General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsThe Savage Arithmetic of the Pre-Existing Condition
The Savage Arithmetic of the Pre-Existing ConditionBy William Rivers Pitt
t r u t h o u t | Op-Ed
Friday 30 March 2012
I went to the doctor
Guess what he told me
Guess what he told me...
- Sinead O'Connor
Five years ago, my wife and I took what turned out to be the longest walk in the world to Brigham & Women's hospital in Boston to get a diagnosis for her that had been six months in the making. She was 25 years old, and her right arm had gone sideways on her over the last nine months with a collection of symptoms - numbness, tingling, and tremors of such severity that her good hand was all but useless for anything besides waving at friends - that we had run out of explanations for. Nerve damage? Carpal tunnel? We didn't know. She had gotten an MRI two days earlier, and the doctor had called that day asking us to come down and talk about it. The conversation began with, "You have multiple sclerosis," and that has been our undeniable reality ever since.
Multiple sclerosis, for those not in the know, is a disease in which the body's own immune system goes to war against its own brain. My wife suffered her symptoms because the disease gnawed through the myelin sheaths of her own higher nervous system and annihilated the nerves that control her right arm. Over the intervening years, her brain has taken it upon itself to figure out some good work-arounds - to wit, when the road collapses, you build an overpass - but her hand will never again have the same functionality (until stem cell research bears fruit, fingers crossed).
I give her an injection every day to control the disease, and she takes a variety of other drugs to manage the symptoms. All told, multiple sclerosis - between the doctor visits, the MRIs, and the drugs required to keep a lid on things - costs upwards of $50,000 a year. Thankfully, she is gainfully employed with a major retail company with a stellar insurance program, so a large portion of that cost is defrayed by the insurance she pays for with every paycheck.
Without that insurance, she would be at the mercy of those who think pre-existing conditions are basically God's funny joke on people, i.e., ha ha ha, you're screwed.
She is not alone. I went to the doctor last month, and found out that I have pretty damned high blood pressure. The doctor had me come back four weeks later to do another check, and, yup, really really high blood pressure. I am now on two different drugs to bring it down to a manageable level, drugs that I am going to be on until they wind me in my shroud. I am on my wife's insurance, so again, the cost of those drugs is manageable, but mine is now a house filled with pre-existing conditions.
What if she gets fired, or the company goes belly-up? She is incredibly good at what she does, which means some other company may try someday to tempt her away...until they hear about her pre-existing condition, and mine, and how much insurance coverage for those conditions will cost thanks to our truly insane for-profit health industry. If my wife leaves her company for any reason - especially if/when Scalia and his merry band of ridiculous fascists decide to curb-stomp Obama's health care law - we are both well and truly screwed. It's like Ayn Rand herself was allowed to draft the rules for getting sick in America.
But that's me and my wife.
Here's you.
According to the American Heart Association, more than 81,000,000 people in America suffer from one or more forms of cardiovascular disease.
According to the American Cancer Society, more than 11,000,000 people in America currently suffer from some form of cancer.
According to the American Diabetes Association, 23.6 million people in America currently suffer from diabetes, and the Center for Disease Control has estimated as many as half of all Americans will suffer from the disease by the year 2050, thanks to our deplorable dietary habits.
According to the National Parkinson's Foundation, between 50,000 and 60,000 new cases of Parkinson's are diagnosed in America each year.
According to the National Multiple Sclerosis Society, some 400,000 Americans currently suffer from MS.
That's a pretty substantial portion of the population, with more being diagnosed with cardiovascular diseases, cancer, diabetes, Parkinson's and MS every day.
Do the math.
It's you, too.
Hundreds of millions of people in this country are sick at this moment, or will be sick tomorrow, the next day, or somewhere down the line. The numbers are spinning like the fare meter on a New York City taxi cab, ever higher every day. If you're not sick, you will be one of these days: bank on it...and in the meantime, at least one person you know is in that tribe.
That's fact.
We're enveloped in a national debate about insurance mandates and the political leanings of nine Supreme Court Justices. That's all well and good, but entirely beside the point.
A nation that does not care for its sick and infirm is a nation that does not deserve to exist. A nation that actively profits from the pain and suffering of those sick and infirm deserves to burn in Hell. A nation that throws those sick and infirm to the wolves is so far beneath contempt as to beggar description.
