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Friday, July 01, 2011


Really, Nothing Wrong With Our Health Insurance America!?

I have many friends, family and co workers who think there is nothing wrong with our medical system and insurance. Well I am going to tell you a true story and I want to hear what these people suggest!

Healthcare Background

I have had continuous insurance coverage since I was about 16 years old (never a days lapse). About 8 months ago a I had an issue where my back/shoulder hurt. The pain was so severe that I had to go to the ER on Thanksgiving morning. I went to the doctor and she prescribed some pain meds and such. Later she suggested physical therapy and an MRI. Well the insurance would not approve the MRI so I never could get an accurate diagnostic of what was wrong. But, after a few weeks, the physical therapy seems to have done it's job and I am fine again.

Current Healthcare Situation

I recently decided to start my own business (Sit Means Sit Austin dog training). So I changed over to my wife's insurance through her company. There was one last physical therapy session and I ended up having to pay that out of pocket because it was a preexisting condition (even though insurance coverage never lapsed).

A few months later my wife decided to join our personal business so we had to shop around for our own health insurance. We found a policy we could - barely- afford and completed the application. A couple days later we were approved but told there were riders on the policy that we could review when we got the packet. When we finally got the packet there were different riders in different places in the policy including:
  • They would not cover any work for a bunion I had a doctor look at years ago and have not gone to a doctor for since. Now if it gets worse and I need surgery I am expected to pay that fully out of pocket. Does this make sense? No, but okay fine, that is a particular diagnostic that is easy to see cause and effect on if I do get something done with it in the future.
  • They will not cover any neck or spinal related injury. Please note, it is not that they will not cover a re-occurrence of the previous problem - which would still be unacceptable - but they will cover nothing. If I fall down the stairs, get in a car accident, fall off a curb, anything! Not covered. How shitty is that? Fine, don't cover the bunion but do you seriously expect me to accept an insurance policy that will not cover something so incredibly important such as my spine?
Think abut this. We are in a "recovery" from a recession. People are always saying we can grow because Americans don't stand around; we start our own businesses; we grow them and hire people...But the entire system, not just healthcare" stacks the cards against the entrepreneur!

The Question

What are we supposed to do now? What kind of situation am I risking putting my wife in if I do hurt my back or neck? How is she supposed to pay for it? This is why the preexisting condition loophole needs closed. I am not some person who went without insurance until something happened to me. I have always had insurance!

Really, THINK about this!! Are you always going to keep working for a company that has a group policy? What if you are diagnosed with cancer and have to stop working and get insurance? Yes, you MIGHT be able to get insurance but they either won't cover the cancer or it will be very expensive and you likely won't be able to afford it!

Again, what do you suggest? What did I do wrong? Do I just fall through the system now? Come on people, help make me a believer in the current healthcare system.



Sorry to hear that Troy. Unfortunately things won't change as long as the forces that dictate the type of healthcare we receive are founded on profit. There are other viable solutions including moving healthcare to the public sector, but people have been brainwashed to think that anything run by a gov't agency is inherently inefficient and therefore keeping healthcare in the private sector (status quo) is the only answer. It's not.

Think about why we have (mostly) publicly owned fire and police departments. Would we feel secure as a community if decisions were made on whether or not they respond were based on how up to date your insurance was or if you could afford their services? I wouldn't necessarily mind (and there are some successful privately owned fire departments) if they were non-profit. Hospice Austin runs like that. They are non-profit, they compete for public funding against other Hospices and provide superior service. They are thriving.

Privatization and competition aren't necessarily bad things. But in our healthcare industry can we really say we have healthy competition? They're all just different flavors of the same thing. When's the last time you saw a start up healthcare company? There is no real competition when all the big guys are playing the exact same game.

When you have as much money flowing thru a system like the healthcare industry and everyone looking to take as big of a piece of the pie as they can muster, it no longer serves the community. That's okay with things like who picks up my garbage. It's not okay with whether or not I get the kind of care I need to survive. When I need an MRI or other kind of service, I don't want someone saying no because they'd rather see that money on their bottom line. If a doctor deems a service or procedure necessary, the doctor that EXAMINED you, how do we let some desk jockey at an insurance company look at some statistics and say you don't need it. Worse yet is the situation you're describing, how are we letting those companies say every time you change insurance, any pre-existing condition is now somehow off the table? I've broken several bones in my active life. Are my other bones now non-insurable because I've proven they can break?

We need some kind of reform. It boggles my mind that even the modest reform we got recently is still being fought over. Really?!? We need to take profit out of the picture when it comes to healthcare. It's the only way. But one of the biggest problems is the money you're paying into the system is being used to fund the people that keep it the way it is. We have quite a battle to fight, but at least we're waking up to the fact that it is a battle we need to wage.

By Blogger Don B, at 7/01/2011 10:18 AM  

A friend of mine sent this to me in email. Wanted to add to the thread.
"Remember this when you vote. The republicans want to get rid of the health care law that president Oboma and the Democrats passed.
Just hold on till 2014


By Anonymous Anonymous, at 7/01/2011 10:38 AM  

"Oboma"??? ROTFLMAO You deserve 4 more years. I don't.

By Blogger rod, at 7/01/2011 3:06 PM  

Rod, thanks for the witty, insightful, and oh so helpful and thought provoking comment. I am actually asking the question to see if there is some intelligent thoughts from all sides.

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