~~Medicare and the Dongatta Breakthrough~~

                                 



Where to start? I guess with the fact that, for years, because of my excruciatingly low wages as a professor hired on adjunct contracts, I was unable to afford the obscene costs of the for-profit medical insurers in the U.S.  So, I went without health insurance; on the rare occasion when I needed a doctor (which was all of about twice in the last decade), I paid out of pocket.  Then, the Obama campaign came along, promising to reform the horrible medical system we had.  He promised a public option where citizens could opt into the program that, up until then, was offered only to seniors – the Medicare system.

But once Obama was elected and the healthcare “reform” was underway, what we were told immediately was that the public option was no longer on the table.  It was claimed that the reformed system would work, instead, by forcing through law, all those citizens who did not carry insurance (and shouldn’t we be ashamed for how irresponsible we were?) to buy it – and that with all those people now mandated by the government and paying into the system, the government would be able to come to agreements with the insurers to do away with things like pre-existing condition clauses that allowed insurers to refuse treatment and care for anything a patient had before their insurance existed.  This included things like menstrual cramps, eye infections, yeast infections, broken bones, even pregnancy…..anything and everything that a for-profit insurance company could find in your medical history in order for them to refuse treatment, or worse, completely nullify your coverage.

The Obama administration said that they would do away with this (but didn’t entirely), they promised greater controls on premiums, and to make sure that women were no longer paying more for their medical coverage than men (they didn’t entirely).  So now, by law, you were required to purchase insurance from one of these dastardly for-profit companies, no matter what.  But the system, of course, was still tied to your income level – what you could afford determined the level and quality of medical care you could receive.  In looking at these options, I realized that, because of my low wages, all I could afford were policies with enormous deductibles -- $5,000 and $6,000 deductibles – which meant that I would receive NO medical coverage for the premiums I paid until those deductibles were satisfied.  Every single year.  As a woman who has not gone to a doctor once in the last 7 or 8 years, who does not take pharmaceutical medication, what that meant is that by law I was now going to be required to pay one of these insurance companies hundreds of dollars from an income that was already stretched to the breaking point…..for nothing.  The company would rake in my premiums, but have no responsibility to pay for any of my medical treatment until I paid out of pocket $5k or $6k a year.  This was something I knew would probably never happen.  Why not, then, defy the law, work with my accountant to prove that I still couldn’t afford the insurance required by this mandate, and risk the penalty imposed on citizens for not following the law?  That is what I did. And each year, my accountant managed quite easily to prove that I was, indeed, exempt from the mandate because of my low salaries.  But that meant more years of being uninsured in a country where many doctors refuse to see uninsured citizens, where hospitals demand that you are insured.  It meant that I was continuing to live without even the most basic assurance of healthcare. A Pyrrhic Victory at best.  I know that this is incomprehensible to people living in most parts of the civilized world.  But in America, there is such successful propaganda protecting this for-profit system that many people believe we have “the best medical care in the world”.

One thing I’d like to point out here in terms of the ACA (called “Obamacare” by some).  The claim made by the Obama Administration and its functionaries was that now everyone could “afford health insurance”.  Not ONCE did they ever say that now, everyone would receive health care.

So…..years have gone by, and I am turning 65, the magical year when our U.S. government finally offers something resembling “universal” healthcare.  But it is still a complicated system.  Part A covers hospitalization, emergencies, surgery.  Part B, which is deducted from your pay or your Social Security, covers doctor visits and tests.  You need to find coverage for pharmaceuticals, called Part D. Part C is something that people take out to cover the “gaps” in the insurance so that they aren’t driven to bankruptcy by the treatments that are not covered.   At least I think that’s what Part C is.  My brain stopped working after a while.

It felt a bit overwhelming, so I went to a medical advisor to discuss the options.  I was told that all my problems and confusion would be solved if I simply chose to opt OUT of the “original” form of Medicare A and B for what is called a “Medicare Advantage” policy.  You guessed it – these policies are administered by the for-profit healthcare providers.  You can pay a “zero” premium for these policies, which bundle coverage, including drug costs, and often make some nod toward dental and vision, and hearing – which are not covered by regular Medicare.  They also provide something called “Silver Sneakers” – a program in gyms across the country that provides exercise for seniors.  I can't even imagine.

