If I Ran a Health Insurance Company

Dave, listen, I used to run a non-profit. I can wring water from stones… Well, that’s why you brought me in, to show you how it’s done… Ha ha ha, you’re hilarious, really… But seriously, the priority with this one is to raise $X million without raising rates, right? I can find you $X million in 45 minutes. I mean, this budget is 18 pages of ...

Well, first off, why does Chris need an executive assistant and an administrative assistant? I mean, Carol’s a machine, she does most of June’s work anyway…. Well, I never see her at her desk…. No, we do need them, our work-flow is constant throughout the year…. Let’s revisit that, ok? And I think we should consolidate secretaries.... Absolutely. Just because you’re a VP does not mean you need a secretary, I can tell you that from personal experience… No, I say one secretary per division…So if things get backed up we bring in a temp around year-end. Kelly is so desperate for our business, we could probably pay them in animal crackers. Why do we have X goddamn VPs anyway?... All right, all right, hands off that one…Here, everybody gets a temp budget, see?

Except Legal. What the hell are they doing -- you're telling me Randolf & Heard billed us X00 hours last year? Why do we even have a legal division? They’re all attorneys, for Christ’s sake, why are they bringing in attorneys at $300 an hour? $450 an hour? Jesus, Dave, what are we running here, a law school?...

Yeah, and I think we should put the audit out there, too. I know, but we’ve been using them for 5 years and they’re just going through the motions at this point… Because they’re supposed to be auditing us, Dave… $X million is reasonable. On the low side, but reasonable…Because you don't decide "Undercover Boss," Dave! And I'm not sure you even get paid anything...

Whoa -- Karen’s doing 8 campaigns again next year? Somebody needs a reality check. Eight separate campaigns! Jesus, and all those brochures she’s got stashed everywhere? ... For one thing, she starts from scratch every single time... I think we should look at which campaigns have been most effective in the past and bring those back. That saves on creative hours. And no more creative consultants for Karen! She has a graphic designer on staff, what the hell is he doing?... We should find some way to re-use this stuff we have left over, too – I don’t want to see 12 boxes of 16-page glossies sitting downstairs by Karen’s desk, ever again.

Here’s what we tell the staff: One, we are not paying out for vacation time. Use it or lose it. And we’re not getting new copiers this year -- scratch that one right out… By the way, the winning cost-saving idea was Meredith’s... Yeah, if you shake the cartridge it will last another 50 – 100 copies.... You know, Dave, some people think “Every little bit helps" ... The idea came FROM the people, Dave! What are they gonna do, walk? They’re holding on to their jobs for dear life like everybody else… Right, like you, sure…Once we do the first round of layoffs nobody will say a word…Yes, layoffs... Well, I would start with VPs...

Then let’s get every single goddamn VP in here and tell them they have to downsize 1 position… Let them figure it out, what are they getting paid to do? Everybody’s team could use tightening, I’m sure… Oh come on, think back to your team-leader days, there is always a weakest link… I don't like it, either Dave, but would you rather piss off X number of employees or X million subscribers?... You're going to have to make some tough choices..

Except for the holiday party, that's an easy one... I’ll tell you what we do, we do like every other goddamn company in the Northeast/Atlantic and have it here… Catering? No… Get Meredith and what’s-her-name to organize a potluck, they’ll be all over that…. I don’t know, Dave, you take ‘em to lunch and you ask ‘em. They’ll be yours for life. … Because that’s the sort of thing I notice, Dave, I’m a people person… and a woman – ha ha!... I take it back, I take it back!... We can even provide beer, wine, and punch, and boom! You’ve got a Christmas party… Holiday party, sorry… No more going to the Marriott and everyone getting drunk and laid at company expense… You know what I mean...

Hello! another easy one, no more coffee, tea, hot chocolate in the break rooms. What are we, at church?...

Quit bitching, Dave, it's 1 lunch, 2 hours of your time…If you had any idea what I do around here...

