Portly and the Loony Bin

Or "Why I Don't Want Anyone To Force Me to Buy Health Insurance."

Most of the Healthcare "reform" that's being touted by political candidates these days involves some sort of mandate that requires individuals who are not covered by their employers to buy health insurance from a private health insurer. Some of these plans include proposals for penalizing those who refuse by garnishing their wages or damaging their credit.

The following explains why I will be one of those who will face the penalty, rather than comply, if such a plan is put into law.

On April 1st of this year, I will celebrate 20 years of self-employment. Prior to 4/1/88, I had "regular jobs" with benefits and health-coverage (albeit shitty, Kaiser coverage) for my entire working life. After I became self-employed, I did the "responsible" thing and purchased private health insurance (thus foregoing any hope of long, lingering vacations in warm, sunny places, plus an arm and a leg).

I was an insurance company's cash-cow wet-dream -- the only claims I have ever made on my car insurance policy in a 36-year driving history were as a result of being hit by other drivers (which the insurance company recouped from the at-fault driver), I never made a single claim on my home insurance, and I'm generally healthy as a horse.

Except for this one thing that happened 15 years ago, which I've talked about before.

Hence the title of this post.

I'm not going to go into huge detail about my loony bin experiences in this post (hmmmm -- although I may start another series of posts -- "The Bedlam Yarns" -- what do you think?)

Suffice it to say that my first 8 day hospitalization for clinical, suicidal depression (the first time I had been hospitalized since I was born) -- cost $14,000.00.

At this time, $14,000.00 was well over half my annual income.

I didn't worry about that at the time, though -- because I had insurance, you see. Insurance that I paid upwards of $3000/year for. Insurance that was supposed to cover me if something bad happened -- like having a nervous breakdown.

Or so I thought.

Turns out that my insurance plan had a limit on any treatment for mental illness.

That limit? $1000/year.

Oh. Guess I missed that in the fine print (and it was very fine), on page 38 or so of the very lengthy policy.


So now, I was not only a wreck mentally -- I was also facing a $13G hospital bill. At a time when I was, shall we say -- not exactly "suited for work"? Not precisely a candidate for financial mover and shaker of the year?

It was at this point that I began to realize: Health Insurance is not about health coverage. It's about money. It's a gamble between you and a huge corporation.

They're betting that you don't get sick, and you're betting that you do.

Which is all kinds of fucked up, because the only way you "win" the bet is to do something that you probably don't want to do -- get sick.

(Life Insurance is an even weirder bet, since you're essentially betting that you'll die young -- and they're betting that you'll live to a ripe old age -- after they've sucked the bucks from you.)

During the five years I had been paying my insurance premiums before I got sick, I went to the doctor once a year for an annual check-up (which wasn't covered), and purchased a prescription drug called "Naproxen" (now known as "Alleve) for menstrual cramps (which also wasn't covered). That was it -- the entire extent of my need for medical care.

In fact, I had been taking Naproxen for cramps (as prescribed by my physician) before I purchased private health insurance, so the insurance company "rated" me on anything that involved my reproductive organs for the first 3 years of my coverage (which meant that they would not have covered any illness related in any way to my ovaries or uterus had I had a problem in those 3 years).

When I first applied for private insurance, I argued with the person who "rated" me for reproductive issues because I had taken a prescription medication.

I said: "Yes, I take it for cramps. Nearly every woman I know takes pain-medication for cramps."

She replied: "Not everyone takes prescription medication for cramps." (Note: Naproxen was de-regulated and went over-the-counter as "Alleve" about a year later, but I was still shit out of luck on my lady-bits. See how that works?)

But back to my story. I was mentally ill, suicidally depressed, owed $13,000 that I didn't have, and was unable to work. I was ineligible for any type of public assistance until I had been unemployed for four months or longer, and even after that, a social worker told me that applying for and getting medicaid assistance generally took one to three years -- if I qualified -- which meant that I would have to prove a long-term disability -- which meant that I couldn't get better if I wanted any help. The social worker told me, to my face: "You're going to have to look very sick to qualify."

During that first year, I was hospitalized again -- this time through an involuntary commitment process, as I was deeply depressed and ragingly suicidal at the time -- cuz life was looking so rosy, dontcha know.

The second hospitalization cost around $8000, which the hospital billed to me, even though I had been involuntarily committed. (They also booted me out much more quickly, because they had figured out that my insurance company wasn't going to pay up.)

I was able to work only very marginally for the next three years. I survived, during this time, through receiving generous help and support from loved ones (my ex, with whom I had purchased a house, cashed me out on what little equity I had), scaling back my life to nearly nothing (I lived in a used RV on community land where I paid $180/month for rent, and was able to raise a lot of my own food), and living on credit (which didn't last long).

Two years after my breakdown, I ended up declaring bankruptcy. Ironically, even though I had now learned the hard way that the insurance company was not my friend, I continued to pay my health-care premiums for four more years after the bankruptcy (like I said, I used to be crazy).

When they hiked the premiums to a level which I absolutely could not pay, I dropped my coverage. Since I was no longer grandfathered into a plan, and now had a history of mental illness, I became "un-insurable". To this day, I remain pretty much un-insurable -- at least in terms of insurance I could remotely afford (even though all this occurred 15 years ago).

I don't have health insurance now -- and I don't want it. For one thing, even if I had it, it wouldn't cover the type of health care that I focus on today (I see a naturopathic MD when I need a doctor, and focus on cultivating my wellness and health rather than "fighting" disease). I focus on preventative care, diet, and activities that tend to keep me away from the doctor's office.

I want to make very clear that I'm not "anti" traditional western medicine. There are some things that TWM does very well -- if I'm having a heart attack, or I cut my arm off -- for sure, take me to a well-equipped, traditional western hospital.

I'm just not convinced of the following: That the majority of western medical institutions, pressured as they are by the need to "show profit", inextricably intertwined as they are with private, for-profit insurance companies and Big Pharma interests who are more responsive to their stock-holders than to the people they are supposedly "helping" -- I'm not convinced that these institutions really have their eye on the ball concerning "health".

That's why I'm incredibly disturbed that the politicians of today, with rare exceptions (like Kucinich) seem to be focusing their health care initiatives on expanding a system (privatized insurance) that is already not working. ("Something broken? Let's do MORE of it! Yipee!!")

The only way a mandatory, privatized health plan would work for the customers/consumers would be if health insurance was incredibly regulated, and companies were forced to cover their customer's medical needs -- and if you're going to do that, why not rebuild the fucking system from the ground up?

The reason that they want everyone enrolled is that it broadens the "risk pool". That makes sense -- but in fact, it's just a form of socialized medicine, which is one of those "third rail" words that you will never hear falling out of a candidate's mouth. I'd be happy to pay into a system that honors my health choices, and let my "healthy-as-a-horse" condition subsidize someone who isn't as fortunate in their genetics or circumstances -- but not if my subsidy is doing more to line the pockets of some board-room fat-cat than to get a low-income kid an annual check-up, or a new kidney, or to help some working stiff get his back repaired after years of lifting garbage cans.

What I learned through the loony-bin insurance fiasco was this: The insurance company is not my "friend". It isn't there to "help" me. I haven't forgotten the lesson of that harsh thump against the Reality Wall -- that all those years I paid my premiums, we were just engaged in a particularly vicious little card game.

I won my bet. I got sick. Lucky me. But then, the company wriggled and squirmed and fine-printed its way out of its commitment to me.

Stupid me.
"Caveat emptor."
Let the buyer beware.

And that is why, in matters of health care, the game must not be one of sellers and buyers, but of providers and patients. Providers who are well remunerated for the invaluable service they bring (and I'm not just talking about Doctors, here), and patients whose health is the paramount focus of the entire system.

In my state alone, the biggest three health insurers nearly doubled their profit from 2003 ($243 million) to 2006 ($431 million), while the number of people that they actually covered dropped by 16.9% in approximately the same period (2002:2.37 million covered, 2006: 1.97 million covered).

Yeah. Let's take that as a national model. Yipee.

You can probably tell how moderate and calm I am about this topic -- and it is in that tone that I hope you'll receive my last sentence:

If the fucking government wants to fucking force me to buy fucking private health insurance, then they had better fucking BY GOD guarantee me that the fucking insurance company has to fucking cover my treatment -- every . . . fucking . . . . bit of it.

