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[cancer] The high cost of disability and dying - Lakeshore — LiveJournal
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Jay Lake
Date: 2013-02-21 04:52
Subject: [cancer] The high cost of disability and dying
Security: Public
Tags:cancer, child, family, health, personal
I've been working through a lot of details with my employer about late life and terminal issues. As I (most likely) get increasingly sick, at some point, I may go back on Short Term Disability (STD) for a while. (This is what I did for last month's surgery.) Somewhere in my terminal stages, I'll go on Long Term Disability (LTD).

On STD, I am still an employee. My benefits still apply, most specifically health insurance. My income is reduced by a third, but I believe that reduced income is paid pre-tax, so it's not quite as painful as it could be. This is a benefit managed by a third party provider, but my understanding is that it is funded by my employer.

On LTD, I am no longer an employee. Instead I am living on an insurance benefit provided by a third party insurance company through my employer, the premiums for which I pay as pre-tax dollars. Because I am no longer an employee on LTD, my insurance lapses unless I elect to carry it through COBRA.

To belabor the obvious, if I go on LTD because I have terminal cancer, letting insurance lapse would be about the most bone-headed move I could possibly make. Yesterday I found out the COBRA costs for coverage for me, [info]the_child and her mother. $1,800 for the health coverage alone, plus a small bit more for the dental.

That's huge rise in monthly expenses at a time when my income will have been substantially reduced. On the same LTD plan which reduce my paid benefit by the amount I might collect from any other LTD plan, such as the private plan I've paid into for the past thirteen years.

Think about that for a minute.

Our system of disability and late life care is profoundly cruel, punitive, inhumane and illogical. The whole point of putting the LTD benefit at only a percentage of my salary is that sick people are somehow assumed to need less money. At the same time, I'll be putting out $1,800 per month for health insurance (about four times more than my employee-paid contribution currently coming out of my paycheck) and hundreds more per month for co-pays and out of pockets.

What never-been-sick idiot thought this up?

This system puts me and my family under intense financial stress at a time when we can least afford either the direct costs or the associated emotional strains.

This is insane. Is this how you want the end of your life to go? Unraveling financially no matter how hard you've worked, how good a job you've done?

Tell me again how we have the best healthcare system in the world? It couldn't be better designed to drive a dying person into bankruptcy and premature death if that had been the primary objective.

This is not how a just, humane and moral society should treat its sickest members.

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Julie, JulieInTheGreen, "Squire!": Sigh
User: brickhousewench
Date: 2013-02-21 13:07 (UTC)
Subject: (no subject)
Keyword:Sigh
I actually had to un-Friend a Conservative Republican high school classmate on Facebook a couple of years ago because he was arguing so violently against the Affordable Care Act and how he didn't want to subsidize health care for all those lazy people who just decided they don't want to pay for their own health insurance. I asked him if he even knew anyone whose employer didn't offer health insurance? If he actually knew anyone who had to make the choice between paying rent or food and buying insurance? Of course he hadn't, he was a stockbroker. I doubt he even had any middle-class friends, let alone any that were living at the knife edge of the poverty line.

The absolute worst part was that he was making these arguments against ACA while he was being treated for cancer. Apparently he never stopped to think about what it would be like to go through a health crisis without insurance, about how even a single surgery or round of treatment could bankrupt someone who didn't have a trust fund to fall back on. I was appalled at his lack of empathy.

Please keep writing about this. It needs to be said, and repeated often until I sinks in with some people.
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Matthew S. Rotundo: Radioactive
User: matthewsrotundo
Date: 2013-02-21 14:23 (UTC)
Subject: (no subject)
Keyword:Radioactive
The whole point of putting the LTD benefit at only a percentage of my salary is that sick people are somehow assumed to need less money.

Actually, the point of setting the LTD benefit at a percentage of predisability income is to provide what is called a "return-to-work incentive." The logic (and I use that term loosely) is that if you stand to make as much money on disability as you would while working, you will be that much more tempted to remain on disability for as long as possible, even to the point of what doctors euphemistically call "symptom magnification." Fraud, in other words.

Yeah. That logic breaks down when you're permanently and totally disabled.

And you're definitely not alone when it comes to COBRA sticker shock.
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Jay Lake
User: jaylake
Date: 2013-02-21 14:34 (UTC)
Subject: (no subject)
Right. When I go on LTD, there will be no return to work because I will be terminal.

So what's the point of deducting my other LTD policy benefit from my primary policy benefit? I understand why health insurance does that — essentially to avoid double paying for services. But each of my LTD policies is actuarially distinct, and presumably actuarially sound. All I see is a punitive illogic, I don't see any justification for collecting premiums for the full benefit level, but declining to pay that benefit level because I was wise enough to purchase a separate policy to supplement my income shortfall.
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Tom
User: voidampersand
Date: 2013-02-21 15:51 (UTC)
Subject: (no subject)
I think the logic is you don't get to piece together multiple policies to obtain more benefits than they have decided you need. The key is that their decisions are the operating reality. Everyone's actual needs are irrelevant.
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Matthew S. Rotundo: Radioactive
User: matthewsrotundo
Date: 2013-02-21 17:14 (UTC)
Subject: (no subject)
Keyword:Radioactive
So what's the point of deducting my other LTD policy benefit from my primary policy benefit?

Same logic, actually. They don't want your disability benefits to exceed your predisability income.

But as you said, you're paying for the damned thing. It's reasonable to expect that you'd get the benefit you've paid for.