Maintenance can do the bathrooms everyday, and the whole place every other day, nobody will even notice… Get that guy Phil to organize an office clean-up ... The one who’s always bitching about going green…. Have him set something up, like, I don’t know, everybody has to do x,y, or z before they leave…. I’m not saying you have to do it that way, I’m brainstorming…

No, let's talk about the executive retreat, because that goes up every year... Chartering a jet to Cancun? For ALL those VPs? ... Well, Beth has that huge place in Martha's Vineyard, why not go there? And charter a bus. Why are you looking at me like that?...

You're really going to hate this one, then -- leasing an executive fleet? I cannot justify that. … For one thing, you’ve got X fucking executives! They’re all getting car privileges, all the time? Nope, cross it right out… Sure, sure… Okay, X vehicles, okay? X vehicles, X drivers -- for you, me... Yes, me. I have to go to Regional twice a month, those people can't cope on their own... you, me, Hartson, Jean, Barry and whoever takes Oversight…Pharmaceuticals, fine… God, don’t get me started, that one’s on you, my friend.

Oh, for the love of… Dave, stop. Fine. I’ll take them to lunch. But you owe me.

Sure, I’ll see you tomorrow… You’ve got Sales at 10 a.m. and please don’t forget, we’ve already rescheduled twice…. I’m just going to finish up your PowerPoint and send a fax and I’m headed home. Listen, Janie’s off tomorrow, so I’m on snail-mail, ok? Snail-mail goes through me tomorrow, if you can please try to remember that… Dave, turn your office light off, please! Reception doesn’t have to do everything, you know.

Thanks to Obama, I am going to vote for the first time in 10 years

People who know me are often surprised to hear that I haven’t voted since 2000. It’s not something I’m proud of. This is not meant to be an apologia or a defense of myself. It’s meant to demonstrate further just what President Obama has meant to me.

It wasn’t (all) laziness. It was a boycott.

My parents aren’t from the South, but I grew up in Arkansas, where my family fell into the category of “Yellow-dog Democrats” – people who would vote for yellow dog as long as he was a Democrat! My stepdad drives around with a stuffed donkey in his rear window. Like most kids, I shared my parents’ views.

Like everyone my age, I grew up hearing, “Every vote counts!” and learning about all the people who had fought for the right to vote. I grew up with political discussions around the dinner table and the daily newspaper spread all over the house. I loved current events so much I majored in journalism in college. When Bill Clinton ran for President I volunteered at one of his local campaign offices. I was super pro-choice, and in college I was able to help with that cause, too.

I suppressed the sneaking suspicion that my vote wasn’t as valuable as someone’s in Ohio… or Florida… I was part of the system -- with all its flaws.

Then 2000 happened. As someone raised to believe in the system, someone who was so deeply proud of the United States, for all its ups and downs, someone who got into deep political discussions with everyone from my sorority sisters to my cross-country coach, I was crushed by what happened in 2000. I felt deeply betrayed. And very, very angry.

Suddenly “Every Vote Counts!” just sounded naive. How could anyone say it with a straight face? All those votes in Florida didn’t count. They didn’t GET counted. I’m sure some of those people thought of voting as a civic duty and privilege, too. And then the Supreme Court said not to count them.

What I saw was the people in power – the governor of Florida, Supreme Court justices appointed by the “other side” – deciding who was going to be president. They were going to put their guy in the White House no matter what it took. I was so angry that I started avoiding the news; I didn’t want to know. I wasn’t living at home, so I was able to avoid talking politics with my family as well. I started to dodge jury duty. It was a short leap from there to boycotting American elections.

Then I got a job in adult literacy, working in Southeast DC. That didn’t help. It didn’t help because I saw, day after day, how little it mattered who the president was. No matter what was going on in the political stratosphere, high above my head, I was still privileged and my students were still poor. The Metro kept running and I kept going to happy hours. I wasn’t thrilled about the war in Iraq, but I wasn’t angry, either – I was numb. Desensitized to all of it.

