So far in my own life, I’ve been very lucky as far as health goes. It’s easy for me to love my family’s high deductible HSA qualified health insurance policy, because other than Jay’s knee surgeries, we’ve never had to use our policy. We do work very hard at maintaining our health, but we can’t deny that we’ve also been lucky. Not everyone is so lucky, and my father is a perfect example. I’ve shared his story before – perfectly healthy, active, non-smoking, vegetable-eating 54 year old stricken with Wegener’s Granulomatosis. The disease attacked his kidneys, leaving him on dialysis since 2001. Dialysis on its own is less than pleasant, as are the myriad of other troubles that go along with having an autoimmune disease and kidney failure. He spent nearly five months in the hospital in 2004 – including several days in intensive care – fighting a wicked bout of peritonitis brought on my peritoneal dialysis. He has to be hyper vigilant about how much fluid and potassium he consumes, and take a handful of pills with every meal, in addition to spending three hours each evening with needles in his arm while his blood filters through the dialysis machine. The Wegener’s has been in remission for two years now, following a round of treatment with Rituxan. But the kidney failure remains, and does put quite a damper on his quality of life.
When my father got sick, he was working for the state of Colorado. He was covered by an employer-sponsored group health insurance policy, which picked up the tab for most of his care. Still a few years away from his planned retirement, he kept soldiering on, dragging himself back to work after dialysis sessions, and trying to avoid vomiting at his desk. But eventually he just could not continue working. He was too sick. He had never called in sick in his entire career, but the Wegener’s and kidney failure were taking too much of a toll; he had to stop working about a year after his diagnosis, and retire earlier than he had planned. Obviously health insurance was a major issue, as having to leave a job at age 55 with a serious medical condition will strike fear in the hearts of many. But the one bright spot in the whole sad story is that Medicare covers people with permanent kidney failure, regardless of their age. So for the last several years, my father has been on Medicare. That coverage, combined with a Medigap supplement that picks up the 20% that Medicare doesn’t pay, and a Part D policy that pays for some of his medications, has paid for most of his care over the years. The beauty of Medicare is that it’s portable and permanent. It’s not tied to a job or a particular state of residence. My parents have spent some time in other states in an effort to see if different climates have any impact on my dad’s health. And wherever they are, Medicare pays for his dialysis (and any other treatment he might need, which other than the peritonitis debacle, has luckily been minimal).
Duncan Cross, whose blog I very much admire, has written about the right to health care and how a chronically ill person is indeed denied some very basic freedoms because of how our health care and health insurance systems are set up. He writes that “The most obvious rights being denied the chronically ill are economic rights. It’s unquestionably true that the terms of my access to health care impinge on my economic rights: I simply cannot work in certain professions or positions – not because I can’t do the work, but because those jobs don’t offer health insurance. So I can’t start my own business, or work in most small businesses, or try my hand as a free-lance writer.” And yet if he had kidney failure, this would not be the case, as he would qualify for Medicare. Don’t get me wrong, kidney failure is a horrible, debilitating condition. But so are hundreds of other chronic illnesses, including the Crohn’s disease that Duncan Cross endures. Metastatic cancer, diabetes, COPD, autism, MS… there’s quite a list of conditions that require ongoing care, significantly hamper ones quality of life, and require people to structure their lives around maintaining health insurance coverage. Employment opportunities are limited to those that offer good quality group health insurance. It seems odd to me that by providing Medicare coverage to those with kidney failure, the government has removed the problem that Duncan Cross describes – but only for those with a very specific illness, (0r those who have been deemed disabled and qualify for social security disability benefits). There’s a huge group of people with other serious illnesses who are having to struggle with not only their health condition but also with the status of their health insurance coverage. An expansion of Medicare to cover anyone with a chronic illness makes sense, and would eliminate some of the economic burden currently endured by those individuals.
Many thanks to Nurse Kim at Emergiblog, who hosted Grand Rounds this week, where I found the article from Duncan Cross. The Colorado Health Insurance Insider article that I wrote last week about health insurance coverage for autism was included in the Grand Rounds.