Tuesday, July 01, 2014

How The Healthcare Mandate Saved My Nephew's Life

For those fighting the good fight, here's a real world example of why the healthcare mandate is a good thing:

Do y'all remember when I posted the gofundme link for my nephew who was diagnosed with leukemia? Thankfully, the donations that people sent made it possible for him to have his mother there with him while he went through treatment. If you haven't been through cancer, I hope you at least have the sense of compassion and empathy necessary to understand why a child would want their parent around while strange people poke and prod and inject potentially lethal chemicals into their body. The only thing worse than being a child with cancer and not having anyone there to help you through it is being a child with cancer and not being able to receive care at all. That's what I really want to talk about.

My sister works full-time. She PAYS for insurance through her job's group plan, so skip the drama about people wanting something for nothing, s'il vous plait. Her 2 kids were both created with her husband, so skip the drama about people being irresponsible with their sexuality. Despite the fact that she is a good and loving Christian woman, that marriage didn't last. That shouldn't be a surprise. Christians actually divorce more than non-Christians in the USA. Still, one would think that the father could help her through this ordeal with their son, right?

Well, that wasn't possible. You see, he has lung cancer. Like me and like their son, he was raised in a little part of the country called Allée du Cancer (Cancer Alley). Look it up, if you want to understand why I'm always talking about some new person in my life who has been diagnosed with cancer. Why, you'd almost think that the government should do something to stop companies from poisoning us! But I guess folks who are for "less government" wouldn't approve of that sort of interference with the "freedom" of companies that are allowed to operate here. My sister actually moved across the country and got another job to provide a better life for her kids, but it wasn't soon enough for her son to avoid becoming a part of the cancer statistics here.

So, there it stands. My ex-brother-in-law can't work, because he's dying, so he can't get insurance through any job. That means he can't cover his kids on any plan and my nephew must rely on his mother's insurance. Now, let me explain how this dealing with cancer and insurance companies has worked in the USA. Insurance companies were able to deny care to people, PEOPLE WHO WERE PAYING FOR IT, using multiple tactics. by claiming that a condition existed before the purchase of the policy. They were also able to deny care to people by putting a cap on the amount of money they'd spend on the care of any person on the policy.

If science education was what it should be, people would know that we all have "cancerous" cells in our body. However, it's only when those cells reach a certain mass that doctors make a diagnosis of cancer. Since doctors can only detect cancer once a mass of these cells reaches a certain size, it is never possible for a doctor to prove exactly when it first developed in a person's body. Because of that, unless you were on the insurance plan from birth, the company could always claim that you got cancer before you purchased the policy. This is the "pre-existing conditions clause". The healthcare mandate makes it illegal for insurance companies to deny care to people paying for it simply because the person may not be able to prove when they developed a condition. Without this mandate, people who were deemed to have pre-existing conditions could pay for their policies faithfully and on time and still be denied care.

There are some folks who weren't affected by the pre-existing clauses, because they were lucky enough to be on the same policy since birth or because their doctors were able to prove when their condition started. They were still screwed, though. Insurance companies were allowed to place a limit on how much money they would spend on a person, even if the person did meet the qualifications for coverage under the plan they were paying for. This is the "cap" that you may have heard of. Now, if the worst thing you've ever had is the flu or a broken limb, you probably won't reach that cap. However, if you have a condition like incurable cancer or renal failure or you're in need of an organ transplant, you could reach that cap in just a few years or even a few months. After that, all of the insurance that you paid for, faithfully and on time, didn't matter. You'd have to find some other way to pay for your care. If you couldn't do that, you died. It's really that simple.

Oftentimes, people who reached the cap on their insurance plan were forced to stop working at a time when they need money the most. It may be hard for some folks to believe but, sometimes, it's hard work to continue showing up for work when you need a new lung or you have a tumor restricting the blood flow to your heart and you're not able to afford the necessary treatment for it. I actually worked throughout the chemo treatments for my lupus, but the radiation for my cancer is what made my work and school life come to a halt. I guess some folks would just call that lazy and irresponsible though. However, being a pharmacy technician means working with people who are sick and having a fifteen inch open wound stretching across my back and an immune system compromised by both lupus and cancer makes for a legitimate claim that one can no longer do their job. You're free to decide otherwise, of course. Anyway, when you stop working, any insurance policy through your job is cancelled. That means the job of paying for your care has solved itself, as far as the insurance companies were concerned.

So what happened to those people? Well, if they could prove that they were completely disabled, then they MIGHT qualify for healthcare through the Social Security Disability program. Lord knows these jerks who whine about the existence of government run healthcare weren't stepping in to keep these disabled people alive. Of course, S.S. turns down most disabled people who apply for care. It decided that though I had an incurable cancer and systemic lupus, I didn't meet their standard of what it meant to be truly disabled. It took them over a year to let me know that, though.

Meanwhile, my doctor was forced to risk his job in order to treat me. He was the only orthopedic oncologist in my state and all of those bordering it. If he didn't treat me, then I'd simply die of my cancer. The hospital he worked at wouldn't allow him to treat me for free, so he had to sneak and do it. Because he determined that my cancer was actually terminal, I was able to appeal the initial S.S. opinion and have that appeal expedited. Because of this, it only took me TWO YEARS to get healthcare coverage through S.S. If that doctor hadn't treated me while I went through the process, I'd have died before even having a chance to appeal. In fact, that is what happens to many people. Even though they'd qualify, the process has been made so difficult, that they still die for lack of care. I was lucky/blessed/fortunate--call it what you will--because, by risking his career, the oncologist was able to change my cancer from terminal to simply incurable. When the alternative is death and you know that most people in your situation do die, having an incurable cancer doesn't sound half bad. However, is it really right to force a doctor to risk his entire career just to keep a patient alive? What about those who don't have doctors who could take that risk? Should they just die? I'd love to hear those who are trying to make this mandate a matter of religious belief explain to me why Jesus would rather people die than have the ability to get treatment.

Because the healthcare mandate stopped insurance companies from placing caps on care for people who were paying for comprehensive coverage and stopped them from refusing to provide care via the pre-existing conditions clauses, my nephew was able to get his treatments when he needed them. Childhood leukemia is very survivable nowadays. However, that doesn't matter if the children with the leukemia aren't able to receive these treatments because of how extremely expensive they are. My nephew was able to get care when his cancer was still curable. I wish that had been the case when I was in that position, but I'm glad that he'll now be able to live without this sword of Damocles that I'll have for the rest of my life.

Even with the mandate in place, it was a struggle for my nephew and my sister. After using all of her vacation time, she had to drive hours every day back and forth from the hospital to her job and back again. She had to have a family friend move in and care for her daughter during the process. She had to come out of pocket for all of that. The donations people gave helped so much and I appreciate it. I should add that of all of my friends who did contribute, not even one of them were folks who identify as Christians. But then, if I'd considered the Good Samaritan parable I'd have expected nothing different. I'm so grateful to all of those who choose to help others instead of sitting around being self-righteous and self-absorbed.

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