That is all.

(Please vote in comments if you would like to read any of The Bedlam Yarns -- don't worry, they're not all grim. The mental ward can actually be kind of funny . . . . after 15 years have passed.)

Posted byPortlyDyke at 8:20 PM  


Beppie said... January 16, 2008 at 8:53 PM  

Portly for President!

Proper, well-funded and well-staffed, state-run healthcare is the only way to go. Good health is a basic condition that is necessary if we are to live our lives in freedom; private health insurance simply curtails that freedom.

Anonymous said... January 16, 2008 at 10:39 PM  


When Kucinich said, "Medicare for everyone," I became a backer. That system works, no matter how much the GOP tries to mess with it and how big pharma wrote its own drug plan into it, which needs to be chanted, BTW.

I would also be privately uninsurable: bipolar and diabetic.

I just found out last summer that the man who raped me in college in 1985 also gave me HPV. I had my first abnormal Pap and subsequent biopsy. The doctor said it may clear up without cancer, but there's another concern. Twenty-two years later this virus shows up. (Yes, I was always good about having my girly bits smeared annually. I was stunned.) When I tearily told Tim I had HPV, he just held me and said it didn't matter, even if it affected his health. I love him. (We'll be married 22 years in May.)

I was hospitalized for mania without insurance for a few days, and we spent years paying it off. Now, I'm pretty much a serf, bound to my employer for insurance. And even with a pretty decent plan, still pay $80 to $120 a month for prescriptions, and will always do that, along with $20 office visits, since copayments don't count towards out of pocket maximums.

My first job out of college was paying health claims for an insurance company. The first day of training made me a believer in socialized medicine, and that was in 1986; insurance has become much more cynical since.

For me personally, health care is the most important issue of this election. It's beyond scandalous how our government treats our health. Steroids in baseball is more important than nearly 50 million uninsured and not overturning Bush's veto of S-CHIP? Fuck S-CHIP, insure everyone without the profit motive, no matter how young or old they are.


Joan Rooch

Anonymous said... January 16, 2008 at 10:41 PM  

changed, not chanted

I forgot my mantra, Preview Is Your Friend


LD said... January 16, 2008 at 10:42 PM  

I totally agree with you on the health insurance thing. I've been self-employed for 11 years, and have no insurance. Like you I'm healthy as a horse - the last time I was sick was 15 years ago and got food poisoning from a cheeseburger, nad the last tme I went to the ER was 13 years ago with a broken bone in my hand. (Both events were precipitated by my ex, the Energy Vampire...but I digress). Anyway, I really can't afford, and don't wish to shell out the 300 a month for insurance that, as you so aptly pointed out, is not insurance at all, merely a way for the insurance companies to line their collective pockets and laughing up their sleeves at the fools who actually think they might get what they pay for...
/end rant

Anonymous said... January 16, 2008 at 11:03 PM  

"The Bedlam Yarns," absolutely. I'm thinking Louisa May Alcott's "Hospital "Sketches" with Thorazine instead of Morphine.

Joan Rooch

cheri said... January 17, 2008 at 12:44 AM  

yes to the Bedlam Yarns, please.

And don't get me started on insurance . . . The health care system in this country is badly broken and has been for quite some time.

This is the number one or two issue (along with the global warming/energy policy issue) of the election, as far as I'm concerned.

Fannie said... January 17, 2008 at 9:25 AM  

"If the fucking government wants to fucking force me to buy fucking private health insurance, then they had better fucking BY GOD guarantee me that the fucking insurance company has to fucking cover my treatment -- every . . . fucking . . . . bit of it."

Amen to that.

And I vote yes on The Bedlam Yarns.

Anonymous said... January 17, 2008 at 9:54 AM  

Yes to Bedlam Yarns. I'm dealing with some of the same issues. I'd like to hear more.

witchtrivets said... January 17, 2008 at 11:47 AM  

Well said, I am having trouble understanding how forcing consumers to buy insurance is seen as a solution to the health care issues in this country. I have been uninsured, I have paid for private insurance, and now I am afraid to leave a job I hate partly because I really good insurance (which means, still expensive and doesn't cover much) via my employer. All interactions with for-profit insurance have been unsatisfying, to say the least. Health care should be a basic right and should not be in the hands of for-profit corporations. But we all know why it is.