Two years ago, Republican Mike Huckabee compared people with pre-existing conditions to houses that have already burned down. Just the other day on the Leno show, likely GOP presidential nominee Mitt Romney voiced a very similar opinion.
They both have awesome health insurance.
Do you? Forever?
One of these days, you are going to have a pre-existing condition.
Hope for the best, but expect the worst. "The worst" is exactly where we are headed, if matters continue as they have.
Straightforward stuff, folks.
Think it over, while you can.
We're on borrowed time, after all.
How are you feeling today?
http://truth-out.org/opinion/item/8202-the-savage-arithmetic-of-the-pre-existing-condition
= new reply since forum marked as read
Highlight:
NoneDon't highlight anything
5 newestHighlight 5 most recent replies
xchrom
(108,903 posts)
Moostache
(9,895 posts)I am in the exact same boat.
When I was 37, I got sick from eating some food I left in the fridge while out of town for my sister's wedding...I ended up in the emergency room with acute food poisoning and stomach cramping that had me doubled over or throwing up for hours. In the ER I went to, the attending physician decided to do an X-Ray to check for anything internal that might be the cause. The X-Ray tech noticed a very small lesion on my right kidney and recommended I follow up with an internist immediately.
The next day I was having an MRI and within 36 hours of the onset of my food poisoning I was diagnosed with stage 1 kidney cancer. Just like that I was forever removed from the ranks of people who CAN buy insurance on the individual market.
This is my reality until the day I die. I am a pre-existing condition and without ACA or a steady job, if my cancer comes out of remission I will die from it as surely as the sun rises in the East and sets in the West...
global1
(25,251 posts)
drm604
(16,230 posts)Well, I guess 4 of them would.
Kennedy is the one to watch.
lark
(23,103 posts)Guaranteed, he will vote to strike the mandate. the only thing that seems a little unclear is if he will vote to strike the entire law? Either way, we are once again screwed since Thomas is allowed a vote and his wife has made $700,000 leading a group that is totally anti-HCRA. It's a total travesty, and would never be allowed if he were a leftie. Righties can do any crazy damn thing they want because Liberals are so timid. Makes me sick that this isn't topic #1 in msm.
xtraxritical
(3,576 posts)
DFW
(54,399 posts)Five of them think "stay healthy or die quickly" is a perfectly good policy for our country.
It wouldn't ever occur to them that Grayson was being sarcastic.
drm604
(16,230 posts)Fortunately, like you, I have coverage, but we never know what circumstances could change that.
Mopar151
(9,983 posts)Thank (deity of choice) that the SEIU had the foresight to write terms of health insurance coverage into the State of NH contract.
Major Hogwash
(17,656 posts)Today 99% of Americans cling to the hope that there will be change in this country, and that the President's national healthcare plan is deemed legal.
jeff47
(26,549 posts)To fall into the old "pre-existing condition" exemption, they'd have to be uninsured for a period of time. Switching to a new company would not cause them to fall into that hole.
It would make it damn near impossible to buy their own insurance if they wanted to become self-employed, but they'd still be covered from employer-based insurance.
kestrel91316
(51,666 posts)a PEC and refuse to insure you.
You don't get out much, do you?
JDPriestly
(57,936 posts)You would laugh to know the conditions I have that are considered to be pre-existing.
jeff47
(26,549 posts)If you had employer-based coverage that covered the condition and changed to a new employer, with new insurance, you were covered.
If you went uninsured for a while, you were not covered when you get new employer-based coverage.
In the personal market, the situation was much different - and far more dire.
lark
(23,103 posts)Therefore, you do have a pre-existing condition and can't get coverage for 18 months.
Repug judges & legislators don't care at all, the rich don't have to wait 90 days for coverage and they'd just as soon the non-rich died fast anyway.
WillowTree
(5,325 posts)So long as the 90 day (or 30 day or 60 day or whatever) waiting period begins within 63 days of when the prior coverage terminated, they still can't impose a pre-x clause. It's been that way for over 15 years.
WillowTree
(5,325 posts)Under the terms of HIPAA 1, if you change jobs and become eligible to enroll in the new employer's health insurance plan (or, if that plam has a waiting period, if the waiting period begins) within 63 days of when your current coverage terminates, the new plan cannot, by law, impose a pre-existing conditions clause. That's the "portability" part of the Health Insurance Portability and Accountability Act.
