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And the Democrats Wonder Why They Lost the Election?

Now I have insurance. But I can’t use it. What am I supposed to do? I know this one is long but it’s worth a read if you want to understand issues pertinent to the Affordable Care Act. My personal story illustrates many of the problems with the ACA.

I started taking notes on the Health and Human Services Secretary hearing, and I will share more as I scrutinize the hearing in more detail but let’s start with the breakdowns below and my experience with Obamacare.  Here goes:

These are the breakdowns of who gets what coverage in the United States:

Medicare 18% – 52m

Employer 61% – 178m

Medicaid 22% – 62m

Individual 6% – 18m (exchanges cover 4% of the 6%–these are the people who have been forced onto the Obamacare plans)

Note: this writer is in the BOTTOM of the barrel here (Individual). Most of the individuals in the “Individual” category are either the upper contingent of the working poor, those who work for small businesses like restaurants or family owned grocery stores and the like that don’t provide health insurance benefits (more and more common these days), and/or sole proprietors like myself. Many health care providers are self employed hence we have been forced into the Obamacare exchanges if we are not high earners. High earners won’t buy on the marketplace and will purchase individual plans outside of the marketplace.

I find it interesting to note that the 22% who pay little into the system get better coverage than the 6% who actually work and pay taxes into the programs that support their health while much less is paid into the healthcare for those who work and earn between adjusted gross incomes of $23,540K (yes, exactly) and $45K per year. Adjusted gross income versus gross income are pertinent here but not necessary to go into detail about this at this point.

I have no objection to the poor being covered by Medicaid. However, I do find it OUTRAGEOUS that the United States is paying less for healthcare costs for those individuals who are actually working and paying into the system and making every attempt to rise above their circumstances. This seems to be shortsighted — at the least — as workers need to be kept healthy otherwise they wind up in the category of non-workers who will wind up on Medicaid anyway (or dead and then voila! They won’t cost the taxpayer a dime).

Before Obamacare came into existence, I had coverage through a New York State program (thankfully) that assisted sole proprietors. I paid for that program and at that time, I paid much more than anyone who had an employer-subsidized plan (a $400-$500 monthly premium was unheard of for an employer-subsidized plan but not for an individual plan; most of my clients on employer-subsidized plans did not pay anywhere near this amount for their plans monthly, at least not directly). I had Oxford Health Insurance and a decent network of doctors that I could visit a ten minute walk from my home through New York Presbyterian Hospital at 168th Street & Broadway (I live off of 181st Street). 

My benefits were more limited than employer-subsidized plans (for example, I did not get outpatient physical therapy, mental health, or post-surgical inpatient rehabilitation coverage). Without inpatient rehabilitation coverage, I was screwed when I had lumbar spinal fusion surgery (L4&L5 discs) in April of 2013. 

I was essentially partially crippled by an “equipment failure” and thus endured two surgeries within 48 hours. I was in bad shape and was recommended from two to four weeks of inpatient rehabilitation by the doctors. Because my insurance did not cover inpatient rehabilitation, I was sent home barely able to function. I managed for three years with little if no support from family (which is usually what socialized medicine counts on to plug in the gaps caused by nursing and other staff shortages). If one is alone and with no family support, one is essentially SOL.

I went to my first medical followup appointment alone. I could barely walk or stand. The doctor’s office found me on a bench across from the reception desk nearly passed out. That was my first visit to the doctor following major spine surgery — no help, no aid, no support. 

Then Obamacare came into being approximately 8 months later and my life became a shit-show. I lost every single one of my doctors whilst in the middle of this healthcare crisis. I still could not walk more than a quarter mile, I could not even drive my car, and I’d had to shut down my midtown office due to the fact that I couldn’t physically get there. I was unable to use buses and subways since I could not manage to go up and down stairs.

I had supported Obama’s vision of providing health insurance for all notwithstanding my doubts about government sponsored healthcare. However, had I known that I would be lied to (told I wouldn’t lose my doctors), been provided with the skinniest network of doctors imaginable, and that my local Democratic party representatives would not lift a finger to help me when I could not obtain care, I NEVER would have supported this plan.

I have known people who have compared my situation to their purchase of so-called COBRA plans (those are plans negotiated by employers with much larger networks than Obamacare plans). THERE IS NO COMPARISON BETWEEN AN OBAMACARE PLAN AND AN EMPLOYER-SPONSORED HEALTH PLAN. None whatsoever. 

