Mike the Mad Biologist

At some point, the debate over healthcare is really going to heat up. Sure as shit, we’ll start hearing about long waits in other countries, ‘rationing’, and other tales (I put rationing in scare quotes because the U.S. rations healthcare: if you’re lower-middle class, you don’t have it). With that, I bring you this post by John Aravosis, who recounts his experience–and why, I think, we need a public option for healthcare:

As I’ve written before, in detail, my prescription drug coverage is a joke. Blue Cross hasn’t increased my drug coverage in 14 years – I have the same $1500 limit I had in 1997, even though $1500 bought you a lot more drugs in 1997 than it does in 2009. Oh well, guess I’ll just die, or go bankrupt, if I ever get sick. And the thing is – and this is important – there is no better plan at Blue Cross that I can buy. So even if Congress were to help me, and they clearly won’t because I’m not “poor,” but even if they did help me buy into a plan, the plans suck.

And the details:

I am self-employed. I bought, what I believe I was told, was the best self-employed health coverage I could get, from the local CareFirst BlueCross BlueShield. And the bastards just tried to charge me $250 for two prescriptions I had filled last month, and paid at the time something around $20 to $40.

I called BlueCross to find out what was up. They told me that I hit my annual limit of $1500 coverage for prescriptions. $1500? First I ever heard of that one. What other little surprises are hiding inside my $340/month health insurance package? I have numerous prescriptions I have to fill between now and the end of the year (not to get into too many details, but my allergies have finally gotten to the point where they’re impacting my lung capacity – and the allergist tells me that’s a bad thing long-term, not being able to breathe and all). And I’m on Vytorin for cholesterol control.

So, my choice is:

A) Skip my cholesterol medicine for December, and skip all (three, I believe) of my lung/allergy medicines for the next two months, or…

B) Pay somewhere between $500 and $1000 out of my own pocket because BlueCross BlueShield has super duper double secret limits on how much prescription coverage they’re going to give you.

This is scary. I haven’t been unusually sick this year. Yet I’ve already reached my limit of coverage. What do people do who are actually really REALLY sick? Who come down with cancer, or HIV, or some serious months-long illness?

In the end, I’m fortunate. I can spend $1000 out of my own pocket to try to ensure that my lungs don’t collapse at the age of 60, and to ensure that I lessen the chances of having a heart attack shortly thereafter. But what kind of health care system do we have when you’re told you’re buying the best plan you can get, and the bastards have so many loopholes in the unintelligible fine print of the contract that you literally have no idea what your plan is, no idea what is and isn’t coverage, no idea what limits you face on an annual basis or a lifetime basis. (I have a law degree from Georgetown and I can’t make heads or tails of my coverage.)

As I’ve mentioned before, private health insurance is so byzantine, and the ability to determine what level of health insurance you need is inherently impossible to determine (because you don’t know what you’ll need), it leads to substandard care. And, as Aravosis points out, he’s not even that ill.

Comments

#1 Mahakal
May 17, 2009

I had to move to California to get decent affordable coverage, and only then because I was able to use the Federal HIPAA law to force a policy to be issued to me.

People with employer-provided health care have a special risk as well, if they become too sick to return to work, what happens to their coverage?
#2 Steve Smith
May 17, 2009

The health care system is in complete disarray, and will continue too cost employers and individuals a higher percentage of thier expenditures’ each year. President Obama’s Administration has creatively designed a comprehensive health care spending cut reform bill, focused on reducing a few trillion dollars over the next several years. This is a start, considering all the other issues the country is faces with in the 21st Century.
#3 Tony P
May 17, 2009

Best coverage I ever had is when I worked for the State of Rhode Island.

At first I didn’t pay a dime for it, then as time went on it went up to about $20 per paycheck. Reasonable if you ask me.

Medical was $10 or $20 depending on the service, copays ranged $4 to $30 on drugs.

The thing is, UHC only administered the plan. The State paid out the claims.
#4 natural cynic
May 17, 2009

One simple way for Aravosis to reduce the cost of meds is to go generic with the statin. Vytorin is a proprietary combination of simvastatin [good] and ezetimibe [useless in a recent study]. You can get lovastatin or pravastatin for $4 a month or $10 for three months. His doctor should know this.

People with employer-provided health care have a special risk as well, if they become too sick to return to work, what happens to their coverage?

And for the real shit going on with health insurance, the bigwigs that were so overawed and amenable to Obama during a meeting last week have already reneged on their promises. Quelle surprise!

It’s called COBRA, and it will bite you for the full cost of the insurance, but at least will give you the same coverage until it expires. Normally, it lasts 18 months, then you’re SOL.
#5 DJ
May 17, 2009

This is an issue close to me. I make just enough money to survive month to month. I have no extra money to buy the company offered health insurance from BCBS, and because the company offers this insurance to all employees I am not eligible for government health care plans (or so I have been informed). I’m living with hypertension and GERD that is going untreated due to not being able to afford to see a doctor. Somethings gotta give here in the U.S., we are basically saying that people who can afford medical care have lives of more intrinsic value than those that can’t. This just doesn’t make sense if we are “all created equal”.

