Health care- what's this guy supposed to do?

[Ella]

I am going to quote from the transcript of Frontline’s episode “Sick Around America” because this case illustrates what worries me- personally- about health care in America. What is this guy’s options? What would you suggest he do?

Five years ago, Paul Stephens was living comfortably, working as a manager for a Houston-based telecommunications company. He owned this large house. He had comprehensive group health coverage. Then in 2005, when he was 58 years old, Paul Stephens was laid off.
PAUL STEPHENS: The company dumped 600 hourly employees and one manager- me. So I left my job, or was downsized, 1st of April of 2005.
NARRATOR: Under the federal COBRA law, people like Paul Stephens can continue their health insurance usually for 18 months, provided they pay the entire premium.
PAUL STEPHENS: I elected not to take it because the premiums were, like, $750 a month, which is, you know, pretty hefty when you consider you’ve got a mortgage payment and everything else going on at that time.
NARRATOR: COBRA premiums are so expensive that 90 percent of those eligible don’t use that option. Paul Stephens says he felt sure he would soon find another job with health benefits. But after a few months of failure, he set out to get insurance in the private individual market.

…he had a history of diabetes, so he was turned down flat in the individual market. He then turned to Texas’s high-risk pool, the insurer of last resort. But this required Stephens to wait 18 months, and the premiums were still expensive. PAUL STEPHENS: I believe the premiums were $600 a month with a- it was either $5,000 or $10,000 deductible. So I’m going, “Whoa, I can’t afford this, either.”
NARRATOR: Then, unemployed and uninsured, Paul Stephens had a heart attack and was rushed to a cardiovascular center in Houston.
PAUL STEPHENS: I had four arteries blocked. And I told them, "I don’t want to be, you know, go into open heart surgery because that’s going to cost a big pile of money. And here comes this woman in, in a pair of high heels, dressed to the nines, carrying a clipboard, and she goes, “Mr. Stephens?” and I go, “Yes.” And she said, “You didn’t give us any insurance information when you checked in.” And I said, “Well, I don’t have any to give.” So she said, “Well, you’re uninsured?” And I said, “Yes, I am.” She said, “Well, how’re you going to pay the bill?” I said, “You know, that’s a real good question.”
NARRATOR: Paul Stephens was treated and his life saved, but the bills came to over $200,000. After struggling to pay for a few months, he sold his house and almost all his possessions and declared bankruptcy.
Too rich to qualify for Medicaid, too young for Medicare, Paul Stephens moved to Indiana to live in his mother’s house. A Harvard Law School study estimates about 700,000 Americans go bankrupt each year partly because of medical bills. No other developed country’s health care system lets that happen.
PAUL STEPHENS: Thankfully, this house was here. It was my mother’s. And otherwise, I’d be living under a bridge somewhere, quite frankly. So I was able to come and I was able to pick up a few jobs that I could make a few dollars at.
NARRATOR: Paul Stephens’s plan now: wait to grow old enough for Medicare.
PAUL STEPHENS: I’m 63. I’ve got two more years and Medicare can kick in. And then I can go and get some extensive health care, perhaps, or whatever. So I’m really rolling the dice until I’m 65, at this point, and gambling that I’m going to make it.

 

[aspawloski4th]

Funny no answers here. Why am I not surprised! Those who seem to have an answer for everything are now silent.

 

[Ella]

To be fair my post hasn’t been up here long.

About the only thing I can think of for this guy to do is pray.

 

[St_Francis]

From the article: A Harvard Law School study estimates about 700,000 Americans go bankrupt each year partly because of medical bills

Are all these people uninsured?

 

[wade_a_wilson]

I think he was suppose to have 3-6 months salary saved up so that he could pay for COBRA, sustain his house payment, and feed his family until he found another job. He is also suppose to be using some income to build up a retirement plan (which he could use in an emergency without penalty to keep his house or pay COBRA premiums).

I am not saying that I do that, but every single personal finance magazine and personal finance advisor will tell you this is the thing to do.

And I don’t know his situation in detail. But it sounds like a case of living beyond his means. Doing that means accepting risk. That was his right to do. Now he has the consequences.

I would have much more sympathy (as a tax payer) if his hypothetical 19 year old kid now could not afford college and needed a federal grant or loan to stay in for the last 2 years or so… Or a young mother who’s husband walked out on her leaving her with 2 kids… Those are the people who should be getting help.

 

[kimmielittle]

Hiyas

Can’t he get medicare at 63?

I know a person who did.

Granted this doesn’t solve Health Care issues or the economy…But IMHO nothing on the drawing board does

Personally,I think Congress and Mr.Obama should have focused on jobs first

As always, just my thoughts

 

[aspawloski4th]

I think he was suppose to have 3-6 months salary saved up so that he could pay for COBRA, sustain his house payment, and feed his family until he found another job. He is also suppose to be using some income to build up a retirement plan (which he could use in an emergency without penalty to keep his house or pay COBRA premiums).