That's a fact.
Kablooie
(18,634 posts)according to the previous laws and there is no national legal ceiling on what they can charge you.
jeff47
(26,549 posts)If you already covered by employer-based coverage, you couldn't be denied if you didn't have a lapse in coverage.
The individual market was different, of course.
Zoeisright
(8,339 posts)Grow up and open your eyes. Repukes want everyone who isn't a rich white man to die. And they're getting pretty god damned close to it.
WillowTree
(5,325 posts)
nobodyspecial
(2,286 posts)and you are shielded by the umbrella of group coverage. Your rates will be the same as all others in that employer's group. However, expect to have every claim questioned and challenged for the first year or two. If your coverage did lapse, expect to pay for any treatment or meds for pre-existing conditions for 12 to 18 months. And, if you have a chronic condition, like diabetes, think how many illnesses can be traced back to that pre-existing condition.
However, as mentioned, if you are trying to buy on the open market, the company can't deny coverage, but can set ANY price it wants. It will deliberately price these customers out of the policy since they will lose money on them. Sometimes you can get a policy if you deliberately exclude these conditions, but what good will that do you?
Any chronic condition or something like cancer can destroy you financially in a heartbeat. And don't expect any state or federal help until you've sold all of your assets to put you in poverty. It's criminal to see all of these fund-raisers to help people pay cancer treatment. It's also the most inefficient and expensive way to deliver health care. Maybe they are hoping more of us will just voluntarily off ourselves when faced with a major illness.
Indeed, what our govt. is hoping is that sick people just die. However, our short-sighted govt. is incapable of figuring out that the more people it allows to die from lack of health care, the fewer tax dollars it'll rake in.
freshwest
(53,661 posts)
Generic Other
(28,979 posts)and you speak for so many others who are in similar situations.
It is painful to hear the fear in your voice because you have never been a man afraid of anything. I don't know a single American who doesn't get a worried look in their eyes when the topic of health insurance is raised. The thought of the future weighs so heavily. Life and death hangs in some precarious balance.
Like dumb animals on a factory farm, we mill about like contented cows until we have the misfortune of getting sick. Then we are downers and of no use to them, not worthy of their attention unless we have something of value to offer in return.
We have not advanced much past the days of barber surgeons and leeches. This is the shame of modern medicine. They are ambulance chasers whose first concern is the money. I for one cannot afford the price.
I think the day has come when Americans need to start practicing medicine without a license. On ourselves.
Kablooie
(18,634 posts)Including quality of human life and even life itself.
SCOTUS said that corporations have the same rights as citizens and has even set them above citizens as 'people' worthy of help and support from the government.
The 99% of citizens in this country are being defined as an undeserving underclass.
This will change some day. It will have to.
But when?
?
cyberpj
(10,794 posts)I had my first symptom in 1985 but at that time they were unable to diagnose me for another ten years when, in 1995, lesions finally showed on my MRI. At that time, the first MS drug, Betaseron, was so new you had to get get a number to join the lottery of those who could obtain the medication.
Since that time, as you probably know, several other MS medications have all come to market; all of them costing thousands per month to obtain. A price which we all know has been super inflated to cover "research and development" costs for the drug companies. When I was diagnosed the published figures said about 250,000 had MS. Your figure shows the increase in this disease which seems to be cropping up everywhere. Almost anyone I speak with knows someone with MS; it's been amazing to me.
I'm both grateful and lucky that I worked almost 20 years for a Fortune 500 company and already had decent benefits. When things got rough I was allowed to retire on a disability pension and since then my Medicare has taken on part of my costs.
Getting to the point - so far ALL MS medications are prescribed and taken in order to slow down any progression of the disease. People should see fewer exacerbations and a much slower progression of the disease. There is no medicine to date that is proven to stop or reverse the disease process or symptoms. If I, or anyone else, had been covered and using my meds but had then been laid off (which happened to several of my co-workers after I left because the department's work was outsourced) I not only would have eventually lost coverage and become uninsurable due to a pre-existing condition, but on top of that my disease would have progressed in symptoms, attacks and over-all disability because I would have been unable to afford the medications on my own. For some, the big pharma companies will help with costs if you're poor but according to their guidelines my spouse makes too much for me to qualify (which is also laughable).
