Going naked

Back during the Clinton years (remember those?) when Democrats failed to pass "Hillarycare," Paul and I had a debate with my parents about health care reform. I wasn’t a huge fan of the Clinton plan, I thought it was weak and vague. But the conflict with my parents wasn’t about the specifics of that plan, per se. It was really more about whether some kind of sweeping health care insurance reform was needed at all.

Their attitude seemed to be: they had good insurance (through Boeing) and didn’t see the need for a change and were afraid that any change would be to their own detriment. What Paul and I tried to explain to them was that the two of us were people who would, personally, benefit from health insurance reform. And one of my brothers, maybe both, would have benefited.

Because we didn’t have health insurance.

This fact seemed remarkably hard to communicate to them. They seemed unable to absorb the idea that health insurance reform wouldn’t merely benefit some hypothetical welfare mother in Nevada, it would benefit their very own children. The information just didn’t seem to sink in. At a certain point I decided they were in denial and dropped it.

A couple of years after that  had a job with insurance (one of those 80/20 copays, I think). Then Paul actually used his insurance for something. He had a series of mysterious seizures and his doctors tried to figure out what caused them.

It was just like an episode of House only without the obvious life-threatening-ness. And without the diagnostic genius. They ran him through an astonishing array of tests, all of which revealed interesting anomalies, none of which would explain the seizures.

Concurrent with this, he started seeing a chiropractor to correct scoliosis that he discovered when the doctors told him he was an inch shorter than he was supposed to be. He also stopped taking Ibuprofin, one of the few commonalities to each event. Eventually, after many thousands of dollars in copays, the seizures stopped. We still don’t know what caused them.

Paul lost that job very shortly after this, when the company went out of business. So, really, he had health insurance just long enough to rack up thousands in debt.

We are still, sort of, paying off that debt, having cycled it forward into credit cards which we never completely payed down. And now neither one of us is inclined to trust insurance companies, or even doctors very much. When I watch an episode of House, sometimes, the thought crosses my mind, "Who’s paying for all that?"

A few years ago, Paul was a stupid-dummy-head and drinking alcohol in a hot tub at V-Con. We were in Surrey, very south BC, Canada. He slipped and hit his head. The whites of his eyes turned blood red, which scared me enough that I made him go to the emergency room. The cranky woman at the desk checking people in seemed to assume that everybody who came in there was a crackhead, and she clearly did not want to accept Paul as a patient. We had a conversation that went kind of like this:

CW: We need payment up front.
Me: (Pulling out the Visa) I have a credit card.
CW: Are you sure you don’t want to go back to the states and have your insurance pay for it?
Me: We don’t have insurance in the states.
CW: It’s going to be a couple of hundred dollars.
Me: That’s fine.
CW: We’re so close to the border. Why don’t you go back to the states and have your insurance pay for it?
Me: We don’t have insurance back in the states. We might as well pay you. You’re probably cheaper, actually.
CW: Are you sure you don’t want to let your insurance pay for it?

Like my parents years ago, she seemed completely unable to absorb this simple fact.

Out of the last twenty years of my life, I have had health insurance maybe five years total. I have spent a lot of that time freelancing and working for small companies that can’t afford to provide health insurance. In that time, I have had people suggest that I really ought to purchase some sort of insurance, that it was dangerous, even irresponsible to "go naked." But what realistic alternative did I have? Pay half my income for weak coverage that probably wouldn’t be there when I needed it anyway?

I made flowcharts.

1. No insurance => Disaster => Certain bankruptcy.
2. Insurance => No disaster => Probable bankruptcy.
3. Insurance => Disaster => Probable bankruptcy.
4. No insurance => No disaster => Possibility of bankruptcy.

I went with what seemed like the lowest possibility of bankruptcy. Anyway, it’s hard to make a bet that’s only going to pay out if I get hit by a car or something. I was betting that I wouldn’t get hit by a car.

Not everybody can make the choices I’ve made. You have to be in generally good health, with no dependents. But I really felt that it was the only choice that made any sense.

Last July, after a near decade without, I started working at a job that provides decent health insurance. I still haven’t been to the doctor. I guess I ‘m out of practice.


  1. Whereas I have never gone a single day in my life without insurance, and I know how freakin’ lucky that makes me. And I absolutely freakin’ postively want universal health care coverage in this country. There is just no excuse for this situation.

    1. Author

      Well, it looks like we’re moving closer, anyway.

      And my parents have seen the light.

    1. Re: Hawaii has good healthcare

      flankleft — is that icon as obscene as it looks?

      1. Re: Hawaii has good healthcare

        Sometimes a chainsaw is just a chainsaw.

        Its a picture of chainsaw app on iphone. Just something random I picked out.

  2. And I have had insurance, paid for it, and had it not cover what I needed. whee-la. But I am still a fan of the current reform…

    1. Author

      Yes, the current reform addresses two of the key reasons I thought individual insurance wasn’t worth getting — it tries to keep costs down and it tries to make sure that insurance actually has to cover stuff.

