Health insurance in America
My dog has it; I don't.
I was working on another piece, (or, if I’m honest, I started another piece but it made me feel too many things I didn’t feel like feeling so I climbed back into my rewatch session of Scandal and opened my phone to play the little farm game that has me addicted to its simplicity and quick cause and effect rewards…)
Anyway, I was “working on another piece” (farming virtual corn while Olivia Pope and the President made out in the corner) when I got an email from the union office telling me to pay my premium by Friday to ensure my new health insurance started on January 1st.
And I cried.
When I got my dog two years ago, I immediately purchased pet insurance. I chose a premium package that cost $60/month, covered preventative care without even touching a deductible, and made it possible for me to take my new puppy to the vet every time I even thought about having a question about his health.
I have been without health insurance since I lost my full-time job last January. Insurance for me would have cost $620/month minimum. This was the cheapest plan I could find with the least coverage. It would basically cover nothing until I had met the $4600 deductible. A plan that actually provided decent coverage cost closer to $750/month.
I chose to go without it felt like throwing away money. I could pay 12 thousand dollars this year to an insurance company and receive little to no benefits. Unless something catastrophic happened. Then it would make sure I didn’t go bankrupt. Maybe it’s the “stick it to the man” part of me, but I just couldn’t stomach it. And also, frankly, I had to make the decision right after losing my job and I didn’t know if I could even afford it.
I ended up in an Urgicare once this spring for slicing my hand open after slipping on scree while hiking. Seeing the inside of my hand was the only thing that kept me from trying to solve the problem myself without a doctor.
It happened 10 days after losing my work health insurance and I paid $700 out of pocket for it. I also paid $60/month out of pocket for my antidepressants, carried expired epipens I hoped I didn’t have to use, and sat in a car outside the ER waiting to see if enough Benedryl would stop an allergic reaction I was having after accidentally eating just a bite of a cookie with a sneaky walnut in it. I paid $300 out of pocket to get my annual pap. I haven’t gotten the bill for the bloodwork yet. I am also currently putting off a doctor’s order scrape of cells looking for a cancer until I get my insurance in January.
All in all, financially I made out. I did not spend those $12,000 I would have spent on insurance on out of pocket costs. Did the eggshell walking anxiety shave years off of my life? Hopefully not.
As a freelancer for most of my life I have mostly not had employer-based insurance. The law (the law?! why is the law involved?!) kicked me off of my parents employer-provided insurance plan when I was twenty-six. I am chock full of preexisting conditions - asthma, allergies, cysts. At that time, insurance wouldn’t cover them and they were the only reason I needed insurance so why bother? I opted for “catastrophic insurance” from Oscar which covered very little and cost $120/month. It had some preventative care included, but was “affordable” because it assumes people in their 20s won’t really need it. I didn’t really use it, but the peace of mind and one free annual appointment were helpful
When I was 30 catastrophic insurance disappeared. Once you turn 30, you are too old and too risky for cheap insurance options. My premiums for the exact same insurance plan jumped from $100 to $600. So I wrote a strongly worded text to the customer service chatbot and cancelled my coverage.
I have been without health insurance for most of my 30s. Despite what I’d like to think about my tough self, I’m really not the kind of person who should be without health insurance in this country. I am a walking ER visit risk. I’m deathly allergic to nuts. I grew up with excessive respiratory problems that have mostly tapered off, but made COVID super fun. I sometimes have cysts on my ovaries and I have had irregular PAP smears for the last few years that require follow ups to check for cancer. I work a job that is rough on my body. I see a therapist. I should always be carrying an inhaler and a $700 EpiPen that expires every year.
And still insurance hasn’t been worth it to me. I’d apparently rather walk around terrified.
Why you eat nut?
The best hospital experience I’ve ever had with an allergic reaction was in Thailand.
