Finance Based Health Choices

I'm quite privileged in the area of health care. For my entire life, I've been able to participate in private health insurance -- health maintenance organizations, to be even more specific -- and never have had to make decisions based on finances.

The first time it even affected my life was when I was 29 years old. My daughter, Joli, had just been diagnosed with cancer, and we were faced with an $88,000 surgery to remove her right eye. Her eye had been destroyed by dozens of tumors, and each day brought the cancer cells closer to her optic nerve. Her surgery was an emergency; we had no idea we were going in to the doctor for a cancer diagnosis. In fact, we thought she was going to just need glasses.

Due to a mix up in paperwork, we found ourselves at the hospital with no health insurance coverage. The paperwork was never sent in by my husband's Human Resources representative, despite the fact that he had already been working at his job for more than 6 weeks.

"You need to pay $88,000, sir," said the medical billing representative at the hospital, "in order for us to operate on your daughter."

"I have $20. Is that enough for a down payment?" begs my husband.

"No," insists the biller. "No, it's not."

My husband was begging for my daughter's life in this office, while I was praying for her life in the entrance to hospital room.

There was a moment when I wondered if we would be able to go through with the surgery. Family members began to silently calculate the amount of credit they each had available on their credit cards; not enough.

Thankfully, my husband's employer realized the dire state of my daughter's life, and personally drove to the hospital with proof of medical coverage. And, as soon as the paper touched the Biller's hands, the surgery was approved. Joli would live.

At the time my husband had completed his paperwork (6 weeks prior to our incident at the hospital), he had signed up for the "Best of the Best" insurance plans. I remember arguing with him at the time that it wasn't necessary. "We never get sick," I remember saying to him. "That plan is a waste of money! Highway robbery!"

Because of the purchase of the premium health plan, we were mostly covered by our insurance for my daughter's enucleation (removal of her eye), her prosthesis, and the months of chemotherapy, MRIs, CT scans, injections, etc., etc., etc. We did have copayments of $250 a month, yet that was nothing compared to the thousands of dollars that were billed each month to our insurance. We did not have to worry about financial choices, we simply took care of our child.

Four years later, I'm finding myself making health choices based on finances again. I recently went in for some dental work, and my dentist made a mistake. Nothing to lose sleep over, but a mistake nonetheless. I had already sunk hundreds of dollars into this dental work, and we were reaching that threshold -- the point at which I need to make decisions like, "Can I get gas this week or will I have to pay more for dental work?" type of decisions. When I called the specialist that the dentist referred me to, I asked about the price. "How much is this going to cost?" I asked. "Twelve hundred dollars," says the kind voice on the other end of the line. "Very funny," I responded.

There was silence on the other end.

"Wait, you're not joking, are you?" I asked in obvious disbelief.

"No, ma'am. Sorry. It's $1200."

"Right, that's before you bill my insurance, isn't it?"

"Actually, no. If your other dentist already billed for the first procedure, then you will have to pay out of pocket for this. It would be $1200."

"WTF!! You gotta be F-ing kidding me with this BS!! Thanks for that information! Is there a cheaper way to do this?" I asked politely.

"Sure, we can do some of the work, and then you can go back to your dentist to finish it."

"You mean, the idiot dentist that botched this up the first time?"

"Exactly," says the voice on the phone. "If you do it that way, then the procedure will only be $200."

No brainer, I thought. I have to go back to the original dentist. I don't have an extra $1000 just to slosh around.

Now, I know that this dental work is necessary. I definitely put off some of this work for far too long. I can explain it away -- got wrapped up in a new job, got pregnant and had to avoid x-rays, was busy with the newborn, work got busy again, etc. But, the truth is, I just can't financially afford to do it right. I can't afford to go to the specialist who would fix this problem. I am left with no other option than to go to the same dentist that messed it up to begin with, leaving me nervous about a repeat mistake.

And, yet, I'm holding a lot of privilege here. Why? Because even though my out-of-pocket is a lot of money, it's still hundreds less than if I didn't have insurance. Also, I actually had the privilege of routine dental care that would have been covered, and instead wasted my premium payments each month and put myself in this situation. I'm privileged because so many people don't even go to the dentist because they can't easily take off during work hours to seek medical attention. Others avoid treatment because of the cost. And many already have it so bad that the best option is just to let it get worse.

These are just a few reasons why I believe health care is a right, not a privilege. I take responsibility for the fact that I didn't go and see the dentist sooner. Instead, like many, I waited until it got unbearable. My fault. Yes.

Yet, I don't eat sweets all day. I brush 2-3x a day with the proper brushing technique -- which few people do these days. I floss after every meal. I flouride rinse. I don't drink soda or sugary drinks. I don't chew sugary gum. I am a model-dentist-patient. And, yet, beyond my control, for whatever reason, I am prone to cavities. It's always been that way. My genetics? My biological make up? Something that I just can't alter....

A health care option for all means that we, as a nation of people, can avoid having to make life or death decisions simply based on finances. It means that everyone has a right to be healthy.

I know too many cancer families who have made decisions based on finances: Can we afford to buy the injections to increase white blood cell counts? Do we stay in the hospital an additional night or try and prove we can leave a day earlier to avoid paying another night? Do we purchase the food that would help us get better (organic, healthy, vitamin packed food), or do we have to purchase pre-packaged, dried food because they are cheaper?

And, if it helps you imagine this -- we're not talking about people who have "chosen" a risky cancer lifestyle (smoking, etc). Much more common are people who have been diagnosed with cancer despite an incredibly healthy lifestyle.

So, what is the solution? We make choices based on finances all the time. Yet, when it comes to health and treatment, should we have to make health choices based on finances?