The Plight of the Uninsured

Imagine that you do not have health insurance. It may be because you were dropped off of your parents' policy when you finished your schooling and you never bothered to activate your own policy. It may be because you switched jobs and your work no longer provides group insurance. It may simply be because you cannot afford the premiums of group or individual insurance.

At times when you find yourself without insurance--especially if you've always had it before, but now it's gone--you live very carefully in an attempt to make up for your lack of coverage. You spray disinfectant all over the entire apartment after your sick roommate goes to bed and you avoid hanging out with your family when someone has a cold or the flu. You cringe when someone sneezes and hold your breath while their germs "settle"--or you try to breathe through your sleeve, using it as a filter. Despite your best efforts, you occasionally get sick, but are relieved when you get better without requiring the assistance of a prescription.

After a while, years maybe, you begin to develop a sense of security. You think to yourself, I've saved myself thousands of dollars by not paying for insurance--and look! I didn't even need it! Maybe it's better not to have insurance at all until I get older. I mean, I'm sure I'll need it sometime...maybe I'll try to get it next year. You keep putting it off because you keep not needing it.

Then--and this may happen suddenly or it may creep up on you gradually--your body is at some point different. You've been telling yourself that this weakness was merely residual from the flu-bug you're getting over, but then you realize that it's been over a month since you were sick. You've been assuming that your fatigue and rapid heart rate are because you're falling out of shape. But then you realize that you've been in worse shape before and you've never felt like this in your entire life. One day you wonder if there is something wrong with your body, but you shrug it off and try to convince yourself that you're being a hypochondriach. A few days later, though, you google some of your symptoms on the internet (the grand E-Doctor to those without insurance) and you're terrified by what you find. No, you tell yourself, I'm too young for that. I'm just exaggerating this. I'm just really out of shape. And you almost convince yourself that you're fine. Until you begin to notice other things with your body that could possibly be a symptom of what you saw on the internet and after a few days, you resign yourself to the fact that you are not well. Hopelessness ensues.

You know that you need insurance if your worst fears are confirmed, but there's a problem. Your problem may be that you still just can't afford the premiums or that you are not healthy enough to pass a physical exam required before acceptance because of what's going on or because of past injuries or conditions. Your problem may be that you can't meet reasonable underwriting guidlines because of your age, weight, smoking habit or other high-risk factors.

You wonder if you can share your fears with your family or closest friends. If I talk about this to someone now and then get insurance later, could my insurance company refuse to cover it saying this was a preexisting condition? Could my conversations be used to prove that I had suspicions about my health? Would they think to interview my family or friends? At this point, you decide you can't risk it and you feel completely alone facing this situation without anyone even being aware of your struggle. You feel sick to your stomach and begin to experience symptoms of extreme stress.

Finally, you can't hold it in anymore and you confide in someone you trust, telling them how you've been feeling, what you've read about it, and how you don't know what to do. They respond encouraging you to go to the doctor. You want to see a doctor, but you're fearful that if you do you may be diagnosed with something that will preclude you from ever being able to obtain private insurance. You keep hoping that if you wait a few months more, you can improve whatever is keeping you from meeting the insurance underwriting guidelines now: you can quit smoking or lose weight. Or if it's a monetary issue, maybe in a few months you can save up enough money to help with the premiums.

You feel relieved that you now have someone to talk to about your situation, and some of your stress subsides. But without insurance you're between a rock and a hard place: you fear that waiting months before seeing a doctor could complicate your medical situation, but if you go see him now, you risk being diagnosed with something that you can't afford to treat and that will keep you from ever getting private insurance that could help you afford treatment. So you make a choice.

Since we are imagining, I can't happy-end this hypothetical post. There are too many alternate endings: the uninsured person could...

1. Wait to see a doctor, obtain health insurance, and be happily treated.
2. Wait to see a doctor and obtain health insurance, only to find out that irreversible damage has been done to body in the meantime.
3. Wait to see the doctor, still not be able to obtain health insurance and be in the exact same situation, only with a progressing medical condition.
4. See the doctor immediately, find out that the problem is serious, but that treatment is insanely expensive.
5. See the doctor immediately, find out that the problem is not major or that it can be affordably treated.

How does the uninsured person choose?

I know this is a bad ending to this post, but you know what? For the uninsured person, the story sometimes ends badly or with uncertainty.

I bet you've probably guessed by now that this isn't a hypothetical situation for me. You'll have to read my next post to see where I am in this journey.