The biggest thing happening in this country right now is the debate on how to reform healthcare. And among the majority people, be they simply opinions or long-studied scholars who can recognize economic patterns of cost analysis, there is consensus that the system needs to be changed. Im with everyone- I am (ok.. was AND am) lucky to have the healthcare I did when I discovered my lump, and to have been in a situation where I would not be dropped by my healthcare provider. I was also lucky that research, trials, and treatments had previously been put in place to be available to me in order to classify my outlook as extremely treatable -- whew!
While my out of pocket costs for care landed at around $2500, the total dollar amount was around $45 -$100,000 that without insurance, I would have needed to pay out of pocket. My amounts due were usually in the form of $30 copays for treatments, $65 for a two week supply of drugs (including shots, immune support, ativan, and sterroids which I quickly discontinued) and ultimately $1000 for my reconstruction that was covered at 90+%. While it was a strain it came nowhere close to the stress induced by chemo, surgeries, missing work, and having everyone around me thinking i was dying. I realize then, and I still realize now, that having it lucky the way I did was the only way to manage having this at all.
Now that Im healthy and thriving again, this healthcare debate is finally moving off of the soap box and onto the legislative floor. Super. One way it might affect me would be to make healthcare available to me within the next two years, regardless of my employment status. Currently being within 5 years of the end of my treatment, I am 100% ineligible for private health plans. This leaves only the possibility of state health plans and group health plans. In short, if I dont work for a company that provides health insurance, my best option is paying $400 a month for a $1500 deductible. So I do. And thats the only option I have until spouse benefits become an option, which is a lifestyle choice that doesnt usually have anything to do with how affordably we wish to stay alive. In my observation, this healthcare policy likens me and others with remission or worse status as second class citizens, for having cost private healthcare companies too much money. [url=http://www.reuters.com/article/euRegulatoryNews/idUSN2146504720090622]http://www.reuters.com/article/euRegulatoryNews/idUSN2146504720090622[/url]
Aside from a quick exodus of my five-year purgatory (the time until I can be considered insurable again) the outcome of this debate does not affect me any differently than most normally healthy people. Yes, some day I might get the flu. Yes, some day I might get a melanoma. No, I dont smoke. I dont smoke that either. I exercise, I consider my wellness of 94% of my daily decisions. I choose to be happy and I can sustain that. I drink once in awhile to keep an ace in the hole for laughter and fun. Mostly just on weekends. whatever. Im healthy and fighting the good fight. My cancer is not coming back, and I am normal.
Its easy to see why I dont agree that being married to my job is ultimately the healthiest thing for me or anyone else in my shoes. Im an artist AND a web developer, not just one or the other. Yet, one of the strongest incentives for me to stay employed is the promise of affordable no-questions-asked healthcare, and I know Im not the only one in this boat. To branch out and find my own balance, which is constitutionally something Im supposed to allow myself to think about, could potentially be a disaster I regret until I never retire, due to six-figure bills. I am so glad the government is bringing in a new option for all of us, even if they dont know what yet. Everyone needs healthcare. Everyone deserves GREAT healthcare. I know what great healthcare is. Ive used it before, and Ive felt it, through the heartfelt advice and gazes of doctors and nurses who held my hand when nothing made sense.
The easiest way to think of providing this for everyone is the single-payer system model that is often referred to as socialized health care from the political right. Same for all, all for all. Its really quite utopian when you think about it. You get sick, you go to the doctor, you get your scripts, you go to the pharmacy. End of transaction. You recover peacefully and go on with life not thinking about how youre going to pay for that shit. The idea is consistent if you think of yourself coming down with something really bad, like gawd-forbid cancer. You see the best doctors available to you, go in for treatment, as long as necessary, and you go along until you are cured, which happens as soon as possible based on how aggressive your condition is and how it responds individually. Since it costs the system more to have you treated longer, the system responds by caring for you intensely with the intention of sending you on your merry way as soon as it is no longer needed. And this will happen for everyone. All for the best right? .. Right?
Actually.. this is where it gets a little complicated.
Youll have your prelim screenings. Youll have a physical. Youll wait a little longer than usual, but hey- what did you expect from 1000 extra people at the doctors? That being so - they find something - they dont know what, but here is the kicker. You have to come back for further tests - they cant just do them now. Thats right. You might have cancer but instead of knowing in 3 days, youll have to wait 33 days. If youve ever waited 3 days to find out you have cancer - I have - youll know that there is nothing else you can think about, talk about, read about, plan about. Why do you have to wait so long? Because the system is budgeted. And theres a line. A lot of people might have cancer, and they can only run 3 MRIs a day for this kind of cancer, as only a certain percentage of people have this kind and thats all they are allowed to screen.
So you finally get your results back, they are less hopeful than expected. What to do? In my situation, I fought tooth and nail like a screaming 4-year-old to avoid chemo, radiation, surgery and everything else, but my doctor just said here are your facts, here are your options. This will give you the best chance at life. I took that advice, but heres what it really boiled down to:
Youre 26 years old.
Youre strong and young and this isnt just about putting off cancer. Its about putting it away forever.
Youre going to have the strongest, most expensive and most effective chemo we have, even though your cancers development is early enough that we would not always indicate chemo at all -
Youre going to have surgery until you get clear margins. Even if they have to cut away your whole breast like a carrot. No matter how long it takes.
Youre going to have follow-up radiation for 30 sessions, even though we know its gone.
