Sunday Night Thread in America

We have a well known PPO for our health insurance. Our family deductible is $1000 per year. So, when my husband and I had sinus infections in the spring our doctor’s visits cost us $105 each. That’s not counting all the bills for mild stuff like strep or ear infections the kids had.My biggest gripe is that we have a 3 year old daughter with an autism spectrum disorder and NOTHING is covered. The primary treatment is Applied Behavioral Analysis (ABA) and insurance companies consider it experimental even though it’s the only treatment with science behind it, proving it’s effectiveness. Fortunately, we live in a county in Maryland that provides ABA to children who need it in a preschool setting (she goes to school 30 hours a week… very intensive) and she’s getting that at least. If you do not have access to this treatment in school, it can cost parents around $50K a year.Our daughter would also benefit from speech therapy, occupational therapy, and physical therapy. While insurance companies will tell you that it is covered, it really isn’t. The best speech therapists for her, the ones who have experience dealing with kids on the spectrum DO NOT accept insurance. The ones who do, and there aren’t many, are a pain to deal with and not as qualified. Our insurance covered the “speech”portion but not the “cognitive” portion of the therapy. I called around looking for OTs for her and was told “You cannot do occupational therapy on children!” Again, the places that provide the OT that she needs don’t accept insurance.We are so lucky that she is getting the help she needs, but it’s never enough. We are in a precious window of opportunity… between 2 and 6 years of age, and we need to do as much as she can. When school is off this summer we are going to use a private tutor that we used last summer to do ABA with her. We’ll do 4 hours a week… that’s $200 a week… $800 a month. And from everything we have heard that’s cheap. Her tutor is a miracle worker so it’s money well spent. Needless to say, we don’t really have $800 a month. But you find a way when it’s important.It makes me physically sick that there are so many children on the spectrum and autism isn’t covered at all. We are so lucky, and it’s still hard for us. I know it’s a million times worse for other families.

I have type I diabetes, a currently incurable, but treatable chronic autoimmune condition. My immune system ate my beta cells that produce insulin. Unless they come up with a different treatment, I will have to inject my self multiple times a day with insulin. Insulin in the US is 2 to 3 times the cost of the exact same insulin in Europe. I have never received an answer to why this is. The pharmaceutical industry seem to have received a license to price gouge from congress.My health insurance expired in 2004 when my Cobra coverage expired. I looked into health insurance but the cheapest plan I could find with my diabetes would have been $1500 per month. This is a mortgage payment and so I decided to just pay as I went and run the risk of economic collapse if I had a stroke or a heart attack both of which I am at an increased risk for.The job I had in 2004-2006 paid very well but no medical benefits. When I lost this job in 2006 there were no jobs to be found. Software engineering is being steadily exported to India and China. Health care costs have made employing US engineers too expensive.I now have public insurance. It is pretty good. It works better than my Aetna health insurance ever did. The private free market health insurance system is an abomination. I strongly support a single payer system.

I am finishing up my MBA (graduating at the end of this month), at which point my school insurance (which offers no preventive care – only medical emergencies) will cease to cover me.Due to the economy, I have no job lined up yet. Thus, at the end of this month I will not even have emergency coverage. The private plans are far too expensive for someone with no salary and heavy student loans.Bill Maher is right. The Dems have moved to the right and the Republican’ts have moved to a mental institution.

Congrats on your MBA Tim. Good luck with the job search, I am in Charlotte and have 2 degrees and just got laid off. It is a tough economy around here. Have you tried TIAA-CREF? They have a multitude of job openings. With an MBA you should be qualified for them. Give it a look. I have applied and not heard anything back yet. Good luck!On the health care front, I am thankful that I haven’t needed it. My previous employer will be paying through the end of July, so I am crossing my fingers until I find another job. It really shouldn’t be tied to your job. I want single payer.

I own a small business. In my state, you are allowed to create a management group for health insurance. This allows you to cover your key employees, and it works fine. Because we have a group of 3 people under 30 and 2 people over 50, my husband and I (the old folks) can get health insurance. It is the biggest single bill I pay every month, but I am grateful for it. What frosts me is that, due to the depression and falling sales, my staff now is down to the original management group and one other employee. This employee is smart, talented, committed and she can do anything. Although under 30, she has diabetes, high cholesterol and high blood pressure. There is no way I could ever afford to insure her. If I try to insure her, we’ll all lose our health insurance. This situation stinks. Why on earth do we have an employer-based system anyway?

I am a state employee. My health benefits are a bargaining chip and are whittled away annually. I haven’t had a raise in six years, so this represents a decrease in my salary each year beyond the effects of inflation.