Some states are better at cracking down on "illusory benefits" than others. Oregon's Insurance Department can be tough for insurance companies to deal with, but California, for example, is MUCH tougher.
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threeoutside
User: threeoutside
Date: 2013-02-21 15:23 (UTC)
Subject: (no subject)
Jay, I think you should offer every Senator and Congressperson in D.C. a free subscription to these posts. Free as like the catalogues I keep receiving even though I have called and used the online "stop sending them" sites. Failing that, maybe we readers should start printing them and mailing them to our Congresscritters & Senators.

Knowing there are thousands going through what you are without your support network, education, eloquence and savvy makes my mind reel. That you have to go through it at all breaks my heart. *hugs*
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cathshaffer
User: cathshaffer
Date: 2013-02-21 16:04 (UTC)
Subject: (no subject)
If it comes to that, you might want to price out some health insurance policies on the individual market. We found that COBRA premiums are priced way above market value of the policy. If you are going to be terminal, your palliative care expenses would be much less than your ongoing treatment expenses, so you could come out ahead, also, by going with a higher deductible policy. I'm sorry you have to struggle with this, and I agree it is ridiculous and wrong.
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Jay Lake
User: jaylake
Date: 2013-02-21 16:09 (UTC)
Subject:
I am dubious about my being able to get private health insurance, given the prevailing medical insurance in our family. Dad is going to look into this.
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cathshaffer
User: cathshaffer
Date: 2013-02-21 16:15 (UTC)
Subject: Re:
It varies by state. Here in Michigan, there is blue cross blue shield, which turns no one away. Their premiums are higher than picky competitors, but even that would have been much cheaper than COBRA for our family. However, keep in mind that many of the key provisions of ACA will be kicking in next year, including health insurance exchanges and requiring everyone to buy in, so the market *might* help you out when the time comes. I really don't know. I also wonder if a lawyer could help you out with those LTD policies. Something seems wrong, there, but you're obviously not going to get honest answers from the insurance companies.
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Jay Lake
User: jaylake
Date: 2013-02-21 16:18 (UTC)
Subject: Re:
I may try lawyering up on the whole LTD issue, but apparently those deductive provisions are pretty standard, which strongly implies they're enshrined in Federal law.
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kimberlywade
User: kimberlywade
Date: 2013-02-21 17:31 (UTC)
Subject: (no subject)
Will the ACA help you in any way? Here in California, they already have the website up including a calculator to figure what you'll be paying. My husband and i will be paying about $100 less a month for a more comprehensive plan. For the last 15 years we've paid for private, high-deductible "insurance" that will surely leave us bankrupt if we do have any major medical issues. We've never gotten insurance through an employer. ACA is really going to help but not until 2014.
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Karen
User: klwilliams
Date: 2013-02-21 18:15 (UTC)
Subject: (no subject)
In California, STD isn't taxed at the state level. Also, STD is paid (I believe) via the state, similar to unemployment, unless your company has a plan to pay it directly (which is better, since you get more money that way). Not that I've had any experience with this, of course.
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mlerules: Brain
User: mlerules
Date: 2013-02-21 18:49 (UTC)
Subject: (no subject)
Keyword:Brain
Have you written to any of your congressional/senatorial reps 'bout all this? You're well-placed, highly intelligent, and quite articulate. I'd love for you to testify before a congressional committee re: all this. Making your voice heard and effectuating some serious health-care change would be a glorious legacy, TMM.
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andelku: Apu
User: andelku
Date: 2013-02-21 19:01 (UTC)
Subject: (no subject)
Keyword:Apu
Okay, what state are you in?

Some of the ACA stuff is starting to kick in. And Medicaid may prove an option if your LTD is low enough.

COBRA isn't your only option anymore. Well, I know California is harsher overall than Illinois. But look into it ... or even better find an actual insurance broker to look into it for you.
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Karen
User: klwilliams
Date: 2013-02-21 19:23 (UTC)
Subject: (no subject)
Obamacare calls for members of Congress to start using health care that the rest of the country uses, not their current coverage, in the next few years. Even though most of them are millionaires, it will be interesting to see what effect, if anything, using what the rest of us use will have on health care laws.
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User: mmegaera
Date: 2013-02-22 01:14 (UTC)
Subject: (no subject)
Really? Oh, that's the best news I've heard all day.
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threeoutside
User: threeoutside
Date: 2013-02-23 18:48 (UTC)
Subject: (no subject)
At long damn last. Maybe the minions they have to handle all the icky real-life stuff will have enough nerve to point out to them how hard it was to deal with. Maybe the congresscritters will actually have to experience some of what they've been dishing out to us all these years.
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User: lindadee
Date: 2013-02-22 02:39 (UTC)
Subject: (no subject)
Have you looked into SSDI (Social Security Disability Insurance). I would think you're entitled to it, since you've paid into it all these years. That should help some.
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(no subject) - (Anonymous)
Jay Lake
User: jaylake
Date: 2013-02-23 14:49 (UTC)
Subject:
Thanks! Yes, please. I will pass this info to my Dad, who is doing much of the legwork for me.

Insofar as I can tell, the two big problems I have with SSDI are the waiting period (12 months?) and the fact that it leaves [info]the_child and her mother uncovered even if it covers me. Sigh.
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(no subject) - (Anonymous)
Jay Lake
User: jaylake
Date: 2013-02-23 17:45 (UTC)
Subject: Re:
Got it, thank you!
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