First of all, the network of providers in Obamacare plans are — and I’m guestimating here but don’t think I’m far off — somewhere between 10-20% of the size of the network of employer-sponsored plans. Not only did I lose ALL of my doctors, the ten minute walk to my previous medical doctors’ offices became 45 minutes to 1-1/2 hours of travel to get to whatever new providers I was able to find.

I have yet to replace all of the doctors I lost. When you rip the rug out from under a sick individual by taking away all of her doctors, she is not physically capable of replacing those doctors (particularly when travel to those new doctors’ offices is near impossible and is time-consuming). Yesterday, I traveled 1-1/4 hours to get to my endocrinologist’s office from my home in Washington Heights to 59th and Park Avenue. Theoretically that trip should have taken less time however trains were slow yesterday and so a minimum of a 45 minute trip took half an hour longer. 

How would I have been able to make this trip when I couldn’t walk? I couldn’t get to the midtown area in New York City for at least ONE YEAR. How was I to manage with no support at all? 

Now, this is where left-wing Democrats start explaining to me that some people will “fall through the cracks.” The people who say this aren’t usually the people who do the falling so they are more than content to watch others fall. 

It was egregious enough that the President I voted for betrayed me by lying to the public about the costs of these plans (my premium costs were $600 per month with the government subsidy covering roughly a quarter of that cost; my copays and medication costs were anywhere between $100-$200 per month). I met my out-of-pocket limit of $2000 which means I spent an additional $167 per month for my medical costs. This adds up to $767 per month – roughly a $150 subsidy for a network that initially didn’t even exist because BCBS had not even completed its contracts with providers, and then when it did exist, it was so thin to be practically negligible.

The only providers in my neighborhood in Washington Heights that take Obamacare policies are doctors you would not send your children to much less yourself.

I was offered “assistance” by a local church whose prayer leader met with me. The assistance she provided was a piece of paper. It was a copy of the New York State of Health’s Official Healthplan Marketplace. She could not understand why, a few months before the Obamacare plans went into effect, I was worried about losing my doctors. She thought I should “wait” until it actually happened to be concerned. This was the “help” offered me by the local Liberal-oriented church. It was more than my local congressman or senator’s office would do.

When I called my local congressman’s office to complain that I could not access care in January of 2014 because I had no insurance identification and the insurance company did NOT ANSWER THEIR PHONES for three weeks (!!!), I was told that they had no power to do anything about a “private” insurance plan. I said, “Private? I bought this policy on a New York State government website! Private? Are you kidding me?” They maintained this position and essentially blew me off.

When I attempted to find information on the internet and essentially just said “I’ve lost my doctors, does anyone have any ideas as to what I should do,” I was viciously attacked by Democrats who assumed that this sick person without any medical care was a closet Conservative attempting to knock the Affordable Care Act. I was accused of presenting a false story in the guise of a Conservative-hater of the ACA, and it was also suggested that I had a mental health disorder. 

And the Democrats wonder why they lost this last election. This is what’s called willful ignorance and I direct my fury at the party that I was loyal to and that betrayed me. The Democrats have betrayed all of us and now we get this racist, misogynistic moron in place of probably the best president we have had in generations. Democrats, he couldn’t do it alone.

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John ChamberlainSteve2alison.kathleen.bowles@gmail.comgvenkatAllan Recent comment authors
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John Chamberlain
Member

Our focus for the last 50+ years on curative solutions rather than preventative solutions has resulted in the “sickcare” system we suffer under today. A combination of 1) Membership medicine (Direct Primary Care) 2) high-deductible catastrophic insurance 3) expanded availability of HSAs 4) price transparency and 5) product transparency will finally get is headed back towards a true healthcare system. It will restore the physician/patient relationship, put the choice of services back in the hands of the consumer, lower cost of care both at the primary care level as well as downstream cost (due to earlier diagnosis of potential problems),… Read more »

Peter
Member
Peter

“and remove government and insurance intermediation”

WOW! Just how will that happen?

