One Big Heathcare Rant

So, I’ve been thinking about health insurance. A lot. For a long, long time.

Aren’t teachers supposed to have really good benefits?

I don’t know whether I am accident prone or plain sickly, but I’ve had a couple long hospital stays and many emergency room visits, which, when added together, probably cost around $450,000.00. Clearly, I couldn’t have paid my healthcare bills without the aid of good insurance.

Before I get into the rant part of this post, I must say, insurance has treated me well on several occasions. The one time I was hospitalized for two months straight and had a smorgasbord of treatments and procedures because the doctors couldn’t figure out what was wrong with me and my pancreas-on-strike, my insurance paid 100% of my charges without argument. I only paid a paltry $100.00 hospital co-pay or something. Not bad, right? It is especially not bad considering that I was working for a not-for-profit legal company and only paid $15.00 a month for individual benefits.

Speed ahead about seven years.

I am speeding past the CVS on the way to school, even though I feel like crap and need my prescription, because I don’t have money to pay for it.

I don’t live extravagantly. My only splurge is an occasional stack-o’-books or music. My salary is decent, not as high as local public schools but in the 90th percentile for private schools (state or country I’m not sure). I get a little extra pay for sponsoring the school’s news magazine and academic bowl. I should have enough money left over after I pay for rent, food and evil credit card to cover my medical expenses. Except, I don't. And it doesn’t make sense.

Here’s my deal: My school opted for one of those high-deductible insurance plans. For an individual, that means I have to pay $3000.00 out-of-pocket before any insurance benefits can be applied to anything, including routine doctor visits and prescriptions. The school lessens this burden by paying half of that deductible, in 12-month installments, into a bank account. For me, that means I get around $125.00 a month.

Last week I listened  to Jonathan Cohn, author of Sick: The Untold Story of America's Health Care Crisis — and the People Who Pay the Price,  on Fresh Air, and I would like to declare myself one of those price-paying types. He talked about the challenges associated with high-deductible insurance plans. While the news wasn’t positive, it was a relief to know that many people are struggling with these plans.

Here’s my complication: Have a mentioned that I am a wee bit crazy? Both sides of my family have mental health issues ranging from depression to schizophrenia to alcoholism. All those happy chemicals I’m supposed to have in my brain don’t exist. They never did. So, I need help. Many milligrams of help. My meds cost about $300.00 per month. And I don’t get any luxury medication, like for example, my allergies. I just learn to accept that my nostrils are split at the seams because I’m so snotty.

I’m not shy about my mental health issues because I don’t believe in being ashamed for no good reason. I choose to view my situation in the same light as I would, say, a diabetic. A diabetic’s insulin doesn’t work right, so it must be controlled. It’s pretty helpful to know if someone is diabetic in case he/she starts shaking like a leaf and sweating like Julia Roberts in Steel Magnolias. In the same way, if I start crying or punch the wall when you say hello, you might like to know why.

Ok, back to the math. In addition to the $200ish I spend on my premiums each month, I shell out $175 for my meds. Every year I go to the doctor about four times: two shrink visits, one lady visit, and one sinus infection visit (then they just call in the antibiotics for me as I get four or five more sinus infections each year—remember no allergy meds).  On average, those visits probably average $150.00 each.

Yikes. I don’t know if my a + b = c and is totally logical. However, I conclude that I don’t get to utilize ANY of my insurance benefits until October or November in a full year, and now the ins. only pays at 80% instead of 100%.  So, I pay over $200 a month for insurance that I DO NOT GET TO USE.

Ludicrous, I say!

Purveyors of high-deductible insurance plans argue that when consumers are faced with the real costs of medical services, they will stop abusing the system and spend less money. I bet this is true sometimes. I know I take generics whenever I can because it makes a huge difference in the cost, but I’m not into brand-name medicine anyway. The whole concept is appalling.

Here’s the bottom line: I have to have my pills. They are not a luxury. When I don’t take them, I am a mess. But who has $300 a month to spend on silly pills?

