American health care and coverage
I do remember that when I was 18, I struggled with depression. I asked my parents to help me see a doctor about it and they refused, saying that they couldn't afford it. So I know it must not have been covered by insurance.
I went away to college (university, as the Brits call it) and I was covered by the university health service. In my third year, I was diagnosed with a rather serious health condition. The university doctor wanted me to go to the hospital for treatment. When I told him I didn't have health insurance, he seemed dumbfounded. The university I attended was the University of Michigan, and most of my classmates were from families with more resources than mine, so this probably wasn't that usual for this doctor. He agreed to treat me himself in a series of daily visits to the student health clinic. Because I didn't have health insurance, it was several years before I really came to grips with this health condition or got proper treatment for it. I was studying acting in school and dreaming of moving to California to take my shot. If you know anything about this situation, you'll know that actors work as waiters or barristas until they 'make it.'
What having a chronic health condition meant for me was that I wasn't eligible for insurance except through work. And not just any work. An hourly wage job would offer, at best, major medical, meaning it would cover part of the cost if I were in an accident or were hospitalized for a serious illness, like appendicitis. At 22, the cost of this relatively useless insurance didn't seem worth it to me. I gave up my California dream and took an hourly wage job as a costume designer, paying for my medical bills myself, or more often, just not going to the doctor.
Being in a relationship with someone who was a graduate student allowed me to have health insurance for a few years in my twenties. I got regular treatment for an eating disorder including medication and therapy. I began to get see a doctor for my chronic health problem. Then, after a couple of years of feeling that my job was a dead end, I decided to go to Africa and teach.
I'd always been a writer, but while I was in Africa I began to take it a bit more seriously. I started a memoir about my experiences there and wrote every day. I hadn't thought about getting published since I was a teenager, but now the dream of writing for a living began to haunt me again.
I had no access to health care in the North African country I was teaching in, and at around the year mark, I got seriously ill. I returned home and lived with my parents for five months. During that time, my chronic health issue became an acute health issue. I couldn't stop vomiting and hadn't been able to keep food or water down for a couple of days. My poor dad had to take me to the hospital. He was obviously panic-stricken. I remember him picking me up and carrying me under his arm like a small child. He was so shaken that when he checked me into the hospital, he couldn't remember what year I was born. (He told the hospital registration office I was born six years before I was, and three years before he even met my mom.) I spent several days in intensive care hooked to monitors and an IV bicarb drip. I remember one of the nurses commenting on how thin I was and asking if I had an eating disorder. I'd gone off the medication when I left the country. My eating disorder was in full swing, but I denied it.
I had no insurance at this point. I hadn't been back in the country long enough to even begin looking for a job. I checked out of the hospital a few days later. I was never able to pay the bill. I don't even know how much it was. My dad asked me if I didn't feel some responsibility to pay it. After all, they'd saved my life. I didn't know how to make him understand that whatever sense of responsibility I had didn't come with a built in ability to pay. I knew he wasn't suggesting that I (and he) should have let myself die because I couldn't pay for the life-saving treatment I'd received. So what was the solution?
I moved back to Michigan and went back to the hourly wage job I'd had before I went to Africa. I started getting acting jobs on the side and hanging out with actors and writers and other creatives. I began a search for a better job, one that would give me health insurance. It took a couple of years, but I got one. It was a demanding job, sometimes requiring me to work 60 hours a week with no extra pay. That's what I was salaried for, right? It began to impinge on my ability to do creative work on the side and there were other issues with my boss. I quit when I found another job with a lawyer friend who was also one of the part time actors I'd met while doing a show.
I had a succession of three jobs with health insurance. It became the main goal for me in choosing work. Not what I was good at. Not what I wanted to do. Not whether there was opportunity for advancement. Not what the salary was. Did it have good health insurance?
The first insurance I had was Blue Cross/Blue Shield, a not for profit insurance company. It paid 80% of my medical bills. Later I changed jobs and got a great HMO (health maintenance organization) through the university hospital. I had $15 co-pays for doctor visits (even specialists) and $10 co-pays for prescriptions. My third job was for the university itself. I kept the same insurance. The university paid a big chunk of my premiums, leaving me to pay around $50 per month. I didn't have to think twice about seeing a doctor. Which was lucky for me, because right after I started this job, I had an eye injury that would have blinded me if I hadn't had immediate treatment.