Steve2
Member
Steve2

“THERE IS NO COMPARISON BETWEEN AN OBAMACARE PLAN AND AN EMPLOYER-SPONSORED HEALTH PLAN.” Stuff like this intrigues me. Employee plans vary quite widely. Ours is pretty good. A survey of my employees, family and friends found employers that offer no insurance, mini-med plans that provided a set number of dollars of coverage ($5000 for my sister in law, so your out of pocket for your 2 back surgeries with that plan would have been over $100,000) and a number of high deductible plans where the employee contribution was large. An example would be the guy I hired who had an… Read more »

Steve2
Member
Steve2

In a recent Health Affairs study, researchers from CHOP’s Policy Lab used Medical Expenditure Panel Survey data from 2008 through 2013 to look at levels of insurance for children from various sources over that time. They tracked the coverage rates of low and moderate income families where one or more parents were offered employer-sponsored health insurance (ESI). Over this time period, they found that in families where parents were covered by ESI, the percentage of kids who were not covered by that insurance increased from 22.5% in 2008 to 25.0% in 2013. The percentage of such children who were covered… Read more »

gvenkat
Member
gvenkat

First of all Allison – as a physician – let me start by saying this was horribly tragic. There is no excuse for Democrats (or anyone) dismissing your legitimate complaints. But, that said I think (and I was a Republican-leaning surgeon) what Obama attempted to do was noble. The solution is to repair and make sure that folks like yourself are covered, not abandon you wholesale by repealing it. The ACA was imperfect – a lot of middle class, healthy beneficiaries fell into the black hole (A colleague of mine spent $20000 in premiums and had a $8000 deductible). I… Read more »

Matthew Holt
Editor

I agree–it was terrible that this happened to Allison. But the rational alternative of Medicare for all covering all doctors was denied Americans over 55 directly by Joe Lieberman. The ACA was the least bad option that could be got through a Senate dominated by right wing Democrats like Nelson, Baucus & Lieberman. And yes the implementation was a shit show, but again that was because of tooth and nail opposition from the Republicans who ran Congress after 2011, and the fear of the Obama administration that doing anything to highlight it would cost them the 2012 election. I hope… Read more »

Allan
Member
Allan

Don’t blame the Republicans for the PPACA and how bad it is. That was passed by a Democratic Congress, Senate and President. That means the Democrats had total leeway to pass what they wished. Too many on the extreme left wanted their ideological dream realized rather than to make sure all Americans could get good health care at an affordable price. They took an unproven idea and made the entire nation suffer.

Matthew Holt
Editor

I was unaware Nelson, Baucus & Lieberman were Republicans. The point is that Obama left it to right wing Democrats to structure the ACA in an effort to get bipartisan support. Which in the end amounted to one vote in committee from Snowe in the Senate and one vote in the house. Everyone, especially Allison, would be better off with medicare for all, or at the least a buy in to standard Medicare for those over 50. Stopped by Lieberman. There is NOTHING extreme left about Obamacare. Its a Republican idea from 1993 and the ONLY reason the Republicans oppose… Read more »

Allan
Member
Allan

What you are saying is that those three Democrats couldn’t be bribed enough to pass something futher to the left and more onerous. Even Harry Reid asked for state waivers. The Democrats were pushed hard by their leadership to let this piece of cr-p pass, but their guts are yellow and blinded by their wishes to be reelected and to please their masters. The bill was passed despite the fact that all the things that pulled it down were written about before passage where what would happen was accurately predicted. Face it. The bill was stupid, the passage non democratic… Read more »

alison.kathleen.bowles@gmail.com
Member
alison.kathleen.bowles@gmail.com

I hear you, Matthew, however that does NOT justify the treatment that I received at the hands of Democrats and the complete and total lack of care and sensitivity shown to me. I accept that the implementation was, as you call it, a “shit show.” What I do NOT accept is that my own party discarded me as a human being and when they could have lifted their pinkies to help me, they refused. Much of this was a knee jerk reaction to perceived criticism (that I was not making — I was simply desperate and asking for assistance). I… Read more »

Peter
Member
Peter

Is Mr. Bowles complaining he wasn’t getting enough government subsidies to pay his insurance? I wonder what he thinks about those, prior to ACA on the individual market, who weren’t getting any subsidies to buy coverage – and were working and paying taxes. When on the state subsidy plan did he also get to deduct premiums from his taxes, cause when I was paying for insurance on the individual market I got no help from anyone. I hope he’s happy with the subsidies (and coverage) that are coming from Trump and Repugs to cover his medical care. From what they’re… Read more »

alison.kathleen.bowles@gmail.com
Member
alison.kathleen.bowles@gmail.com

Peter, darling, Mr. Bowles is not a mister! Allison (even though John Irvine spelled it incorrectly he has promised to fix it — “Alison”) is a woman’s name. If you couldn’t get that right, I can see how you didn’t get anything else right either. I could give you more information — and will – but if you can’t even get my gender right, I wonder if you’ll understand it.