Anyway. My thoughts are with you and your wife. As someone noted previously, changing jobs might keep her covered but losing a job probably won't. I really believe our own congress will never understand how the 'health system' works for the entire rest of the country because their own coverage is so wonderful that they don't even have to think about it. What I liked was when I heard commentators telling Washington D.C. "All we want is what we pay for YOU to have".
All the best.
And thanks for shining your personal spotlight on this issue.
-PJ
kas125
(2,472 posts)Now, I know at least a dozen people who have MS, including my best friend and my sister. At least five other people who grew up within six blocks of our house have it. Something is causing the increasing numbers of people to develop MS and I wish someone would figure out what the hell it is.
Raven
(13,892 posts)gave him, I'm pretty sure of that. So I guess you could argue that he had a pre-existing condition at birth.
Fix The Stupid
(948 posts)I tried to PM you, but I don't have enough posts.
All I can say, and this is 100% anecdotal, and you don't have to trust some anonymous DB on the internets but...
A good friend of mine is battling MS. The only and I mean the ONLY thing that keeps her somewhat pain free and mobile is pot. Yes, that evil, soul sucking, plant is literally a miracle worker for her.. It takes away some of the numbness, eases her mobility, etc, etc.
She was probably the last person I could think would ever try it or smoke it, but it works for her.
Sorry about this as well - it is a horrible disease. Good luck to you and yours.
Martin Eden
(12,870 posts)That should be the simple, straightforward, true message in this election.
Brainwashed teabag idiots protest "Obamacare" as an infringement on their "freedom" but the hard truth of the matter is that millions of Americans dare not leave their jobs to advance their careers or start their own business because if they lose their current health insurance they can be financially ruined and die prematurely.
The Affordable Care Act is far from the best solution, but it was perhaps the best Congress could pass at the time and it's a big improvement. If the SCOTUS kills it the optimist in me sees an opportunity to take a big step towards Single Payer, but that requires a major advance in public perception and acceptance. A great deal of political heavy lifting must be done by this president and his party that to my eyes have been incremental, cautious, and to some degree owned by the big money interests that finance political campaigns.
We live in interesting times, but that detached observation fails to convey the gravity of what's at stake here -- the lives of millions of good people, and the soul of our nation.
mmonk
(52,589 posts)Was waiting for it. 
trumad
(41,692 posts)Quit watching Super Bowls.
lapislzi
(5,762 posts)She's very, very smart. She looked at me in disbelief. She could not believe that her nearest neighbor could behave without a shred of decency towards its citizens.
She did offer to marry me so I could become Canadian, but, alas, I am already married.
WilliamPitt
(58,179 posts)trumad
(41,692 posts)
Nye Bevan
(25,406 posts)Before Obamacare (and I deliberately use that term as it is a *good* thing) people with chronic diseases would live in fear of hitting the lifetime limit. It sickens me that thanks to the SC both the pre-existing condition exclusion and the ban on lifetime limits may be thrown out.
McCamy Taylor
(19,240 posts)Zalatix
(8,994 posts)A nation like that is little different than a jungle. It is not even a civilization; and it does deserve to collapse.
RagAss
(13,832 posts)
ellisonz
(27,711 posts)There is a small hole in my right eardrum since I was a toddler. It gets infected, my left eardrum had holes too and was surgically grafted to close it up. I could be denied health insurance for this alone. I currently have health insurance only because Obama extended the period of time you could stay on your parents coverage. Several members of my family have preexisting conditions, my sister was denied coverage by Kaiser Permanente because of it. This is a very important issue to real people; it is not about broccoli.
CaliforniaPeggy
(149,627 posts)Well written, as always...
Uben
(7,719 posts)My wife got cancer in 2002. Our premiums for our private policy went from $600/mo to $2100/mo in the ensuing years. $25K/yr in premiums isn't something the average American can do, but fortunately, we could. It took sacrifice, of course, but we kept paying the premiums because we knew there was no cure for breast cancer. Then, in December of last year, it came back. She died last month, succumbing to the chemotherapy....it was just too much for her body to handle.
We were lucky to have been able to afford the outrageous premiums because without the insurance, we would be out several hundred thousand dollars. That would have bankrupted even some well off folks. It isn't fair or right. Every American should have hope when disease strikes, without the worry of bankruptcy. But they don't, and why? Greed.