Of course I knew it mattered in an abstract, indirect way – my tax dollars, etc. But I came to believe that, regardless of who was in office, regardless of policies set or overturned, the real progress was made in one-on-one interactions between regular people. What mattered to my students were the tiny steps forward they were able to make. That’s what changed their lives.

That’s where I channeled my passion and bitterness and fury. And, sure, voting and keeping up with local politics took work – work that I no longer had to do. The whole thing made me sad. I felt like I was watching this country circle the drain, and I couldn’t do anything about it. So I tried not to think about it.

I have never been one for bandwagons. I take a snobby kind of pride in not liking whatever is “hot” at that moment, whether it’s a TV show or a presidential candidate. I waved at the Obama bandwagon as it passed by; a lot of my friends and family were on it. But I believed that not voting made more of a statement than voting did. And when I heard Obama talk about all the things he was going to do, it reminded me of what every politician said in every campaign.

I remember thinking, You talk a good game, Barack Obama, but do you really think you’re going to be able to do this stuff in 4 years? In 4 years, maybe 10 of my students will get and keep jobs. Things take time. And the partisanship in the Congress was a mess. Iraq was a mess.

Good luck.

And then President Obama slowly but surely proved me wrong. It took a while.

First, there was the stimulus package. Of the many things I saw it do – build new roads in Arkansas and Michigan; create new job training programs for my students; assist friends of mine with their mortgages – my favorite was a “BOGO” deal on AmeriCorps volunteers. My little non-profit could afford to get 2 AmeriCorps volunteers instead of 1, effectively doubling the number of students we were able to serve, even as foundation and private funding dried up.

Then, the Edward M. Kennedy Service Act tripled the number of AmeriCorps positions available in the United States, which I think is brilliant. Under George Bush, AmeriCorps programs were cut. Joining AmeriCorps was the best choice I ever made, and watching the President sign the bill at a ceremony at a Washington, DC, school, made the moment even more powerful.

Perhaps the most significant, for me, has been health-care reform. Simply put, health care reform saved my ass. I was in an impossible situation and completely amazed when the federal government came to my rescue.

That’s what really brought me back to life. The president had done something that made my day-to-day life better. He didn’t have to take on health-care reform first. He could’ve done something else, something that people weren’t scared of. But I guess he knew there were people like me out there who couldn’t wait. I started to watch the news to find out how he did it. I blew up at some LaRoche people with their “Obama-as-Hitler” signs. I went to Jon Stewart’s Rally to Restore Sanity.

Like a lot of other people, I had become unemployed. I saw the president stand up for me again. He said, If you’re going to extend tax breaks for the wealthy, you have to throw everybody else a bone, too. My extended unemployment benefits have made it possible for me to stay in DC, and I am determined to do everything I can to give back to my city.

And, even though I still have my doubts about the integrity of American elections, I know I owe it to Obama to take 2 hours out of my day and vote for him. It won’t matter much, but it is the right thing to do. It does matter who the President is.

I am part of the system -- with all its flaws. I am a voter, with all my flaws. I’m an American, and that means something to me again.

Pt 3: "It wasn't me, Deborah; it was the President"

Here’s the bottom line (details in earlier posts): Before health care reform passed, I was paying $220 a month for health insurance and getting nothing for it. Specifically:

• I paid out-of-pocket to get my teeth cleaned, even though I had been paying for dental, because of an insurance company mistake!

• I paid out-of-pocket for my annual exam, because my insurance didn’t cover any gynecologists in the District.

• And now I was paying out-of-pocket for my prescription drugs because I had hit the $1,500 prescription drug maximum?

• I had no recourse. In this world, Goliath shows up with a nuclear missile. You fight, you lose. The End.

What exactly was I paying $220 a month for?