I considered it, and came dangerously close to buying one of these policies.  That is, of course, until I was told that I needed to choose a “primary care provider”.  This is a system that is called an HMO, which requires that you choose a doctor who then oversees all of your history and treatment, and who provides “referrals” to specialists.  So you have a kind of overlord, and you have a system – called a “network” of approved doctors and hospitals which, in order to get the full benefits of the coverage, you are required to stay within.  Woe betide anyone who wants a doctor or a treatment, or a hospital, outside the “network”.  Then you are paying more....often full price, out of pocket.  This includes any medical treatment outside your state – since the approved network of doctors is not an easy thing to stay within when you leave town.  I spent hours trying to find “in network” doctors that I would even consider using as my physicians. (After nearly 25 years spent as the wife of an attorney who was partner in one of the most highly recognized medical malpractice firms in Philadelphia, I have a healthy skepticism and a high level of demand where doctors and hospitals are concerned.)  Hours of wasted time were spent as I searched and searched for those elusive “in network” providers.  I realized I didn’t want an HMO.  I wanted what I had had for all the years of my marriage – a PPO which allows you to choose your own doctors and medical venues (imagine that).  But here’s the catch.  For that, you had to pay extra.  PPOs are always much more expensive.  Now, keep in mind that the “zero” premium these companies offer to medicare recipients for the HMO-level of coverage is not really zero.  These companies are taking your part B deduction from the government….so you are paying at least whatever that year’s cost for part B is.  In 2018, the year I am required to make this decision, that deduction is $134.00.  So, the for-profit Medicare Advantage insurers were getting $134 of MY money to provide less choice in doctors, in hospitals, in treatment.  And if I wanted choice, I had to pay more for those PPO policies – in some cases, several hundred dollars a month more.  Yet, even then, I had to stay within a “network” of their selected doctors and hospitals.   But guess what?  When I searched through the doctors in my city for those I would choose as my physicians, and searched my preferred hospitals, what I found was that, without exclusion, every single one of them accepted Medicare.  Just plain old Medicare.  So, by staying with the original Medicare A and B, I eliminated the need to spend hours of my precious time searching for in-network doctors.  I eliminated the problem of out-of-pocket costs when traveling to other cities and states. Why, then, I wondered, would anyone opt to pay Blue Cross, for instance, over $250 a month in addition to their $134 to have little beyond the illusion of choice?....to have less?

The answer appeared when I emailed that healthcare advisor to tell her that I was opting for the original Medicare A and B, and would not be taking out one of her policies with any of the for-profit insurers.  Her response went quickly to an all-out attempt to trigger fear.  Those gaps in coverage meant that there were no “caps” on your spending, she said.  That was risky, she said.  You could “lose everything”.

All the bells and whistles went off.  That was how these companies were selling themselves to seniors.  They played on the fear of bankruptcy and loss of all that the seniors had earned and worked for all their lives.  And yes, this is a very real fear.  The highest percentage of bankruptcies in the United States are due to medical costs.  People do lose their savings, their homes, their assets. Nothing frightens anyone more than that – especially seniors who, given the societal indoctrination we receive, anticipate our later years as years of sickness requiring perpetual daily medications, doctors and hospitals.  We are completely indoctrinated to believe that our golden years will be the sickly yellow-gold of jaundice, and that we will be left living in state-run senior homes eating canned catfood.

We’re a huge portion of the population now – we old hippies who are now aging into seniority and aging OUT of the for-profit medical system.  So, this is why a huge effort is being made to keep us in. (What was the line from Godfather III?  “Just when I thought I was out, they pulled me back in!!!”)

And of course, these companies and their functionaries are adept with the smoke and mirrors of “look what you get from us”, when the truth is, as ever, the for-profit system of healthcare doesn’t provide actual health care.  As I said earlier, it provides health insurance, in a system rigged to allow them to deny you coverage whenever possible. So, it, in fact, insures very little.

When I re-read this woman’s email, I burst out laughing.  “Do you want to take that risk?” she asked, implying Do you want to lose everything?

For me, unlike most people I know, this threat holds absolutely no power.  Why?  Because I already lost everything.  Because when Wall Street imploded and the market crashed in 2008, I was wiped clean.  Savings, assets, homes......gone in a matter of months.  At first, it nearly killed me. I was crushed psychologically and emotionally; and for the longest time I felt ashamed, blaming myself for what happened, feeling that I had made “wrong decisions” somehow.  That I was “ruined.” But I survived.  I experienced what we are taught to fear most, and lived.  And since then, my response to the experience, ultimately, ran contrary to what others who had experienced these losses did.  Unlike them, I didn’t try to rebuild.  I didn’t try to restore my “credit” or replace my savings.  Instead, I divested further.  Unlike the Old Testament Job, I didn’t want it all back.

For this, I will always be grateful to my professor and mentor, Bibhuti Yadav.  When I was still an undergraduate studying world religions, I took his Hinduism course.  He talked about the stages of life from a Hindu perspective.  When you were a student, you were expected to devote yourself entirely to learning.  When you were a householder, you devoted yourself to being an active member of the community, caring for your children, working to keep the community healthy and well-functioning, and what you acquired, you acquired for that purpose.  But, he said, it was realized that this was only a stage of life.  Those things you acquired were necessary for a time, but not forever.  In fact, if you held on to them beyond their time of usefulness, they became burdens you carried which held you down.  There came a time in life when the goal, he said, was to “walk naked.”  You were expected to divest of everything you no longer needed. In the case of our modern life this meant homes, cars, savings, clothes…..all material goods that now became more burden than blessing.

