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– Million Dollar Baby

My western medical insurance billings for cancer have passed the million-dollar mark. Thank god for insurance. So, more than a million dollars later (that’s $1,000,000), I am still alive. ‘The system’ paid for it. Ultimately, that means all of you. Was it worth it? I would like to think it is but, trying to objectively address an issue here… WTF? I am so unworthy. Rather, there are so many people out there that are more worthy than I that haven’t been so lucky.

I was lucky enough to have had insurance before diagnosis. Now, with the Affordable Care Act, other people like me cannot be denied insurance for pre-existing conditions and I think that’s great. But the system is gonna break.

The ACA forced me to pick a new plan and so, because I knew that my immunotherapy is $20,000 every 3 weeks, for example, I needed a plan that would cover everything after a deductible (no copay, no pharmacy exclusions, etc.). So, I have a high deductible ($6300) but everything is covered after that. That averages to only a little over $500 a month. My premiums went down from $1000/month to $46/month. So my total out-of-pocket cost for this million-dollar care is less than $600/month. Great!… for me.

But everyone with an expensive chronic disease will choose the same sort of plan as I, and it will bankrupt the system. See, in choosing a plan you have to assess your risks and take a gamble as to what plan will be best for you with an unknown future of what you might actually need. For example, you can choose a high premium/low-deductible/high- copay plan or you can choose a low-premium/high-deductible/no copay plan depending on how lucky you feel. The system balanced out because some people profited from the gamble and others didn’t. People like me, who know we are facing huge costs, couldn’t previously get insurance so we couldn’t choose an unlimited coverage plan with the knowledge that we would need it. But now? We have carte blanche! Why not do that MRI every two months instead of every 3? Why not do 5 types of chemotherapy? It’s covered!

It’s not the ACA that is the problem here or even the fact that people like me can have coverage. The problem will come from the fact that there are no limits and there is so much corruption and abuse of the system with very little oversight. It will come from the fact that my immunotherapy costs 3 times as much in this country as in others. And if we think Medicare fraud is bad, just wait. Unlike other drugs, doctors are allowed to directly profit from chemotherapy… like, ridiculously. They buy at wholesale and sell at retail. Plus, hospitals that buy oncologists practices, are able to charge the insurance companies more for the same chemotherapy. And, it’s not a cure. It’s only buying time and, in some cases, causing more cancer!

So, I am blessed. I am lucky. I can afford to be alive, for now. But, unless a system for capping costs and oversight for fraud prevention is put into place, I think the system will implode. If I’m lucky, it won’t happen until I’m gone… but, as with the state of the planet, I kinda feel guilty that I reaped more than I sowed. Sorry…

 
 

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