doctor totalling more than $900.  The Humana contribution was $96.  But nobody tells you any of that. They usually tell you as little as possible till they’ve done every possible test they can think of, and then present you with a massive bill.   To add insult to injury, in not one of these cases I’ve talked about did we turn out to have anything  seriously wrong with us, certainly nothing that should cost $12,000, or $14,000, or $4,000, or even $900.  This is highway robbery by the whole medical insurance industry.  
So this is Obamacare.  Much much better than the previous system where the insurance companies could deny coverage at anytime and if you had a pre-existing condition you either didn’t get insurance or had to pay a small fortune for it.  The only reason that I became a permanent resident was because it looked like Obamacare would cover us for not too much money.  But the whole system is so skewed towards making a profit that it really is obscene to a Canadian like me.  
The whole day I was looking for a doctor for Natalie, none of the people I talked to gave me the impression they were  really concerned about her welfare.  All they cared about was whether they took our insurance.
I lived in Canada from the age of seven, till I left for Austin at the age of 43.  I confess for that whole period I never gave a single thought to healthcare because it was just there. Though each province has a slightly different way of doing things, the bottom line is that all essential healthcare is covered.  
You just give the doctor or hospital your health card and almost all the charges are covered by the government.  No co-pays and no deductibles and almost no paperwork.
When I was 20 I grew a cyst the size of a tennis ball on my forehead, and had to spend a week in the hospital as they drained it to make sure the infection didn’t spread to my brain.  The cost to me… $0.  When I was 24, my lung collapsed.  That was another week in the hospital.  Then it collapsed again.  One more week in hospital.  Then I had to go in for chest surgery to fix it.  That was a MONTH in the hospital.  Again… the cost to me.. $0.
Five years ago, my Dad almost lost his left eye.  Only a specialist in optic surgery was able to save it.  Cost to him… $0. In 2007 my mother died after two years of daily at home nursing and doctor visits plus two longish spells in the hospital.  Her care was uniformly excellent.  Again cost to my Dad… $0.
“Oh but you’re paying way more in taxes,” I hear someone saying.  Well as someone who has paid taxes in both the US and Canada, I think I can say with authority, that I wasn’t paying any more in income taxes in Canada than I have in the US.  Alcohol, cigarettes and gas are definitely more expensive, and the cost of living can be higher, but that is really because Canada and most other first world countries have higher standards of living, and access to excellent healthcare.  And I have spent roughly the same amount of time waiting in emergency rooms in both the US and Canada.  
The US spends twice (that is double) what most other countries pay for healthcare per capita, and I can see why.  So much time, energy and money is spent trying to eke a profit out of the consumer that its no wonder Americans are so unhealthy.
There’s certain dignity that comes with being confident that when you get sick, you will be taken care of.  That dignity is sorely lacking here in the US and that is why the citizens need to elect Bernie Sanders to put the idea of single payer healthcare squarely on the table.
It will save us a ton of money and lower costs in the process.  The other aspect that no one seems to be talking about is that it will be amazing for business.  I saw somewhere that the average cost to the employer for healthcare is now in the neighborhood of $12,000 per employee.  So even if the taxes were $3,000 per person for the government to pay all the costs, businesses would still be saving a ton.  Hell, if I had to pay $3,000 in extra taxes I would still come out ahead of Obamacare.
I can’t vote, but you know Natalie will be voting for Bernie Sanders…  Feel the Bern!!!!!

1 comment:

  1. I do not know why the health care situation has to be so convoluted and confusing. Why would people not want other people be able to go to the doctors? It seems like madness. Healthy people means healthy workers and in the end that is always better for the economy.

    Anisha Cason @ U.S. HealthWorks Berkeley