Repost: Dear President Obama

First published July 29, 2010, then again on November 7, 2012, and now brought out again and brushed off on October 6, 2013.

Sometimes it is good to look back, to see how things were, how impossible the situation seemed, and, having come out the other side with only minor wounds, to be grateful.

So let this be a companion piece to today's bookend of rejoicing: Dear President Obama: My Experience at the HealthCare.gov Marketplace.

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Dear President Obama,

This is a follow-up letter to the one I wrote you exactly one year ago.  I thought you might like an update.

It's been a long time since I cried tears of happiness, and I would like to thank you for creating the opportunity for me to sit here like a complete nitwit, boohooing my teeny-tiny brains out.

Truth be told, the occasional blissful moment in an excellent movie can provoke a brief weep -- but tonight, we're talking floodgates, and bitter saline drawn for release from the Secret Inner Pool.

On September 30, 2009, I became one of the many uninsured.  That's no great story, no Big Whoop, as the kids used to say, and I still do.

One of the many things I admire about you and your administration is your willingness to hear individual stories, and to believe in the integrity of the storytellers.  You don't ridicule instances, you don't seem to fear being overwhelmed by them.

Already permanently disabled by a severe case of one of the most severe of pain syndromes, CRPS/RSD [Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy], lupus [SLE], avascular necrosis/osteonecrosis [AVN/ON], and Some Other Annoying Crap [SOAC] -- it was a real blow to my quality, and even hope of, life to come down with osteomyelitis in my prosthetic shoulders and in the long arm bones themselves.

A complicated but not unmanageable situation, given enough Local Talent, and I am blessed with Local Talent Galore.  There are three excellent medical schools within spitting distance of Marlinspike Hall.

The Author of My Story decided to spice things up with plot twists:  Make the offending bacteria be so obscure, nasty, and recalcitrant that it could not be identified by the wily microbiologist's eye and proved resistant to any antibiotic made by mortal man;  Create such a snarl of confusion that even the we-have-seen-everything, ennui-stricken researchers at the CDC threw their hands in the air, preferring an honest Ebola virus to my obscure domestic germs;  Dictate that the conditions under which these bacterial cultures could be successfully grown existed only in the warm, moist, rum-soaked environment of my shoulders.

Each shoulder having previously been replaced, the prostheses had to be removed.  Surgical concrete laced with all sorts of charms and amulets took their place for periods of up to 3 months, and then, most often, had to be replaced with new ones, as surgical concrete, like all other things in my life at this point, tends toward entropy.  Seven surgeries, President Obama, in the space of 18 months.  Five stays in ICU, three stints on a ventilator, and two resuscitations.  A partridge in a pear tree. 

It was not easy.

Lest you think that the drama lessened between sessions in the operating room, I also single-handedly supported a cottage industry of infectious disease warriors, and co-opted all the free time of Marlinspike Hall's Manor Denizens.  Back and forth we went, inserting and tending PICC lines, infusing intravenous antibiotics several times a day, making blood offerings to appease the demanding serum levels of Haute Society Pestilence, and so on, and so forth.

None of this would have been possible, of course, without excellent insurance coverage.  It was thanks to the reluctant involvement of the Grand PooPah of Tête de Hergé's Insurance Commission that I had any coverage at all once our version of COBRA ran out (here, it's THE ASP).  I was already in a high risk pool, but it was an unregulated pool over which the Grand PooPah could only utter tsk:tsk:tsk! 

BCBS of Tête de Herge is a wily enterprise, and my insurance premiums began to rise, rise, and then rise a lot more.  Finally, it was decreed that as of October 1, 2009, I was to pay, in U. S. Dollars, $1513 a month, in addition to the annual $5000 deductible/out-of-pocket expenses.  The cost of being insured would now amount to 96.6% of my private disability income of $1996.20/month, an amount never adjusted for inflation, despite the spiraling costs of Everything, Everywhere.

Of course, we all know that if they would just accept Lumps of Pure Gold Studded With Blue Topaz, there'd be no problem.  It's this Social Contract involving Oblong Green Rags of Value that is screwing everything up.  Some proprietary blend of cotton, silk, and linen is worth more than my Studded Lumps?  I don't think so.

Anyway, a 41% hike in the space of 9 months finally forced me into the scary position of being in the middle of a health crisis without benefit of insurance.

If you read my blog, and we all know you don't, you would read account after account of daily fever, pain, sweats, fatigue, and the certainty that I would need to cheer up to be suicidal.  It's nothing but a broken record, and to make matters worse?  I now write like H. P. Lovecraft.

I almost went permanently insane during the Great Health Care Debate, especially when it looked like the Tea Baggers might succeed in excluding Aliens from Tête de Hergé (très décédé, d'ailleurs).  ArseHoles!

You about lost me as a supporter when you stopped fighting for the Public Option, and at several other murky junctures.  I lost a lot of my natural optimism, my well known spunk. When the package was passed, it was not clear to me what was actually about to happen, if anything.  Everyone said it would be years before the real impact of reform would be felt.

But whispers in the dark persisted, and the word on our unpaved back-country roads was that some sort of High Risk Pool for people labelled uninsurable was going to be available... in July 2010!

Tall tales went the rounds about some website somewhere, rumored to be PCIP.gov, that explained the possibilities in accessible language and without endless complication.

I went, myself, to the fabled site -- I saw it with my own eyes -- It is real, it is real!

There was one hoop through which I had to leap, and leap I did.  The application for coverage by the Pre-Existing Condition Insurance Plan required that a rejection letter based on pre-existing conditions be attached for eligibility.  The letter must date from within 6 months of the time of application.

Last weekend, I spent four hours filling out an insurance application from InHumana, detailing every instance of hospitalization, complication, treatment, diagnostic procedure, and ingrown toenail, and sent it off to Underwriter Land with fervent hopes for swift and complete rejection.

My rejection letter, which Fred is having framed, arrived today.  It is riotously funny, a moment of hilarity in the midst of my Personal Health Tragedy Epic Saga -- every Long Boring Story needs comic relief.

Sincere in my intent to make application to the PCIP, I poured myself a stiff one this evening, downloaded the .pdf file, printed it out, and girded my loins.

Five minutes later, I was done.

My vision blurred as I read about provisions for those who qualify within Tête de Hergé's territory.  I finally made out that my monthly premium would be $495. 

My hands began to shake when I stumbled on this:

In addition to your monthly premium, you will pay other costs. Covered in-network services are subject to a $2,500 annual deductible (except for preventive services) before the plan starts to pay benefits. Once you’ve met the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most drugs at a retail pharmacy for the first two prescriptions and 50% of the cost of the prescriptions after that. If you use mail order, you will pay $10 for generic drugs or $75 for brand drugs on the plan formulary for a 90 day supply. You will pay 20% of the cost of any other covered benefits received from a network provider. Your out-of-pocket costs cannot be more than $5,950 per year.

And it was not long before I was weeping.  Fred, too.  La Bonne et Belle Bianca Castafiore even joined in, though she is well-insured by her operatic company.  Unfortunately, she pays more than your average soprano due to a, uhhh, errr... Cyst Situation.  But we won't talk about that...

I would love to shake your hand and give you a hug, maybe even a kiss on the cheek.  Michelle, too.  The girls and the darned dog, as well.  I don't think the Secret Service would much like that, so please accept the enclosed 2010 ManorFest TeeShirts for you and your whole family, instead.

I hope we guessed right on sizes, as they tend to run small.

Sincerely,

The Retired Educator
Your Greatest Fan




If you have serious medical conditions and cannot get insurance because of them -- this is a good place for helpful information and suggestions: Foundation for Health Coverage Education/Coverage for All.
photo credit: Steve Hopson

The Affordable Care Act: Info on PCIP (And Some Whoop Ass Thunder Rumble!)

The article below this garbled prologue was written by the good folks at PCIP.  I can attest to its accuracy, having purchased this coverage beginning with its very first month of availability in July 2010.

If I could add anything, it would be to plead with people who feel a responsibility to accuracy to understand that the PCIP program is in no way a charity or an entitlement, and that it is run in an admirable "tight-ship" sort of way under the auspices of GEHA.  My premium has been lowered TWICE since July 2010.  It started out at well over $400/month and is now $338/month.

I have even drooled with appreciation at my exposure to actual customer-oriented customer service representatives, each of whom quickly and efficiently answered my questions and cut through the inevitable red tape of a brand new insurance program.  It helps, I'd assert, that the precepts under which these customer service types work make efficiency easy, as a common sense of fairness seems to be the guiding principle.