(Let me add that I have always paid out of pocket for my therapist, whom I have been seeing for years. She is an out-of-network provider. Years ago, at my old job, and on COBRA, I got partially reimbursed. Under my “open enrollment plan,” which I joined in 2005, I got nothing.)

My feeling had always been that I had to have some kind of insurance in case I got hit by a bus, but this was getting worse and worse. Besides, I was starting to doubt if getting hit by a bus would even BE covered. (Don’t even want to think about that fight.)

I had no idea what I was going to do.

See, I had two essential problems: 1) I had a pre-existing condition, depression, and 2) I was self-insured. Pre-health-care-reform, HIPAA required insurance companies to offer me some coverage, but they could charge whatever they wanted. Care First had the best plan available to me. A comparable plan from Kaiser was $574 a month, so I actually felt pretty lucky at first.

I decided to stay on the phone until I got some answers. Maybe I could upgrade my plan – almost anything would be an improvement at this point.

In a phone-bank scenario I keep calling until I get the same story twice. Everybody says something different. So I had called a couple of times when I finally spoke to a lady who – very apologetically – explained “the $1,500 prescription drug ceiling.” The insurance company pays up to $1,500 for prescriptions per year. Once that’s maxed out, the subscriber has to pay out-of-pocket.

“But I’m paying $220 a month,” I said to her.

She told me to get a generic.

“But I’m paying $220 a month,” I repeated. “I already have to pay out of pocket to get my teeth cleaned and get my annual exam. I’ve always paid out of pocket for my therapist, that’s never been covered. And now, I have to pay out-of-pocket for prescription drugs, too? What exactly does my $220 a month pay for?”

She felt for me, she really did.

“Lisa,” I said (her name was Lisa), “This is the kind of stuff pushes folk over the edge.”

She laughed and said, “You need to quit the plan and re-enroll. The health care law gets rid of the $1,500 maximum, but they don’t have to apply it to existing subscribers, like people with the old plan."

She told me what to do – fax a hand-written request to quit the open-enrollment plan, along with an application to the open-enrollment plan [sic], a copy of my ID, and my original insurance card.

It was like finding out how to get into Skull and Bones. For some reason I lowered my voice.

"Lisa," I said. "Lisa, why doesn't anybody else at the phone bank know this information?"

She said, "It's really new. Not everybody knows about it yet." After a pause, she added, "It takes a while.”

Now that rang true. It sounded like a dream, and I had long ago learned not to "hope" for anything when it came to health insurance. It was a fact of life that health insurance sucked, and that I would be victimized.

But Lisa sounded like she believed what she was saying, and at this point I had nothing to lose. So I did what she said, and went back to contemplating a prescription run to Tijiuana.

A few weeks later I got my new health care "package" in the mail. It was a big envelope with a manual and a letter that said, "Congratulations!"

I was in the same plan -- at least, it had the same name -- but when I sat down with the manual and looked for the $1,500 prescription drug maximum, it wasn’t there. Flipping through the manual, I found a section on dental. Apparently, my plan now included dental (it used to be an additional $10 a month, and an additional bureaucratic nightmare).

Later, I got another letter saying that “due to federal regulatory reforms,” they were now required to offer something for out-of-network providers if you had a referral from your PCP. They explained the procedure. I damn near fell out of my chair.

I still refused to hope. Because you don’t really know what the deal is until you’re at the pharmacy cash register.

For the past 2 months I had paid $430 for one of my prescriptions -- $430 for 30 pills (see parts 1 and 2). This was after paying my $220 monthly premium. And paying for therapy.

I read that manual cover-to-cover. Then I called in the refill and went to the pharmacy, where my $430 prescription was infamous. I’ve been going to this pharmacy for 10 years, so they know me. The pharmacy tech on duty, Deborah, looked sorry for me as I walked up.

I closed my eyes and crossed my fingers as Deborah retrieved my prescription and looked at the blue label. She usually flinched. This time, her eyes got wide.

“That’s $60,” she said.