  3. I hear ya. I had some unexplainable chest pain last year and I went to a gastroentorologist (sp?) who ordered up a ton of tests: endoscopy, CAT scan, MRI, etc, etc. We had decent insurance through Western at the time, but we still ended up paying around 100$ a month for seven or eight months.

    After I graduated and we had no income, we went begging to the bishop of our church for help with the medical bills. I’m grateful they helped–and sad that one has to be a member of an organization like a church or else have a rich family member to get that kind of help.

    1. Oh, and the chest pain? I was talking to my dad about that and he said, “Oh yeah, I get that. It’s a stress thing. Your acid reflux gets so bad that it scars the inside of your esophagus. De-stress, buddy.” Pause for irony.

    2. Author

      I’m not sure what part this plays in right wing anti-safety-net considerations, but I have sometimes wondered, do they think every misfortune should be handled by private charity because they like the idea of forcing people to be dependent on things like church and family?

  4. I remember having a conversation with my Aunt recently about how much money a person in their thirties should be putting aside for health care, whether they have insurance or not. She had this figure of $5,000 a year. Never mind that that was half my yearly income at the time, she couldn’t seem to grasp that I had only enough money to pay for rent, bills and food. We each repeated the same sentence three times. It wasn’t much of a conversation.

    Now I finally have a job where I am putting aside some money for health care. I’m earning three times what I’ve every earned, and I’ll have an Employee Health Savings Plan starting April. $5K is still a stretch.

    1. Author

      Yeah, it’s not chump change.

      Although your Aunt and my parents then do give a suggestion as to how people can find themselves out in the streets yelling about how we should keep government out of Medicare.

      It’s almost like the reality of health access in this country is literally too frightening for many people to contemplate, so they retreat to a fantasy world where we have the best health care system in the world, bad things only happen to bad people, and they or their loved ones will surely never lose their insurance or have a medical disaster they can’t afford to pay for… la la la I can’t hear you…

      1. La La land..

        It’s tough to have civil conversation with people who mentally block out reality.

        Some of those same people screaming against healthcare reform and calling it “Socialism” get social security every month and are happy to be on Medicare. When this is pointed out to them they see no irony in it.

  5. Every person I’ve talked to that is against reform has insurance and can’t figure out why other people don’t. The best was my brother, who said anyone that needed insurance should just join the National Guard like he did. Strangely, he could not imagine people not being *able* to, much less not *wanting* to.

  6. The story’s a lot better over hear. Medical cards to cover bills for the old, unemployed and other qualifying people, but I’m not sure about hospitals, but health insurance is a lot better priced then in the US. In England it’s all covered by the NHS. People complain about service, but it is free.

  7. Well, people could also do a better job shopping around and asking about costs instead of just blindly going along with whatever the doctor suggests.

    A policy that costs half your income is not the only option. For the past 6-7 years I’ve only had major medical ($10k deductible) which means I paid premiums without ever actually getting to use them for anything, but I was protected in case anything *really* bad happened.

    I just got in the habit of comparison shopping and getting in the habit of asking “and how much will that cost? is there a cheaper alternative? is it really necessary?” for everything. (Hint: if a doctor’s office can’t answer those questions quickly and easily, you probably want to switch to a different office that’s used to working with cash patients.)

    Personally, I’ve found that office visit costs vary by a factor of 3-4 times, and prescription costs vary by a factor of more than 10 times EVEN FOR GENERICS (one drug is $11 vs $116 at the pharmacies in my town). Lab tests don’t vary as much (because there are usually only a few labs in town) but which labs you need is definitely open to scrutiny.

    But whenever I meet anyone who rants about the high cost of medical care, I find that they have no clue about this… they never bothered to call around and shop for a lower price, or investigate whether the tests/procedures their doctor is recommending (as part of a cover-his/her-ass medical strategy) are really necessary, or consider whether that’s what they really want to be spending their money on. It’s like everyone wants to eat filet mignon and lobster and not look at the price, when they could be getting by just fine on beans and rice (and beans and rice from the cheap Mexican grocery instead of Whole Foods).

    I could get the $1800/month shot for my psoriasis, and suffer the side effect of having a depressed immune system, which would likely lead to other medical problems/costs, and then rant about the high cost of medical care. Or I could skip it and decide that the $21,540 annual marginal difference between that and the $5/month shampoo is not worth the marginal benefit. I could blow $500-$1000+ on an emergency room visit for food poisoning and feel better a day earlier, or just wait it out and carefully maintain my fluid intake so as not to *need* to go to the ER and just lose an extra day of work (worth less than the cost of the trip to the ER and the exposure to the risk of infection there). I could take my sprained ankle to the doctor or wait for it to get better on its own (which it will). Etc.

    Buying goods and services is about tradeoffs — would you rather have more of this, or more of that? I don’t understand why people think health care is a special case where people should be able to get all they want for free or a low fixed cost that is much less than the cost of what they are consuming. Get health insurance as health *insurance* — coverage against *unexpected*, *catastrophic* costs — and then budget for routine health expenses. Like you budget for oil changes and new tires for your car, but buy insurance just in case you get into a crash.

