Can someone explain exactly how Andy fell through the cracks?

[Ladyhawk]

I know the gist of the story about never getting benefits under his employer, the nasty lay-off (the other "F" word), but my Republican mother always taught me that if someone can't pay, they'll still get health care.

My own experience has shown me that no one really gives a hoot about my health care, except for me and a few friends. I'm on the bottom end, which means I get health care that is often sub-par, takes forever or not enough. One of my friends has some pull in the health care field or I wouldn't even get what I do. Currently, I'm extremely frustrated because I had to let my mother back into my life because In-Home Supportive Services can only come twice a week for two hours a session. That isn't enough right now. :( What else could I do? Had there been no family to help, I'd be in a heap of shit.

So, you have the marginally-insured poor who get care, but not quite enough, or soon enough, or good enough. And you have the rich, who don't have to worry about such things. Ever. You have the gainfully employed who have "decent" health care coverage through work. Then there are a whole stack of folks who work and can't afford coverage.

My mother always said no one would be turned down for medical services and that she wasn't responsible for the medical coverage of other people. I mentioned our fund-raising drive for Andy and she can't wrap her brain around the idea that Andy was going to be denied care unless we came up with money. I heard her automatically excuse the idea, "Pancreatic cancer is always terminal."

WTF?

She also says that if you're not a good risk, insurance companies won't cover you. Is this a good thing, mother, because it's what you voted for. Every nasty thing that's happened to me under the health care system she's excused in a similar manner. It makes me feel sad and diminished. I'm not good enough. Once I figured out that truth, I realized that I have to basically beat down walls to get the care I need, which is something I don't need to be doing when I'm ill. Putting Andy through that was inexcusable, you officious corporate bastards.

I don't need to know the names of people, but I think an exact description of the crack Andy fell through would help me wrap my brain around this. In my own struggles, I've tried to forget these instances. Really. I just don't want facts reminding me that I really don't matter. None of us does, except to each other.

[blondeatlast]

1. Such a complicated issue can be so easily solved.

Businesses would be by far derive the most benefit from a single payer health CARE plan.

The whole thing sucks, and those who tend to be perpetually healthy can't possibly understand what it's like to desperately need care. I'm fortunate that I get it through my husband's work, but we just got a major shock. We managed to avoid COBRA while he changed jobs, but if we hadn't, it would have cost us TWELVE HUNDRED DOLLARS to cover us for one month--and that would still be less than my medical expenses that month.

It makes your head spin, doesn't it?

[greatauntoftriplets]

2. Bev Harris never paid for the healthcare insurance he was...

supposed to get.

When he and his partner termite owned the Subway store, they could not afford health care coverage. And it bugged the hell out of him that they could not provide that to their employees.

I totally agree about "officious corporate bastards. "

[Ladyhawk]

6. When I'm well enough to fight for my own health-care, I get a fraction

of what I really need. It's the truth. Much of what I've gone through has nearly killed me. When I needed help the most, the person in charge of my health care clinic BARRED me from access to my primary health care physician and psychologist by simply saying my case was "too complicated" for her clinic.

So, when I was at my sickest, they kicked me out. The doctor who made that decision would burn in hell if there was a hell. Last I heard she was promoted. Sigh.

But no matter how bad a story sounds, there's always one that is worse. I don't say that to minimalize anyone's pain. Too much of that goes around as it is. I only say it to show the scope of the problem. I had to go through two days of horrible withdrawal symptoms (dissociation, heart racing, panic attacks) because my health care providers couldn't get their shit together and prescribe the goddamn pill I needed. That may not be as bad as losing the health care providers I trusted, which happened a couple of years ago--that long?--but neither should happen in a system that functions well.

Oh, as for the withdrawal problems? I threatened to go to the ER, which I've had to do when presented with this same problem last year. OH, THAT COSTS MONEY! WE'D BETTER FIX LADYHAWK'S PROBLEM!

The only thing these bastards understand is the bottom line. If you threaten the bottom line, you'll get their attention. To finally get IHSS--a little is better than none?--I went to the office and in a quavering voice asked for the paperwork they had done turning me down. I told them my lawyer needed it to file an appeal.

I didn't have a fucking lawyer. I hate lying, but I'm slowly learning that if you threaten the corporation's bottom line, people will listen to you. It's the only way to survive because these officious corporate assholes don't care about you.

THEY DO NOT CARE ABOUT YOU.

THEY. DO. NOT. CARE. ABOUT. YOU.

That used to make me cry. It doesn't much...not anymore, because I bury the incidents. I bury the pain. When I can, I try to think like a friend of mine who is a great manipulator. (He uses it only for good.)

