The Country is Sick

It has been a week now since returning from my month in the States and of the myriad of wonderful conversations and experiences and reunions, one topic has stuck in my mind: health care. Maybe it is because I came back home to a letter telling me my application for a “cure” had been approved by the national health insurance. That means that I will be spending three weeks in a “cure spa” in the mountains near Salzburg exercising with trainers, getting physiotherapy, eating healthy, and learning to replace my bad old sedentary habits with better and healthier ones. And yes, the whole thing is covered. My copay comes to $9.35 per day.

There are other reasons that health care in the States has been on my mind. In conversations with friends and family, the subject came up often. A lot of us are nearing or at retirement age, slowly winding down our careers and making decisions about “the right time to go”. In the case of two couples, the husbands were working into their 70s – putting off retirement till the day their wives qualify for Medicare. Another woman wanted to stop working and had saved enough of a nest egg to do so – she just couldn’t afford the private health insurance in the interim. One woman who was basically self-insured through her own business talked about how much those costs ate into the company’s earnings. Two more women – one with a pre-existing condition and another with a special needs child – knew that losing their jobs would have more than mere ripple effects – it would mean a financially ruinous tsunami washing over them.

“People like the health insurance they get through their employers.” How many times have I heard that statement since the start of the health care debate way back in the Clinton era? 100 times? 500? 5000? And I have never understood it. I know very few people with 100% job security, so if the employer decides whether or not you continue to have a job, don’t they also decide whether or not you continue to have health insurance? Doesn’t that yoke you to your place of employment and limit your own freedom and self-determination?

The last school year was not the best for me. There were even times when I considered leaving – to the point where we had a mini family conference about it. It would have meant bridging the last two and half years of my professional life with other “unofficial” work (tutoring, translating, etc.), but what to do about health insurance was not one of the considerations. I find myself wondering now what my situation would have been, if I were on my own and in the States . . .

 

https://smartasset.com/taxes/wisconsin-paycheck-calculator#eOxo4LJPs8

I decided to make myself a fictional 57 year old single woman with no dependents, living in Milwaukee and earning $50,000 a year. A nifty paycheck calculator online told me that I would end up with $3,196 a month to live on. Ouch! That seemed pretty low. I thought Americans paid a lot less in taxes, but this was only slightly more than the Austrian equivalent of this fictional woman would take home. In her case, about $700 a month would be skimmed off the top to pay for her health care and pension.

 

From there, I went to the Healthcare.gov website. After first figuring out what “deductibles”, “out of pocket” and “copays” meant, I entered my fictional information and clicked on “See Plans”. Of the 24 options, here were two at the opposite ends of the spectrum:

The cheapest Bronze Plan – “only” $709 a month. (Gasp!) But if I understand deductibles correctly, I would have to pay my own medical bills up to the tune of $650 a month before the insurance ever kicked in. So . . . why am I paying the additional $709??

 

The best of the Gold Plans. If I’m doing the Math right, I could technically afford this one with my $3200 monthly take-home pay – that is, as long as I never go to a doctor. Or take any medicine. Or own anything requiring maintenance. Or go on vacation. Or eat out.

Again. I don’t understand.

People protested last year to save this system. They camped out at congressional offices and marched on streets with signs saying “Don’t take my health care away”. They clearly supported this system in which they pay what seems like exorbitant prices to keep insurance and pharmaceutical companies profitable. I assume many of their employers have to pay such high prices too. It must make the cost of labor a burden on their bottom lines, which in turn incentivizes downsizing, relocating, outsourcing and all of the other euphemisms for “You’re fired!”

Navigating this system, making financial or life decisions based on this system, being constantly worried about losing this system . . . that all must create a great deal of stress in people. Anxiety too. Sleepless nights. Depression. All things that can lead to other, more serious illnesses . . . but never fear! The pharma industry is on it! Whatever your problem is, they’ve got a pill for that. What’s that? You don’t know what your problem is? Well, here’s an array of possibilities to choose from . . .

