As anyone in America without a secure salaried job knows, getting and keeping affordable health insurance is not so easy these days. I for one applied for private insurance a few months ago after a change in my employment arrangement— I went from one full-time job with benefits to multiple part-time jobs, none of which qualify for benefits— and assumed, like so many Americans would, that since I don't have any ailments that demand treatment and almost never go to the doctor, I would be a dream candidate for private insurance.
By now you likely know where this is going. As it turns out, any time you get treated for anything under our health insurance system, your doctor puts a diagnosis code in your file. That little code, meant to facilitate your effective treatment, labels you as officially having an illness and stays in your file whether the illness ever shows symptoms again. And it can become the basis for a "pre-existing condition" claim by any insurance company considering you for coverage. Apparently they don't want to insure anyone who actually seeks out health care. So I, having seen a health care provider in the previous 6 months for something other than a routine exam, was easily labeled as having a pre-existing condition and not qualifying for private insurance.
Since I don't qualify for government-subsidized programs because I am not poor or old enough, my only insurance option is COBRA (which my former full-time employer facilitates, though she is not required to do so by law because her company is too small). Which is temporary and hardly affordable. HEY! Thanks for nothing, big useless American health insurance gulag! You call this a "system"?
But c'est la vie. I'm lucky. I'm not actually sick. I have work— sometimes more than I want. I have over a year of COBRA coverage left, during which time I'll continue to reassure myself that President Obama will pass his reform legislation, which might allow me to get insurance by means other than the graciousness of one small business owner. We all tell ourselves little lies to get through the tough times.
Make no mistake about it, though: if President Obama passes the reform he is hoping for, it will not be "health care" reform. At best it will be "health insurance" reform. The two terms, "health care" and "health insurance," have become synonymous in the American consciousness in recent years, and herein lies part of the problem. As Americans we have come to expect that doctors are responsible for our "health care" and if we could only fix the "health insurance" system that mediates our relationships with doctors, why, we'd be able to prevent diabetes and cut the deficit and teach the world to sing in perfect harmony. Perhaps this is a moot debate since the fate of the reform package is now itself in doubt. But needless to say, even if health insurance in this country does change in the near future, our collective attitude towards health care probably will not.
Fortunately, if I've gained one thing from this insurance mess it has been the conviction that as long as my brain is functioning no doctor or company will ever be responsible for my health. I will be responsible for it. This is because I've learned that health insurance = protection from financial catastrophe in the event of an illness. On the other hand, health care = the little decisions a person makes every day to promote his or her physical and emotional well-being. Health insurance is institutional; health care is individual. When, years ago, I went to one doctor after another looking for tests to explain my insomnia and weight gain and none could detect anything worthy of a diagnosis and therefore treatment, that was health insurance. When I started exercising regularly to deal with the problem even without a diagnosis, that was health care. When, a year or so ago, my coverage changed and I was unexpectedly forced to pay $600 out of pocket so a dermatologist could tell me I do not have skin cancer, that was health insurance. When I started eating more antioxidant foods in hopes of preventing cancer, that was health care.
This is certainly not to say that doctors and other health care providers are merely slaves to the big ugly insurance system, that they do not have an important role to play in one's health care. Human beings have always looked to others —those our society deems experts by virtue of their training, their spiritual experience, their age— for counsel and healing. We need these people most when we are in acute distress, which is likely to happen to every one of us at some point in life. But never before have our relationships with health experts been so mediated by external structures that are so out of our control, that do not even know us. Looking outside ones' self for help and healing may be natural but there is nothing natural about the health insurance system that we labor under today. There's nothing natural about a system that will pay for addictive pain meds but not a visit to a chiropractor. There is nothing natural about being given exactly 12 minutes for one's annual gynecological exam. There is nothing natural about spending a hour on the phone with a faceless third-party corporation called "Datalink," who somehow has the rights to one's medical record, just to find out the charge for procuring a copy of the record for onesself. (That's $25 not including postage, if you were wondering, though it's free if you have the record sent to another doctor instead.)
This is why the only way to have a "healthy" relationship with one's health care is to see insurance and everything insurance mediates as a part of it, maybe even just a small part of it, while the rest consists of variables that one can actually control. Eating well. Sleeping. Exercising. Emotional, intellectual, and spiritual development. Holistic approaches. Getting someone to rub your feet once in a while. (Quite a few of my peers in San Francisco skip the insurance part altogether, either by choice or by lack of option, and do OK with just this stuff. As long as they don't get hit by a bus.)
I've been tinkering with this approach and I must say, at least this way I'm the administrator of the cockamamie project called Keeping Ellen Healthy and I get to call the shots. This is also why I need all my health care providers: my doctor, my nutritionist friends, the nursing-school neighbor who will undoubtedly perform CPR on me if I ever have a medical-bill-related heart attack, the two women who rub and crack my neck so I don't get a pinched nerve from endless hours at the computer, my yoga teachers, my boyfriend who cooks for me when I have the flu, all the family members whose wisdom helps me keep my perspective. Some of these people are reimbursed for their services by Oxford/United Health. Others I have to repay myself, any way I can.
These exchanges add up to the true price of my health care, which of course ranges far beyond what I pay for insurance each month. It stinks. I pay more each month for combined health care costs than I do for rent, which is amazing considering that I live in San Francisco (no cheap rent here) and get a lot of services for reduced cost, barter, or free. It's even more amazing considering that I'm not actually sick. The only thing insurance provides me is the security that neither myself nor my loved ones will be bankrupt if I ever do. As part of my total health care budget, I file it as a mental health expense.
Anyway this is my personal health care reform plan for 2010. This is also why I eat a lot of vegetables.
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment