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Our broken Health Care system – My story

Date: June 28, 2012
Author: julietjeske
Categories: Politics, Scam, Uncategorized
Comments: 1 Reply
Front entrance of the old Cook County Hospital.

Front entrance of the old Cook County Hospital. (Photo credit: Wikipedia)

I graduated college at the age of 23.  I was living in Chicago Illinois and working as a stage actress.  My pay was low and my job did not provide health insurance, although it was a professional union theater.  I also had any number of part-time jobs but none of them provided me with health insurance.  Yet I was paying all my bills on time, and completely supporting myself.

My mother took me off of my father’s COBRA plan once I graduated from college.  She thought I could purchase an individual plan with no major problem.  She was wrong.  I applied for Blue Cross Blue Shield for a standard individual plan.  The costs were extremely high even back in 1996.  I was also being charged about double since I was a woman, I thought this was a bit absurd but it was explained to me that since women might need maternity I was paying in for myself and for all women.  A slightly twisted concept I thought since women can only get pregnant with the help of a man yet only women have to pay extra for other women.

I filled out the paperwork and waited, and waited and waited.   Finally after about six-weeks the insurer informed me that I had too many medical problems and they wouldn’t cover me.  I was 23 years old with no chronic conditions.  My asthma wasn’t even diagnosed until years later.  When I demanded to know specifically why I wasn’t covered they said it was because I hadn’t had enough healthy pap smears in a row, and because of a cervical  biopsy I had at the age of 22, I was deemed high risk.  Even though the biopsy showed no signs of disease and I didn’t even have an STD.  My exam was free and clear.  The biopsy was given to me because my pap smear was slightly off due to being on the tail end of my period.

I had only had two pap smears up until that point, which is perfectly normal for a college-aged woman.   Blue Cross said that I need five healthy pap smears in a row before they would consider insuring me.  A woman typically gets a pap smear a year, so what they were really telling me is that I had to wait five years.

I tried to apply for coverage with other insurers, I even went to an insurance broker who sat me down and told me what the real problem was, no other insurer would cover me at any amount.   My paperwork would get “lost”, phone calls were left on voice mails never answered, I would spend over an hour on hold, mail would be returned to me.  The broker told me that I was basically being blacklisted by Blue Cross Blue Shield, and yes he used those very words.  Blacklisted.  Somehow the fact that Blue Cross Blue Shield was denying me was showing up in my medical records and no other insurer would touch me due to the size of Blue Cross.  If an insurer that large wouldn’t cover me, it just made me look extremely high risk.

So we devised a plan.  I was able to get emergency only coverage for six months, that could be renewed but only for two years total.  So I couldn’t use it to go to the doctor, but if I got hit by a bus I could go to the hospital.  The coverage was lousy but better than nothing.   I also decided to get those five healthy pap smears and send them to Blue Shield, but my plan was to do it in half the time.  So every six months I went to Planned Parenthood and explained my problem.  The nurse practitioners sympathized with me and obliged me, even though they thought it was ridiculous.  So after getting and paying for five healthy pap smears in about 2 1/2 years I applied again, and was denied again.  The insurer cited health concerns again, but they wouldn’t give me a specific reason.

Meanwhile during this time I got sick, nothing major but I ended up at Cook County hospital twice.  Cook County was a no frills, bare bones public facility that could turn down no one.  The first time I went to Cook County I waited eight hours to see a doctor, and then got a free prescription, only waiting an hour to get the prescription.  The second time I went it was only a five-hour ordeal.   While waiting to see the doctor I sat in a waiting room of wooden benches along with the poorest of the poor and homeless people.  It was a rattling experience to say the least.  When I applied for the health insurance program through the state of Illinois I didn’t qualify.  Since I did not extend my COBRA coverage I was ineligible.  The cost of extending my father’s COBRA coverage was astronomical once I left college, but according to Illinois state in order to be eligible for their plan I had to extend my COBRA for as long as possible.  Of course I had no way of knowing any of this when my mother opted to stop covering me at the age of 23.

Finally my luck changed a bit and I ended up with a full-time job, at all places the American Medical Association.  When I was filling out my employment paperwork I noticed their health care plan was through Blue Cross Blue Shield.  I panicked, I thought surely they would deny me coverage.  The woman in HR told me that no one had ever been denied coverage.  Of course, they had employees with major chronic health problems, or children with chronic health problems, but in a large group plan it was efficient to cover everyone.   My application went through and I suddenly had insurance.  I went back and asked my friend the insurance broker what exactly had happened.

He explained it like this.   An insurer will most likely lose money on an individual plan.  They have to do the paperwork and claims for one person, a person who is paying their premiums themselves and is probably going to squabble over every charge.  The same person is probably going to use the insurance more often that they are paying a few hundred dollars a month for it.  Whereas a person in a group plan won’t fight over every bill and is more likely to use their coverage less often.   Group plans were just much more efficient and cost-effective both for the insurers and the employers.  That is why the cost of individual plans are so high and why insurers usually don’t want to deal with individual plans.

So given my experience, I can’t really get enthusiastic about a “market based” solution to health care.  In my case the market completely let me down.  I couldn’t get health insurance at any cost.   So my Libertarian friends can rant and send me links to websites denouncing reform, and my Republican friends can call Obamacare socialism and tell me to read this book or that email, but my personal experience is going to trump all of it.  I was a perfectly healthy 23-year-old female with no cancer in my background, no chronic medical conditions and no history of lapsed coverage for more than a few months, yet I couldn’t get coverage.  If an insurance company can deny a healthy 23-year-old, than just about anyone could be denied coverage.

And now that I live in New York state with its much tougher patient protections I don’t want to buy health insurance from a state with less.  New York state is one of the few that a patient cannot be denied coverage for medical reasons.  Some people actually move to New York state after being denied coverage in other states.  I don’t think Affordable Care Act is perfect as it still puts too much power in the hands of health insurance companies and we still have no single payer public option.  But at least now a person who has survived cancer or is born with some type of genetic problem is able to get health insurance.    And a perfectly healthy 23-year-old would be able to buy a plan on their own.  My personal experience has shaped how I view the health insurance fiasco in this country more than any political rant or speech ever could.  I am lucky in that I didn’t get anything serious in those years I went without coverage.   And if I had, I would have ended up in the emergency room with bills that were never paid and probably ended up on Medicaid which would cost everyone that much more.

If you don’t believe my story, then sit down and talk to some of your friends, especially anyone with chronic medical conditions, small business owners or the self-employed.  You are likely to hear similar stories of denied coverage, frustrations over claims, skyrocketing premiums and financial ruin.  I have heard stories much worse than my own with some blaming health insurance companies for the premature death of family members.  After all putting a profit motive into denying coverage can have deadly consequences.  Hopefully we will figure this mess out soon enough, I know I never want to end up without any options again.

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Birth Control Debate: Religious Freedom or Sexism?

Date: March 29, 2012
Author: julietjeske
Categories: Agnostic, Politics, Uncategorized, Women and Feminism
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U.S Postage Stamp, 1957

U.S Postage Stamp, 1957 (Photo credit: Wikipedia)

I am completely floored by the current debate over the health care mandate requiring health insurance companies to pay for birth control and religious freedom. For starters no one is arguing that men receiving a prescription for the erectile dysfunction drug fill out any forms or prove that they are married or using the drug to procreate. Other than a few crafty legislatures who have introduced bills as a means to protest these insane attempts to limit access to birth control, no one has argued against viagra in terms of religious freedom.

And what about religious freedom? When did the right to worship as you please change to the right to influence or direct the personal behavior of your employees? Health insurance isn’t a hand-out paid for entirely by the employer and given to employees out of the goodness of their hearts. It is part of an employees compensation, so the employee is in effect earning their health insurance through their hard work. Most plans take a portion of the premium directly out of the employees paycheck. And the employer is allowed to deduct a certain amount paid for their employees premiums off of their tax liability, as health insurance is just another cost of doing business.  I also cry foul because so far there has been no mention of IVF fertility treatments.  The Catholic church is against IVF treatments because they create many embryos that ultimately get destroyed in the process of trying to create a pregnancy.  IVF treatments are not being mandated as part of basic health insurance coverage by the government but it is interesting how the pro-life movement rarely mentions them or brings up the topic.  We don’t see throngs of protestors outside fertility treatments for the great multitude of frozen embryos destroyed as a result of these fertility treatments.

So how far are we going to take religious freedom?  How much can an employer influence the lives of their employees in the name of religious freedom.

Would Muslim employers

  • Require female workers to wear a veil while at work, or even a Burka
  • Be allowed to discriminate against women and refuse to hire women based on their religious beliefs
  • Pay women less than men, based on their religious beliefs
  • Ban all pork and other prohibited foods under Islamic law in the workplace even for non-Muslim employees
  • Make non-Muslim employees observe Muslim holy days and traditions including fasting
  • Require moments of silence in the work place for all five times during the day that Muslims pray towards Mecca

Would Mormon Employers be allowed to

  • Ban Coffee from the work place
  • Institute modest dress code laws
  • Require mandatory readings of the Book of Mormon

Would Scientologist employers be allowed to

  • Refuse to cover any psychiatric or psychological drugs or care
  • Force employees to attend Scientologist meetings or treatment such as for alcoholism or learning disabilities
  • Demand every employee to be audited with an e-meter

Would an orthodox Jew employer be allowed to

  • Force female employees to wear wigs and forgo pants for long skirts and modest clothing.
  • Institute all Kosher laws regarding the Sabbath and food restrictions

Would a Jehovah’s Witness employer be allowed to

  • Refuse to cover many surgeries that would require a blood transfusion

Christian Scientist

  • Ban most medical procedures in favor of spiritual healing and prayer

Seventh Day Adventist

  • Require all employee to adhere to a strict vegetarian diet while at the work place

And could any religious employer refuse to cover the legal spouse of a same-sex marriage in the states in which same-sex unions and marriages are legal?  Most states mandate employers to cover their employees for some type of health care coverage depending on the amount of employees.  Could an especially frugal employer simply state that their religious beliefs would only support 100% faith healing and prayer, pretty much wiping away the need for health insurance entirely.  Why not?  If an employer gets to act as a parent to their employee and decide what is morally acceptable and what is not, what is to stop such an action.

The birth control debate is just another ridiculous attack against women.   And I don’t know when the employer’s right to freedom of religion supersedes the right of an employees right to privacy or their own religious freedom.  I thought religious freedom was the right to worship as you chose, not the right to dictate to others how they should or should not live their lives.

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Rush Limbaugh – Sluts, Prostitutes or just a pack of Lies?

Date: March 2, 2012
Author: julietjeske
Categories: Politics, Uncategorized
Comments: 4 Replies

OK so regular readers of this blog know that I have a very popular entry with the title

Dating After Divorce in a City of Sluts

That one article completely changed the course and direction of my life, got me international press and indirectly a literary agent.  When I used the term, I used it in a lighthearted attempt to describe the sexual behaviors of the entire city of NYC.  To quote myself.

I find frustrating is that if you really want to get to know a guy first before having sex with him, it seems like there is no end to the women who will jump into bed with them. And this isn’t to say that only men do this, as women engage in the same behavior as do people of all sexual orientations and gender identifications.

So although some have misinterpreted my use of the term slut, I do indeed refer to every adult male, female, gay, straight, bisexual and transgendered person indirectly as a slut.  Not to say that every adult in NYC engages in slutty behavior, but people from every sexual orientation and gender specification certainly do.  Why people felt obligated to associate the female gender to the term “slut” is beyond me, but I meant slut in terms of people who engage in promiscuous behavior.  Some men and women proudly identify as sluts so given the context, I really didn’t see what the fuss was about.  But now that we have my history with the term “slut” addressed I would like to move on to Rush Limbaugh.

Rush Limbaugh decided to personally attack Sandra Fluke, a law student at Georgetown University who testified before the congressional committee on the cost of birth control.  For sharing her personal story about the high cost of her birth control Rush labeled her both a slut and a prostitute.  I am not going to address the name calling or equating a woman using birth control as a prostitute because it is pointless to even bother.  But I am going to break down his arguments.