I only watched about three or four hours of TV during my month in the States – but that was more than enough to get a picture of what is going on. Rachel would do her 20 minute A block without interruptions, but from then on it was a constant flow of commercials broken up by sporadic 3 minute news segments. And it seemed like a third of those ads came from pharma companies. So here’s what the experience was like:

Rachel tells me about an explosion during a Russian nuclear missile test and how the radiation is spreading in my direction.

Then a nice woman in a commercial asks me if I ever feel anxious. If so, I should ask my doctor for xxxxx which, in some cases, might lead to dry mouth or mysterious sounding “sexual side effects”.

Then I see a short report about an immigration raid with desperate crying children, after which

a pharma commercial guy asks me if I am feeling sad. If so, I could try yyyyy  (but I should watch out for such side effects as fever, confusion, uncontrolled muscle movement, decreased white blood cells, seizures, impaired judgment, coma, suicide or death).

The next news report is about a recent mass shooting by a white supremacist, followed by

another nice lady asking me if I am having “racing thoughts” and trouble sleeping. I should try zzzzz (but beware of tongue swelling, memory loss, and/or hallucinations). Her successor knows what I could take for my “restless leg syndrome”, but it might increase my gambling urges or make me fall asleep while driving.

In the final news report, I hear that the pwesident is leaving to go on vacation. He has done nothing in his 2½ years so far to combat the country’s widespread addiction to painkillers, but never fear,

there is now a treatment for OIC (opioid induced constipation)! Just watch out for nausea, vomiting, stomach tearing and constant pain.

 

I think most people -me included – have a touch of hypochondria (aka “Illness Anxiety Disorder” or IAD) in them.  Who doesn’t hear of some new disorder and think briefly “Ooh! Maybe I have that!” So I wonder what the cumulative effect of all these messages must be. And then to continually hear these gruesome lists of possible side effects which often seem to end with “death”.  It’s unbearable. Four or five more hours of watching this stuff and I’d have started tearing my hair out.

Which, thanks to a sign in a Chicago el train, I now know is an official thing: trichotillomania or “hair pulling disorder”.

The industry is working on a treatment for it.

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I appreciate living in a country with a social welfare economy, but that doesn’t make me a Socialist. I also don’t believe in Capitalism for Capital’s Sake. From everything I have seen, a healthcare system that is privatized and profit-driven has every inducement in the world to keep the country sick. As long as it continues on like this, there will be no cures.

 

Sick Leave

I was just standing in the kitchen Saturday evening and talking to my daughter when a fairly intense pain suddenly flared up in my left hip. It came out of the blue and was strong enough to make the trip up the stairs a bit of a struggle. I muttered to myself, once again, about how it sucks to be growing older and hoped a good night’s sleep would take care of it.

On Sunday, I could barely walk.

Having gone through something similar with my shoulder a few years back, I self-medicated with some expired anti-inflammatory pills, checked my doctor’s office hours for Monday, and then called my boss with the potentially, probably, bad news. With three of my colleagues away as it is, my absence meant a lot of scrambling and improvising for the few remaining teachers.  But then, what else can be done? As my boss said to me when she called back later, my only job for the moment was to take care of myself. Health comes first.

Sunday night, in bed, my condition reached peak pain. It got so bad that I actually panted. At 2 am, I stumble-schlepped myself to the bathroom and back, took another pain pill ahead of schedule and then somehow managed to fall into a shallow sleep.

I had to wait till 1 pm on Monday to see my doctor. When she heard I was having yet another one of these inflamed joint bouts, she announced that she was going on a mission to get to the bottom of it. Over the next four hours I was pricked with needles three times, I gave up a substantial percentage of my blood supply, and I peed on demand. I also posed (almost) nude for hip and lung x-rays. I allowed Vaseline to be smeared on me repeatedly for thyroid, hip and breast ultrasounds. I was shanghaied into my very first mammogram. Finally, I was also informed that I am officially on sick leave until my doctor informs me otherwise. I was ordered to come back on Thursday with another urine sample and to take it very easy in the meantime.

Strangely enough, I came home feeling much better.

Two of my thoughts since have been that 1) a person in pain will do pretty much anything a doctor tells them to and 2) the Austrian health care system is something of a miracle.

