Wednesday, October 16, 2013

On Obamacare and the Shutdown

When I'm home in the US - as I just was - one question constantly comes up:  Do you think you'll ever move back?

The truth is, I would love to at some point move back. I don't think I'm at a place career-wise where that makes sense right now, but there's also one, very practical reason that right now, I'm fighting like hell to find a way to stay in Europe: health care.

When I left for the UK, I had catastrophic health insurance. I was self-employed and with an extensive, scary family history of cancer, I was afraid that I would get sick and would go bankrupt if I had anything less than catastrophic health care. So I paid $150/month premiums in order to be capped at a flat $1,000 deductible. After that, everything would be covered up to $1 million / year.

One year, a single ER trip followed a series of routine medical procedures - pap smear, mammogram, yearly check-up with the doctor. That one trip meant I met the yearly deductible and my insurance kicked it. I knew then that as long as I was independent, I would need catastrophic health insurance.

Of course, my premiums were immediately raised to $300/month, doubling because of a single hospital visit. For those wondering, that was almost the same cost as my rent at that time (I shared a house and if memory serves, we each paid approximately $350/month). Now, I know my insurance was not expensive compared to my US friends who have multiple kids. But I was a single 30 year old, non-smoking female in good health without a history of anything serious.

At this point, I feel the need to translate the concept of premiums and deductibles into a UK term for my European-based friends, but I've never had to buy health insurance here so I have to use my phone insurance experience and hope it works. A premium is your monthly payment just to have health insurance, while the deductible is both the amount the claim must exceed before it kicks in and the excess you pay.

For my first year in the UK, I retained my US-based private health care. Even after learning I was covered by the UK National Health Service, I was afraid to give it up. Thinking I would return to the US in an uncertain job market, I didn't want to go through the pain of finding a new insurer - or try to anticipate what that cost would look like after time without insurance. So I paid over $5,000 to cover me for 18 months just so I didn't lose the right to be healthy.

For my UK and European friends, the concept of anyone paying $5,500 in addition to taxes just for a right to be taken care of is an insane proposition. Some of my friends know of my first trip to use English health care. I had one of those things women get that we need to go get an official diagnoses even though we know what the problem is. I called the Nurse's hotline to ask if I really needed a diagnoses or could pick something up over the counter. I needed a diagnoses. I explained I was American and asked how to use my health insurance here, knowing it covered me overseas.  She said she wasn't sure of the procedures in my area, but I would probably have to pay $25 and then submit the claim for reimbursement.

I went, got my diagnoses, and picked up the drugs from the counter as I'd been told to do. "How much do I owe you?" I asked, flipping my wallet open and putting my hands on two £10 notes. "£7.10" the sweet nurse replied.  "Oh, um, I think I owe you more than that.  I'm an American."

I said more about US health care than I intended.  As these graphs, compiled by Ezra Klein, indicate, as an American, I'm used to paying almost double the average cost to industrialised states. And according to an article in the Journal of the American Medical Association, that increased cost didn't get me better health care. It got me "mediocre" healthcare.

The nurse behind the counter looked at my slightly indulgently and said, "You live here, though, don't you?" "Yes, but I'm a student."  "Right, but you live here, so you only have to pay for the prescription."  "But, I'm a student. I think I owe you more money." "No, love, you live here so you only have to pay for the prescription." "But, I'm just a student. From the US."  "Right."  I could tell she was starting to lose her patience with my inability to accept free-ish healthcare. She reassured me the lady on the phone probably didn't realise I was a student, but it really, truly was free. Except for the £7.10 for the prescription.  If I was poor, that could be waived, too.

I left, set aside £25 in an envelope and didn't touch it for 3 more months, waiting for the bill to come. It didn't.

Then, there was the time I broke my leg. I got laughing gas and morphine, an ambulance ride to the hospital, x-rays (multiple), a cast, crutches, pain killers, and follow up appointments for the grand total of $ 0.  For those from the US, let me reiterate: that's not a typo.  I paid zero dollars.

Technically, I paid for those X-rays, etc., before and after through the taxes I pay.  But it was so nice in that moment to not have to quickly calculate how much money I had in my bank account, minus rent and phone and food costs to determine how much I could offer as a first payment towards my treatment.  I just sat there, begging people to give me water and getting a recurring 'no' until a doctor could confirm I didn't need surgery.

I also thought about how I would get home, when I should bother my friends with the information that I'd broken my leg, and whether I should call my parents before I learned about that potential surgery.  I never once thought, "Can I afford this?"

When the laughing gas wasn't working, I didn't hesitate to tell the paramedic it wasn't working. Well, that's not quite true. I tried the gas for about 7 minutes; it regulated my breathing but did nothing for my pain.  The US-trained part of my brain briefly thought, "Shit - can I afford --" before the UK side of my brain said, "Don't worry! You won't need to pay for a switch in treatments!"  I looked him in the eye and said, "This isn't working. I need something stronger."  He offered morphine; I said yes.  Within 5 minutes, I was feeling a lot better.

