Connecting the Dots: D-Day and Health Care

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I woke up cussing this morning. A heated verbal altercation with an ignorant coot in the parking lot of a Waterbury, Connecticut, dive bar last night gave me unsettled sleep, as our argument over health care policy rattled on in my head throughout the night.

This piece should begin with a clear disclaimer: I am not an angry person by nature. A friend who had the misfortune to call right after the incident last night expressed surprise that I'd actually been yelling and cussing at someone. I can be passionately opinionated about certain subjects, but only a heavy drenching of blindly stubborn ignorance or heartlessness can move my temper. On the rare occasions I'm provoked to tumble over that edge, a loud spectacle laden with expletives emerges from the fury. Thus it was that I totally lost my shit last night.

My stop in Waterbury came at the end of a long and frustrating day, during which I'd been unsuccessfully canvassing for my Connecticut recession story. Yesterday afternoon I'd had a long and heart-wrenching conversation with a 53-year-old woman whose life has essentially been destroyed by the cost-conscious decision-making process of a for-profit health insurance corporation. Her situation lacked the recession-related hook, which made it inappropriate for my project, but I will summarize briefly so readers can understand why at the moment I encountered the ignorant coot last night, I had limited patience for his point of view.

Regina Wren contracted Lyme disease in the mid-1990s. The regimen prescribed by her specialized doctor would have almost certainly led to a full recovery, but her insurer, UnitedHealth, would not authorize the treatment. As a result, the disease nearly killed her and has continued to ravage her body and mind for over a decade, requiring repeated rounds of medical care when the most severe symptoms flare up. Regina deals with chronic pain and mental fog, sometimes to the point where her mind has trouble retrieving the most simple vocabulary.

The notion that hurts her most--and the point in the conversation when we both began to cry--concerns her lost potential. Regina was in nursing school when she contracted Lyme disease. She was hard-working and ambitious. She had overcome the limited opportunities of her lower-middle class upbringing, nurturing big dreams about how she was in command of her own destiny. That all disappeared because she could not afford to pay out of pocket for the treatment that would have stopped the disease before it burrowed deep into her system.

That treatment would have cost UnitedHealth less than $10,000. If Regina's muddled brain recalls correctly, the company's CEO, William McGuire, earned a $40 million bonus that year.

By refusing to authorize her treatment, UnitedHealth preserved a sliver of profits for its shareholders, but the subsequent expense passed on to U.S. taxpayers has been enormous. Because of her chronic health problems, Regina has been on disability for almost a decade--a painful but unavoidable reality for someone with her work ethic. Medicare will be paying for an upcoming surgery, which will sever a nerve and, hopefully, lessen the cognitive effects of the disease. In the bigger picture, America has lost the contribution of someone who would have otherwise been a productive member of society.

After listening to Regina recount her life's struggle, I'm nurturing a pre-existing simmering anger as I pull into the parking lot of a Waterbury dive bar during happy hour, intending to canvas the bargain drinkers for a recession story.

The 58-year-old man I meet in the parking lot--I'll call him Joe Schmoe--had been laid off from a printing company earlier this year. Fortunately, his boss called him back to service after three months. When Schmoe started working again, the boss invited him to rejoin the company health plan immediately. The monthly premiums in the company plan are $350, so Schmoe told his boss that he would just stay with "Obama's plan" as long as he could, since that only cost $279 a month.

I don't quite understand what Schmoe means by "Obama's plan," but a little questioning clarifies that he's referring to the 65 percent COBRA subsidy provisions included in the stimulus package. "Isn't that ridiculous?," Schmoe asks. Again, I feel slightly befuddled. "Isn't what ridiculous?" I respond.

"Taxpayers subsidizing health insurance premiums," Schmoe answers. I think it would be technically illegal for Schmoe to continue on subsidized COBRA after returning to work, but that doesn't seem to be his problem with the situation. He views the COBRA subsidy as the creeping edge of a government takeover of healthcare.

Sigh.

"If there hadn't been a subsidy, your COBRA would have been around $750 a month. Could you have afforded that?" I inquire.

"No," Schmoe laughs. "Especially not if I'm unemployed."

"So what would you have done?"

"I'd have gone off insurance," he says matter-of-factly.

There's some kind of disconnect here, I think to myself, still calm and determined to attempt a logical and rational discussion with a man who does not seem entirely capable of rational logic.

