Editor’s note: This commentary is by Walter Carpenter of Montpelier.
Twenty thousand dollars. The hospital’s “going rate” for the operation necessary to save my life. I suppose I was lucky: It could have been $30,000 or $40,000. I listened in stunned disbelief. Without this operation my life was gone. I was 52 years old and uninsured.
I knew the operation. I already had three of them behind me. The illness was liver disease, caused by gallstones clogging the bile ducts, the liver’s drainage pipes. The toxins that the liver normally flushes out the body had nowhere to go except back up through me like detritus gurgling up from a plugged sink. I was poisoning my liver and myself. I turned yellow, then ashen-gray. A liver transplant looked like the only way to have a future.
I was fortunate then to possess some measure of health insurance through an employer. Some measure is being kind. It took me five years with the company to obtain it. The insurance (an out-of- state insurer) proved as much a fight if not more than the liver disease: claim denials, medical procedures deemed “unnecessary” by their bureaucrats, out-of-network problems, and much more. This was one reason why I attained the ghastly state I did before the previous operations.
While I fought for my life against the disease and the insurer, my employer kindly “eliminated” my position. I discovered this only when I returned from medical leave. Everything I worked for vanished with this “elimination,” including health insurance.
The ACA finally begins the long, long overdue separation of health insurance from employment. For all its start-up glitches and imperfections, like the perversion of income eligibility to determine subsidies, it at least commences the end of this grotesque injustice.
I somehow landed a similar position at a new company despite my age and medical history. They promised benefits after a six-month probationary period. Five months into this probation, however, the old symptoms reappeared: yellowing first in the eyes which started to spread through my body like autumn leaves changing colors.
Then the new company suddenly reneged on their promised benefits. I was out there all alone as the jaundice and other symptoms continued their march unimpeded. I knew from the ex-insurer’s “summary of charges” notices that they had paid a fraction of this $20,000. I did not, though, then understand how pricing in our broken system victimizes the uninsured with far higher costs than the insured. I learned.
It was August of 2007. The new Catamount health program was a couple months from kick-off. I knew I could not hold out until then. Also, would this new program cover pre-existing conditions? How long was its probationary period before I could utilize the insurance? My income rendered me ineligible for VHAP. A private health insurance policy with all its co-pays, deductibles and premium costs was out of the question. Unaffordable. My “choices,” as opponents of single-payer like to say, were two: years of medical debt or death.
None of this would have happened if the Affordable Care Act (ACA, better known as Obamacare) had been around back then. Better yet, single payer. Although the ACA is only a half-step to single payer, my health insurance and, thus, my access to health care, would not have been hostage to the caprices of employment, income eligibility, or merciless price-gouging.
The ACA finally begins the long, long overdue separation of health insurance from employment. For all its start-up glitches and imperfections, like the perversion of income eligibility to determine subsidies, it at least commences the end of this grotesque injustice. To stop this abomination alone makes the ACA worth doing in spite of its travail — not the least of which is a certain segment of a certain political party perpetually trying to destroy it.
Once in full stride, the ACA will at least begin to stop the kinds of terrifying choices I was obliged to face and so many other Vermonters have no doubt experienced. Unfortunately, because the ACA is still based on private insurance, it will not end them. This sadly must wait for the Green Mountain Care Board and universal care in 2017. Here the choices of death or $20,000 will be completely unknown like in every other democratic nation.
If the ACA gets us to where no Vermonter must confront a decision like this ever again, it is worth the initial chaos.
