Just another health insurance lecture

A Time article got me thinking about healthcare in America again. And then The Daily Show reminded me of how the Medicare Prescription plan started (with a really shitty enrollment period, not dissimilar to the ACA sites problems). And it reminds me of how frustrating people are.

They claim they want government to stay out of their lives and yet ....their actions often say something completely different. Many senior citizens used to be surprised that Medicare didn't have prescription coverage....then when they got it all they want to do is bitch about what it doesn't cover or that the plan tells their doctors what meds to prescribe. Forget the fact that Part D doesn't cover benzodiazepines (valium, xanax, etc) because the package labeling (as well as some prescription safety groups) states it isn't safe to use in the elderly..why the hell should it cover a drug that shouldn't be being prescribed?? And why doesn't anyone ever question the doctor about this? Doctor says to take it, well it MUST be ok then. Forget that Prior Auths are in place to ensure that doctors have tried alternative medications that are not only less expensive but in many cases a better treatment. No let's just assume that the government is trying to deny you medication....the same government who created the plan that you NEVER had...and you would certainly not have been able to afford the hundreds of dollars per month that the drug you feel you are being denied would have cost YOU, out of YOUR pocket. So, yeah, prior auths are in place solely to deny you something you, yourself, would never pay for...so let's bitch about that. I swear if the pharmacist I used to work for said one more time "I can't wait til we all have it" I would have been justified in killing him....For starters, the ACA was never about us all having a government plan, so his statement is stupid before it even starts BUT let's just say we were "all going to get it"...do tell me how having a prescription plan that requires your doctor to justify why he feels you need a particular expensive drug is better than NOT HAVING A PRESCRIPTION PLAN AT ALL??? No, really, please help me understand!

Which reminds me of another argument I love...when a patient is told that a drug is not covered and they emphatically state "BUT I NEED IT" and you remind them that they can pay out of pocket...isn't it amazing how when THEY need to give up something (maybe they can't get that new iPhone if they "waste" their money on their prescription) it's amazing how suddenly their health isn't nearly as important if someone else isn't going to pay for it. This happened a lot when companies stopped paying for Brand drugs that had generics available. "But I have always paid $10 for the brand and I am allergic to the generic" "Well now your insurance expects you to pay the difference between the generic and brand--and that will be $147" "Oh---well give me the generic"...what happened to that allergy? Somewhere along the road we have been led to believe we are all entitled to healthcare that costs us next to nothing.

But I digress, this isn't about Part D (or annoying pharmacy customers)...and how no one wanted that, and how it got off to a rough start but try to take it away now and you would have mobs of seniors beating you with their canes!

This is about health insurance in general, not even about ACA. The Time article mentioned that health insurance didn't become attached to employment until the 1940's...I don't have the article beside me so don't shoot me if I got the year wrong. What happened was the government put a freeze on wage increases...something to do with the war I think... I speed read so I miss stuff. Anyway, companies took to offering health insurance and other benefits to entice workers. And, voila, an entitled nation was born. It was just assumed that if you had a job, you should get health benefits. No more personal responsibility. The article also points out that over the past 20-25 years employer's contributions have been decreasing and the benefits themselves have been gradually being reduced. Somewhere along the road we have been led to believe we are all entitled to healthcare that costs us next to nothing. We have gone so many years with it being given to us that we just can't accept that WE should have been paying more all along. It has become more acceptable that we have deductibles now and eventually I think we will accept that we all will be expected to pay for something we should have paying for all along. Kind of like gas prices...it really hurt when it jumped to $3 a gallon...now that would seem like a bargain!

Twenty to twenty five years....that's when I first got into the healthcare field. And, yes, I witnessed this. You used to pay next to nothing to have really good coverage. Low copays for office visits, prescriptions and you weren't expected to pay for things like labs and X-rays. And deductibles? PFFFF, no one even knew what that word was. I watched prescription copays go from $1 for brand name and zero copays for generics to the system we have now...not triple tier copays but FOUR tier copays. There are generic copays (rarely below ten dollars), brand copays, Formulary copays and then non preferred formulary or whatever words they use to try to classify the drugs they really don't want to pay for. Some people have deductibles to meet before their prescription coverage even kicks in. And some plans don't even use flat dollar copays, it's percentage based, so you will really feel it, if your doctor writes for one of those new drugs the drug rep tells him is superior.

I experienced it personally, I, too, took for granted the health insurance I had. If the doctor said I needed an MRI, I didn't question it. I didn't shop around, I wasn't going to be paying anything for it anyway. It seems quite obvious the flaws in this system, If you don't have a personal financial stake in your healthcare why worry about cost. I once had an ER visit that cost $5000, I paid NOTHING! This system is why we are in the current mess we are in. When my husband needed knee surgery, we found out how crappy the system is. Even when you try to find out what your costs will be, you are blatantly lied to....and once you have an MRI, there's no returning it because the bill now states you owe a thousand dollars more than you were quoted or that you could have gone somewhere else for less but since there is no transparency you, as a patient, are screwed. This is why I support the ACA. It isn't just about getting millions of uninsured people insured it's about trying to fix the system.