I will support you on posting the Bedlam Yarns, but I don't think I can read it. Too close to home on that.

katecontinued said... January 17, 2008 at 1:21 PM  

PD, I have been uninsured most of my adult life. My breakdown was 26 years ago - but I somehow survived. The free mental health clinic I found in Syracuse helped me stay away from hospitalization. (Reagan had just been elected so there were a few safety net services still running).

But, eight years later I lost my daughter to suicide and she was uninsured. Surviving that loss along with the job loss that followed pushed me into bankruptcy.

So, I am with you 100%. I am a Michael Moore fan and longed for Dennis Kucinich to be heard. Sigh

The Bedlam Yarns are a good thing. But, like witchtrivets, I may not be able to read what seems so close to home.

Anonymous said... January 17, 2008 at 1:36 PM  

This is a major hot button issue for me. I was 30 when my breakdown hit; I was dirt broke and homeless. Fortunately I was assigned an excellent social worker who guided me through the back alleys and tunnels of the system, and I ended up getting my bills taken care of - including a day treatment program, two years of one-on-one therapy (the real life saver for me), and residence in a halfway house. The insurance industry would have let me die.

You are absolutely spot on about the emphasis needing to be shifted to focus on patients and doctors rather than insurers and stockholders. The idea of being denied health care because you are already sick or possibly prone to a particular disease or condition is simply inhumane. It should be a criminal act on the part of the society which perpetuates it.

I live in Ontario now. There is a massive shortage of health care professionals of all stripes. Consequently when a doctor opens up her/his patient list for new applicants, they can and sometimes will turn down those who are going to require more care. The doctors here are paid by the patient, regardless of the medical problem the patient has, so it's to their financial benefit to stick to the folks who will come in with the occasional cold or flu rather than someone with a chronic condition.

I waited two years to get a doctor, and I'm counting myself fortunate that I wasn't diagnosed with Lupus until several months after she took me on. I would still have had the option of going to a walk-in clinic, but the continuity of care necessary to a disease like this would have been very, very difficult to manage.

Wait times for MRIs or specialists normally run many months. I went to the States to get my brain MRI, to a clinic in Buffalo that specializes in taking Canadians who can't afford the long wait but who can afford to pay out of pocket. Or in my case, can charge it and worry about paying later.

Also, while almost all doctor visits and procedures are covered (there are some blood tests that I have to pay for), prescriptions are not. I've forgone some meds because I simply cannot afford them, and I know that I'm not alone in that.

My point is that a truly viable health care system requires not only universal coverage but also universal and timely access to doctors, procedures and the necessary medications. Health care is not a privilege, not an a la carte benefit. As you would say, it should be required for every . . . fucking . . . person, for every . . . fucking . . . condition.

pidomon said... January 17, 2008 at 3:19 PM  

Just Wow
To the post and the comments. I always learn so much when I come here (which is pretty much daily so youd think Id be one smart dude but im not really!)

Ive never had a health care crisis so this topic has always been, not difficult for me to understand, but not as easy to GAH cant think of the correct words but hopefully you know what im trying to say.

Reading posts and comments like this puts the topic on a faster learning curve for me.

So thanks for that.

And I'm all for the Bedlam Yarns or any other dang thing you want to write about PD!

(hope this all made sense in not a writer you know:))

NameChanged said... January 18, 2008 at 9:00 AM  

i agree with you and i would love to read the bedlam yarns.

Anonymous said... January 18, 2008 at 8:56 PM  

Bedlam Years, you betcha.

I've always thought it was totally immoral to make profit off of illness. Some things are just not meant as a profit-making enterprise.

War, foster care, prisons, and yes, health care.

Semaphore said... January 14, 2009 at 2:20 PM  

(Just working my way through your archive. Don't mind me!)

See, it's posts like this that remind me why I'm so lucky to have the NHS. We Brits get very snippy about it, especially after six hours in a dirty, crowded, Accident and Emergency waiting room with a kid with a broken arm. But at least we don't have to pay for it. (Or not then, anyway). But the number of absolute bastards I've spoken to who don't believe in paying for someone else to be ill... It makes me FUME.

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