Then there was the cancer scare. I haven't told very many people about the cancer scare.  It happened over the summer, and I got the news 2 days before I left for Turkey. They set up the follow-up for the day after I returned.  Two weeks later, a letter informed me I was cancer free, but would need to be seen again in six months.

The other health issues were minor and I never worried that they would actually affect my ability to get health insurance in the US.  What I was concerned about was how my use of a national, universal, and foreign health insurance system would be counted by US insurance companies, who, prior to Obamacare and if they accepted you, had to cover pre-existing conditions if your insurance had not lapsed by more than 6 months. If they accepted you. At least that was the rule in Ohio.

It was the cancer scare that made me realise I actually only knew the rules in Ohio.  And even then, I didn't know whether the UK national insurance system would count as being "insured." Surely it would, right?

I only cancelled my almost-as-expensive-as-my-rent health insurance when I was back in the UK starting my PhD.  I realised I was staying for at least 3-4 years and that I would hopefully get a job teaching here after. I decided the expense of US-based health care was too much.  I was paying $3600 / year not to be insured in the present, but to protect the potential need for health insurance five years down the road.

That cancer scare, though, made me wonder: what if my UK coverage doesn't count?  What if returning to the US suddenly meant I couldn't get health insurance that included coverage for cancer treatments?

The answer is clear: I literally cannot return to the US but for Obamacare.  I would have to do anything I could to find a job or way to stay in the UK or Europe.  I would seriously need to update my online dating profiles.  I would need to be willing to accept jobs below my qualifications and to do things like teach property or wills and trusts, not exactly my go-to for excited teachings.  But I would do it if it would secure me the necessary right to remain.  The right to have a future cancer diagnosis covered.

That's ultimately what Obamacare - actually, the Affordable Care Act - is about.  People want to make it into something big and bad: a tax; socialism; government intrusion; new welfare; Hitler-esque notions of government.  But Obamacare is actually about allowing people to get coverage that couldn't get coverage under the old system. It's about giving people an opportunity to be healthy.

Some will get that through government assistance, but I am unlikely to be one of those people.  I am one of those people who are not only willing but able to pay into the system for insurance but who under previous rules would be unlikely to get coverage if I returned to the US - or at least unlikely to get insurance that would cover the thing I fear the most and the thing I would most need coverage for (cancer).

Of course, this is the second time that cancer has dictated life and career choices in my family.  The last time was after my mother's treatment for breast cancer in the 1980s.  It was before HIPPA - the health care privacy act that ensures if you're diagnosed with something your employers or future employers don't get to know about it unless you tell them.  It's the law that helps tamper down health-related discrimination.  Before HIPPA, my mother was told she was too costly to employ as a teacher; her cancer negated her excellence in the classroom and she took a job selling real estate. It's a nice job, and she's good at it, but I've always thought she should've been back in the classroom.  By the time HIPPA was introduced, though, her teaching credentials had lapsed and it would've been costly for her to go back and pass the classes necessary to get re-licensed.

We passed HIPPA because of the absurdity of situations like my mother's; we passed the ACA because of the absurdity of situations like mine:  that someone can be denied health care not for anything within their control, but for the very reason they would need health care, because they got sick.

Now the GOP wants to stop it and they are willing to sacrifice the good faith and credit of the US to do so. For reasons they haven't ever been able to really articulate, much less prove - unless "it's evil" and "it's socialism" are legitimate accusations.  But they aren't.

The ACA is one of the most capitalism-loving forms of universal health care. It actually mirrors the systems in the Netherlands and Germany. It allows for insurance companies to be competitive, while requiring they also do part of the job of the medical profession: ensure people who get sick can get better to the extent science and God allow, not to the extent their wallets can afford.

Yes, the ACA requires people to buy something, but it requires them to buy something that we as a society would have to pay for if they didn't buy it. In that sense, it encourages individual responsibility.

If I had never left the US, I still could have found myself in the same position I'm in now - cancer scare, no private insurance. It's the reality for millions of Americans, sometimes through their own fault, often times through no fault of their own.  If that had been the situation, I would have found out about the potential cancer after more symptoms developed, meaning after it had developed into cancer and had progressed to a stage where it is harder to fight. My necessary or emergency care would be covered by the government, meaning the other taxpayers.  And I would probably die because I wouldn't be able to afford the medicine or treatment. So the government would be paying not to get me better but to make sure my pain wasn't excruciating while I died.

Instead, the ACA gives me an opportunity for early diagnosis, takes the burden off other taxpayers to pay for my care, and gives me an opportunity to live. It gives me assistance in finding healthcare if I've had problems finding it, or if I'm still too poor to actually afford it.  And it does so while remaining true to capitalism.

The GOP wants to make the ACA some big bad socialist plot to kill America.  It's not.  It's a program for people like me.  And it's the only hope I have of returning to the US full-time in the future.