Since 2 years after I became disabled according to the government, I qualified for Medicare. But during those 2 years it was tough. You either tried to get on Medicaid or you paid cash or did without. Doing without wasn’t really an option, because then you had no medical records for your claim.Talk about the rock and hard place, any savings you have is quickly eaten up by tests and living expenses trying to get your disability in the time it takes, which can be up to 4 or 5 years.It took me 3 years and 3 months from the day I had to stop working until I finally was approved, and then it was more because of my age than it was anything else. Not that I didn’t have the medical reasons, just that the judge felt sorry for me and didn’t want me to have to wait any longer. I had already dealt with one idiot judge who had mixed my case with 3 others, I straightened the file for them, and when he wrote up the review it made no sense and the appeals council reprimanded him.That’s another reason I got it when I did. I didn’t even see the second judge, just my attorney did.But, in Missouri with Baby Blunt as Governor, he ruined our Medicaid system. Now, if I want to be on it it would cost me $285 a month for a premium you might as well say, in addition to my Medicare premium.

Thanks veralynn. I’ve applied to TIAA-CREF and haven’t heard anything back. I really hope to stay in Charlotte but I’m looking everywhere.Best of luck to you in your search!

I have to work a part time job that I’m way overqualified for, at a wage that can’t provide a living even if I worked at it full time, just so I can have health insurance. The rest of the week I scramble at my chosen, self-employed profession to make a living. I have a pre-existing heart arrythmia and if I could get health insurance at all, it would be prohibitively expensive. More than the rent I pay. My employer will no longer be offering insurance for part timers after December. The doctor I’ve seen at the HMO doesn’t really do anything. I’ve gone in a couple of different times and after marching in with his laptop and chatting a bit he shuttles me off to a different specialist within the company, generating more income for the HMO. Now I know to do my own triage and go to appropriate specialist. Until December that is. How many people are out there working at the wrong job out of fear of impending financial ruin that one illness could cause?

I have health insurance from Anthem for 75 dollars per month. The only reason its that low is because I haven’t gone to the doctor in a long time. I need to visit a doctor because of asthma and sinus issues, but Im pretty sure the first time I go my monthly rate will double atleast so ive been avoiding it.

Thanks Tim..you too!

unemployed, no insurance since January. 58 yo, not particularly healthy, high blood pressure, arthritis.Savings is running out so when unemployment benefits end will e on the streets or on friend’s couch somewhere. With no car as that will be repossed.Very dire straights here in VA- as we all seem to be everywhere.My thoughts are with you all.

I’ve been unemployed since December, and where I live jobs are few and far between even in good times. Needless to say I’m without any health care coverage at the present. I have high blood pressure and I was diagnosed with diabetes a year and a half ago, which oddly I exhibit none of the symptoms of, but luckily I’m managing it with my diet and a glucose meter, and I’m on meds for the blood pressure. Still, I need to pay for the medicine and any doctor visits and those aren’t cheap. Thank goodness most pharmacies offer great generic discounts, so for that I’m grateful. I’m looking at going back to school to get a law degree so no matter what happens for me I probably won’t have any health care coverage for a long while yet.

Oh I should add another reason mine is low is because im young, and even if mine doubles it still wont compare to what many people have to deal with. Still, doubling of mine would mean that much less money to eat on each month.

My throat started hurting last Wednesday night. As the PTT will recall, I lost my job (and therefore my insurance) a few weeks ago. The cheapest MD appointment I could find was $25 cash, and that’s because she knew me. The price might sound right but my former employer is fighting my unemployment claim. In order to make the rent I am going without care, and today is the fourth day since I could swallow without pain.I could call the little local VA clinic to set an appointment for next Thursday, fully two weeks after the symptoms began. Or else I could drive two hours and be seen at the Birmingham VA center’s ER. What I’ll wind up doing, probably, is visiting the local ER under an assumed name and address claiming indigent care.

Unemployed so uninsured. Laid off before the Stimulus which provided assistance paying for Cobra. My monthly Cobra bill would have been more than $300.00.On the outside I look fine. I feel fine and I haven’t had a cold this year. There are only so many free screenings you can get, so I may have a ticking time bomb inside and not know it.

We have health insurance through my husband’s company. Over $200 a month is taken out of his paycheck towards the premium. The coverage itself sux! The deductible is $500 per person so unless you have something really wrong with you to eat up the deductible, they barely pay anything.On another note: Are you all aware of Community Health Centers? They charge on a sliding scale fee based on your income and will also make payment arrangements. I believe they are getting some stimulus funding, so they may be hiring more employees to help decrease the waiting time.

Short and sweet:I have what would be considered “good insurance” by the standards of this country.I would love to start my own business. Of course, if I quite my job to do that, I’d lose my health insurance.Love how our free market system is killing entrepeneurism?

I basically have emergency coverage, as I have a high deductible so I pay for most all my medical expenses. My premium is high, about the same as my rent payment. I figure I use 40-50 percent of my income to cover medical costs. But heck, I’m interested in living, and being as healthy as I can. I haven’t seen a dentist in 2 years, have no dental, and so I’ve procrastinated. Know that I will have to go soon, probably have a cavity or two growing. Our insurance system is beyond disfunctional.

