Surviving the Medical Meltdown (10 page)

To my horror I again landed in the proverbial lap of the same phone navigator – is there only one of these guys for the whole state? So now, I asked more questions, and discovered the dirty little secret about those three options: there are
not
three insurance options. There is really only one option and only one possible policy. The
only
“option” is whether the great state of Iowa or I will be paying the premium!

So let’s be clear. A policy once costing $47 a month – a price many young people or their parents could afford – is now made vastly more expensive ($167 per month), but the price tag is being picked up for the “poor” at the same inflated price by the State of Iowa.

Am I the only one who sees a basic flaw in this scenario? I, one of the few remaining taxpayers, will be paying four times as much for my own insurance and paying taxes for state-subsidized insurance. And this “insurance” for the poor is also four times the actual market value. So, unless I choose to be an underworking deadbeat and go on the government dole myself, I lose financially on every front.

And remember that ACA is an acronym standing for – my fingers are cramping just typing this – the
Affordable
Care Act.

Don’t think these increased premiums are increasing any payment to the hospitals and doctors who care for you. We are all taking big cuts. Small hospitals all over the country are teetering on the brink of financial ruin.

Remember when Obama said you could “keep your doctor”? What he really meant was, you may have to actually keep your doctor – like, in your basement. And you may need to bring in a few unemployed hospital administrators and nurses as well.

The reason for this outrageous price hike is what insurance insiders refer to as the 1:3 rule, a regulation in PPACA created by a government
economic brainchild that specifies that the ratio of cost for an insurance policy written to the lowest rated age group (20s) and the highest rated age group (60–64) can be no more than 300 percent.

I’m sure those lovable pranksters in DC wrote and thought in reverse, thinking they could limit the cost to the elderly by limiting the rates of the elderly to three times the rates of the young. But of course, insurance companies – companies filled with actual thinkers – realized immediately that they could meet the letter of the law simply by forcing young people to pay through the nose for insurance that should be quite a bit cheaper (to wit, 400 percent cheaper!). No wonder insurance companies lobbied hard for Obamacare. Wouldn’t you love the government to step in and force people to pay 400 percent of the real cost of some product you create… and to make ownership of the product mandatory?!

Unless common sense, the free market, and the rule of law are reintroduced into America – and what is the chance? – we shall probably be forced to divide the twenty-first-century into BO (before Obamacare) and AO (after Obamacare). Using that system, one of the real problems of the BO era was the fifty-five-year-old individual who lost his insurance when he lost his job. He had some established (preexisting) disease and could not get or could not afford a new insurance policy. This truly was a problem created by employer-based health insurance. Had that person lived at an earlier time BO – say, 1952 – and bought private insurance as a twenty-year-old, he would have paid premiums for thirty-five years and during that thirty-five years would have used very little of the insurance money on health care. The insurance company would have made money on that patient during those early years and would have invested the funds. Then the insurance company would have been able to afford the actuarially predicted payouts as the patient got older. The patient would not have lost his insurance by losing his job because he owned and had total control over the conditions of his policy. Of course, this required a modicum of personal responsibility, as does any enterprise or activity in a free
society. Freedom entails personal responsibility, and the consequence of failure (in the absence of personal responsibility and failing to be responsible) is a problem for the individual. In a free society you cannot act irresponsibly and force your neighbors to pick up the tab.

In our society today, people with preexisting conditions who have lost their employer-based health care are falling into a huge crack, and they have limited options. If they are indigent, they qualify in most states for a form of Medicaid with new rules dictated by the ACA legislation. This can be good for some and worse for others. In Tennessee, for example, under the BO Medicaid rules, a single mother with a child could qualify for Medicaid with an income 400 percent of the poverty level, but a man could not qualify unless he was below the poverty level. So when, in year one AO, the requirement was changed so men could now qualify at 100 percent of the poverty level, men did better; but women who now also qualify at 100 percent of the poverty level were worse off. And let’s face it, where are most of the children of single parents domiciled? With the mother. The deep thinkers in DC strike again.

If you are not indigent, or are technically indigent but of the mind-set not to be dependent on government care (good for you), you can be very clever and start your own company group insurance. So, for example, you lose your job but take up selling fire extinguishers or working several part-time jobs or selling Amway. You become your own corporation, hire another family member who also needs insurance, and then buy “group” insurance – for the two of you – and this is guaranteed issue in all states, regardless of your preexisting conditions. Unfortunately you are now hit in the face with the new rates, which can be considerably more than you would have paid for the same or better insurance BO.

On a practical level today, I would urge you to seek out a single-family or single-person insurance policy that you can afford, with a high deductible. If you combine this policy with an HSA (health savings account) or you buy it through your own corporation, you have the best of all worlds. The health savings account allows you
to put money tax-free into an account to cover the deductible. The corporation allows you to pay for the insurance with “pretax dollars,” so it effectively lowers the cost of the insurance.

If you have employer-based health insurance, to avoid spiraling costs and to avoid the problem of portability, it might be best to own your own policy – but currently you cannot convert directly. Perhaps, someday it will be possible to convert your employer policy to a self-directed, personally owned policy within the same insurance company if you are older. But this is not available today even if, within the same company such as Blue Cross, the employer-based insurance and the single individual insurance are completely separate – it is as if they were two separate companies. So if you lose your job, the fact that you were insured for years with a medical insurance company through your employer does not help you get private insurance through that same insurance firm.

If you are young and healthy, you definitely should consider private, single-party insurance. Some employers will simply put the money back into your paycheck. As an employer I found out I was paying $800 for an employee’s insurance that she could buy for less than $400 for herself. You might make money on the deal by switching.