My premiums are now $900/mo+. I am 57, in good health, and the only thing I have ever been hospitalized for is a broken leg in 2005.
So, I am gonna shop around for a better deal. The insurance industry is no more than a legal organized scam created by congress and the lobbyists designed to bilk people's money to pay people who do nothing but be a middle man.
A-Long-Little-Doggie
(1,011 posts) 
libtodeath
(2,888 posts)
GoneOffShore
(17,340 posts)As always you cut to the chase.
Posted to my Facebook page and Tweeted.
PA Democrat
(13,225 posts)What many people don't seem to realize is just how vulnerable they are, even if they have perfect health and/ or great insurance ....today. Life has a way of catching up to you and it is the rare person who will not someday face a job loss, a serious health issue, or even a very manageable one that the for-profit insurance racketeers do not want to have to cover.
Profit motives and quality health care are incompatible if you believe as most of us here do, that health care is a basic human right.
All the best to you and your wife, Will.
GreenPartyVoter
(72,377 posts)
Brigid
(17,621 posts)He needs to see this too. Not that he would get it. 
WHEN CRABS ROAR
(3,813 posts)
juajen
(8,515 posts)I don't even recognize us anymore. I grew up in the fifties and sixties. We were a blue collar family, but our health insurance was stellar, and my father worked for a huge corporation and he had job security that was amazing because of the union. He was an alcoholic. It was recognized as a disease back then, and, when it got bad, he was hospitalized until, once again, it was under control. As far as I know, there was never a question that he would lose his job over this. He was a valued employee. It was a health condition. Imagine the difference in then and now. Not a day goes by that I don't hear someone in dire straits because of health care issues. We are in a stranglehold and controlled by moneyed interests. God help us all, for it seems nothing we do changes anything. Too many bought people with no soul.
As usual, Will, beautiful writing and so disturbing. Bless you and yours!
SheilaT
(23,156 posts)tend not to understand what everyone else deals with. And all those who work for the federal government tend to have really good health care plans, and are utterly astonished when you explain to them how it works out in the rest of the world. If you have a job with any kind of health plan, you get the plan your company has. Not much in the way of choices, other than perhaps opting for some extra coverage.
I happen to work for a hospital that seems to have a very good health care plan -- I say seems because I have almost no real experience with it. I get an eye exam and new contact lenses once a year, and a couple of years ago I tripped in my driveway and broke an arm. I paid around a hundred dollars out of pocked, and recently, a good two years after that whole thing, I got a check from our insurance company that was a reimbursement of a co-pay I should not have paid.
I tell people I have the Republican Health Care Plan. I don't get sick. I am fortunate enough to be blessed with incredibly good health, and it angers me beyond words when I listen to the crap that's out there about how people don't deserve coverage, or how one person shouldn't have to pay for someone else's bad health. No! We should all be helping each other out however we realistically can. Just because I'm healthy doesn't mean someone else shouldn't get all necessary health care. No matter what the circumstances. And we should have a single payer system that covers all of the basics -- annual check-ups, vaccinations, all prescribed medications, coverage for illnesses and accidents and anything else I haven't just thought of.
Besides, we ALL have the pre-existing condition of being alive.
sellitman
(11,606 posts)Thanks Will. Hope they work the fuck out of those Stem Cells and fast.
DFW
(54,399 posts)"According to the American Heart Association, more than 81,000,000 people in America suffer from one or more forms of cardiovascular disease."
I'm one of them. I just do not break down cholesterol. Period. I almost died in late April, 2004 when a very alert German cardiologist sent me in panic to a cardiac clinic and got 2 stents put in two clogged arteries. The specialist who put in the stents spoke German the whole time except when showing me the before/after images, when he said "just in time." I have relatively low blood pressure (115/75), so I had no chest pain, no idea I was in mortal danger. A couple of years after that, my outfit wanted to change health insurance plans. The insurance company looked at my record and demanded $35,000 a year to insure me. We said we were looking to get an insurance quote, not hire an assistant.