And why aren’t dental and vision covered by regular insurance? I mean, I have to have glasses to do anything. I can’t see farther than 5 inches in front of my face. If I can’t see, I might get into an accident or something.What a racket insurance is.

I live in Canada. ‘Nuff said.I have always lived with the assumption that I could see a doctor or go to the hospital without paying a dime. Everything I’ve experienced indicates that the level of care is good. Doctors, nurses, equipment, and facilities are excellent, from what I can see.I hear that the waiting lists for certain procedures and specialists can be long, but I’ve never encountered a problem.I pay for “extended health care” with deductions from my paycheque. It covers 90% of the costs of my prescription drugs, and entitles me to a certain number of visits to “paramedical” practitioners – psychologists, physiotherapists, chiropractors, naturopaths, even acupuncturists.

I too live in Canada. Last week my wife gave birth too our first baby and it turned into quite the ordeal. About 48 hours in labour, half or so at the hospital, with a nurse in the room most of the time and a at least one doctor and often 2 checking in each hour.Turned out she had to have a cesarean, which means major surgery with probably about 10 people in the room for the operation.After the operation she and baby spent 3 days in hospital being looked after with tests and visits very regularly. Some really great nurses (and a few not so great ones), she was very well cared for. Admittedly there were times when the nurses were very busy, and they couldn’t wait on her hand and feet, but I am sure it is like that in just about any hospital in the world.I guess I pay a little higher taxes than Americans, but out of pocket this didn’t cost me a dime. I feel so sorry for average Americans, and can’t imagine what it would be like to worry about whether my insurance would cover the huge cost of something like I just went through. Just about nobody in Canada, Conservatives included, would trade what we have here for the American system. I truly hope something changes for you.

I have no healthcare and even though Pennsylvania law says that as a self employed person I can not be refused coverage. Due to a pre-existing heart condition the cost of my coverage would be $4500.00 per month with a $5000,00 deductible.I am an uninsured Father with an uninsured family.

So this is the American dream? Increasing costs of health care and ever reducing coverage? If you’re healthy you’ve got it made, if you get sick and need health care, prepare for financial ruin?After working for almost 40 years, our retirement savings are all but depleted thanks to not only, the financial meltdown, but due to the for-profit health care industry’s goal of maximizing profits and also, the apparent congressional ignorance of the health care perils facing the average American. In fact, I would argue that, in part, the health care crisis contributed substantially to the financial destruction of many hard working citizens of this country and possibly to the financial industry. Rather than invest in retirement savings, IRA’s, 401K’s, stocks, etc., many of us must chose instead, to pay exorbitant insurance premiums, deductibles and high annual out of pocket expenses. In addition, those of us who are near retirement age, must continue working (probably until death) in order to have some semblance of health care coverage, at least until Medicare kicks in, thus contributing to the jobless rate of younger workers.As for the supposed high quality of care in the US, its obvious profits are more important than people …not just by the insurance industry but by the health providers. For example, after a recent surgery, my wife almost lost her life shortly after surgery. We suspect this was because the hospital announced cost containment efforts by reducing bed space and “floating” inexperienced nursing staff to other areas of the hospital where they had never before worked in certain specialties.And, of course, the insurance magnates decided that one week of post-operative follow up at home was sufficient and/or any additional in-home care was too expensive to cover. This, despite the fact, that my wife was unable to walk or drive to the nearest health facilities to continue the required post-operative treatment that the doctor ordered. Of course, friends and family pitched in without question, to do what was needed for the recovery despite aforementionedinsurance company refusal.After recovery, comes the hard part. The insurance payments to the doctors are not suiting the doctors or hospital, our required “up-front” payments are being held hostage, and possibly facing threats of collection procedures by doctors and/or the hospital if we don’t pay the thousands of dollars in fees the doctors’ demand and/or the insurance company doesn’t cover or won’t pay.All this “convenience” is for a mere $1200 per month in insurance premiums. Hey, the good news is that we still have about half of our monthly net income to cover the mortgage and all other living expenses. I know I’m “preaching to the choir,” because millions of others have had similar or worse experiences.I don’t know about you, but if our past experience is any indicator, paying some higher government taxes in order to obtain some reasonable health care that benefits the people, seems a helluva lot less complicated, less life threatening and less stressful than having to continue facing the worsening health care labyrinth based upon profits. After all, when we get our taxes done each year, all we basdically have to do is provide a driver’s license & a W-2.

To Nora:Whoever told you OTs don’t treat kids is not correct! ASD kids are among our largest group of clients. Please contact AOTA (the American Occupational Therapy Association) for more information. OT needs to be in your daughter’s IEP as well; request an OT evauation from your daughter’s public school. Get Sensory Integration/OT therapy for your daughter: it will really help her.