Monday, August 10, 2009

A Canadian Living in the U.S. Offers Her View of American Healthcare

Our local paper printed an article written by a Canadian currently living in Nevada, offering some of the facts about a system where people's care is decided by the level of their insurance coverage and the company's cost calculations. While the American right-wing is trying to terrorize the public with fantasies about government bureaucrats deciding who will live or die, the fact is that health insurance companies are making those decisions on a daily basis.

Insurance firms run U.S. health care

Co-payments, spotty coverage, sky-high premiums if you're already ill

August 10, 2009
Jane Carnahan Khaldy

(Aug 10, 2009)
I am a Canadian citizen who has lived in the United States since 1989. The U.S. has been very good to me, but don't get me started on health care.

The changes to the current system proposed by the Barack Obama administration are being criticized as being too much like the Canadian system due to the fact that government would control our health-care system. Currently in the United States, it is insurance companies that have this power, and that is my issue. Here is a snapshot of my experiences with American health care.

My husband died of lung cancer in September 2006. In July 2006, his insurance coverage with COBRA (a government-mandated continuation of health-care coverage at group rates in the event one loses employment) ended. Due to the government regulation on "qualifying events" (events that change your eligibility for health insurance coverage), I was able to obtain coverage with my work insurance. However, my husband's oncologist was not covered under my plan, and during the last 30 days of his life, he had to endure a 40-minute commute to begin all over again with a new doctor. We could have avoided all this if we obtained a divorce, which also would have been a "qualifying event." We chose not to do that.

In July 2007, I was diagnosed with breast cancer. Here are just a few salient events in my health-care saga:

The chemotherapy lowered my white blood-cell count to dangerous levels and thus, I needed a shot called Neupogen. One day, I was in danger of being admitted to the hospital due to the low white blood-cell count. As the oncology nurse prepared the needle for an injection of Neupogen, the office manager rushed in, stopped the procedure, and told me it would cost me $4,500 if administered in the office and that the shot had to be shipped to me and self-administered.

When my surgeon determined that I needed a mastectomy, he ordered a routine breast MRI prior to the operation. However, my insurance company denied the procedure four times before finally agreeing. The cost of the MRI was simply too high for them to confirm.

On my final day of chemotherapy -- January 25, 2008 -- as I waited in the exam room, a staff member came in and advised that my chemotherapy was no longer covered by my insurance and if I wanted it that day, the cost would be approximately $5,000. Finally, after several hours, the doctor was compassionate and granted it. To this day, I do not know who paid for it.

In 2008, I spent approximately $10,000 in out-of-pocket monies for health-care co-payments and noncovered treatments.

My story is only one of many. My friend Patty, 56, will lose her insurance in December as her COBRA will have ended and she is not employed.

An individual policy will cost her $1,200 a month because she has a "pre-existing condition" -- breast cancer. She is too young for the medicare system that provides covered health care for those over 65.

I just took out an individual policy for my 15-year-old daughter, and the cost is $93 a month, which is cost-effective enough. However, in order for her to receive the insurance, I was advised not to mention she had recently had a sore throat, as that would raise the premium.

The policy also carries a $1,500 deductible and, of course, office visits, lab tests etc. have co-payments which start at $25 per visit and go up from there.

During the previous bout of sore throat six months ago, her then-doctor wanted to perform a rapid strep-throat test to determine the appropriate treatment, but my insurance company would not cover this five-second test.

So the doctor was forced to prescribe antibiotics as a precaution, which the insurance company would pay for. They wouldn't pay for the test to correctly diagnose the problem but would pay for drugs that might not be needed.

In summary, I feel that government intervention in U.S. health care would vastly improve the situation and create an America where no one who needs health care will be denied, including those with pre-existing conditions.

Jane Carnahan Khaldy, a graduate of McMaster University, was born and raised in Dundas and is currently a resident of Henderson, Nev.

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