      1. For most of the lifetime of health care being science-based and not snake oil, we’ve not really had a free market in health insurance. So it’s hard to say what would happen.

        Anyhow, the fundamental problem in the whole debate is that people keep conflating health insurance with health care with being healthy, when they are three very distinct things. If our goal is to for people to be healthier there are far more effective ways to go about it than the reform bill. But politicians’ goal is not to benefit people, but to redistribute power and resources to their allies.

  8. Also, it’s not fair to say that you and Paul could not “afford” to buy health insurance. You simply chose to spend your money on other things. If you added up everything you spent on trips to Europe, Asia, local and national conventions, parties, books, comics, etc., it is a lot more than buying a health insurance policy. My husband and I have been spending $135/month for our policy, recently raised to $188/month when we aged into a more expensive bracket. Having known you for ~15 years and observed your lifestyle, I am sure that you and Paul average more than $1620-$2256 a year on travel and other fun. You’ve basically spent your adult life free-riding off the fact that there are enough responsible people who *do* buy insurance so that the hospitals will be there for you if anything bad ever happens to you.

    1. (In that respect, I suppose that I will enjoy a bit of schadenfreude over the irony of health insurance reform forcing you and people like you to finally buy a policy. You might have to skip WorldCon, oh no!!!)

    2. Author

      With all due respect…

      I don’t go around making assumptions about your lifestyle, income, obligations, various financial tradeoffs, or what kind of health insurance you, personally found available to you, and I think it’s a bit rude to make those kind of assumptions about other people.

      One of the peculiar thing about health insurance that makes it different from, say, a trip, is that a trip is a discrete one-time cost. If you’re having a good year, you can go to Worldcon, or not go to Worldcon if you’re having a bad year. Insurance is a fixed monthly obligation.

      Also, I think I made it clear that I considered the insurance available to me to be a poor investment, I never claimed I couldn’t “afford” it.

      What, do you want a cookie because you’ve been a “responsible adult” all this time? While I made a gamble that paid off?

      Some libertarian you are. Next you’ll be telling me you think people in upside-down mortgages shouldn’t walk away from them because it’s “irresponsible.”

      1. Hey, don’t hold your personal life up as an example of poor people who couldn’t afford health insurance if you don’t want your personal life examined in that context.

        If you’re having a good year, you can put money in savings to pay your insurance premiums when you’re not having a good year.

        The only reason that insurance was a “poor investment” for you is that you could rely on the fact that hospitals were legally obligated to treat you anyway, and that you could just declare bankruptcy to avoid paying your medical bills. That you could do this, and that people like you took advantage of this, is why our health care/insurance system ended up being “broken” and in need of “fixing.” It wasn’t the market that was broken, because it’s not a market if some people can just take whatever they want for free and never pay for it.

        Homeowners and banks signed contracts that put the houses up as collateral if the borrowers couldn’t pay the mortgages. I don’t have a problem with that. The problem came from banks knowing that they would be bailed out if anything went really wrong, so they had no incentive to be careful in who they lent to. Again, that’s not a market.

        1. Author

          Hey, don’t hold your personal life up as an example of poor people who couldn’t afford health insurance if you don’t want your personal life examined in that context.

          Hey, don’t be an asshole on my blog if you don’t want to get banned.

  9. Anyhow, it will be fun to revisit this issue in 5 years after you’ve had a year or two of being legally obligated to buy insurance, and then in 10 years after your reform has had a few years to “work.” I’ll try not to be TOO smug about what a disaster it turns out to be. :)

    1. Although I should note that I’m less pessimistic than the conservatives having apoplectic fits over this. It may turn out to be not that bad, not because of anything the government does, but because of Walmart’s impending rollout of thousands of $65/visit walk-in clinics staffed by nurse practitioners, added to their existing $4 prescription drug program. If anyone is big and powerful enough to save us from the ineptitude of the federal government, it’s Walmart. They’ve already shown that they can kick FEMA’s ass. :)

  10. I’m a tad embarrassed that you used events that happened to me 16 years ago — but having them become your problem (due to marriage, thanks!), gives you that right.

    What the hell is jacqueline1776 going on about? I can’t imagine arguing in favor of the US being the #1 spender on health care and #39 in services. I just can’t step into that pile of nonsense. It’s like the prosperity-doctrine churchgoers, without the “god” part. I’m just glad she’ll be building her own highways from now on, instead of using tax-funded roads and taking part in this whole “living off society” bs.

    1. I have no idea what she’s rambling about.

      Hawaii has had 90% of its citizens covered by mandatory health insurance for 30+ years and their health costs tie ND for for some of the lowest in the country. The whole concept of giving people cheap access to doctors before it gets bad enough for an emergency room visit has really paid off for them. Per 100,000 people e-room visits are down 30% compared to the mainland.

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