Wednesday, April 24, 2013

The Best Laid Plans

Well, I am writing to you from a hotel room in Riverton, WY which is NOT Cody, WY where we were supposed to be bedding down for the night.  A winter storm diverted us several hours off course, and we needed to be settled by 6:30 PM tonight so we pulled into this little town and are in avery old fashioned, but clean (and hopeuflly spider free) little motel.  Luckily, are kids are about as flexible as they come, and we just finished a gab fest in the Girl Room where we giggled a lot after eating microwaved TV dinners, listened to Matthew sharing random facts that we looked up about snoring, and had Kenny wiggling his booty pretending to be MC Hammer...the lite and uncool version. At first we had been dismayed that the entire trip would be spent in separate rooms with the family divided, but we have been fortunate to have almost all adjoining rooms with connecting doors, and after seeing how AWFUL AND DISGUSTING the boys are keeping their room (Yes, Dominick...I mean YOU!!!) we girls are quite pleased with the arrangement.  No dirty tidy whiteys thrown on the floor, no wet towels crumpled up and put wherever, no suitecases sitting in the middle of the floor for 3 days.  We girls are ORGANIZED, we are NEAT, we don't smell like WET SOCKS!!!  Hurray!!

Yesterday evening's entertainment, which consisted of ripping apart two beds down to lifting up the box springs to see if we could find a Mom Eating Spider, was unproductive, but unfortunately I woke up with 3 smaller bites (I hope they stay that way) on my cheek and one more on my arm.  Luckily, the others are shoing signs of improvement, though one has left me with a half inch blister. I have never seen anything like this. Complaints to the front desk of the hotel fell on deaf ears, and so I will be utilizing Trip Advisor to warn others of booking that room.

You know, we fall in the "underinsured" category.  We have been diligent about always having health insurance, but as our family size increased right along with our ages, our premium has ballooned to a point where we had to take a high deductible plan to just protect ourselves against the Big Loss that might hit someday, but it does little for our day to day expenses.  I will reveal some financial information here because I think people need to understand why families like ours are truly struggling in ways others don't fully appreciate.  There are so many comments in the media about people being "irresponsible" and not having insurance, or not going to the doctor early enough, but maybe I can explain why.

For example, we pay just a little over $700 per month for health insurance with a $10,000 annual family deductible.  We have no copays, we have to pay $10,000 before any coverage kicks in at all.  It is a Blue Cross Blue Shield plan...a real insurance plan, not a cheesy one with a no-name company, but it is all the coverage we can afford and we really have no idea how we will handle further rate increases.  We have to pay for all medication out of pocket as well until that deductible is met.  We have current medications for Kenny, and the girls' acne, along with Synthroid for me, which equals approximately $245 a month...on top of our $700 a month premium, on top of paying all other medical costs that might arise like doctor visits, tests, blood tests, xrays.  Throw in Kenny's $140 a month for braces for the next 3 years, and basically, every month we are at well over $1000 a month in medical costs by the time we make payments on office visits, my blood tests, etc. that come throughout the year.  When the average lower middle class family is paying this much for ordinary health care, the question has to be long do they remain middle class before medical costs alone cause them to slip down a rung or two on the socio-economic ladder?

It is families like ours that delay medical care, because we can't afford it...even though we have insurance.  It is families like ours who are trying our hardest to be responsible and good stewards of our finances who often put off going to the MD for minor issues which turn into more serious things because we can't have yet another bill on our plate.  If there is anything at all we can do to avoid it, we do.  If we think giving something time to heal on its own might work, we wait.  If we think maybe we can muscle through some pain, we do it...all because we can't rack up even more medical costs.

I have been embarrassed at times when visiting the MD and he says, "Why didn't you come in sooner?" because millions of other Americans...have to say "Because we couldn't afford it."  I had an emotionally paralyzing moment right before our trip when we took Olesya to a new dermatologist ($268) and she prescribed new medication to try.  There at the Target counter with all 5 kids in tow and others behind me, the pharmacist says, "These are a little expensive." and because I am thinking they will still be comparable to medication to what we are already paying I am not too concerned...until she rings up our purchase and wants $670...for a one month supply.  I just about died, because that literally is the difference between my daughter's face permanently scarring as her acne is quite bad right now, or food on the table.  I had to sheepishly ask the pharmacist to put it back because there was no way I could pay that much.  The kids all got a look that was just as stunned as mine was, and Olesya said, "Don't worry mom, we don't have to get it..."  We lucked out and eventually got the MD to prescribe something else less expensive, though not quite as effective, but still almost $300 for one month.

There are millions of families like ours in America, who are technically "insured", and yet can't afford health care because of high deductibles that really cover only catastrophic events.  We are not unique, we are the ones on the edge with so many others hoping never to meet that deductible because of what it means in terms of your family's health if you did...but really wishing you could get some value out of the plan you pay $8400 a year for.  We and countless others make health care decisions based not on need, but on cost.  Our  monthly health care costs for what are really relatively minor things, now exceeds our mortgage.  We aren't alone, but we don't get talked about much in the national debate about health care.  We hear mainly about uninsured folks, but really, for many of us, while we are perhaps not in as dire straights as some, our health care decisions are made in the same way for the same reasons. The only difference?  We won't lose our house for the Big Bill that one day might come.  If we had a $500 deductible, as in days of old, we would not put off care,and would quickly make an appointment to get in to see someone.  Those days are long gone, hence our reticence to seek out medical care as early as we once did.