America's system is so whacked out. Last year, before a minor procedure, I was told to go off my blood thinners for ten days prior. I did so. Sue enough, about an hour after the procedure was done, I had my very own, very first heart attack. One of my stents had clogged right back up, due to not taking the blood thinners for ten days. For 3 days in the hospital in Dallas, I got the first bill: $35000, but discounted to $26,500 (WTF?) and our old insurance covered 90% of that.
Now, I've been in German hospitals before, and when I had my stents put in here, I was in the hospital for about the same amount of time as I was in Dallas, and with far more intensive care. The bill was less than $10,000, and our insurance screamed bloody murder for my emergency not having occurred at a clinic (or, apparently, on a continent) approved by them. Yet covering 90% of a $26,500 bill in Dallas was no sweat. Now, as far as I know, Germans don't drop dead with any significantly greater frequency than Americans do. No do the French, the Scandinavians, the Dutch, the Belgians, or any other denizens of neighboring countries. My wife just spent three hairy days in a hospital getting her tumor-laden thyroid taken out. We had to wait 3 days to find out if it was cancerous or not (it wasn't), and she needed the three days to recuperate from the invasive procedure anyway. The cost to us? About €1.50 a day at the hospital parking lot so I didn't have to walk a kilometer to her hospital to visit her.
So, William Pitt: how am I feeling today? Better, but no thanks to a system whose motto truly is "Stay healthy or die quickly."
Tobin S.
(10,418 posts)The drugs that I use to treat it work very well, but they cost about $700 a month. I used to be self employed as a truck owner-operator. No insurance company would cover my pre-existing condition while I was self employed. The best I could so was get a prescription discount card through one of the pharmaceutical companies that saved me about $75 a month. I have to be employed by someone else who has a group health insurance plan to get my illness covered in a substantial way.
Technowitch
(8,488 posts)A little over 10 years ago, I discovered no health insurance company wanted to cover me, except one or two that would specifically include riders for the main reasons why I'd ever go to see a doctor in the first place. Namely hayfever allergies and migraine headaches. They also wanted to exclude chiropractics (since I occasionally went for adjustments due to a lower back malformation) and a couple other things. The cost for the privilege of having insurance I could barely use, with a high deductible anyway? $650/month.
Luckily, I found a professional organization that offered group insurance for self-employed folks like myself. So yay, I had insurance again, and it wasn't that bad or terribly expensive.
Then the underwriter dropped us, and we were all thrown back into the individual market. At this point, for the same cited reasons -- allergies and migraines -- I was told that NOBODY wanted to insure me. I have a whole folder full of rejections from 2004, making it clear they truly didn't want to cover me. All because of two conditions I can handle 95% of the time with OTC meds, and where the other 5% of the time, some Flonase or Imitrex helps my quality of life be that much better.
At no point in my entire life did I ever come close to drawing out more in claims than I paid in. I had nothing more than the minor complaints suffered by millions of other Americans, and this was enough to deny me coverage. Back then, I was told my only option was to get on my state's High Risk insurance pool waiting list, where I could be expected to face premiums well north of a grand a month, probably close to two.
This year, I decided enough was enough, and I applied again. Got the expected rejection letter -- for exactly the same reasons. This time, however, I had an option -- and I applied to the Federal High Risk Pool...discovering that the subsidized rates aren't that bad, and that I qualified for the subsidized rate.
Absent the ACA and its eventual ban on refusing coverage due to preexisting conditions, and on charging more for them, and absent the interim high risk pool, I'd still lack insurance and any means for getting it.
And this is why I become furious when these GOPer sociopaths try to insist that not having insurance is entirely a choice. I have an inch thick folder of rejection letters over the course of eight years that says otherwise. For seasonal allergies and migraines!
Bluenorthwest
(45,319 posts)I'll take a moment to note that it is nice for you that you share Insurance with your spouse. Not all of us are allowed that. The 'reform' will not change that. So keep in mind that there are people in your exact same situation who are denied that right. Things are hard enough for you guys, imagine what it is like for those who are counted as strangers to each other in the tax and insurance language of discrimination.
Just something to keep in mind
WilliamPitt
(58,179 posts)"...So keep in mind that there are people in your exact same situation who are denied that right. Things are hard enough for you guys, imagine what it is like for those who are counted as strangers to each other in the tax and insurance language of discrimination."
...is exactly my point.
Thanks.
Romulox
(25,960 posts)Insurance companies make money by denying people care. That's incontrovertible. 