Hormonal birth control is prescribed to many woman for health related purposes that are not related to preventing pregnancy.  NO ONE in the press wants to address this.  Birth control pills are prescribed for many female reproductive health problems such as – ovarian cysts, heavy periods, irregular periods, painful periods, hormone imbalances, light or infrequent periods, early onset menopause even cystic acne.  In many cases, the pill is effective in most cases for reducing these symptoms, it is not exclusively taken to prevent pregnancy.

The cost of hormone based birth control when compared to condoms.  Rush and his staff “crunch the numbers to try to show that hormone based birth control pills are not cost-effective.  But comparing condoms to birth control is like comparing a raincoat to an umbrella.   According to AmericanPregnancy.com hormone based birth control pills have a 93-97%  success rate when used in real life conditions.  And according to the same site, condoms have a 14-15% failure rate.  So solely basing birth control on condom use would result in more unplanned pregnancies.  Also according to AmericanPregnancy.com the cost of delivering a baby could reach as high as $6000-8000 which does not include prenatal care or the extensive costs of a complicated pregnancy, especially one requiring a Caesarian section.

The Tax Payer is on the hook for birth control Rush also claimed that the “tax payer” is somehow paying for Sandra Fluke’s birth control but I don’t know where he is getting that other than thin air.  The subject being debated on congress had nothing to do with the federal government spending any tax dollars on anyone’s insurance.  If Rush would like to debate that topic he is free to do so, but this particular issue has to do with either the employer or the health insurance company paying for birth control, it says absolutely nothing about the government paying for anything.  It is designed to set national standards for essential healthcare benefits.  And using that logic, anyone in a health insurance plan is paying for another member’s care.  Pay $8,000 in yearly premiums, but use only $2000 worth of care?  Then you are paying directly into the profits of the health insurance company but also for another member’s heart surgery, cancer treatment or for a premature infant clinging to life in an incubator.   That is just how health insurance works, most people pay more into it than they get back and a few patients cost the plan more than they put in.  If it didn’t work this way the companies wouldn’t be able to turn a profit.

The women are having too much sex and that is why they need birth control – The way hormonal birth control works a woman has to take it for an entire month and stay on it for months whether she is having sex daily or once a year.  The amount of sex is irrelevant.

Married couples should not have hormonal birth control as an option for helping them control the size of their families? Rush doesn’t address this directly but the vast majority of women including Catholic women in the US use some form of birth control.  The Guttmacher Institute in a new report, Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use. The report showed that, “among all women who have had sex, 99% have ever used a contraceptive method other than natural family planning”  Are married women who use birth control sluts in Rush’s world view? Most married women only have one sexual partner, not exactly a slut.

And of course his last ridiculous statement simply made to get press more than anything else. –

Since “WE” are paying for it, these women should video tape their sexual encounters.  According to the proposed legislation, the health insurance providers or the employers would be paying for the birth control, NOT the tax payer.  And even with that insane logic, then Rush might as well start producing some of his own tapes, after all a health insurance plan most likely helped pay for his Viagra.  So everyone paying a premium to the same insurance company better start demanding videos of his erections, just because they helped pay for them.

And if he is going to make personal attacks – Rush Limbaugh – married four times, yet has no children, three of his wives were of child baring age, so either he is sterile, or someone was using birth control.  No one knows this for sure, perhaps he successfully used the rhythm method for each wife and through some miracle no one got pregnant.  Rush who has had problems with abusing prescription drugs himself, was caught entering the country with the erectile dysfunction drug Viagara.   So is it acceptable for a health insurance company to pay for a drug that certainly would increase the sexual capacity for a man, but not for birth control for a woman?  That seems like ridiculous hypocrisy to me and most Americans would agree, in fact according to A Kaiser Family Foundation survey nearly 2/3 of American Adults favored Obama’s birth control policy.

Rush Limbaugh is a blow-hard who says crazy things to get attention and press.  He might have finally gone too far.  Attacking half of the adult population directly is not always the best method for winning over converts to his cause.  But we shouldn’t tell him that, let him alienate half the voting population.  Seems like a winning strategy to me!

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