People get so offended when the government tells them they need to be insured. The funny thing is most of the offended people ARE insured. Now they are getting pissed because it will cost more. The "free" ride is over. They blame ACA for rising premiums....well you may want to check your paystubs....premiums started rising LONG before Obama was in office and your benefits were being cut before then too. The ACA is trying to make everyone more accountable....citizens more accountable because there is no excuse to not have health insurance, you can not be denied anymore. We all have been paying for people who don't have insurance, it is hidden in the ridiculously high costs that we pay. ACA is making insurance companies more accountable, there are many rules in place regarding how much they can charge and penalties if it discovered that they are charging too much.

Corporations are taking advantage of the ACA and using it as an excuse to cut workers to part time or to stop offering health benefits if they don't have 50 employees and therefore aren't required to. Or maybe your contribution is expected to increase. THIS is on them....place the blame on them. Many companies have already been using these tricks to avoid offering benefits (yes, Walmart, I am looking at you!). and again your benefits have been eroding over the past 25 years....this is just an opportune time for corporations to hide behind ACA and blame it for their stinginess.

Is it even stinginess? Health insurance has been a BENEFIT offered by employers....let me repeat that a BENEFIT...not a requirement. Ultimately it is up to each of us to be responsible for our health, including insurance should we need it. You don't expect your employer to pay for your car insurance, so why your health insurance? Just because you have come to expect something doesn't mean it is owed to you. And yes it hurts to lose it but we have been slowly losing it --before Obama "took it away from you" --and a fix is in order.

So, instead of us all balking at the ACA and what it will cost us personally, let's try to look at the big picture. Maybe this will stop the craziness that has become the American healthcare system. Maybe with more personal financial accountability costs can start to be contained. With higher office copays maybe the next time you have a runny nose, you will wait to see if it's just a friggin' cold that will go away on it's own. Because when it's YOUR money and not some insurance company paying for it...well maybe you can try some Neosporin on that cut, and just in general, stop being a spoiled, whiny little bitch that runs to your doctor every time you aren't feeling 100%.

Every big change that has occurred in our country has come with naysayers, you will never get 300 million people to agree on everything but can we at least give things a try before we call it a failure. I still don't know how this will turn out, it could be a disaster or maybe, just maybe, it will be the start of something that one day we all look back on and say "why did it take so long to fix...it wasn't so bad after all"  And if it sucks ...well there will be this permanent record of how I was on the wrong side and you can copy and past the link with a big I TOLD YOU SO!! ;)

Ramblings of a depressed mind the day after

We have been in California almost exactly 6 months now. It is everything I imagined and more. Now that winter is here, I am realizing that even with highs in the 60's, it won't be so bad. almost every day is still sunny, no gloom to bring me down.

There is truly nothing negative for me to say about our new life. We have finally found jobs, yes, making a little less than we hoped for, but we planned for that. And the only bad part about living a "poor" life as opposed to having a pharmacist's salary is having a rich friend (CORRECTION: A, singular, not plural as erroneously stated in the original blog post) that doesn't quite comprehend that we have to watch EVERY dollar. WE don't feel like we are sacrificing and that is the most important thing. We didn't go out to eat when we had money, so we aren't really missing anything. We have always enjoyed doing things that don't cost money--like hiking. We really don't feel like we are missing anything. No, we won't be vacationing like we used to, but that's why we had one last hoorah with Africa, those memories will take us through many years.

SOOOOO ---we are happy, I speak for both of us, because we have discussed this. Dave is 100 percent behind my decision to stay out of pharmacy forever. That begs the question...why depression?

It comes and goes, I assume it's hormone related. The last few weeks have been really bad with morning nausea and extra long hot flashes. And depressed thoughts. They are gone now. I want to write while they are here, to show how bad they can be. The mind is so amazing. I may have mentioned Rick Springfield has named his depression Mr. D. And I agree that it does feel like a being, a voice so convincing. It wants to drag you down. And, again, I thank my therapist (did I mention she's retiring the end of this year? I know she's way back East and I haven't seen her for a long time but she was a crutch that I enjoyed having in the closet ...just in case...)...anyway I thank her for the tools she showed me that I can use to combat these bad thoughts. They work...for the most part. But sometimes....sometimes...I wish that I hadn't had such a horrible experience with antidepressants, because I am tired of fighting the thoughts. I just don't want to have them anymore. I want to just enjoy the palm trees and the sun and my loving husband....I don't want to have to remind myself about it...I want to just fucking enjoy it! But then I remember that while the pills take away the sadness they also take away everything else...no more crying...EVER...no empathy...no disgust at atrocious sights (Walking Dead just wouldn't be the same!) and sleep...lots and lots of sleep. They take away LIFE...and maybe not with everyone, but with me they did. I was a zombie. And I lost so much...time with Andrew being at the top of the list.