Why *yes*, the ACA was created by mostly the same idiots we watched screw the pooch a few weeks ago in their criminal attack on The World Economy.

Screw the pooch is a particularly vile militaristic expression, popularized by Tom Wolfe in the novel, and subsequent film, The Right Stuff:

But now - surely! - it was so obvious! Grissom had just screwed the
pooch! In flight tests, if you did something that stupid, if you
destroyed a major prototype through some lame-brain mistake such as
hitting the wrong button - you were through! You'd be lucky to end up
in Flight Engineering. Oh, it was obvious to everybody at Edwards [Air
Force Base] that Grissom had just f*cked it, screwed the pooch, that
was all.

For those of you fascinated by my constant dabbling in dirt, I did some research and it turns out that the  original form of screw the pooch was fuck the dog.

Umm, also integral to your understanding of the Affordable Care Act, Obamacare, is the distinction between screw the pooch and fucking the duck, though one might be considered the governmental correlative of the other. You'll see this explained in the commentary to the pertinent Jennifer's History and Stuff blog post:

Custer screwed the pooch. Wasting time is another quite profane term. It's 'fucking the duck'. There is, or was, a difference. Nobody buys the farm from fuckin' the duck.

Well, not so.  Had President Obama fucked the duck and given up on any meaningful health care reform legislation, thereby effectively screwing the pooch,  I would likely have bought the farm, as a result.

I'm just sayin'.

And, of course, on to what *really* matters, which would be my actual reference underlying that trite and overwrought "The World Economy" nonsense: the completely undeserved assault-and-battery on Haddock family equities! The Haddocks, they ARE the world!  I mean, if no one takes care of the Haddocks, how will The Captain take care of me and Fred, as well as tend to the upkeep of the miniature Wimbledon All English Lawn Tennis Clubbery? Not to mention seeing to the hygiene of the garderobes of Marlinspike Hall, so necessary to the success of ManorFest?  Infrastructure, people, infrastructure!  Oh, God, just the thought of next year's percolating strains of moat algae...




{hum, hum, hum}

What? Oh.  Right!

To prove my assertion that Obamacare is not Welfare, here's a screen capture of the details of what *I* have paid out in deductible, co-pay, and out-of-pocket expenses (NOT including pharmacy costs).  So the next time someone yammers about "socialism" and "entitlement" in reference to the watered-down health care bill that the President spearheaded, refer them to my actual costs.

What is it, then, if it isn't some welfare "ripoff" perpetrated by a bunch of whiners?  It's FAIR.  My costs are exorbitant -- not so much this year as in the past three when we were actively attempting to stop the infection in my joints and long bones, but still, they are higher than most people's average medical expenditures.  The difference is not some sense that I am deserving or "entitled," no!  The difference is that I am actively *sick* and also deal with severe disabilities and pain brought on by a progressive neurological disorder -- to such an extent that when I was priced out of my private BCBS coverage, no one would offer me a policy.  That's the foundational requirement for eligibility in PCIP -- to have been so rejected!

Medical plan detail

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	In network deductible	Out of network deductible	In network out of pocket	Out of network out of pocket
Current medical plan limits	$2000.00	$3000.00	$5950.00	$7000.00
Accumulated to date	$2000.00	$2098.88	$5950.00	$2199.22

BCBS of Tête de Hergé ended up raising my premium three times in 2009, and finally demanded $1513/month, with a $5000 deductible.  They had also begun to refuse to pay for services that were clearly covered, dragging their feet and making my tending hospitals and physicians request payment many times before moving on to some other delay tactic.

One of my favorites, as well as least-mentioned around here, because it renders me unusually apoplectic, was their assertion that I received not one, but two (and a year apart) policy booklets that had an unfortunate misprint.  That misprint concerned the lifetime cap to my coverage.  My two, year-apart copies both said $5,000,000.  BCBS said, "Au contraire, ma chère!  That was supposed to be $2,000,000." They also scoffed -- in writing, if you can believe their hubris -- at my concern about it, saying that most people wouldn't even have an issue about it, as most people don't max out of 2 million in coverage (negotiated coverage, at that!).  Well, of course, I did.  Max out, that is.  They really do count on us being total hebephrenics.  They do not anticipate things like me turning it all over to the Tête de Hergé Insurance Commissioner... who promptly collected a whole bunch o' "misprinted" policy manuals, including many in their own holdings.