One day at school, after one of my tires blew and all my med money went to fix it, I was invited to an English teacher tea party. There was no tea, but we are dada like that. My chair mentioned being on a teacher compensation committee and asked us to share any concerns we had before an upcoming meeting. I briefly mentioned my insurance issue.

A couple of days later my chair took me aside and told me that she was worried about me after my comment. She didn’t know what my situation was, but she wanted to help. I started crying.  I didn’t explain my full situation (damn stupid stigmas), but I told her a little. All I know is that I have worked in both private and public sectors, and I have always been able to handle paying for my medicine. Somehow, that changed.

The next day, my principal came by and told me that they worked a new $3000 stipend into my contract for next year. He said it was technically for taking on a study hall/learning lab in addition to the writing center but really for helping the school out of a few jams and staying really flexible. He said it was a stipend for “being wise beyond my years.” I thought it was crazy-lady money. I talked to my chair later, though, and she said she hadn’t mentioned anything to the principle.

I want to say thank you to the universe for that gift.

I also want to say that the health care system in this country is royally screwed up. I’ve got my fingers and toes crossed that the next president will help create a federal, universal healthcare system. I’ve got my fingers crossed about many things, but that one is near the top.

Comments

[Flaming Cheeto]

I'm not sure where you got the idea that teachers should have good insurance. I laugh at that one. My insurance sucks. My daughter broke her arm over the summer and when I had my yearly lady appointment (as you put it) I went over the diagnostic/lab/x-ray limit and had to foot the bill. Geez. No well visits are covered but once I meet the deductible they will cover 80% of my counseling visits. Counseling that I no doubt need because I work there. Ha! At least we have decent dental...as long as you go to the right dentist.

And here where I am to work for a private school is take an incredible pay cut. I thought about a private school and realized...no way. I have two kids. Just can't do it!

[NYC Educator]

It's awful that working people have such terrible insurance. Where I am, public schools offer better coverage than private schools, as well as higher salaries.

But really, everyone should have decent health insurance.

[Syb]

Do they spell +principal+ differently in other places? I am a gramar nazi... but.. I learned wayyy back.. "yr princiPAL is yr "pal'"

Just thought you would like to know.

I enjoy yr blog ooooooodles and dont mean to be mean- hope yr not offended/slighted.

Syb

[hipteacher]

Syb,

Yikes, if I got offended everytime someone had to correct my spelling, I would be a terribly negative person. I am the worst speller! I do try to check things over before I post, but I don't always catch them all. Thanks!

hipteacher

[Ms. Mettle]

I like your blog. Can you link to sassyteacher.com?

[Ms. Mettle]

I like your blog. Can you link to www.sassyteacher.com?

[mary]

I can relate. I remember back at ASC when I got diagnosed with the dermoid tumor but couldn't have the medically necessary surgery because it wasn't an emergency and because I hadn't signed up for the "extended" or "major" student insurance. I ended up waiting a year and by then the tumor was 1/2 inch bigger. Hooray!

I wonder if it's really better in Canada?

[Jeremy]

Oh my, that sounds like a total nightmare. People here (in Canada) do occasionally complain about nitpicky issues in health care, but at the root, it's something we never really have to think about it. You get sick, you get health care. No decisions about money.

[Kelly]

I too have that wonderful insurance - I found out I was pregnant in May, and as I looked closely at my benefits, I found prenatal isn't covered. I will be paying out of pocket for each visit. One of my co-workers almost didn't go to the doctor for some strange lumps around her neck, due to the high costs of this new, great insurance. Someone convinced her to - turns out: cancer.

My other favorite part of this is that the insurance company does NOT apply all of your out-of-pocket expenses to the deductible if they deem the cost too high. It's my money paying the doctor, and they don't apply it. I figure it will take me about $6000 to meet my $4000 deductible.

My school got many of us to switch to this new plan (which will be effective for all/staff faculty in Jan. 08) by doubling our premiums if we kept the old plan. I didn't have an extra $500/month, so I switched my family to it. It is the worst insurance I've EVER had - I have had to question almost every bill, keep extremely close records of the deductible. And no one in my family is sick. I can't imagine what it would be like if we needed monthly medications - I feel for you!