Why the US is the only country that ties your health insurance to your job
Nobody would build a system like America’s on purpose.
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This is super personal to me because it almost killed me. I've told this story on reddit, but it bears repeating:
tl;dr lost my doctors due to an insurance change 4 weeks in to a 6 week open heart surgery recovery...
In 2018, my company was in the process of being sold. No big deal, above my paygrade, nothing for me to worry about.
Then I got sick right after Thanksgiving. Really bad heartburn that lasted 5 days. It wasn't heartburn. I had a heart attack. 12/3 I had open heart surgery, single bypass, and that started a 6 week recovery clock.
On 1/1, the sale of my company closed and we officially had new owners. I also officially lost all of my doctors because the new employers don't do Kaiser in Oregon. They do it in WA and CA, but each state has to be negotiated and they never had presence here.
1/2 I start working with Aetna to find doctors, hospitals, etc. Beyond the cardiologist I need a new pharmacist, podiatrist, diabetes care and a general "doctor" doctor.
Fortunately, my new employer is a big enough fish, they have their own concierge at Aetna and she gets me into the Legacy system.
On 1/3 I start developing complications, but I don't know it at the time. It starts with a cough. All the time. Then, when I try to lay down, like to sleep, I'm drowning, literally choking and gagging.
The concierge and I try to get an appointment, we're told 2-3 months. For a dude still recovering from open heart surgery? Best they could do is 2 weeks. 1/14.
I can't lay down to sleep so I buy a travel neck pillow and sleep sitting up.
I get to see the new doctor at the "official" end of the 6 week recovery. He doesn't know me or my history so he wants to run tests.
I'm sitting at home playing video games and waiting on test results when the call comes... Congestive heart failure. Report to the ER immediately.
My heart developed an irregular heart beat, which caused fluid build up in my chest. They admitted me and were getting ready to pull fluid off me.
"What happened to your foot?"
"I dunno, what happened to my foot? I can't feel my feet."
Remember when I said I was sitting around playing video games, waiting for test results? Yeah, my foot was touching a radiator and I didn't know it. 3rd degree burns, first four toes. Pinkie was spared.
So I'm in the hospital a week. I lose 4 liters of water per day. 50 lbs. of water. No wonder I was drowning. Regular bandage changes.
So now I'm facing two procedures. Electrocardio version to fix my heart, skin grafts to fix my toes.
This whole time the new insurance covers 80% until I reach the out of pocket maximum of $6,500. Then it will cover 100%.
The old insurance? ER visit for heart attack, hospital admission, 8 days in the hospital, open heart bypass... $250.
So we hit the out of pocket maximum almost immediately. My wife had a problem with her foot running through the Seattle airport. The doctor who did her toe amputation was decided to be out of network so that was another $1,100.
I was never unemployed through all this. I had enough vacation and sick time banked to cover it. Cobra didn't apply. Buying my old insurance wasn't an option, it was far too expensive without employer backing. Income is too high for assistance (thank god) and I took steps to max out my HSA account, which is good because we drained it twice.
Three 1 week hospital stays (2 for me, 1 for my wife), multiple ER visits, two more major medical procedures... That would be enough to break most people even with good insurance.
So if you read any of that, let me ask you something... Why does the quality of my health care and my quality of life have to depend on who I work for and what insurance companies they choose to work with?
This is always what I think of when I hear arguments that our health care is "free market". If it were, you could fire AETNA and go back to Kaiser. But that's not the case, so insurers aren't really beholden to satisfying their users, because their users aren't their customers.
it is free market. It actually is the definition of free market, accompanied with lobbying which is direct consequence of lack of regulations.
Yes exactly, anyone is free to set up a competing business, and incumbant players are free to make that as hard as possible while also being free to provide poor service because there is no viable competition.
and to top that up, OP could had just bought an additional care package by paying by his own pocket in the health clinic that he initially was. Completely free to do it if he wanted to pay 3 times the price. People don't understand that in the so called free market there are actually unwritten rules set by the ones in power. They think that they would somehow be benefited from the lack of regulations while the regulations should be there in order to protect them from the greed of the mega-corps.
Exactly. Regulations are meant to level the playing field between the two parties, when one party has a big advantage due to size.
This is the kind of story libertarians can’t imagine because they simply lack an imagination. We don’t choose when we get sick. Your companies merger should have had no impact on your ability to get healthcare. What an absolutely insane thing to read.
Someone at some point should have told you this, but it rarely gets communicated until its too late. If you have peripheral neuropathy, even if you are not a diabetic, you should be doing nightly foot inspections with the aid of a mirror.
It drops the likelihood of acquiring an amputation by around 70%. Pretty much all my patients who have had amputations acquired them because they didn't know about a foot wound before it became infected and spread to the bone.
Simply flashing your feet at a mirror kept propped next to a nightstand can significantly improve your overall health outcomes.
Oh, I'm well aware, but at that time I was also sleep deprived. :(
I figured as much, though preventative healthcare is so rare nowadays I thought I'd chime in.
Fucking brutal, man. Murica, I guess.
Holy. Fucking. Shit. I’m sorry you had to go through that. That’s really horrible.
I got a question!
How did forcing the doctors who knew you were in the midst of a sensitive medical situation not get forced into violating their hypocratic oath?
So, a couple of things... Kaiser is a membership hospital, if you aren't a member, you don't get in and as of 1/1/2019, I wasn't a member anymore. :(
There is this thing called "Continuity of Care" but that only applies for services I had under the old hospital that aren't available under the new one.
Because the new hospital DOES have a cardiac department, continuity of care didn't apply.
Lastly, the Hippocratic Oath is largely a myth. ;)
https://www.health.harvard.edu/blog/the-myth-of-the-hippocratic-oath-201511258447
"According to a 1989 survey, barely half of U.S. medical schools used any form of the Hippocratic Oath and only 2% used the original. In a 2011 study published in the Archives of Internal Medicine, about 80% of practicing physicians reported participating in an oath ceremony, but only a quarter felt that the oath significantly affected how they practiced."
Well shit.
Glad you're alive and doing alright.
thank god capitalism is the most efficient system people ever imagined!
I read that with EU dates and thought it was weird to wait from Nov to March to get your heart looked at, and then March to Jan to actually have the operation. ISO 8601 FTW.
Really sorry for you both and your toes though, that sucks. Glad you're still with us!