People in my age bracket got hurt the least by the cost of private insurance under Obamacare. I just purchased health insurance de novo. (I started over.) I am a sixty-one-year-old, healthy, nonsmoking female with a little need for thyroid support and intermittent inhalers for bronchospasm. I was able to purchase health insurance with a $5,000 deductible for under $367 a month (albeit my quote BO was under $200 a month). There is no free lunch. But this does not strike me as exorbitant considering what I am getting for it.

If in the future the government outlaws all private care and makes government the “single payer,” then insurance will become meaningless. But in any country that allows a two-tiered system as England has had, real catastrophic, high-deductible, understandable, actuarial-based insurance is still the best way to go.

PART II
GETTING PREPARED

7
ADDICTION

O
bviously, the most important thing you can do to survive a medical care meltdown is to be so healthy and safety conscious that you will not need a doctor’s intervention. It is beyond the scope of this book to educate the reader about all aspects of wellness, but in
appendix A
you will find a reference list for further reading that is well worth the time and effort to work through if you want to maximize your health.

Regardless of your current health, there are several things that are basic to wellness. I will outline these, then provide a clear strategy for attaining optimal health based on the latest science.

I don’t need to outline the risk of disease from smoking, chewing tobacco, or doing harmful drugs – do I? And if you are a smoker, you are already finding the cost of your habit getting higher and higher. But imagine for a moment a time in the future when suddenly your supply chain of your addictive substance is cut off. Imagine if you woke up today and could not get a cigarette anywhere at any price because of an economic collapse. How would you feel? Now, imagine going through withdrawal from cigarettes or drugs (even legal, prescription ones) at a time when there is no food in the stores. When you should be worried about your children getting enough to
eat, instead you are focused on your own physical withdrawal from cigarettes or alcohol or some other addictive substance. America is approaching a 300 percent debt-to-GDP (gross domestic product) ratio. No country has lasted for more than a few years at that level without experiencing a severe economic “readjustment” (less politely, a “collapse”). At such a time in the future, you will need all your wits focused on day-to-day survival. You cannot afford to be “jonesing,” as you are suddenly forced into abstinence from your habit. It is far better to stop now in a controlled environment than to suddenly be forced to withdraw from the habit due to collapse of the economy.

Regarding cigarettes, I suspect, too, that American socialized health care will significantly discriminate against tobacco users, even denying some treatment options to smokers as being “futile.” And of course, tobacco vastly increases your risk of cancer, heart disease, bone fragility, and other aspects of premature aging. You cannot afford to increase your dependence on a medical system that will no longer be able to respond to your needs.

Ditto for anyone addicted to alcohol. Time to clean up this act. Not every alcoholic experiences the withdrawal symptoms known as DTs or delirium tremens – a very serious disruption of normal body function with skyrocketing blood pressure, increased heart rate, sweating, total body itching, and hallucinations. In the old days, before modern medicine, DTs were 50 percent fatal. The fatalities often were from hallucinations that caused the alcoholic to jump from a hospital window. Again, you don’t want to have this happen to you suddenly because the supply of alcohol is unexpectedly disrupted. (You can’t get your “still” working in the three days it takes to experience DTs or other withdrawal symptoms.) You don’t have to give up the occasional martini or the dinner glass of wine. But you must give up the excess.

Everything I just wrote about alcohol also applies to people who regularly take antianxiety drugs, such as Xanax or Valium. Sudden withdrawal of these drugs – in the family known as
benzodiazepines
– may cause you to experience delirium tremens just as you would
during withdrawal from alcohol. You cannot suddenly stop such medications. While time permits, discuss with your doctor how to get off all substances that – if suddenly stopped – will produce physical, not just emotional, withdrawal. If, for example, you take Xanax for anxiety, your doctor can
slowly
wean you off and replace it with something that won’t give you DTs if suddenly stopped. Yes, you may have to live with depression if medication is not available in a meltdown, but you won’t be dying from withdrawal. If, for medical reasons, you cannot stop the drugs, then you must ensure an adequate supply. I will discuss that in the chapter on stockpiling medications, but keep in mind that storing thyroid medications is easier to do than building up a stockpile of highly controlled substances that are closely monitored because they are subject to being diverted from real patients and sold in the street drug trade.

Coffee has many healthful effects, and caffeine in small doses has benefits to daily life and sports performance. But if you are a caffeine junkie who cannot go without that morning jolt and continue to jolt yourself through the day with sixteen cups of java – you might be laid low should your supply dry up. Slowly wean yourself down to one to two cups of coffee or caffeinated “power drinks” a day. A sudden withdrawal of caffeine will give you days to months of headaches and can precipitate severe constipation.

In sum, if you are addicted to anything – psychologically or physically, consider what would happen in an economic collapse when for three to six months you had no chance to obtain your substance of choice. I don’t really care what the addiction is – it could be Krispy Kreme donuts – although some substances are clearly more dangerous to stop precipitously than others. It is much better to wean yourself off these substances slowly before the meltdown. In a mass economic shutdown, keep in mind you will not be the only one involved, and medical facilities will quickly be overrun with people out of their medications and their addictive substances. If alcohol is your problem, if you smoke or chew, or you use any other addictive substance – deal with it now. Consult your physician
and/or support groups, such as Alcoholics Anonymous or the local smoking cessation organization.

I am always amused by people who smoke and take vitamins. I once gave a talk on health to a group of government workers. To make my point I showed a cartoon of a safe falling from a second-story window. In the cartoon, a man is walking down the street and is looking down at a wad of chewing gum, being very careful not to get it on his shoe, while above him a safe is hurtling down on his head. The gum was labeled “supplements,” and the safe was labeled “smoking.” I think you get the point. Before worrying about diet, exercise, or supplements, you must eliminate the problems that are
really bad
. Do it now.