I am not saying that I do that, but every single personal finance magazine and personal finance advisor will tell you this is the thing to do.

And I don’t know his situation in detail. But it sounds like a case of living beyond his means. Doing that means accepting risk. That was his right to do. Now he has the consequences.

I would have much more sympathy (as a tax payer) if his hypothetical 19 year old kid now could not afford college and needed a federal grant or loan to stay in for the last 2 years or so… Or a young mother who’s husband walked out on her leaving her with 2 kids… Those are the people who should be getting help.

If health isurance rates wouldn’t have gone up exponentially that could likely been covered by his income. Ofcourse dummy me, he was supposed to have planned for that too!

 

[wade_a_wilson]

First of all, yes. He is suppose to pay attention and have a plan. That is what grown ups do. But even so you suggest that rate increases are the cause of his problem. I am not sure what difference $500/month or $750/month makes…

He clearly has some responsibility for his situation. It’s not like he was a young waitress that didn’t have the time to figure out how the world works, or the income to put something aside for a rainy day.

Your story about this guy would not be compelling to many people I know, which may be why very few people are responding to the post.

A real compelling story is one in which the victim did the “right” thing, and still wound up in a very bad spot. This is not one of those stories.

 

[aspawloski4th]

First of all, yes. He is suppose to pay attention and have a plan. That is what grown ups do. But even so you suggest that rate increases are the cause of his problem. I am not sure what difference $500/month or $750/month makes…

He clearly has some responsibility for his situation. It’s not like he was a young waitress that didn’t have the time to figure out how the world works, or the income to put something aside for a rainy day.

Your story about this guy would not be compelling to many people I know, which may be why very few people are responding to the post.

A real compelling story is one in which the victim did the “right” thing, and still wound up in a very bad spot. This is not one of those stories.

I know from personal experience that health insurance rates went up more than the 50% example you gave. When I worked at a car dealership a little more than a half a decade ago. in a 3 year period of time my rates quaddroopeled. I went from living like a dog to worse than an ally rate in that timem because of that rate hike. Maybe you are a details person your self, but many people a detail like that can slip by. Not everyone is capable of being a Dave Ramsey.

 

[St_Francis]

First of all, yes. He is suppose to pay attention and have a plan. That is what grown ups do. But even so you suggest that rate increases are the cause of his problem. I am not sure what difference $500/month or $750/month makes… …

I don’t know about this exact story, but I’d say you must be pretty rich to be able to say you don’t know what difference $500 or $750 a month would make. That’s our food or heating cost.

Hmmm, let the children freeze, or let them starve, which should I choose? Well, at least I’ll be able to take them to the hospital

Even *grown-ups *make mistakes, have unexpected things happen to them, etc. You pay attention and have a plan, and, whoops! Suddenly you can’t sell the house you sunk all your money into restoring for re-sale. Whoops! Your house is destroyed by a flood, which never happens where you are. Whoops! Your bookkeeper makes off with all your money, *and *all the money he was supposed to pay to the IRS. Whoops! Your wife leaves you for another man, then tries to back you into a corner so as to get even more money from you.

I guess you are living in Heaven, because you don’t seem to be living here.

 

[AndrewJaffery]

I am not sure what difference $500/month or $750/month makes…

I don’t like butting in like this, as I only know about living on ones own in theory, the differnce between 500 and 750 a month is $250. $250x12 months=$3000…which, in my understanding, can be very hard for someone to pay extra added on to what they make…I don’t think my mom and dad cold cover an extra $3000…

 

[Arwen037]

Umm, he made he choices, he has to live with them. You are supposed to have enough money saved up to cover all of your payments for 6 mo. That should be accounting for the increase in health insurance. Then, he chose to let his insurance lapse. So yeah, he’s going to have problems getting insurance because everyone is going to deny him. Four blocked arteries means he probably hasn’t been eating healthy and doing cardiac conditioning. And how long was it before he had the heart attack? Depending on how long it took, maybe he should have considered downsizing his house sooner, so he could afford insurance payments.

Finally, I thought that some of you would think he got what he deserved since he was a manager and must have been making much more than he deserved. (Yes, I’m being sarcastic)

 

[Charlotte408]

I am going to quote from the transcript of Frontline’s episode “Sick Around America” because this case illustrates what worries me- personally- about health care in America. What is this guy’s options? What would you suggest he do?

Theres two types of assistance, welfare, in which you usually have to have a kid to qualify for or, be poor- you can have this for up to 5 years of your life. If you dont use it, you lose it. This would be a good time (hes unemployed) for him to go on welfare. Since he is ABLE to work, they will mandate him to participate in job search programs. If he finds a job, the amount of his monthly welfare alotment will be reduced depending on how much money he makes. But regardless, once your on welfare, if you dont have health insurance, they will provide state medical. In california, we call it medi-CAL.

If he doesnt qualify for welfare, he can go for ‘general assistance’. The services and programs are not as numerous, and the montly cash amount is not as much, but the insurance will still come into play.