People may scream over "Obamacare", they may yell over the idea of "socialized medical care" that so many other developed nations have turned to, but something has to be done.  We have two children completely uninsurable due to pre-existing conditions in Kenny and Matthew.  We can't even consider changing plans, and even if we could, there is nothing more affordable out there to choose from.

And I know we are not the only ones.  I hope that someday there are dramatic changes in the way we, as a nation, view health care.  I hope we begin to talk about the real hard costs of health care, and not just how to offer lower cost insurance which will always be out of reach of so many.  We need to have a non-reactive, non-partisan, true revolution in our health care delivery system.  As time goes on, the challenges we face as a lower middle class family will continue to creep up the ladder to hit the upper middle class.  I won't pretend to have the answers, but I know other countries have managed to provide a solid level of health care to all their citizens so that no one has to sit one night with an injury and say, "Should I go to the ER, or do I want to eat or pay the mortgage next month?"

But then again, the best laid plans are always interrupted by something, aren't they?  


Anonymous said...

What a fun and adventurous trip for your family! Haven't looked at a map to trace your route, but seems you might have come through not so far from our neck of the woods! Would have loved to host you ovenight...but not much in the way of westward expansion to view here.
Wonder if you've heard of Proactiv. Someone told us about it, and it's helped some of our kids with acne...especially our son who wrestles. It gets bad during the season. It's a mail order deal. We don't get all the products, but three. It's something like $19/month. It's topical and not a medication. Just a thought. It's been successful, when they remember to use it. But maybe your dr feels she needs medication.
Safe travels, through the always unpredictable weather. Keep an eye on those spider bites, though. (I hear ya''...we also have $10,000 deductible! I have to remind myself we're saving on premiums...sort of. Hubby is getting two hip replacements this summer, so this year it's kind of like, "Anyone need anything repaired?? This is the time to do it!")
Nancy in the Midwest

Anonymous said...

Yes, we have the same problems/bills with insurance. I was a laid off teacher, spending 2000/month for the 3 of us, more than my does that work, paying your employer back all the money and then some? When COBRA ran out, we discovered that my self-employed husband wasn't able to buy us a plan, due to (relatively minor) "pre-existings." We now finally learned to form an LLC, and pay ourselves as our own bosses, and then we qualified for a small group business plan. Our deductibles are as high as yours, tho. It's a mess!

r. said...

It makes me so frustrated when people bring up the spectre of "rationing" and waiting lists. As if people aren't going months or years without needed treatment already! The only difference is that our country "rations" according to ability to pay rather than severity of need. Supposedly that makes it better?

To people who have insurance, though, it's hard for them to even comprehend the panic that wells up in the rest of us. I just got laid off, COBRA would cost over $600/month for me alone, and I have a chronic condition (depression) that makes me uninsurable. Fortunately my parents have offered to help pay for the pills until I'm officially poor enough to qualify for the drug company's patient assistance program, because they know what the consequences can be if I go off them. But not everybody is so lucky. I feel fortunate to live in a state that has strong debtor protections, so I'll never have to worry about losing my home (if I ever own one) or having my paychecks garnished over ordinary, non-secured consumer debt. But it's still an untenable situation for our country...

r. said...

On a serious note, if you need expensive prescriptions filled while you're out traveling, Costco tends to have the cheapest prices for those of us who pick up the full tab. You don't need to be a Costco member to get the meds; just explain that you're going to the pharmacy when they ask for a card at the door. (The meds are even cheaper if you're a member, but it looks like the nearest Costco to your home town is 90+ miles away, so it would hardly justify the fee.) That said, my mom, who is a drugstore pharmacist, discourages the shopping around because if you stay with the same chain all the time you at least have all your records in one place, so the pharmacist is more likely to be alerted to possible drug interactions. But sometimes you gotta do what you gotta do...

Anonymous said...

Prayers for you--each of you. Bits and pieces of thoughts, I spent over 20 years working with families on EPSDT Children's Medicaid, watching some families who were so grateful to have the care their children desperately needed and who learned to be careful health care consumers, and others who had never known how to use and rarely learned to use health care. When Colorado Children's Care came in there were so many grateful families who could afford care at least for children--something that all children--no all people everywhere should have. Rationing! Waiting lists! What makes me who can afford insurance more worthy of quick service than you Cindy, you Dominick, you the reader, you one of the LaJoy children, or anyone else of quick service. Maybe when I enter a doctor's office I should be at the front of the line because my deductible is paid through the insurance, or if I paid cash up front, I could go to the front of the line. Maybe if my insurance paid better than yours, I would get in faster. Or we could all run for Congress and get whatever...well, the other random thought I had, Cindy, was that vinegar took away the sting of jellyfish immediately. You might buy a small bottle and try it on spider bites. If it doesn't work, you can take it home and use it on salads.

Love you,