Peter
Member
Peter

“If you couldn’t get that right, I can see how you didn’t get anything else right either.” Sorry for the error, but I get most things right. So tell us exactly what benefits were in your state subsidized policy that made it so cheap? No pre-exist exclusion, no caps, networks, wellness, etc? Sorry also if I don’t easily jump on board the, “I feel sorry for you bandwagon”, I’ve learned to get all the information first and have heard all sorts of terrible stories from people with no coverage pre-ACA. Yes, the health care system is an expensive mess, but… Read more »

alison.kathleen.bowles@gmail.com
Member
alison.kathleen.bowles@gmail.com

I had to think about responding to these rather malicious posts but I decided to do so for the benefit of others since a good deal of misinformation was evident to me. For someone who claims NOT to miss much, you most certainly did (and the article is still posted up above for you to re-read two or three times if you need to). First of all, the state subsidized policy was not necessarily cheap because it had limited benefits although that probably was a factor; it was cheap because someone in New York State, clearly not MY local representatives,… Read more »

Peter
Member
Peter

Your title, “And The Democrats Wonder Why They Lost The Election” was incendiary and ill informed. And as I read your post, is why Trump supporters are delusional denialists, on healthcare and everything else. People receiving subsidies on the ACA actually like it. You did not get a subsidy, like most employer sponsored plans, and certainly like Medicare. Subsidies are the only way most people in America can afford health insurance. The state plan was cheaper than the ACA because it had limited benefits and you were subsidized by the state to buy private insurance. The math involved in pricing… Read more »

alison.kathleen.bowles@gmail.com
Member
alison.kathleen.bowles@gmail.com

Again, you make assertions that are unfounded and assumptions (and you know what assumptions do to you). Are you assuming that I am a Trump supporter? IF you are, then once again, I refer you to the original article and ask that you reread it because clearly you need to read things a few times to understand them. The state plan was NOT cheaper than the ACA. In 2014, if would have been exactly the SAME cost to me personally. You did not see me complain about the costs of my premiums either on the state plan or the ACA.… Read more »

Niran Al-Agba
Member

Alison, I had the same difficulty with Peter. He refers to me as a male also. Don’t be too offended if THCB does not correct the spelling of your name… it is a common issue for me. So far, they are on four variations and still counting… Nir, Nina, al-Agba, and Al-Agbra 🙂 (Sorry THCB) Keep writing, the most effective way for us to repair this mess is for physicians and patients working together in collaboration to bring about change. Best wishes…

pjnelson
Member
pjnelson

I join Niran to say thank-you for the effort to report your healthcare disaster. I spent a year at 135 and Lenox for part of my training. I probably understand, a bit more than most people, what travel is like in Manhattan. Best Wishes.

alison.kathleen.bowles@gmail.com
Member
alison.kathleen.bowles@gmail.com

Thank you, PJ. What was your training?

William Palmer MD
Member
William Palmer MD

Thanks for this poignant story. It makes me want to help you. When I started practice, docs would spend a half day a week giving pro bono services. I used to go to Cowell Hospital, the student hospital at UC Berkeley. Then, a law was passed–or a fed regulation came down–in California: “Thou shall not perform any service for a lower charge than you charge MediCal”. That was the end of this altruistic culture that had probably gone on for fifty plus years. Can’t you imagine the mind of the young attorney writing this reg: “Why shouldn’t Medicaid be given… Read more »

alison.kathleen.bowles@gmail.com
Member
alison.kathleen.bowles@gmail.com

Dr. Palmer, you are indeed the kind of medical practitioner we need and who has been hammered by the American medical system (I blame both parties for this). I believe it was Shakespeare who said ‘The first thing we do, let’s kill all the lawyers” (through Dick the Butcher in ”Henry VI,” Part II, act IV, Scene II, Line 73). Your comment made me think of that oft-repeated line particularly in light of Trump’s mouthpieces who apparently think the rest of us are a bunch of morons and don’t actually understand the English language. I could get more potty-mouth here… Read more »

Niran Al-Agba
Member

Thank you for telling the real story of the ACA. There are so many where I live suffering the same way. Healthcare reform needs physicians and patients banding together to make a difference. Do not give up!

alison.kathleen.bowles@gmail.com
Member
alison.kathleen.bowles@gmail.com

I’m like the Terminator. I appear to always “be back.” Niran, I’ll be in the Washington DC area over the President’s Day weekend. I’d like to meet with you (I can’t figure how else to invite you to lunch than this way). You can contact me at alison.kathleen.bowles@gmail.com should you be interested.