health care exchange

Rant alert. No humor today.

On October 3, 2001, at 7:30 in the evening, I sat in front of the TV, waiting for Farscape to start and my brother, Alan, to arrive to watch it with me. It was a regular thing, and I looked forward to it every week. Tonight he was late, but that wasn’t unusual.

About five minutes into the show, the phone rang. It was a woman, who asked, “Who’s this?”

I replied, “Who’s this?”

She only kept asking who I was, and I finally hung up. I have no patience for anyone who can’t identify themselves on the phone. I went back to watching the show.

The phone rang again, and it was the same woman, asking again who I was. I insisted she tell me who she was, and got another runaround. This was beginning to annoy me. This was before we had a DVR, and I was missing my favorite show. Again I hung up.

A third time the phone rang. This time it was a police officer, who informed me the call was about my brother, who had just had a heart attack. Apparently I was his emergency contact, and I was summoned to the hospital. I picked up my purse and left immediately.

On the way there, I sorted out in my mind how we would take care of Alan during his convalescence. I was his only local relative; he would need to stay with us and I would be responsible for him. That was how it had always been. He was my little brother, and all my life I had been held responsible for him.

In the ER, I learned he was still coding. They’d been trying to restart his heart for about half an hour. I was told that at this point, even if he responded he would probably end up brain-damaged. But as it was, they gave up soon after and pronounced him dead.

It turned out that the woman who had called twice then hung up was a friend of his, who had discovered him on the floor of his computer shop about half an hour after he called her, complaining of severe chest pains. (And by half an hour I mean God only knows how long it really took that flaming idiot to finally decide Alan needed help.)

Much later, from various sources including witnesses, emergency responders, and hospital records, I was able to assemble the truth of what happened. Alan began experiencing chest pains early in the evening, and phoned his friend the brain trust. She later said to me he told her to not call 911, because he couldn’t afford another trip to the ER and thought he could just tough it out the way he always had before. I learned he’d been having these episodes for about six months. Two months earlier he’d gone to the emergency room after going unconscious during one of them, but by the time he got there his rhythm had normalized and he was stable. The ER had done nothing; the episode had simply ended. By law, hospital emergency rooms are not obligated to find out what happened, they’re only required to stabilize. I know this because the ER at TriStar Hendersonville Medical Center, where Alan went for help and where he ultimately died, has notices posted on every available wall space stating in detail that they are not responsible for treating patients who are not insured, and once a patient is stabilized he is expected to leave the premises. So, since my brother was conscious and breathing, the hospital booted him out the door and he went home with a medical bill he would never have been able to pay even if he’d lived. He was a self-employed computer tech, new in town and barely scraping by, and had no way of affording individual health insurance. Ever. An individual policy for someone his age would have cost more than his entire income.

Alan told his friend not to call 911, and told her it was because, if he incurred another medical debt, he would never be able to have anything for the rest of his life. So she didn’t call anyone, and a while later wandered over to his shop to see if he was all right. He was, at that point, quite dead.

Had he been insured and not afraid to call for help, he could have been taken to the hospital in time and ::cough:: stabilized. And they might have stumbled across the cause of these episodes. Or perhaps, even, he might have had a diagnosis after the very first episode if he’d had access to a GP. But almost no GPs take new patients who are not insured. Why didn’t he get on Medicaid? Fffff…right. Be real, this is Tennessee. You need a lawyer to get on TennCare. In short, my brother died for lack of health insurance, as surely as if some actuary from Blue Cross had put a bullet in his brain.

So…I told you that story to tell you this, and some other stuff. (Yeah, this is going to be a long post, but I hope you’ll bear with me.) Skip ahead a few years. President Barack Obama, after at least a year of struggle which I followed closely, with fingers crossed that he would put an end to our health care system which was killing people, signed into law the Affordable Care Act. I decline to call it “ObamaCare,” because the main thing to remember is the word affordable. Let’s note that affordable is not part of the Republican repeal bill, on any level. We’ll get back to that shortly.

