gfish | (no subject)

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Anyone who wants to see what is (as far as I can tell from my POV in Vancouver) a representative view of how Canadians view their healthcare compared to the US can read through the comments on this story.

And the really funny thing is, most Canadians have no idea how bad it can be in the States. They just don't quite get what it means to not have insurance, having grown up in a civilized country and thus never having faced that particular horror. Or, for that matter, the lesser-but-still-quite-nasty horror of being insured but not being sure how much it will cover until the surprise bill shows up a month later. Or knowing that they'll look for any excuse to drop you if you should ever really need the coverage. Or... blah. Pisses me off all over again just to think about it. I'm going to miss my BC MSP coverage.

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And what a giant horror it is!

"Or knowing that they'll look for any excuse to drop you if you should ever really need the coverage."

Y'know, everyone keeps saying this, but I'm almost the poster child for the person this should have happened to, several times, and not only has it never happened, I've never even felt like it was a possibility. The health insurance industry is running at least 1.5 million dollars in the hole on me so far, I hit my maximum out of pocket limit more years that not, but never once have I even been worried.

Sure, people who don't have / can't get (worthwhile) insurance through work are a problem, and sure, non-single-payer inefficiencies are a problem, but I'm not convinced *that* is.

(I've read claims of people having that happen -- most recently linked from fb -- but they've never sounded very credible.)

Are you independently-insured or through COBRA or something or through the state or? People in large pools that can bear the penalties don't have a problem as often, but most people aren't in such pools.

Is it really true that most people aren't in large pools? I would find that very surprising.

I've had many insurances over the years. Right now I'm on COBRA continuation of crappy Aetna coverage through a temp agency.

I've had to stay pretty well educated to keep my insurance. Most people don't understand how to avoid the medical questionnaire and how important it is to do so.

How *do* you avoid the medical questionnaire? I'm pretty clear on why I'd want to do so.

Keep continuous coverage, and run your COBRA out completely -- don't give up early on it.

Oh. We can't afford our COBRA, even w/ the discount. So I guess that's fucked.

To be clear, I'm not saying it's never happened, or that it's not a tragedy if and when it does happen. I just don't think it's the vast epidemic it's made out to be.

I consulted my mother and she says that basically if you can deny someone coverage is down to the agreement the company has with the insurance commission in the state the company operates in. As a general rule, if the policy is medically underwritten, then they will deny coverage to people with pre-existing conditions. I think medically underwritten policies tend to be cheaper.

Have you ever had to buy the coverage outright, though? You can be insured as part of a pool much more easily than accepted for coverage as an individual applicant. I know your title was 'consultant' for a while - were you actually on your own?

I've also read some pieces on Kos about ill people getting fired for petty excuses if their company is penalized badly enough by the insurer - which of course is highly illegal, but that doesn't mean it's impossible, so I at least want to check that out - and then if they can't get into a new employer's pool before COBRA goes away, or can't pay for COBRA, they become uninsurable except by the state.

I know it's essentially impossible to obtain worthwhile insurance except through employment, and that's certainly a problem, but it's a different problem.

I've read those same pieces on Kos. None of the authors struck me as remotely credible. Which doesn't mean it's never happened, but I'm not yet persuaded it's a vast epidemic.

I think it varies by state as to what the company can or can't do when you're coming in looking for insurance. Like, no one has refused me coverage (just wanted an arm and a leg for it, or to not cover my pre-existing conditions, which makes the policy pretty well useless) but when Nic was looking for new coverage because her work coverage sucks balls, several companies refused her outright on the basis of something or other in her medical history. (I've also spoken to someone who brokers insurance for folks who has had similar problems.)

The whole business of pre-existing conditions is, imo, probably a much bigger practical problem than people being refused coverage outright. (I mean, with my condition and the treatment for it, an insurance company could probably quite happily argue that all manner of things, including getting a cold or infection, fall under the 'pre-existing condition' header because my decreased immunity is directly related to my condition.)

Exclusions of pre-existing conditions are limited by federal law to the first 12 months of coverage at most (and in WA and other states to much less). So I really do not think it's as much of a problem as being outright refused coverage.

I know it's essentially impossible to obtain worthwhile insurance except through employment, and that's certainly a problem, but it's a different problem.

For people with chronic conditions, a full year of no financial assistance for anything that could be vaguely construed as related to one's pre-existing condition is just about like not having insurance.

Exactly. And often it's an either/or thing - you can afford the insurance or you can afford to pay for your treatment out of pocket, but not both.

(I also think the 'vaguely construed' part is very important. I think a lot of people when thinking about pre-existing conditions think of them as very fixed and specific things, but if you're looking at it from the point of view of a company trying to weasel out of paying for something, quite a lot of pre-existing conditions have a whole host of things that *MIGHT* be related, and how can you prove one way or the other? Heck, who has the energy to get into that kind of argument? A lot of people don't, or don't even realize that they CAN argue things.)

(To be fair, I do not think all insurance companies are evil. But I think the way things are now is ridiculous. It really did relieve quite a lot of stress I didn't even know I was under when I was living in the UK and finally qualified for NHS coverage.)

Sure, but it's just about like not having insurance followed by having insurance, which has to be less-worse than not having insurance followed by not having insurnace. (Kris's point that you may not be able to get there is a separate, valid issue).

We can compare notions of relative badness all day, but a person can easily become bankrupt or homeless from medical bills in 12 months.

Edited to add: or, y'know, die from forgoing treatment.

Edited 2009-07-23 03:09 (UTC)

Sure. And that's a tragedy. And I never said otherwise.

Unless you can't afford to pay for the treatment for the pre-existing condition out of pocket, on top of the cost of the coverage. It's quite easy to be in a position where you can afford one or the other, but not both, so the exclusion limit doesn't do you much good.

True enough.

I think HMOs used to pay for things better than they do now - your hospitalization as a kid, and my mom's coma when I was a kid, both about twenty years ago, were nearly fully covered, but my mom's surgery and chemotherapy now are nothing like fully covered and my parents and trying to figure out what they can sell, and we're all thanking the Powers That Be that my brother and I can take care of ourselves financially these days, 'cause the money that was supposed to help us out if a meteor fell on my parents is gone.

I spent a couple of minutes trying to dig up useful data to support 'insurance pays less' but didn't get anywhere, as I don't understand the intricacies well enough to know what to search on. I'll poke at it more tonight, see if I can pull up some non-anecdote figures.

There were no HMOs 20 years ago (to a first order approximation).

What plan is yerMOM on?

We had Kaiser Permanente, which as I understand it was indeed an HMO 20 years ago, SO THERE. :) MyMOM has Uniform through UW now.

My parents had an HMO of some type or another when I was v. small also, which was 20*mumble* years ago.

They've existed since the Nixon administration, but they only became the standard option like they are today in the 90s, iirc.

Goofiness aside, I meant health insurance in general seemed to cover less, not just HMOs.

Who is your insurer?

http://gfish.livejournal.com/286967.html?thread=1506295#t1506295

How about what it means to see a friend die of cancer who might have been diagnosed in time if she had insurance and could have afforded to see a doctor sooner?

OK, I'm still upset about that one 3 years later.

You, and the friends and families of 137,000 other people (http://www.urban.org/publications/411588.html).

For good reason.

I can't actually get to the comments on that story or even see any indication that there *are* comments. Is there some link I'm overlooking?

They're at the bottom of the page. They're added through some weird AJAX voodoo, though, so something might be getting messed up because of that...

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