It was Bibhuti’s voice I finally heard in my head, once the initial shock and humiliation of the experience of loss began to subside.  The universe had wiped me clean…..or at least nearly clean. My work was not to restore all that was swept away, but to sweep away what was still left.

So for the last decade of my life, that is what I’ve done.  I sold what I could.  I donated the rest: antiques and other furniture, Oriental carpets, a piano, a car, a library of books, a vintage album collection, a gourmet kitchen’s worth of cookware, stereo equipment, an enormous wardrobe of clothes.  Believe it or not, I am still cleansing – that’s how much I had left, even after the majority of things were swept away. Just last fall, I donated nearly $2,000 more in clothing that I couldn’t bear to part with when I did the other sweeps.  Some of these clothes still had price tags on them.  That’s how much I didn’t ever need them.

Finally, most of the material belongings are gone.  It’s now time to begin letting go of old, outworn identities and roles that I had once played which are no longer of use.  This gets a bit trickier, because so much of our “identity” seems bound up in those roles.

About a year ago, I divested of the identity of “university professor” – in that I, for the first time since finishing my graduate work, refused to work on an adjunct contract.  I walked away from a role that I had played for decades: that of a suffering, exploited, poverty-stricken scholar in a corporatized university system.  What I understood was that I didn’t give up my intellectual training or my knowledge, I did not give up my skills or my experience.  I did not give up the years of scholarship and research I had done.  What I divested myself of was identifying with, colluding, with my own exploitation.  I gave up accepting an image of myself that was degrading and demeaning.  I liberated myself from a perversion of my identity.

In the course of this process of liberation, I took retirement benefits early, taking a bit of a hit in the monthly payment, in exchange for my ability to declare my freedom – to extricate myself further from the chains of a society that weighed me down.  We live in a society that weighs us all down, that perverts all our identities, that controls through fear and intimidation.  With every passing year, I believe more completely that our true happiness exists in breaking away from the illusions that hold us hostage.

But this is how they get you.  If you follow the “rules,” (as most of us try to do without fully understanding the implications) you go to school, get as good an education as you can (and in America now that means what you can afford, or how much debt you can accrue), you get a job that allows you to pay on that debt.  If you can, you buy property.  You marry.  You have children.  You accrue more debt.  You need the job more now, and will put up with misery – low wages, overwork, exploitation and abuse, because you can’t afford not to.  You work harder because it costs money to maintain a house, repair a car, care for your children, maintain your marriage, support your role in society.  It costs money to go to a therapist and talk about your anxiety and your stress.  It costs money to pay for those anti-depressants and anti-anxiety meds.  What it all boils down to is that you are told to be the kind of person who acquires, because that proves you are successful -- and then you become one who must struggle to maintain it all – and that kind of person is terrified of loss. Terrified, really, of even the risk or threat of loss.  That’s all it takes to control you.  To manipulate you.  To sell you Medicare Advantage.

Do you want to take that risk?   I remembered a scene from one of my favorite shows, “West Wing”, where the Sam Seaborn character (played by Rob Lowe) tells his client, an oil company, that he’s created a “liability shield” for them – which, to their mind, was about protecting them in their decision to buy tankers without updated navigation systems which would run aground and spill oil, cause environmental disasters.  Seaborn had created legal protections that assured the company that none of their “assets” were accessible in the case of a law suit.  He built a wall of debt around them so they were “judgment proof”.  Everybody was happy.

If our U.S. “corporate citizens” can find ways to be judgment proof, in order to protect them against liability for their rampant anti-social irresponsibility, then damn it, we living, breathing human citizens, who work our asses off for a lifetime (and who rarely pollute the Gulf of Mexico or crash an economic system) should do the same.  And I’ve found my way of doing just that:  I own nothing.  At least, nothing that a debt collector would want.*

So when the insurance agent tells me that I should buy her insurance to protect myself from risk, I can answer:  I don’t gotta.

Why?  Because I don’t gotta house.  I don’t gotta chunk of savings.  I don’t gotta portfolio of assets. I don’t gotta damn thing that creditors can get their filthy hands on.

And guess what?  I intend to keep it that way.

I thank Bibhuti for the guidance that led me to this realization.  He sanctified letting go, he sanctified a kind of liberation that is contrary to everything we are indoctrinated to believe in American society. I call it my Dongatta Breakthrough, because I like the Italian-sounding word and what it conjurs:  a kind of in your face sprezzatura.  I’m not exactly “walking naked” because I prefer to be clothed in public; but I am walking free with a kind of bella figura of delicious abandon only possible when you are no longer chained to a dogma of fear.   I highly recommend it.  I also urge you not to wait until you are sixty-five to try it out.


                                                                      ~~~~~~



*Obviously, I know that many, if not most, of you, prefer to have assets.  But what I am saying here goes for you, too.  There are plenty of ways that you can legally create a liability shield to make you judgment proof.  Here’s one.

Artwork:

 (https://www.quora.com/Why-is-Kali-kept-naked)