“They covered it?” I said.

“Yeah, they sure did!” she cried.

“Now that’s what I’m talking about!” I yelled. “Oh my God!”

Deborah smiled. “I’m glad you got it worked out, Ms. Phillips.”

“It wasn’t me, Deborah,” I said. “It was the president.”

And I didn't even vote.

Because my president led this health care reform effort, I am now paying $186 a month and

• There is no $1,500 prescription drug maximum. It ain't allowed. My $430 bottle of pills costs me $60 a month, and I am overjoyed.
• Dental is included, which means it’s understood that I have dental – everybody has dental!
• For certain specialists (like gynecologist and psychiatrists), even if they’re out of network, Care First has to cover between 60 – 75% with a referral from my PCP.
• This was the case for several kinds of specialist, but not for everything. I went to my PCP, got a referral, and filed a claim for my therapy sessions. I got reimbursed for 3 of them – and I will, each year.

That may not sound good to you, but I was ready to take out a full-page ad in the New York Times. After all these years, I was getting something. I really wasn’t asking for much. I am paying $186 and getting something. That’s all I wanted.

It brings tears to my eyes when I think about it. It was so horrible feeling violated, and hopeless, and to have no choice, no help, from anybody. To be at the mercy of an insurance company – a largely incompetent insurance company – was horrible.

I don’t know the ins and outs of health care reform, but I do know that Care First didn’t make these changes out of the goodness of their hearts. They’re not even sending letters to inform existing subscribers about it (unless they happen to talk to Lisa, I guess).

But for those of us who were in a crisis, the federal government came through. I had no recourse, and it was wrong. What was happening to me was wrong. Nobody had to do anything. But President Obama made sure Congress did something. And he’s catching hell for it.

I defy anyone to lay out for me, in black-and-white numbers, how health care reform has harmed them. Because I was in a shitty situation that has gotten sooo much better – and they’re still making changes. They do send a letter periodically explaining some change or update brought about by “federal regulations.”

Instead of letters telling me my premium is going up, I am now getting letters telling me about improvements.

I pray that the health care reform law survives. Just in case, I’m going to start saving now.

I'll probably start voting again, too.

Health Care Reform Has Made My Life Better, Part Two

President Obama’s health care reform law has made my life better. Of course, it wasn’t just him. But he seems to be taking most of the unconstructive criticism for it. So, I hope, we can also give credit where credit is due.

I have been self-ensured for a long time, out of necessity. Self-employed, I had a “pre-existing condition,” depression, so the best deal I could get was $160 a month, from Care First.

Every 6 months or so, I got a letter saying my premium was going up, so when the health care reform law passed, I was paying $220 a month.

And getting nothing.

It was a supremely frustrating situation, especially since I’m generally very conscientious about money. I like to think of myself as a responsible consumer. But I had a friend in similar circumstances and he decided to go without health insurance when his COBRA ran out, and promptly developed gastroenteritis and now owes the hospital hundreds of thousands of dollars.

So I paid the premium and I learned to keep my mouth shut. Evidently health care existed in the same alternate reality inhabited by Comcast and Verizon. It was going to suck, it just was. You don't really have a choice.

At least, I didn't. See, I deal directly with the health insurance company.

And they don't answer the phone.

Say, for example, that, oh, I don’t know, your gynecologist moves his office to Vienna, Virginia. You don’t have a car but you do have a job and you’re going to have to take a personal day to get your annual exam.

You search the Web site for a DC-based gynocologist who is covered and can’t find one. They are all in Virginia or Maryland, miles away on the Metro. This appears to be a new development. Again, you have a job. AND you’re paying $220 a month. It has to be a glitch.

So, hypothetically, before you take a sick day and voyage to Vienna, you decide to call the health insurance company and find out what the glitch is. And let’s say you, oh, for example, sit on hold for 45 minutes and then get “transferred to somebody who knows the answer,” only to wait 45 more minutes before somebody else picks up and says, “Care First, how can I help you?”