I tell him about the Moore family in northern Indiana, who have been able to keep up with their subsidized COBRA payments, but won't be able to afford premiums when they jump up to almost $1500. "Well then they need to get some insurance," Schmoe says, as if the solution is so simple.

So I tell Schmoe about Darwin Moore's brain aneurysm earlier this year, which makes him uninsurable in the opinion of private insurance companies, a situation that will prevent him from receiving the follow-up care he needs.

"What's your solution?" Schmoe asks.

"Like all the other industrialized countries in the world, I think we need some kind of universal healthcare program," I say.

"Look, I'm 58 years old," Schmoe responds, reveling in the superior wisdom his longer span on this earth apparently affords. "If I need a hip replacement, I don't want to be put on the bottom of the list. And that's what would happen."

I'm still holding back, though beginning to grit my teeth, as I advise him that much of the criticism circulated about foreign healthcare systems has essentially been propaganda publicized by an American insurance industry worried about its potential loss of profits. I tell him that I've lived in both England and France and have experienced their systems at work firsthand. England does have some kinks, but the French system is amazing.

"You're young," he says. "You don't have the health problems that would put their systems to the test."

I feel the acid of rage working its way up my esophagus to my increasingly loud mouth, so I shift gears. I tell Schmoe what happened to my Aunt Beth.

Beth was always obsessive about performing monthly self-exams for breast cancer. When I was in college, she sent me a stack of informational how-to guides water-proofed and designed to hang on shower heads. I only had one shower, so the extras were to hand out to all my female friends.

With that kind of diligence, Beth successfully detected her malignant lump at a very early stage. Unfortunately, the discovery occurred just after her husband had graduated from chiropractor school, when they lost the student health plan. Attempts to secure private health insurance for the family failed repeatedly because insurers ruled Beth's chronic pain--from a whiplash injury a decade earlier--a disqualifying pre-existing condition.

Beth could feel the tumor continuing to grow as she struggled to get health insurance. By the time she accepted that procuring coverage would be impossible, and sought care without insurance, her cancer had developed to Stage 3, requiring a full mastectomy and an aggressive schedule of chemotherapy. If her healing phase had begun when she first discovered the lump, it could have been resolved with a simpler and less expensive lumpectomy. Also, Phase 1 diagnosis would not have required such intense radiological treatment.

And attacking the cancer sooner would have probably prevented a stray malignant cell from taking root in her uterus less than two years later.

Because Beth had been unable to secure health insurance, US taxpayers covered a good portion of the expenses incurred trying to save her life. A Stage 1 diagnosis would have cost $30-50,000. The final price tag for the more extensive Stage 3 treatment, plus the second battle with uterine cancer, neared a half million. If a car accident hadn't claimed Beth's life soon after her hysterectomy, the cancer likely would have.

I tell Schmoe that from both a moral and fiscal perspective, the lives and health of American citizens should not be in the hands of a for-profit industry.

He reverts to his position of not wanting to be at the bottom of the list when he needs a hip replacements, some yammering about socialists, a comment about death panels--blah blah blah blah bullshit.

That's when I lose it.

My explosion of rage makes details of the yelling exchange a bit blurry, but I think the breaking camel's back began with something along the lines of: "Go f*ck yourself, you ignorant son-of-a-bitch."

After only a few seconds of full-throated back and forth, I remember as he moves towards me that we're standing alone in a dimly-lit parking lot. So I tell him that I'm not wasting my time with him anymore and head to the car, locking the doors as soon as I'm inside.

As I back out of the parking spot, Schmoe walks alongside the Prius, dragging off his cigarette while shouting about how his father fought on the beaches of Normandy. "Did you die for those boys? No, they died for you!," he screams.

The insanity of that parting shot breaks through my fury, prompting a deep and uncontrollable laughing fit as I drive away.

(Photo: brykmantra/Flickr)

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Christina Davidson is a writer, photographer, and book editor who specializes in national security, terrorism, and war. She also writes for the food blog Feed The Masses. More

Christina Davidson is a writer, photographer and book editor based in Washington, D.C. She specializes in editing books about national security, terrorism, and war, but writes for a broad array of publications, including the popular frugalicious foodie blog Feed The Masses. She is working on a book based on her Recession Road Trip project for TheAtlantic.com.
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