Towanda!

But though they'd lose an occasional battle ("Corporations are people!"), BCBS won the war.  It was highly stressful for all concerned.  It did not exactly improve my health to go a year without coverage, during which time I lost a lot of ground trying to stomp out osteomyelitis. Self pay the $2000+ monthly pharmacy costs for daily meds?  Not likely! Self pay for six weeks of intravenous vanco?  Ya think?  Self pay for removal of a prosthesis and implantation of an antibiotic-laced spacer?  Really?

So... FAIR, to me, is right.  FAIR, to me, is good.  If you must beg to differ, let me know.  We'll talk about it.  Personally, I was profoundly disappointed in the ACA, as the only truly just legislation would have included a "public option."  [Now you may throw words at me!]  To thoroughly confuse you, so long as this country follows the confusion of corporate models with a belief in personal liberty? I am pissed at the people who refuse to pay for coverage but want me to make their health a priority. Who whine and whine about it but don't consider turning off their internet, television, or phone -- who don't move to a more affordable living space -- who consider abusing emergency room services their righteously righteous right, who will pay through the nose for vet services but not "people" assistance. Who eat out on a regular basis, who pay for cigarettes, who put drugs up their nose and in their veins, alcohol in their stomachs and livers, but don't think twice about channeling all that money into health care.  I don't understand people who will not live within their means and are willing to drag others down with them -- children, grandchildren, spouses, live-in lovers -- and us, their neighbors, who end up footing their bills and seeing our own go up as a result.

What truly devastates me?  Watching the mindset passed on to successive generations, watching the belief in the possibility of a better life get actively squashed as a result of a hundred daily decisions to do what is easiest but not best.

Anyway.

Before you have a cow thinking I've betrayed my socialist beliefs -- I've not.  See my original assumption which begins "[t]o thoroughly confuse you, so long as..."  I want that assumption/assertion to change.  But so long as I am stuffed into this ridiculous box of USAmerican denial, yeah, I'm going to go all right wing on your uninsured asses.  Snort!

What's that?  You would if you had a job?  You would if there actually were affordable housing?
My point, exactly.

So "gentle butterfly hugs" all around!  Shazam! [Which is, according to the democratic Wikipedia,  "onomatopoeia for thunder rumble."]


Thunder Rumble!

Please pass this info on to anyone you know who might benefit from it. Thanks!

[If you don't think such people exist in your sphere, well, Towanda, snort, shazam, and thunder rumble.]

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PCIP offers health coverage, even if you have a pre-existing condition
Many people who have been unable to get health insurance can now get coverage through
the Pre-Existing Condition Insurance Plan (PCIP), created under the Affordable Care Act.
PCIP is provided through the U.S. Department of Health and Human Services and
administered by the Office of Personnel Management through GEHA in more than 20
states.

Choose the plan that fits your needs
PCIP has been improved for 2011, with better premiums, better benefits and a greater
choice of plan options. PCIP enrollees can now choose from three plan options, with
different levels of premiums, calendar year deductibles and prescription copayments. The
HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt
account where you can deposit funds for eligible medical expenses.

Each of the three PCIP plan options provides preventive care (paid at 100%, with no
deductible) when you see an in-network doctor and the doctor indicates a preventive
diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer
screenings. For other care, you will pay a deductible before PCIP pays for your health care
and prescriptions. After you pay the deductible, you will pay 20% of medical costs innetwork.
The maximum you will pay out-of-pocket for covered services in a calendar year is
$5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the
amount the plan pays for your care.

Each of the three PCIP plan options:

Includes all covered benefits, even to treat a pre-existing condition, immediately from
the date coverage begins.

Covers a broad range of health benefits, including primary and specialty care,
hospital care and prescription drugs.

Does not charge a higher premium to individuals with medical conditions.

Does not base eligibility on income.

Are you eligible?
To be eligible for the Pre-Existing Condition Insurance Plan, you must be a citizen or
national of the United States or residing in the U.S. legally, have been uninsured for at least
the last six months, and have a pre-existing condition or have been denied coverage
because of your health condition.

Want more information?
Health care options in all states: www.healthcare.gov
PCIP administered by GEHA: www.pciplan.com, (800) 220-7898
To apply for the Pre-Existing Condition Insurance Plan: (866) 717-5826