I won’t go into detail about the law itself; it’s extremely complex and deeply flawed. I’ll spare the rant on why. The central issue on this is that this law enabled millions of people, including me, to have more or less affordable health insurance. For some it is the first time in their lives. I had been uninsured my entire adult life. Being insurance clueless, I approached the government exchange with trepidation. It was confusing, but not nearly as hopeless as the teeth-pulling nightmare I’d experienced when signing my husband up for an individual policy several years earlier. (Just him; we couldn’t afford to insure both of us.) The information I needed was there on the site, I just had to interpret it. I signed up for insurance on the exchange, barely affordable because of the subsidy, and began to feel like I belonged, and no longer fallen through the cracks. It’s impossible to describe how good that felt.

My husband’s profession (entertainer coach driver) doesn’t offer health insurance at any price, because this is Tennessee and entertainment unions are by law prohibited from any sort of collective behavior that might give them any power. Welcome to Right to Work. I have been a freelance writer since 1993, but though I have been a member of the Authors’ Guild they were unable to offer me health insurance because I live in Tennessee. I point out these things lest anyone accuse me of just not wanting to pay for health care. The ugly truth is that over the years I have paid many, many times as much for the smidgens of diagnosis and treatment I’ve managed to pry out of the system as what was charged for the same tests and prescriptions to insurance companies. I’m not talking about copays, I’m talking about total cost to the insurer. Because my husband was briefly insured, and we’re both diabetic and taking the same tests and pills, I have bills to prove it.

During these past few years of being fully insured (except for optical and dental, because apparently the health insurance industry doesn’t consider eyes and teeth part of one’s body), I’ve finally been able to control my blood sugar and blood pressure, goals that had eluded me during previous years when every office visit had to be budgeted and certain medications were impossibly out of reach. In December of 2014 I developed a blister on my foot and was hospitalized with a diabetic foot ulcer. It was caught soon enough to avoid amputation because I hadn’t hesitated to have it checked as soon as I realized there was something wrong. Nowadays any foot sore will send me to my GP immediately, because my copay is one-fifth the cost of an office visit. Though they told me the cellulitis that developed from the foot ulcer might never heal entirely, after two and a half years has healed up and there’s no sign of it. I’ve also managed to lose a little weight, and my thyroid is being properly tested and medicated, which helps weight control and therefore blood sugar and cholesterol control. I can get antibiotics for respiratory infections and stomach bugs, thereby spending days under the weather rather than weeks or months. All in all, the advent of the ACA has enabled me to feel healthier–be healthier–than I had for decades.

Thank you, Mr. Obama.

Now jump to January 20, 2017. Trump put his hand on a couple of bibles and swore to defend the Constitution, a promise we knew at the time he didn’t mean, and now he’s showing us just how little regard he has for it. At that moment I was on a bus full of women in pink knitted hats, headed to Washington D.C. to let the world know Trump is Not My President and that we weren’t going to allow him to plunder the country. Six months in, it’s beginning to look as if our political system–even the rule of law–is crumbling around our heads. Regardless of which side one supports, it can’t be denied that Washington D.C. is not getting anything accomplished, and those of us who are retirement age or close to it, who have the rest of our lives at stake, are watching the three-ring nightmare with white knuckles. I am literally counting the days until I will be old enough for Medicare. Mitch (Yertle the Turtle) McConnell is leading the charge to yank the ACA, among other things. Every few weeks it looks like millions of us are going to lose our health care–and therefore our health–so that monstrously, absurdly, unthinkably rich folks can pay less in taxes and by that become even more monstrous, absurd, and unthinkable. It appears we are doomed.

But I say there’s hope. (You knew I was going somewhere with this, yes?) Trump isn’t going to be impeached this year, or next. However, neither is he fooling most of us. We in the pink hats have made ourselves clear, and will continue to do so. Those in Washington who care about democracy, rule of law, and the individual lives of Americans who are not rolling in money, are sticking up for us. Last night (Thursday, July 27, 2017) the Senate voted on the Republican ACA repeal bill, and the vote was “no.” In a Republican-controlled Senate, McConnell’s mean little bill hasn’t gone forward. Three Republican senators made the difference by joining the forty-eight Democrats in not wanting to hurt people. John McCain, Lisa Murkowski, and Susan Collins helped stick up for those of us who are at risk.

McConnell, having postponed the vote so McCain could participate, is not a happy camper today.

So all is not lost, despite the White House turning into Animal House. The ACA, obviously, is not the whole picture, and there will likely be more repeal attempts in the future, but for now the Senate has moved on to other things and  many of us will be healthier for it.

Now we must get the message to our representatives that we want the ACA fixed.

End rant.