We were at a dinner for a friend’s birthday and I felt the familiar swell. I snuck off to the bathroom and flushed my face with water, rinsed my lips, swished and gargled and swallowed, trying to avoid creating drama. The restaurant was nice enough that they had thick washcloths in the bathroom and I soaked one in cold water and balanced it on my face, wishing the reaction away. I came out of the bathroom and told my friends I was going to go back to the hotel, but no worries no worries no worries.
My boyfriend at the time left with me despite my no worries protests. We stopped at the drugstore that I had been to earlier that day for some calamine lotion. I don’t remember how I tried to explain allergy, but I do remember the same lady from earlier in the day opening some pills, pulling the foil off of a plastic cup of water, and watching intently as I choked back both.
We went back to the hotel because I was convinced I could wait it out. I remember sitting wrapped in a blanket rocking back and forth, shaking, on the edge of the bed in front of the blasting air conditioner. The boyfriend was on the patio of our room, balancing his laptop on his hand and yelling in through the screen door. The patio was the only place we could get the resort wi-fi. My mom was on his screen trying to convince me to go to the ER. I said I was fine I was fine it was passing and I was going to be fine until I looked down at my thighs poking out of the blanket and saw that they were swollen to what felt like was twice their usual size.
We called a car and asked to be taken to the Patong Hospital. I whispered “you’re going to be okay” to myself over and over which is what I always do. The cab driver stopped in the middle of the party district of Patong on a Saturday night and looked at us in the rearview mirror expecting both a good American tip and our exit.
“Patong HOSPITAL! We said the hospital!”
I was surprised a language barrier got in the way of what I thought was obvious distress in the backseat, but alas.
We got to the hospital and asked if anyone spoke English. A woman approached and asked what was happening.
“She’s allergic to nuts, but there was a nut in her dinner. Please help. She’s having an allergic reaction.” I imagine that’s what he said. I don’t remember.
She looked at me.
“If you allergic to nut, why you eat nut?” That I remember.
“I didn’t mean to.”
“Okay.” She was so unimpressed with the dumb American girl with a blanket wrapped around her sundress.
She took me back to a bed behind a curtain. She gave me something to swallow and shot something else into my arm. She handed me a little puke bucket and disappeared. I threw up over and over again. I emptied my stomach. No one came to check on me, my boyfriend had to take my little bucket and empty it and bring it back. They came around and asked for my Passport which was still in my bag in the hotel. We were both freaking out, apologizing to each other for forgetting it until the paperwork man came back, rolled his eyes, and brought me a bill for $30 and 3 prescriptions.
I walked away an hour later, prescriptions filled in the next room.
A few years later, I’d have a similar reaction after eating a salad in San Diego during a dinner break. I’d go to the bathroom in the theatre lobby and look at my swollen face. I’d take an Uber instead of a calling an ambulance. Faster. Cheaper. I’d listen to the driver tell me about his sister who got airlifted from their family vacation and almost died because of a food allergy, while he stopped at every red light. I’d go up to the front desk at the ER and start to cry through swollen shut eyes when they passed me a clipboard of paperwork without looking at me. I’d be rushed into the back and asked why I didn’t use my EpiPen. I’d watch the nurse throw my expired pen in the trash and know I’d have to spend $700 on a new one. I’d be pumped with drugs and held and monitored for 10 hours. And I’d be sent two separate bills totaling $2800 six months later.
Broken, but not broke
I broke the only bone I’ve ever broken when I was dancing at a friend’s wedding in the UK. I’ve been told I should make up a better story, but I slipped on my own dress and caught myself with my wrist. I don’t really remember the fall. I think I can pinpoint around where it happened from the pictures. Close to the end of the reception, there’s a photo where the bride is wrapped around me, both our eyes a little soft from all of the wine, and I’m weirdly holding my own right arm, grinning like a fool.
After the reception, I took a car back to our cottage with the other bridesmaids and I remember texting the bride asking for the number of the groomsman she’d been trying to set me up with all week. I remember doing this and I remember being excited about it. I don’t remember being in pain at all.