I don't know what you would do, but I eventually gave up. It was part of the parallel universe in which "9 a.m. to 4 p.m." is a "service window." Fighting it was a waste of time and energy. I went to Planned Parenthood (a few blocks from my office) for my exam and paid for it myself.

So let's say this sort of “glitch” arises fairly regularly and you can’t call to ask questions because you have PTSD.

Around the time the health care reform law was being debated in Congress, I finally went to the dentist for a (long overdue) annual cleaning.

But first they looked me up and said I didn’t have dental. I assured them I did, in fact, have dental, that there was a line on my bill each month that said "Dental" and "$10." I called the insurance company and waited on hold for 15 minutes before the receptionist said, “Ma’am, do you still want the appointment?”

For the cleaning, check up with an actual dentist, and x-rays, $435.

You think you would take a stand or do something, but you know what will happen if you call. Just like you know what happens if the technician doesn't show up in the given service window -- you take another day off and wait for him again.

I said to hold the x-rays and the dentist and arranged to pay the rest in installments.

Just two months later, I was charged $430 for one of my prescriptions. It must have been “the straw,” because I did not pay the money. I went back to my office and called Care First. One of the janitors, leaving the building, was surprised to see me in the hall. “I thought you left for the day,” he said.

“I have to call Care First,” I told him.

“God help you,” he said.

To be continued...

Health Care Reform Has Significantly Improved My Quality of Life, Part One

President Obama’s health care reform law has made my life better.

The frustrating abstraction that is government and health care reform and pharmaceutical companies is not something I feel compelled to master. But I can give you a truthful account of what happened to me.

I have been self-insured for a while, and it has been pure hell.

Before health care reform passed, I was paying $220 a month and getting nothing for it.

Now, thanks to the Obama-led health care reforms, I’m paying $186 a month and getting something.

And I didn't even vote.

After health care reform passed, I was advised to re-enroll in a new version of the same plan, because Care First had “made some changes” to it.

I have gotten several letters over the last several months “advising” me of changes in my health insurance plan. Some of them are technical and not very interesting.

Some of them have changed my life -- for the better.

In September, after paying my $220 premium, I had to pay out-of-pocket for a prescription: $430 for 30 pills.

I take medication for depression. I have since college. I got a new prescription last year for a new drug that has really helped me a lot. After a couple of months on the drug, I was suddenly charged $430 for the bottle of 30 pills.

What happened? I had hit my insurance plan’s “$1,500 prescription drug maximum,” which I had never done before. Apparently, my insurance covered up to $1,500 in prescription drug costs, which was fine when I was taking generic medication.

Now, I was on a brand name drug, and $1,500 was chump change.

My doctor thought the patent had expired; after some research, I discovered that it was supposed to expire in 2010 but the FDA extended it for 5 years in exchange for the drug company doing some research study.

Not only that, this particular medication was part of a “first generation” of new drugs – (“That’s why it’s working so well for you!). There are no generics yet.

I was paying $220 a month. For nothing.

It was a difficult decision for many reasons, and you might not agree with it, but I decided to pay the $430 until I could figure something out. I tried to get the drug free from the company but my income was too high. I looked at some online pharmacies, but their prices were no better (and somehow I got the impression the drugs were coming from India anyway). I harassed my doctor until he tried to get a better price for me – and failed. I contemplated a trip to Tijuana. I paid for August and September and kept calling my insurance company in a futile attempt to stand up for myself.

Imagine my shock when the federal government came to my rescue.

Finally, one of the times I called Care First, a woman advised me to enroll in the “new old” plan.

I was sure it wouldn’t work, but I was so desperate I actually gave it a shot.

And guess what? In my "new old" plan, THERE IS NO $1500 PRESCRIPTION DRUG MAXIMUM.

I now pay $60 a month for my brand-name prescription. And $186 for my health insurance.

Which, by the way, now includes dental.