My job involved helping low income people with legal issues, including helping them get government benefits. I saw a lot of people without proper health care coverage, many of them in dire need of it. One of our clients, Maria (not her real name) had MS and was in a wheelchair. She was from a Latin American country. She'd been married to an American, but they'd divorced. She wasn't eligible for Medicaid because she hadn't been in the country long enough.
There was a low income medical clinic that she could have used, but their open enrollment happened only every few months. People lined up to get registered, some spending the night outside to ensure they got a spot. Maria couldn't do this. She was very nearly paralyzed from MS and didn't have the physical strength to manage a night outside in the cold.
Many of our clients were dealing with the effects of not having health insurance. One woman would have been eligible for Medicaid when her daughter was born with a disability, but because she didn't know this, the time window passed when she could have retroactively applied and had her daughter's birth covered. She was being pursued by collections for her bill and her tax refunds were being garnished. There was no legal remedy for her.
I saw Medicaid provide a safety net for the poorest people, but it didn't cover everything and it didn't give them an opportunity to get themselves out of dire financial straits. Like all public benefits in the US, medical coverage under Medicaid is income dependent. If someone goes out and gets a job that gives them a wage above the cut off, which to be honest is scarcely enough to live on, much less go to the doctor on, their Medicaid will be the first thing to go. Slightly better household income. No health care coverage. Hmmm. For some, this isn't an option.
In contrast to the people I worked to help, I had world class medical treatment at the University hospital. I feel very lucky to have had the doctors I did. I've even kept in touch with some of them. The worst of it for me was that sometimes I couldn't get all my prescriptions filled on time because the co-pays added up to more than I could afford at the moment. This was rare, but it did happen. I made a good salary,enough to qualify for a mortgage and to buy a car. But still sometimes money was a little short. Not really such a terrible thing given all I'd been through.
The other thing that troubled me was that I really wanted to leave my job for creative work. I was bound to my job by health insurance. Even one of my doctors commented to me during a check up, "You will always have to work." She didn't know she was touching a nerve. I started thinking about how I could get out of my life of working for the man. My father had been a constant entrepreneur while I was growing up, always trying to start a new business and get out of working for someone else. But I was mostly just thinking of doing something that felt like what I was meant to do. I was lucky to have meaningful work, and that was important to me, but it was not creative work and it was very stressful. I could feel myself burning out, becoming too anxious to talk to yet another person in dire poverty, with a host of life-altering problems I might or might not be able to help them fix.
I'd stopped acting because difficulties with my vision prevented me from sight reading scripts at auditions and the idea of having to explain that I had a mild visual impairment to a director I didn't know put me off auditioning completely. I changed my focus from acting to writing, which I called 'acting on paper.'
I started a graduate degree in writing fiction in 2007, working full time and going to school full time. What I hoped was that I'd be able to get a job teaching writing, which would allow me to keep my health insurance and still be close to what I loved doing. It was hard work, but it seemed worth it. When I graduated in 2009 I was full of hope that I might actually be able to work in my chosen field and have insurance at the same time. It didn't take long for that hope to fade. The teaching jobs were few, the applicants many. I was stuck writing in my 'spare' time.
I started taking editing work, hoping that I could build a clientele and quit my job. I was willing to live on less money in exchange for more freedom and more time to write. But the insurance problem wouldn't go away, and it was extremely risky for me to try and live without it. Even if I could have qualified for health insurance, it would have cost a fortune. Anyone who's done freelance work knows that it's feast or famine. Editing is not scalable, meaning I couldn't just get other people to work for me. I had to do every job myself. I could make a wage I could live on, with some sacrifices, but health insurance would sink the whole boat. I took a low wage internship for experience, living with friends and strangers to make it possible. It got complicated.
In 2010 I decided to leave my life and go back to school, this time in the UK. It would only be for a year, but it would be a year focused on writing, one in which I'd hopefully get a book published. Then maybe I could get my dream teaching job.
In the airplane on my way to England, I heard two American women talking. One of them lived in the UK and the other didn't. Would she move back to the US? the visitor asked the resident. The answer: Not until the US gets this health care situation worked out.
In part two, I'll talk about my experiences with health care in the UK.