I’m sorry to hear about the troubles the individual in the letter is facing. Hard to see that even those with insurance are getting screwed over.
#6 The Ridger
May 17, 2009

At some point people who bleat or bellow about “government bureaucrats coming between you and your doctor” are going to have to understand that the government guy just pays the bill; the insurance guy has an active interest in spending as little as possible of his company’s money. It’s a for profit business.
#7 "GrrlScientist"
May 17, 2009

hahaha. try affording to pay for COBRA when you’re unemployed!
#8 Scott
May 17, 2009

Ha! Talk about hidden limits. My wife called our insurance company, and received pre-authorization for doctor ordered breast reduction surgery (the extra weight was putting stress on her neck). We jumped through all the hoops. We thought all was good. Then we got the bill. It turns out that the insurance company only covered surgery on the first breast. The second breast was not covered if the surgery on the second breast was performed in the same 24 hour period!! If she had waited 24 hours then gone in for a second surgery, they would have covered it, even though it would have cost them more if she did it that way. Their reasoning? If she would have had the second surgery, it would have also cost us more in co-payments. So, by not covering the second breast in the same surgery, even though they were charging us thousands of dollars more, they were actually “saving” us the expense of a second surgery. I hope you followed that twisted logic, because I never did.
#9 Captain Obvious
May 18, 2009

For a comparison, I live in the UK and pay around £250 a month in national insurance out of my wages. According to the Oracles of Google, thats currently about $381.

That covers my medical needs, state pension and various other benefits should I need them (like job seekers if I become unemployed and suchlike.)

I love socialist government bureaucrats getting between me and my healthcare becuase apparently it makes the whole process a damn sight cheaper and more efficient.
#10 Ross
May 18, 2009

@Captain Obvious: But as any conservative american will tell you, the problem is that you had to share your healthcare with *poor people*! Think of the scandal! You might even have to see poor people around you while you’re in the waiting room!

(Seriously. I’ve known americans who have lived abroad, and they all come back with “horror” stories about sometimes having to wait a *whole hour* to see the doctor for a regular checkup because the waitign room was filled with those filthy poor people who insist on going to the doctor for every little dismemberment, instead of toughing it out like poor people should. Why, the gall of them, to act like they’re entitled to a decent level of medical care!)
#11 Ellem
May 18, 2009

I have a dear friend whose daughter, about to graduate college, was just diagnosed with diabetes (Type I, not Type II, she’s an abstemious athlete.) Her medications cost $1000/month. Of course, she will very shortly be ineligible for coverage under her parents’ insurance. In this “Land of the Free,” her career choices are severely limited by the necessity of finding health coverage.
#12 ludditeandroid
May 19, 2009

“And I’m on Vytorin for cholesterol control.”

Vytorin is Zetia and Zocor. You don’t need zetia if you eat healthy, and zocor is available as a much, much cheaper generic (simvastatin). It is no coincidence that Vytorin was released and ad-blitz right before zocor went generic.

The cash price difference between Vytorin and Simvastatin is over $3 PER PILL. I really begrudge the existence of drugs like Vytorin because their high cash prices (with little added medical benefit, if any at all) drive up the price of health care for working poor techs like me. I work in health care and can’t afford good insurance. Meanwhile, people with $20 copays don’t care what the cash prices are because they want what they saw on the TV and “someone else” pays for it. Yeah, some of us pay for it with our lives.

I’m absolutely in favor of universal healthcare. And in favor of doctors GROWING A PAIR and telling patients, “No, I won’t write the prescription for the drug you saw in a TV commercial, because it’s the active isomer of an existing generic drug but it costs 20 times more and has not been studied as extensively. I don’t care if you think it has a prettier name and you like the cute cartoon meerkat in the ad. What are you, five? This is health care, not a candy aisle.”
#13 Marilyn Mann
May 19, 2009

I agree, there is no evidence that Vytorin (ezetimibe 10 mg/various doses of simvastatin) is better than simvastatin alone. There are no studies of ezetimibe with clinical endpoints (i.e., heart attacks, strokes, death, etc.). There was an imaging study called ENHANCE that compared simva 80/ezetimibe 10 mg v. simva 80/placebo in patients with heterozygous familial hypercholesterolemia and there was no statistically significant difference in carotid intima-media thickness (thickness of the carotid arteries, a measure of atherosclerosis) between the two groups.

In addition, in the SEAS trial, which compared Vytorin with placebo in patients with aortic stenosis, there was a higher rate of cancer and cancer death in the Vytorin group. Ezetimibe blocks the absorption of plant sterols, which are thought to have anti-cancer effects, so it is biologically plausible that ezetimibe could promote cancer or cancer death.

The cancer issue is uncertain, but there really is no convincing reason to take ezetimibe rather than a statin alone. As pointed out by other commenters, simvastatin and some other statins are available in generic form and are quite inexpensive.
#14 Keith Harwood
May 21, 2009

I can understand an antipathy towards `socialised medicine’ and to a certain extent share it.

And I can understand how this means that people will die because they can’t afford proper medical care.

What I can’t understand is how people who consider this an acceptable price to pay can call themselves civilised.