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this post was submitted on 16 Oct 2023
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This is super personal to me because it almost killed me. I've told this story on reddit, but it bears repeating:
tl;dr lost my doctors due to an insurance change 4 weeks in to a 6 week open heart surgery recovery...
In 2018, my company was in the process of being sold. No big deal, above my paygrade, nothing for me to worry about.
Then I got sick right after Thanksgiving. Really bad heartburn that lasted 5 days. It wasn't heartburn. I had a heart attack. 12/3 I had open heart surgery, single bypass, and that started a 6 week recovery clock.
On 1/1, the sale of my company closed and we officially had new owners. I also officially lost all of my doctors because the new employers don't do Kaiser in Oregon. They do it in WA and CA, but each state has to be negotiated and they never had presence here.
1/2 I start working with Aetna to find doctors, hospitals, etc. Beyond the cardiologist I need a new pharmacist, podiatrist, diabetes care and a general "doctor" doctor.
Fortunately, my new employer is a big enough fish, they have their own concierge at Aetna and she gets me into the Legacy system.
On 1/3 I start developing complications, but I don't know it at the time. It starts with a cough. All the time. Then, when I try to lay down, like to sleep, I'm drowning, literally choking and gagging.
The concierge and I try to get an appointment, we're told 2-3 months. For a dude still recovering from open heart surgery? Best they could do is 2 weeks. 1/14.
I can't lay down to sleep so I buy a travel neck pillow and sleep sitting up.
I get to see the new doctor at the "official" end of the 6 week recovery. He doesn't know me or my history so he wants to run tests.
I'm sitting at home playing video games and waiting on test results when the call comes... Congestive heart failure. Report to the ER immediately.
My heart developed an irregular heart beat, which caused fluid build up in my chest. They admitted me and were getting ready to pull fluid off me.
"What happened to your foot?"
"I dunno, what happened to my foot? I can't feel my feet."
Remember when I said I was sitting around playing video games, waiting for test results? Yeah, my foot was touching a radiator and I didn't know it. 3rd degree burns, first four toes. Pinkie was spared.
So I'm in the hospital a week. I lose 4 liters of water per day. 50 lbs. of water. No wonder I was drowning. Regular bandage changes.
So now I'm facing two procedures. Electrocardio version to fix my heart, skin grafts to fix my toes.
This whole time the new insurance covers 80% until I reach the out of pocket maximum of $6,500. Then it will cover 100%.
The old insurance? ER visit for heart attack, hospital admission, 8 days in the hospital, open heart bypass... $250.
So we hit the out of pocket maximum almost immediately. My wife had a problem with her foot running through the Seattle airport. The doctor who did her toe amputation was decided to be out of network so that was another $1,100.
I was never unemployed through all this. I had enough vacation and sick time banked to cover it. Cobra didn't apply. Buying my old insurance wasn't an option, it was far too expensive without employer backing. Income is too high for assistance (thank god) and I took steps to max out my HSA account, which is good because we drained it twice.
Three 1 week hospital stays (2 for me, 1 for my wife), multiple ER visits, two more major medical procedures... That would be enough to break most people even with good insurance.
So if you read any of that, let me ask you something... Why does the quality of my health care and my quality of life have to depend on who I work for and what insurance companies they choose to work with?
This is always what I think of when I hear arguments that our health care is "free market". If it were, you could fire AETNA and go back to Kaiser. But that's not the case, so insurers aren't really beholden to satisfying their users, because their users aren't their customers.
it is free market. It actually is the definition of free market, accompanied with lobbying which is direct consequence of lack of regulations.
and to top that up, OP could had just bought an additional care package by paying by his own pocket in the health clinic that he initially was. Completely free to do it if he wanted to pay 3 times the price. People don't understand that in the so called free market there are actually unwritten rules set by the ones in power. They think that they would somehow be benefited from the lack of regulations while the regulations should be there in order to protect them from the greed of the mega-corps.
Registered to vote, told this story to the Bernie Sanders campaign, told it again for 4 days at the HLTH 2023 conference in Vegas. And I'll keep telling it until something changes...
I hate to say this, but you are asking for meaningful change in a trillion dollar industry. It's not going to happen through stories, public awareness, or by any other peaceful means.
I survived open heart surgery, telling my story is the only action I can take these days. :)
We need EVERYBODY like you telling their story
That's why I partnered with a company called Savvy Coop and was invited to the HLTH 2023 conference in Las Vegas last week.
I had many good meetings with providers and health companies telling my story and our team was maybe a dozen or so patients with multiple medical conditions.
It's getting out there. I'll be on a podcast tomorrow.
So what, they should just give up? No. Change will happen as more and more people resist the status quo.
It may seem slow, it may be painful, it may feel like it's never going to actually work but you've got to keep going because one day and all of a sudden it will.
Of course they shouldn't give up! I'm just saying, that's not going to be enough.
You're deluding yourself. The wealthy will NEVER part with that much money willingly.
They won't part with money for 9/11 responders dying from cancer, the rest of us have no hope.
Who said anything about them doing it willingly?
It was rough when Bernie had his own heart event, and I use the word "event" because it sounds more festive.
I told my wife "Well, he's done." Even if he has the energy to be President, nobody will vote for someone with a heart condition.
It's a tough thing to recover from, even now, five years later, I don't have the energy, focus, or acuity I had from before. :(
Trump is splintering his party though. Progress can’t happen as long as he’s around, Democrats have to pick up “moderates” (on the US Scale) and that puts everything else on pause. Pushing a progressive agenda now would just amplify Trump and potentially pull those moderates to him.
If we need more parties and more voices, then we need voting reform. FPTP always devolves down to two primary parties. Any secondary party would just be spoiler candidates.
And that’s why it suits the Democratic Party to tone down the progressive wing and focus on attracting moderates. If Donald breaks his party in two, then we’ll have a repeat of Perot in 96 or Nader in 2000. In both cases there were plenty of votes for the alternative candidate just in a few key districts that would have totally flipped those respective elections had they gone to the first-party candidate more closely aligned with them.
This is the kind of story libertarians can’t imagine because they simply lack an imagination. We don’t choose when we get sick. Your companies merger should have had no impact on your ability to get healthcare. What an absolutely insane thing to read.
Someone at some point should have told you this, but it rarely gets communicated until its too late. If you have peripheral neuropathy, even if you are not a diabetic, you should be doing nightly foot inspections with the aid of a mirror.
It drops the likelihood of acquiring an amputation by around 70%. Pretty much all my patients who have had amputations acquired them because they didn't know about a foot wound before it became infected and spread to the bone.
Simply flashing your feet at a mirror kept propped next to a nightstand can significantly improve your overall health outcomes.
Oh, I'm well aware, but at that time I was also sleep deprived. :(
I figured as much, though preventative healthcare is so rare nowadays I thought I'd chime in.
It's really for any peripheral neuropathy that includes the loss of protective sensation (pain).
Fucking brutal, man. Murica, I guess.
Holy. Fucking. Shit. I’m sorry you had to go through that. That’s really horrible.
thank god capitalism is the most efficient system people ever imagined!
She has had multiple problems with ill fitting shoes and infections. She was running through the Seattle airport to make a transfer for a flight, got rubbed the wrong way, by the time he trip had ended the damage was done, the infection went to the bone and the toe couldn't be saved.
She just had too much going on, her mother had died so it was a super fast emergency trip from Portland to Kansas and back.
I couldn't go because I was still on my back from the heart surgery, so it was just her and our adult son.