I am not a manipulator. I'm one of the most guileless people I know. In fact, it astounds me that some folks go through life thinking of how they can screw over others to their own advantage. But these are the people who oppress us now, so we have to learn to play on their turf: How can we threaten the bottom line.

The problem is, without safety nets, without regulations, it's impossible for the little guy to threaten the corporations. This is what is being stolen from us. :(

[tyedyeto]

3. Welcome to the Neo-Con world of health care................

they don't care one iota about you or me.....just what health ins. do you have. If you don't have any...then F* you.

I have a minimal amount of health ins. coverage where I work. Recently, a co-worker told me, he has had about $1,200 worth of medical expenses in the past 3 months. The deductible for this policy is supposed to be $500, not including office visits (which some of his expenses were). The insurance company has paid a grand total of $25.00 of his medical bills. Fortunately, I have been healthy and haven't collected or used one dime for any sort of medical care, but the company is taking a look at dropping all health care for employees. Where does that leave people like me who use it for emergencies??????

[The Velveteen Ocelot]

4. It's absolutely medieval. Makes me wonder if they're just trying to

kill us off. If you have no health insurance you're basically screwed; you might have to take up a collection just to survive. But even if you do have health insurance, you still have a pretty fair change of getting screwed because you might have to wait weeks to get an appointment approved by your HMO; they might decide you don't really need a specialist or some other kind of treatment; or they might decide your plan doesn't cover your problem. It's just insane. And freaking evil.

[Demonaut]

5. you have the patience of a Saint, I hope your mother has some

redeeming characteristics if you've got to help take care of her. No one should be denied health care, not even republicans

[nannah]

7. state health care benefits vary from state to state

WA state is one of the few states who offer full health care benefits to people without health insurance or the means to pay out of pocket. To qualify medically for WA state medical benefits the health condition must be considered totally disabling for a minimum of 90 days. Financial eligibility is based on limited resources (cash or possessions that could be sold to raise money to pay for health care), less than $2000.00; being totally unable to work; and having limited income. Your home and one car are not included in the calculation of resources. The program I am describing is the General Assistance program. It serves thousands of people who need health care in WA state. Once someone is found eligible they receive medical coupons that are accepted by doctors and hospitals throughout the state for medical care, prescriptions, vision care, physical therapy...most medical services.

people served by GA are not limited to people who worked for employers who offered no health insurance; many people who had health insurance while they were healthy and working find they can't afford to continue the COBRA payments to keep their health insurance once they have a major illness, like cancer or heart disease or are injured somehow.

I work as a social worker for the state of WA. I meet with people applying for GA and help them gather medical evidence to support their application. The state of WA provides millions of dollars in diagnostic testing to help people find out what their health problems are, and if they are considered disabling, to provide full medical coverage for the services they need for treatment. As I mentioned in the start of this message, WA state is one of the few that has this program.

Another program in WA state for those with limited incomes and no health care or insurance is the state's Basic Health Plan which offers health insurance on a sliding fee scale. The start is $10.00 monthly for those below @500.00.

The cracks in WA state Basic Health program is the long application time frames and pre existing condition delay. And the program is capped and will stop taking applications when it is considered full.

The cracks in the state medical coupon program is no coverage for mental health counseling or medication management; some doctors won't take patients with coupons but the major medical centers and hospitals all take coupons.

I don't know the ins and outs of other states health care systems, only WA state.

On the federal level there is a program called Supplemental Security Income (SSI) that provides a montly income of approximately $579.00 a month and a medicaid coupon that can be used for all medical services and prescriptions including mental health counseling and medication management. Eligibility for SSI is limited resources and total disability for 12 months or more or having an illness expected to end in death. Since this is a federal program the coupons can be issued in any state. And there will always be some doctors who won't take medicaid coupons, but most do.

This is probably what my grandson would call "OVERSHARE"!!! but health care is such a huge issue in this country.

[ultraist]

10. Less than 2k?

What you described sounds like Medicaid ("health condition must be considered totally disabling for a minimum of 90 days. Financial eligibility is based on limited resources").

http://www.cms.hhs.gov/medicaid/whoiseligible.asp

Person who is Aged, Blind, and/or Disabled
Apply if you are aged (65 years old or older), blind, or disabled and have low income and few resources. Apply if you are terminally ill and want to receive hospice services. Apply if you are aged, blind, or disabled; live in a nursing home; and have low income and limited resources. Apply if you are aged, blind, or disabled and need nursing home care, but can stay at home with special community care services. Apply if you are eligible for Medicare and have low income and limited resources.

