Feeding The Health Care Dragon

Health care in the USA works perfectly, if you never get sick. It works very well if you get an ear infection and need antibiotics. If you fall down the stairs and break your leg, the current American health care system will make sure you get surgery and a cast. It will even cover your crutches and physical therapy afterward. Your deductible will leave you with a massive hole in your wallet, but you will get better. Next year will be better.

Our health care system is designed for people who don't need health care. Just like car insurance, we pay a premium as a bet against needing an insurance pay out. Most people will get through this year without spending more than a few hundred dollars out of pocket for health care. The current system works, except for anyone living with a chronic illness. Then everything falls apart.

I have a deductible I need to meet before my health insurance covers my needs. Once I meet the deductible, my insurance covers 80% of my health care and I am responsible for 20%. It is now September. I have yet to meet my deductible. On my insurance plan, prescription drug costs do not go  toward the deductible. Neither do co-pays when I see a doctor. Nor do lab tests. What a great plan this is... for the insurance company.

Last year I didn't meet my deductible at all and paid 100% out of pocket all year. High deductible health care plans are a disaster for anyone with a chronic illness. I spent all last year skipping doses and cutting them in half so I could afford my medication. This year I have a lower deductible, but I'm not sure I'm much better off. Even with insurance, health care for a chronic illness will slowly bankrupt a family.

How can this be? We have insurance. It's supposed to fix everything. Well, here's what it looks like at my house.

To see a specialist, the co-pay is $50.00 Meaning, I have to pay $50.00 before the doctor will talk to me. The doctor fills out four prescriptions. One drug is Tier 1. One drug is Tier 2. One drug is Tier 3 and the last one is Tier 4.

 What are these tiers I'm talking about? Drugs are sorted based on how cheap they are to sell. Generics are either Tier 1 or Tier 2. Tier 1 drugs co-pays are about $4.00 to $5.00. Tier 2 drugs are $10 to $20.  If all medications were Tier 1 or Tier 2, health care would be affordable. But, they aren't.

The Tier 3 prescription is a brand name. Not all drugs have generic equivalents. Humalog insulin and Novolog insulin have no generic. People who use insulin are stuck with a Tier 3 or worse Tier 4 co-pay. For me, insulin is $100.00 after insurance. My insulin is Tier 3. Now I have one more drug to pay for. It's Tier 4. It costs me 150.00 a bottle.

In one week, I've spent $50.00 on a doctor and $265.00 on medication. That's $315.00  Ouch well, that sucks. At least next month will be better.

Unless I see two specialists next month. And my medication costs double. Now I've spent $630.00 on health care. Then the next month is back to one specialist, but none of the money I'm spending is actually going toward my three thousand dollar deductible. Money is being sucked out of my wallet along with an insurance premium on top of it. It feels hopeless and is hard to face month after month, year after year.

I pay an insurance premium so I can receive a discount on my medication. Without the discount, I cannot afford my medication at all. It's too expensive. In January 2013, I went to the local pharmacy to pick up a box of insulin pens. I was told my out of pocket was $734.00. I burst into tears and left the pharmacy without insulin. This year is better, but not as good as it should be. I can't believe the best system the United States can come up with leaves people choosing between medical care and the electric bill, month after month, year after year.

The health care dragon is never satisfied. I've poured every last penny into its roaring mouth and it still wants more. If you live with a health care dragon, please tell me about it in the comments. How do you manage to pay for it all? Have you had to choose between health care and food, health care and utilities, health care and the mortgage? If you have, you're not alone.

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