When recounting the story the next day, the other bridesmaids said they had no idea I was in pain until we got back to the house and I disappeared into my room. They assumed I was getting ready for company, but then they heard crying. They came to find me in my room with nothing on but my pasties, cradling my arm and bawling. They put me to bed with a bag of peas under my arm.
I don’t remember that, but I do remember the next morning. I woke up still just in my pasties and in so much pain, my wrist swollen twice its normal size and immobile. I pulled a strapless sundress up onto my body with one arm (it was the only clothing I had that I didn’t need to put my arm through), draped a sweatshirt over my shoulders, and called a cab.
I went to the nearest emergency room. I had to wait a bit, but they x-rayed my hand and arm, gave me pain medicine, and set my wrist in a temporary 3/4 cast. As the nurse wet plaster and placed it carefully on me, she told me she had never visited the US because she was too scared of getting sick or hurt there and not being able to afford it.
I did not pay a dime for my visit.
They told me to follow up with a doctor in the US to get a permanent cast as soon as I got back home. Instead I googled how long a splint usually stayed on, went to work and was careful for six weeks, and then cut my splint off myself. I was on the phone when I cut through the soft back and wedged the hard curve off of my wrist. I screamed. My wrist looked like it belonged to a tiny alien. It was pale and emaciated and stiff. I couldn’t bend or move it.
The next day, I called orthopedists I told them I had broken my wrist six weeks ago, cut off my own cast, and asked them how much it would cost me for them to x-ray my wrist and tell me if it was healed. A few people refused, but one doctor did it, talking to me personally about my lack of insurance and charging me $250. I paid upfront in the office. Eight months later, I got another bill, for $500, from their office that disappeared the second I called to ask what they were trying to pull. At the visit the doctor confirmed he could see the break and pointed out where the calcium had grown in and healed. He recommended a physical therapist to get my movement back. I saw him once and then kept doing the exercises daily at home.
The US waiting room
I got the insurance I mentioned here from the union. As a freelancer, if I earn a certain amount of money doing jobs for the union (paying 4% of my pay to them), then I am eligible for union group insurance. I had just made my first year in 2019 meaning I would get coverage starting in July of 2020. I had that insurance for a year before the pandemic took away all of my work and with it that insurance.
Millions of Americans lost health care coverage during the pandemic because of job losses. I could go deep here as it became a major part of the ExtendPUA.org fight as soon as I learned about it, but that’s for another day. Healthcare should. not. be. tied. to. employment. Period.
When I was 33 I got my first full-time, not a freelancer, office job. It had health insurance! Great health insurance that I paid nothing for! I was making considerably less money than I had made as a freelancer, but I felt rich! I became a member of a healthcare startup, I saw a chiropractor for the first time, I finally got tested for my allergies and found out that I wasn’t allergic to every nut - just four specific ones. I also found out I wasn’t allergic to the fruits that made my mouth fuzzy, just the pollen some of them had been grown in. I got a dog, excited to just pay a weekly co-pay for allergy shots. I lost that coverage when I lost that job.
I’m grateful to have health insurance starting back up. I can’t wait to make sure I don’t have pre-cancerous cells, see a chiropractor, get a new epipen, and maybe start combatting my allergy to my own perfect little boy.
But the point is, it shouldn’t be this hard to stay alive. People shouldn’t be making choices between spending money and getting life saving care or even getting preventative care. Healthcare emergencies shouldn’t need to be crowdfunded by our friends and insurance shouldn’t be tied to our employment.
Thank you for letting me write about this today instead of the bigger things sitting on my heart. Thank you for letting me write quickly and to the point. Thank you for letting me meander a bit in the past and then rush an ending. Thank you for not making me copyedit until I never bothered to publish it at all. I needed to write something today, I needed to show up here for me, and mad is often much easier than sad or even scared.
This is INSANE. the us has serious healthcare problems. It’s so interesting to hear the differences in Thailand and UK.