Take the mammogram part, for example. That’s a procedure I have been successfully avoiding for decades, despite the reminders I get biannually from my insurer. But today, when the doctor’s receptionist swiped my insurance card, a notice popped up in her computer that I was eligible for the examination at no cost. She asked me if I wanted to get that over with too while I was there. It would only take an extra five minutes. Of course I said no, but my husband, who was there with me, intervened and said I should just do it. I was trapped. Whoever designed this breast cancer prevention program knew what they were doing – how to reach the resisters and rope in the unwilling.

Now, of course, I am happy that the long war within me was ended by this surprise attack.

My own doctor’s reaction to my condition also fits right in with the design of the system as a whole. One of the policies intentionally tries to maintain enough general practitioners and to distribute them around the country where needed. My doctor knows me well by now and she admitted that she was taking full advantage of my visit to check everything she wanted – because she knew it might be years before I showed up again. She ordered all the tests and examinations; she made sure I got them done right away at the nearby health center in the brand new, state-of-the-art radiology office. And because she ordered them, everything was covered. All the results will be sent back to her and she will decide on my treatment, if any, with a complete picture from all the various experts at her disposal.

 

Back at home, I started googling about the costs of all these tests in the States. Of course the information was all very complicated depending on where you live, whether and how you are insured and how much your co-pays are, but it was pretty clear that those four hours of tests could have set me back as much as $2000 dollars. In contrast, all I had to pay for that Monday was the prescription fees: a grand total of $9.

Maybe the greatest miracle of the health system here are the thoughts that never crossed my mind as I headed toward the doctor’s office in pain. Can I afford this? Can I afford to take a day off of work? What a gift it is that for everyone – and I mean everyone – such factors don’t even make it into the equation.

 

Twickle-Down Twumpcare

It is 8 pm Austrian time. If new reports are correct, about one hour from now, the House of Representatives will vote on their health care insurance accessibility plan.

As I have occasionally mentioned on this blog, our messed up free(d) enterprise(r) system, tweaked into dysfunction by years of corporate lobbying and legislation written at Round Tables and then conveyed by the hand of some bought and paid for politician to the floor of Congress and voted unread into law (pause . .  to take a breath), has made sure that American money now acts like a gas floating upwards rather than a liquid trickling down. Not that I ever really bought into that particular theory either. But Republicans clearly cling to it with an almost religious conviction. In order to sell it to their minions, they coin neat phrases like “job creators” or “makers and takers” or conjure up economic evil-doers like “welfare queens” or “deadbeat dads”. They opine incessantly that “Obamacare” is merely a “disaster” in a “death spiral”, a weapon in the big hand of government wielded to enslave the once-free . . . And now they have their chance – the new tiny hand of government will be more than happy to sign a law designed to bring back the invisible hand. Supply and Demand. Those market forces will make everything healthcare great again.

Except that we all know they won’t. Because as we saw before the ACA, with a health insurance industry orientated toward profit, the demand was universal (we ALL get sick and need care) and the supply was based on ability to pay.  These companies did not magically rise up to meet the needs of the consumers. They found ways to avoid paying the bills of the sick (e.g. “pre-existing conditions”) in order to keep the premiums of the wealthier and healthier lower.

Maybe, just maybe, the health care concerns of our nation cannot be addressed only through insurance industry products being bought and sold. Maybe, this is one of those economic sectors where cooperation is just as necessary – or more so – than competition. Maybe, merely “everyone having access” to health care isn’t enough. I mean, I “have access” to a Rolls Royce. That doesn’t mean I can afford to buy one.

I am in no danger of being financially ruined because I don’t own a Rolls Royce.

Not having a Rolls Royce does not put me at risk of dying or losing a loved one earlier than necessary.

 

While defending the proposed budget, Twump’s spokesperson feigned social consciousness by asking can we really continue to ask a coal miner in West Virginia or a single mom in Detroit to pay for these programs?”  He wasn’t talking about the ACA specifically, but about all larger government actions. My answer to him: “YES! Yes, we can!”

It is certainly better than asking that coal miner or single mom to contribute to the next insurance company CEO’s obscene bonus.

Is this all really so hard to understand?

 

It is now 9 pm Austrian time. I just checked the news and heard that the vote will not happen after all.