Youre going to have follow-ups every six months to monitor your health, because we know that if it does come back, after surviving all of this, its probably deadly and will need to be managed, and we wont be able to find it without MRIs and mammograms. If something is found, you will probably repeat the above steps for the rest of your pitiful life.
My course of treatment was one that was over-kill by the books and expensive when I probably would have survived with much less. But it worked, the first time. My doctors saved my life and spared no chance if something better was available. I also had free counseling, free art projects, and the chance to live at home in relative comfort. I did not live in a state that had legalized medical pot but my friends helped me make do regardless. All along I received bills as expected from my insurance company, which may have been late a couple of times but I paid them and that was the end. And my insurance was never terminated. Neither was my job.
One thing to know about a single-payer system is that doctors and nurses have legal protocols to follow, and generally speaking this involves providing one kind of treatment for one kind of patient, across the board, with no wiggle room. Penalties for veering off the path for various reasons could vary from lack of compensation to loss of license, which would originate with the government and be distributed from there. Now wait a minute, you say - this would not happen with our government. We have too many free-market doctors and nurses who would stand up to these kinds of restrictions and nobody would stand for a more limited system of healthcare. Well youre right, and this is one reason why they are standing up for it RIGHT NOW. No one single body should determine care protocol, making decisions for thousands of individuals with their lives on the line in a single fell swoop. This is not health care. This is excuse.
One argument for single-payer is that it should cost less than the system run by bureaucratic insurance companies - as those who author the system would find trillions of ways to cut costs from the way the system is run now. This is probably true, but only in the short-term. Cutting costs now would do a lot for the economic recovery everyone is trying to feel. Ultimately, the government bureaucracy is no good at cutting its own costs, and will rob Peter to pay Paul every day of the week - so if the war machine is underfunded, for example, your doctors may find that their compensation gets cut, without a trace of how it could be linked to what is costing too much. Or else only certain pharmaceuticals are made available by certain companies for similar compensation issues. Then what is to be done? Overthrow the government, when this thing stops working and gets too bulky? When your care is stripped to bare minimums and where you might have survived cancer before, allocated surgery times, treatment waiting lists and frustrated, apathetic doctors turn your life into a fight-for-survival hell hole when you might have been completely treatable (but of course, youll never know..)Yes I know all of this is heresay, and no, I dont know where the facts are. But they ARE somewhere and I dont have time to find them. This piece is only just to outline my particular awareness of healthcare as I know it.
One thing you might not know about our healthcare system as it exists now: we do have a public healthcare system. Yes. The USA has a public healthcare system. Its called IHS (Indian Health Services) and it provides free healthcare to all Native Americans in urban and reservation areas. Any registered Native American can go to any IHS and see a doctor / be treated. This sounds great, but trust me or look into it yourself - Youre going to want to go straight back to your own doctor when you come up on even the best facilities from the outside. The lawns are not green and do not have sprinklers. There are no parking garages or valet parking. Every location is a hospital. None of them have new chairs or examination equipment. Everything is underfunded. There is a saying Dont get sick after June on some reservations where nothing is treated unless it is immediately life threatening, which is sometimes too late. From the AP:
When it comes to health and disease in Indian country, the statistics are staggering.
American Indians have an infant death rate that is 40 percent higher than the rate for whites. They are twice as likely to die from diabetes, 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure and 20 percent more likely to have heart disease.
American Indians have disproportionately high death rates from unintentional injuries and suicide, and a high prevalence of risk factors for obesity, substance abuse, sudden infant death syndrome, teenage pregnancy, liver disease and hepatitis.
Not only do these folks deserve deliverance from this hell-th system, but what if this happened to every person in this country? What if this was all we could get? You can see that these folks dont have a lot of sway in the going of their own care. Its easy to think of a single-payer system as what we all need, want, and what would best serve everyone, but the upkeep, the funding, the inertia keeping these systems from succeeding year after year after year is staggaring. At least Kathleen Sibelius knows, that by all accounts, this is a historic failure.
Even if youre holding out hope that with such a big possible single-payer system that the conditions would somehow improve, the odds are completely against. You could compare it to governments - which are more successful - dictatorships or democracies with a 3 part government one being a bicameral legislature? Product availability - monopoly vs. competition? Politics - one party or many? Without competition, our health system will fall to pieces. While health insurance companies should not be making money by denying coverage, so should the government not be given the opportunity to underfund the care of the whole country, usurp freedoms to choose doctors, dictate how they are compensated and how they should treat, in the name of cost control. This is socialized medicine and it does not work.
When he is done with Medical school and residency, Travis will be called upon to work for one of these IHS hospitals, as he signed a contract in exchange for his stipend and scholarships. If the Native Americans have access to the same care that privately-insured professionals do, which is the best possible, scenario, the IHS hospitals might have enough funding and resources to treat folks who dont seek such care fully. Hes got 5 years- then he is in here for four. Im still trying to imagine how he will treat psychiatric patients without being able to give them the right meds.
While I am 100% for healthcare reform - I believe the President and Congress are right to styme a single-payer initiative to our healthcare system. Public insurance may be our best option, and as long as it is available to everyone, it could be the catalyst to lower costs for everyone.
Still yet to consider: How will a public healthcare option affect Native Americans?
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Very interesting take on things i’m glad you wrote this to help put things into more perspective.
Very interesting take on things i’m glad you wrote this to help put things into more perspective.