As far as the ‘bill’. Well they are just going to have to bill him. And in another 40 yrs or however long after he dies, the hospital will have to eat it. If I was him I wouldnt care…but I guess thats not socially responsible.

You should see all the freakn bills and dmv tickets and omg…but- hey…what can you do?? only what you CAN do, and when I can…I’ll make payments…

But yes, there is help out there for ANY body who wants it, if they are willing to take that help. As far as the state medical insurance goes, I dont pay any premium, no copays, I dont pay for my medicine- NOTHING. I can choose a primary care physician, or I could go over to Kaiser- thats why I dont understand what the big idea is with all this healthcare reform. Its simple. Those who have jobs and can afford to pay for their own insurance, can and should be able to do so if they wish. Those that are poor or unemployed can get state funded health insurance already…soooo…whats the problem?? 700,000 americans dont? Well get yer behind up and go down to county services and find out what services are available to you.

Welfare aside I can name off the top of my head an insurance thats like, 17 bucks a month, healthy families in CA…and they have low cost car insurance…all kinds of stuff for people who are low income…problem being that most low income people are also somewhat ignorant and too lazy to do the homework…

I’ll make it easy…heres a link : ca.gov/Health/HealthCareServ/HealthInsurance.html

to several agencies that provide VERY LOW cost health insurance for those that dont qualify for NO cost medi-CAL…every state has services…look into them.

 

[pathia]

Umm, he made he choices, he has to live with them. You are supposed to have enough money saved up to cover all of your payments for 6 mo.

That’s not possible for everyone. His mistake was not choosing COBRA, but then it just spiraled out of control. I don’t know anyone that’s ever picked COBRA, it’s just too darned expensive. You can pick food/rent, or insurance. Food and rent is going to win out every time.

I’ve never held a positive balance going month to month in my life, let alone six MONTHS, there’s nothing more to cut out of my budget. I’m in the hospital right now, this is the best food I’ve had in months…HOSPITAL FOOD…the best…I can’t believe I’m saying that.

 

[Arwen037]

Did you have a good job as a manager? And own a nice house? It’s my understanding that you haven’t, so you can’t compare the two situations. The question was asked, “What’s this guy supposed to do.” “This guy” made his bed, he has to sleep in it. It sounds like he had the ability to save and prepare, but he chose not to.

I’m sorry you’ve had a bad life, but you can’t excuse everyone else’s irresponsibility because of it.

 

[Charlotte408]

Again, in answer the the OP main thread question refer to my post. People have the responsiblity to prepare for these types of things, however- s**t happens. And, technically you are all preparing … YOUR tax dollars are going into this welfare fund, its YOUR money YOUR entitled to. Dudes got 5 years of his own hard earned money coming back to him…go and get it.

 

[pathia]

Did you have a good job as a manager? And own a nice house? It’s my understanding that you haven’t, so you can’t compare the two situations. The question was asked, “What’s this guy supposed to do.” “This guy” made his bed, he has to sleep in it. It sounds like he had the ability to save and prepare, but he chose not to.

I’m sorry you’ve had a bad life, but you can’t excuse everyone else’s irresponsibility because of it.

So he’s supposed to be homeless, jobless, just like me now? He’s getting what he deserves, due to random chance? I don’t follow your point. If I didn’t deserve my situation, than no one else does either.

 

[Charlotte408]

So he’s supposed to be homeless, jobless, just like me now? He’s getting what he deserves, due to random chance? I don’t follow your point. If I didn’t deserve my situation, than no one else does either.

DEAR- its not that you deserve anything, its just LIFE. Thats like arguing why God lets people suffer in this world. NO ONE DESERVES a hard life, but sometimes thats the life you get, and if you dont approach your predicaments pro-actively, then you have no one else but yourself to blame for the end result.

And its not RANDOM chance that he’s in the situtation that he’s in. A series of events took place that landed him there. There are alternatives and services available for those proactively seeking them. I have no pity for people that would rather sit and wallow in their problems.

 

[aspawloski4th]

So he’s supposed to be homeless, jobless, just like me now? He’s getting what he deserves, due to random chance? I don’t follow your point. If I didn’t deserve my situation, than no one else does either.

What she is saying is the man in question should of been prepared for everything! So if a meteor falls on you its your fault for not preparing for it by not being in the way. Funny thing I keep prepared for severe weather in my house and she says I shouldnt have the very thing that best keeps me prepared for severe weather, a TV.

 

[aspawloski4th]

DEAR- its not that you deserve anything, its just LIFE. Thats like arguing why God lets people suffer in this world. NO ONE DESERVES a hard life, but sometimes thats the life you get, and if you dont approach your predicaments pro-actively, then you have no one else but yourself to blame for the end result.

And its not RANDOM chance that he’s in the situtation that he’s in. A series of events took place that landed him there. There are alternatives and services available for those proactively seeking them. I have no pity for people that would rather sit and wallow in their problems.

Ok you have established that there are things he can do, and I’m cool with that. Now state specifically what they are. Sometimes the adult imagination is limited.