Some Other Situations
Apply if you are leaving welfare and need health coverage. Apply if you are a family with children under 18 and have very low income and few resources. (You do not need to be receiving a welfare check.) Apply if you have very high medical bills, which you cannot pay (and you are pregnant, under 18 or over 65, blind, or disabled).


What about people who have some assets but cannot afford private insurance company premiums? These are the folks who are falling through the cracks.

[nannah]

15. you are exactly right.

"people who have some assets but cannot afford private insurance company premiums? These are the folks who are falling through the cracks."

The presence of resources blocks a person's eligibility for both SSI medicaid and the WA state programs. People who have resources have to exhaust them before they can be considered eligible for medical benefits. People with resources that make them ineligible for state help, and no health insurance, have to face a health care system that may expect them to pay in cash before they get an injection of chemotherapy or a fracture set. even people with 80% health insurance coverage have been asked to bring their 20% share in cash prior to receiving a treatment or diagnostic procedure.

The difference between the WA state GA standard and SSI medicaid is the duration of total disability. SSI medicaid duration is 12 mos or more. WA state GA is 90 days or more.

[Cleita]

8. You're in California aren't you?

Here's some hope. I just got this in my email yesterday from another DUer, brook.

I worked today at a Health & Fitness Fair in SLO - and one of the women (Pat) who I spoke with is associated with this Health Care For All legislation promotion. She tells me the bill is in Appropriations at this point. I read it over - and it looks good to me. Sheila Kuehl's a good person, imo. I'll be checking on the progress of the Bill.

This bill, the Kuehl Bill, is to bring health care to all in California. I hope Arnold can't stop it.

[Ladyhawk]

14. Yes, I am in California.

And I fuckin' can't stand Ah-nold. I know one of the Repugs in the legislature and he is no nice guy. We're in deep shit if the Repugs take the state.

The Kuehl Bill sounds cool to me. :)

[karlrschneider]

9. Nowadays the "cracks" are numerous and wide

it's like cooking peas on a barbecue grill...there's a LOT of 'fall through'. I plead guilty to a lack of activism on this issue because I'm disgustingly healthy, I haven't been to a doctor in 25 years
(except for routine flight physical exams), never been hospitalized, broke a bone or had any surgery except a tonsillectomy at age 6. A grand total of 4 stitches in my 63 years (on my hand when one of my dogs bit me when I tried to swat him while he was fighting with one of the others over some food.)

Oh, I'm not sure about that...do they stitch up after circumcision? I don't have memories about that. ;-)

[ultraist]

11. I'm healthy too

But honestly, I fear going for my checkups---mammograms for instance. IF I needed surgery or even a biopsy, my rates would go through the roof.

My insurance company jacked up my rates after I had kidney stones on an existing policy. They reserve the right to increase rates, at their discretion every Jan. BS

Insurance companies have us running scared because they can do whatever the fuck they want.

Preventative care is important and 45 million Americans are going without it or recieving substandard care.

[DulceDecorum]

12. This whole insurance thing is a scam,

if you ask me.
Look at AIG if you think different.

What exactly are we paying for?
Some accountant to tell us that our illness costs more than he allowed for outgoing expenses?

I say we hire doctors like we do firemen. Have them lying around just waiting for something to happen so they can respond.

Just imagine what it would cost if we had to get permission form an FMO before firemen could be dispatched. There are some services that should NOT be privatized and I say health-care is one of them.

[kineneb]

13. In some rural Cal. counties there is CMSP

similar to MediCal but for adults w/o children. It is asset/income based. Basic qualifications are:
1. Live in a rural county served by the program
2. income under 200% of federal poverty rate
3. no cash assets (savings, IRA, etc)
4. house and one car exempted

Hubby can't get medical insurance due to "pre-existing condition" of diabetes and failing kidneys. The medical bills were killing us so we spent down our assets to get on the program. Now we have a $12/mo. "share-of-cost" and he gets medical treatment and most medicines. It isn't great; service is really slow and inconsistant, but it is something.

[shadowknows69]

16. From the cracks

"my Republican mother always taught me that if someone can't pay, they'll still get health care."

No offense but.....HA!

from us in the cracks probably dying from something we can't even afford to have diagnosed.

[Swamp Rat]

17. I fell through years ago.

[anarchy1999]

18. Very beautifully written piece.

There is nothing to add but take it forward. I'd love to help you in any way I can.

[Lindacooks]

19. Tell her that 18,000 Americans DIE every year because they

are ininsured.

http://www.acponline.org/journals/news/jan2000/atpress.htm

Of course, it certainly sounds like your mother won't listen to facts or reason. Sorry you have to deal with her - but please try to make her a smaller part of your life. YOU ARE WORTH A LOT. And she has some major problems that she can't see what you are worth.