I hope it's the peri menopause...that gives me a light at the end of the tunnel, it may be a few years til it's all over but at least it will end and I know that it ebbs and flows. In a couple months I may be back to just a bitchy day here or there, thrown in with some paranoia but the depression won't sneak in. It helps so much that Dave is so understanding,  I don't know that I would get it....He can actually feel the heat come off of me with some of the hot flashes, so I know that makes it real and he can understand how annoying that can be. But can he really understand the sadness?  I would take hot flashes and nausea all day, every day...to avoid even 10 minutes of those thoughts. It is so exhausting fighting them. I have tried running more, eating more fish...anything to naturally boost my serotonin but it has just been a bad, bad month.

Being home alone, of course, makes it worse. I am grateful to have a job now to distract me. But the depression robs me of enjoying my days off. There are things I want to do....like paint but the voice just wants me to do nothing. I have started reading a lot more. The voices can't talk when I am busy reading or distracted with games...so I have been playing more solitaire and slot games and of course Candy Crush. As much as I love to run, the voices get me there too. I have started listening to music again while I run....it's weird I kind of don't "hear" the music but I don't hear the voices either. Playing the piano is a great distraction too....it sounds like shit if I don't pay close attention to the sheet music so I really have to concentrate...no voices get through.

This rambling is to try to provide insight into what a depressed mind does. It would have been better (or worse, depending on how you look at it) if I would have still been having the thoughts but I think because they were still so fresh that you can get a feel for what it's like to have a rambling brain and how frustrating it can be. It's like the happy person is suddenly trapped at the bottom of a well and that damn Mr. D is standing at the top saying "You aren't coming back....I'm in control now BITCH!"
Truly depressed people have it the worst because they already hate their life and it doesn't take much to convince them that everything sucks. But I KNOW it doesn't so I fight that dickhead and I win every time. I am so glad every thing is going well because it scares me to see how strong he is and if had even the smallest opening he would seize it and I don't even want to consider what would happen then. I think it would be a true test of how good my therapist was and how strong I have become. Today I know I would win...no matter what....but if you had asked me yesterday....well I just don't know what my answer would be.

On turning forty .....FIVE!!!

It's been many years since a birthday has bothered me...many, many years. Twenty nine was the tough one for me.....I don't know why it bothered me more than 30 but it did. Once I hit 30 and still didn't feel old, age didn't seem to bother me anymore. Plus I had finally grown into the age that I looked. Even at 20 I was mistaken for 30. I have always had a "mature" look, ooohhh lucky me. But for the past 14 years, age hasn't been an issue, most people guess my age as younger now, which could be due to my young looking husband (still being carded at 42!). They still think I am older than him but because he looks so young they still think I am younger than I actually am. Probably also has to do with how immature I can behave....but I am now old enough not to give a damn what others think and have much more fun with that attitude!

My birthday is still 6 weeks away but I have already begun dwelling on it. Forty five represents NOT being in my "early" forties. It represents being closer to fifty. Fifty seems old. My bff is in his fifties and he doesn't act any different than I do...but fifties just sounds like my parent's age...(they are now in their early 60's--but I still think of them as in their 50's--though they do "act" old--no offense mom and dad!). They move slower, are achy....that's what I mean by old.

I see plenty of people in my facebook running groups that aren't old but are in their fifties and sixties but 45 is just really bothering me. I realize I can't really do anything about it, and it is just a number. I suppose I can stop keeping track of birthdays...but have a feeling SOMEONE will remind me...

I think mortality has a lot to do with it. Once you hit forty you start hearing all about people your age dying. Maybe you don't pay as much attention to this in your twenties and thirties, but once you hit forty...geesh...it's ALL you take notice of. And a lot of the time it's the "died suddenly"....no warning. I mean getting cancer would suck but at least you would have some time to knock off some bucket list stuff.

I think every year farther from your twenties is a year closer to your death. Pleasant thought, hunh? Realistically I could be just half way through my years here on Earth...I could easily have 45 more...One of my grandmother's lived until 92, and she wasn't even healthy. I do take after my paternal family though and neither of them made it to 80....but again both weren't fans of staying fit or even following doctor's orders.

I am so grateful that I started exercising almost 4 years ago. At least I know I am in the best shape of my life and the best shape I can be in. If I do die, it certainly won't be for lack of trying to avoid the inevitable. Of course, there's always the possibility that the trying to be healthy actually contributes to an early demise....I think of this when hiking...looking over the steep edges...wondering if a wild animal is going to pounce on me or a snake will bite me....I could get hit by a car while running....I could get attacked while running....but I chose to be as cautious as possible without turning into a paranoid nutjob.

It's such a fine line...to live each day to it's fullest, knowing we aren't guaranteed tomorrow, but to make sure if we get lots and lots of tomorrow's that we remain healthy and wealthy enough to continue to enjoy them.

I think I will just keep being 44...for as long as I can get away with it (maybe even til I am fifty!--by then maybe it will stop being a big deal!)...no one needs to know the truth....we will keep it our little secret!