Since writing my last post, I thought I should follow up with other aspects of the realities of modern living. Health insurance issues loom large in everyone’s life… but I will not go into the woes of the American Health Insurance System. Instead, I’m going to just share my personal experience.
When I was growing up, my stepmother bore the burden of health care coverage. She worked as a paraprofessional in the New York City school system. She earned approximately $13,000 gross per year, but only netted about $8,000 per year (at her highest income level). Besides funding her retirement plan, most of her salary went towards health insurance. My father’s company plan just couldn’t adequately cover a family of 5 (two adults & three children).
I can remember regular visits to the pediatrician, but once my sisters and I hit puberty, most illnesses were treated on an emergency basis. You see, even back then, it was cheaper to have emergencies fully covered by insurance than to get preventative care covered. Prescription medicines were fully covered as well. I can’t remember going to the dentist on a regular basis, however, when I was in high school, orthodonitics was added to my stepmother’s insurance coverage so I was carted off to get braces. (I didn’t take full advantage of it because I was a stubborn teenager, most of my peers had already had their braces off and it was just too painful. I’m a wuss when it comes to dental work!)
I recall that when I was in college my stepmother rushed me through doctors & dentists appointments before her coverage ended for me. I was covered by the college’s health insurance plan by then, and was treated occasionally at the healthcare facility on campus — it felt like an exclusive private hospital. I was even afforded mental health care there, even though it was sketchy at best — you could get weekly therapy appointments, an evaluation by a psychiatrist, and put on prescription medicine, but there was no follow-up care. Looking back, I realize that students, and their families, would address any long-term needs with their own healthcare professional. Once I quit college and moved to Los Angeles, I was on my own.
I lived on & off of health insurance, according to my work record — when I had a permanent job, I had health care coverage. Some coverage was better than most… when I worked for Warner Bros. Records, from 1993-1997, I had comprehensive coverage that included chiropractic, alternative medicine, mental health, vision and dental care (as well as standard emergency & preventative allopathic care) at minimal cost to employees. Of course this all changed when the company had to scaled back for financial reasons in 1997. After that, the premiums and co-payments increased for the “regular” plan, while the coverage of services decreased. They also added an HMO option, which allowed employees to pay less in premiums and co-payments, but it was restrictive in services and number of office visits. Mental health care coverage was drastically revised and administered by a third-party. My therapist had the hardest time receiving authorization and payments.
I was eventually laid off from Warner Bros. Records (massive layoffs were corporate’s answer to ameliorating their financial woes, even though most of the highest salary expenditures at that time went to executives who didn’t stay in office for more than a year). I had been laid off 5 years before by Arista Records, so I knew the drill. I received a much better severance package from Warner Bros. though, as my insurance coverage was extended to almost a year after my layoff. The next permanent job I had (at a employment recruiting firm) didn’t have much in the way of coverage, but at least I could get emergency care. (Too bad I didn’t need Lasik surgery at the time — that was fully covered until someone, again in corporate, closed the loop hole).
My next job, with a division of Mars Inc., didn’t provide much in the way of coverage either, although they had loop holes for certain treatments/surgeries — namely bariactic and orthopedic, so I could have my stomach stapled and remove my bunions for a nominal fee. I don’t have bunions and I’ve never wanted surgery to “cure” my obesity, but I did start going to a doctor (recommended by a co-worker) who was very familiar with the company’s insurance plan and could overcome its hurdles. In retrospect though, he wasn’t a very good doctor — he was a general practitioner who was a self-made obesity specialist and he doled out Zoloft like it was candy. At least with him, I found that Zoloft did help treat my bipolar disorder.
Unfortunately, after I was laid off in 2002, and my insurance coverage had expired, I couldn’t afford regular treatment and my mental health plummeted. Even before that time, I was on the brink of a psychotic break (which I did not reveal to my doctor out of fear — fear that I was crazy and that I couldn’t afford treatment… vicious circle, indeed!) By that time I had been on unemployment, which was running out, and I was in no condition mentally to hold down a job. I went to apply for welfare and Social Security, but my case was re-routed to the Los Angeles County Department of Mental Health. After some initial difficulties (I “presented” myself as “normal” most of the time, but didn’t get “serviced” until I had some irrational crying fits & tantrums AND had a friend’s mother who worked in the “system” intervene on my behalf), I received the necessary and free mental health care I needed and free prescriptions.
