[Masthead] Overcast ~ 45°F  
High: 54°F ~ Low: 43°F
Friday, Apr. 29, 2016

Ross Rambles: A bad decision

Monday, May 8, 2006

The cardiologist was shocked at my irresponsible behavior and I was regretting having agreed to see him.

As I had suspected, a person can't just see a cardiologist once and be done with it. A person isn't supposed to, anyway, although I will, making my one visit a waste of everybody's time.

A slight leakage causes a bit of heaviness in my chest, which becomes mildly painful after exertion such as walking up a flight of stairs. This is a residual effect of pneumonia that hospitalized me back in February. I can live with it, maybe not for long, but at least for now, I think.

I didn't get a professional estimate by the cardiologist of my life expectancy. He was too busy lecturing me on how stupid I was for not having health insurance.

He didn't actually use the word "stupid" but I could tell he was amazed at how lame my excuse was for opting out of the health insurance plan offered through work. I didn't really get far into my explanation, just the description of payroll deductions (pocket change to the cardiologist) and the estimate of total out-of-pocket expense for a major health problem (only about the cost of a decent skiing trip to Switzerland).

I pulled out of my company's health insurance when the deductible was increased to $2,500 with a co-pay that would add another $2,000 to the maximum out-of-pocket expense. This does not include prescription medication, with its own deductible and co-pay, and miscellaneous uncovered hospital expenses.

All of this could push my personal cost of a major medical emergency beyond $6,000, even with insurance. I'm sure the cardiologist can't comprehend what an expense of $6,000 means to a person who lives from paycheck to paycheck.

This kind of heavy out-of-pocket expense for insured people has, I assume, been uncommon in this area until recently. Cherokee's largest employer now has a similar plan for its employees.

Those with a family plan at Cherokee's largest employer are in worse shape than me. Their out-of-pocket expense could be double what mine is. At a place with a $9 an hour starting salary, that kind of health insurance is a bad joke.

The joke isn't as bad in my case, but bad enough. I could probably pay off a $6,000 expense in two or three years of concentrated effort (and cancellation of all my skiing trips to Switzerland), but that would depend on no unexpected expenses in those two or three years. In the case of a major medical problem, it is likely there would be more medical cost, with additional out-of-pocket expense added the next year and the next, creating a debt that could never be paid off.

My thinking at the time of dropping my insurance was that whether I had insurance or not, I could not afford to get seriously ill. I decided that if my existence depended on hospitalization, then my existence didn't make economic sense.

However, I lacked the courage of my convictions. At the point when I was barely able to draw breath, I irrationally decided to continue my existence by dialing 911.

The good people of the Cherokee Regional Ambulance and Cherokee Regional Medical Center saved my life and I feel bad about only being able to pay a tiny fraction of what I owe them every month. Even though I would have still owed them money if I had insurance, they would have gotten a chunk of money sooner. If my stay had been longer or involved surgery, the debt could have been much higher. So, it was irresponsible of me to cancel my insurance, even though it might not have made much difference to me personally.

The cardiologist had two suggestions as to what I could do prior to him providing me with any further service (which I had already decided he was not going to do). One suggestion was that I get back on health insurance. I asked him whether the insurance would cover a preexisting condition. It was his opinion that a group health insurance plan would probably cover it, although a private plan would not.

He said he wasn't sure of that since he did not really like dealing with health insurance matters. I felt sorry for the poor man, having to demean himself by discussing such a sordid subject.

I thought to myself that even if the health insurance covered a preexisting condition, it would not cover a preexisting debt. I would still have deductible and co-pay requirements that would add unpayable debt on top of unpayable debt, with more debt anticipated at the start of the next calendar year and my ability to pay off debt reduced by the regular payroll deductions for health insurance.

After checking into the matter, I discovered that I would not be covered for a preexisting condition if I rejoined my group health plan, although it would cover a preexisting condition for a new employee who went on the plan when hired.

The second suggestion was that I arrange to go to the state hospital in Iowa City for any further procedures, although the cardiologist didn't know whether I would qualify for free services there.

My understanding is that charges for treatment at Iowa City are on a sliding fee formula based on income. I assume that the sliding fee formula doesn't take into account health care debt already accumulated elsewhere. I decided that this will not be practical either.

My situation isn't unique. I knew a person who made a decision like I did, with more justification and with worse results.

Some years ago, Paula was a receptionist at the Cherokee Daily Times, raising a daughter on her minimum wage income. She felt she couldn't afford either medical care or the twice-monthly payroll deduction for health insurance.

Paula decided that her existence didn't make economic sense and stuck by that decision. She died of an impacted colon.