At that time, I was regularly seen by a psychiatric social worker and a psychiatrist. However, I received no other health care insurance. I have always been relatively healthy, despite my obesity. Most of the major physical problems I’ve had have had to do with my menstruation cycle, but those problems seem to resolve themselves with proper diet, exercise (walking, mainly) and mental health care (Zoloft has been used as a treatment for PMDD). If I ever did get physically ill, my only option was to literally camp out at the County Hospital and hope for to be treated, if there weren’t too many indigent people getting stabbed or shot in Los Angeles that day (fat chance!).
By this time my life had pretty much fallen apart — I couldn’t work, I was on welfare & food stamps, my mental health had fully deteriorated, my landlord wanted to evict me, and my only option, if I was to stay in Los Angeles, was to live in a homeless shelter. I opted out of that completely by asking my best friend if I could live with her at the healing sanctuary in Western Massachusetts where she had sought refuge during her dramatic life changes. Although the woman who stewards the place didn’t know I was coming until the day I arrived, I was able to stay there for over a year.
During that time I did have to seek out social services. Now, Massachusetts is a great state if you’re destitute and in need of mental health care. I was able to apply for welfare, food stamps, and health insurance all in one place… and everything was covered! They have a very comfortable, state-of-the-art mental health facility in North Adams for in-patient care, and a very good out-patient care facility (privately administered by state funds) throughout Berkshire County. When I opted to live at a local homeless shelter (I could avail myself to more social services if I didn’t live in a private residence), even more services were covered and my food stamp allotment was increased. It was a very different story when I finally began to receive Social Security Disability Insurance.
You see, I have been working at relatively high paying jobs since I was 14 years old. For much of my adult life, I sacrified my mental well-being in order to keep working, until I could work no longer. So in all those years I accrued a higher than most value for my SSDI. When I started receiving SSDI (over 3 years after I applied for it), I actually began making too much money. My state health insurance coverage was dropped and all other benefits ceased. I couldn’t apply for many programs because I earned too much. I went on Medicare Part A and Part D (since I was still on MassHealth when I began receiving SSDI, I mistakenly believed I would continue on that plan for outpatient care coverage so I opted out of Medicare Part B).
I should note that my therapy was no longer covered. It seems that Medicare will only cover therapy with a psychiatric social worker. In my town, there was only one affiliated with my clinic and she was grossly overbooked. I had to pay for all doctors’ visit myself. And Part D (the prescription plan) was a fiasco! The first year I had all sorts of co-payments until I accrued enough to cover the deductible. Once the deductible was paid, my prescriptions were only $4 for brand-name drugs and $1 for generic. This year, when I went to fill a prescription, I got the shock of my life (I believe it is called “The Donut Hole Effect”) — one brand-name prescription was going to cost me $256 for a 1-month supply!!! At least the pharmaceutical company kept my prescriber well stocked, or else I would have had to go back on a generic medication that giving me trouble with its side effects. Not being on that medication (it is a mood stabilizer) is definitely not an option in my case!
Once again I must give credit to the Commonwealth of Massachusetts. There are programs and agencies available to help people on fixed incomes get the necessary supplemental coverage to alleviate the financial burdens of health care costs. I went to a great local agency called Ecu-Health Care. They are lifesavers!!! I was able to apply, and receive, additional coverage through the state health insurance agency (MassHealth) at an affordable fee AND they “grandfathered” me into Medicare Part B. More to the point, the 5 medications I take daily to manage bipolar disorder are all covered… I pay $1 each for the 3 generics and $4 each for the 2 brand-name medications. I can schedule my annual physical this year with peace of mind.
I don’t think Henry David Thoreau had to consider any of these issues when he was living on Walden Pond. From what little I know, he was steadfast in his belief that a vegetarian diet and life lived in nature could cure all ills. I followed that regime for over a year at the healing sanctuary, and I still had the same illness I arrived with. Yes, the perils of modern life can be attributed to many dis-eases, and I have limited my exposure to a great many of those things by choosing to live in the peaceful & serene Berkshires. However, I have a hereditary chemical imbalance of the brain (yes, other members of my family have also suffered variations of this illness) which must be treated and managed.
I manage quite well now because the medicines which are available to me work and because I’ve made the necessary lifestyle changes. Unfortunately money issues and stress can erode my delicate balance and put me in a mental state that cannot be easily managed. At least I have the coverage I need now and I can take more steps towards preventative care, rather than always having to rely on emergency care. Also, my “experiment” in living deliberately is allowing me a deeper sense of self-care.
