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Warts and All, Obamacare Saved Me From Bankruptcy

| August 10, 2014

The light at Shands's Davis Cancer Center that cost the author $3,000 every time it went on, with him on the table. It lit up here for the last time for him in mid-April, after 35 treatments, none of which would have been affordable without Obamacare. (© FlaglerLive)

The light at Shands’s Davis Cancer Center that cost the author $3,000 every time it went on, with him on the table. It lit up here for the last time for him in mid-April, after 35 treatments, none of which would have been affordable without Obamacare. (© FlaglerLive)

Trashing Obamacare has been a national sport for half a decade. Because we live in an age when ideology is all and facts are a nuisance, most of the trashing is the product of anecdotal fictions, exaggerations and ulcerated assumptions. That’s especially been the case with the cost and quality of insurance under Obmacare.

Let me propose a factual corrective and use myself as an example, because Obamacare literally saved my family from bankruptcy.

pierre tristam column flaglerlive.com flaglerlive I’m not the biggest fan of Obamacare as it is. I favor a single-payer system. In other words, Medicare for all. If it’s good for geezers, it’s certainly good for the rest of us geezers-in-waiting. But it’s been one of the nasty little ironies of this proxy war on Obama that the Medicare generation, the most selfish and lowest-taxed generation of the last hundred years, has led the battle against universal health care. Obama also favored a single-payer approach, which would have been simpler, cheaper and fairer. But he saw the fanatics arrayed against him and figured he should compromise. So the very health insurers who have created the most byzantine and costly health care system in the West not only survived but were granted millions of new customers.

Obamacare is their system–a system conceived in 1989 by the ultra-conservative Heritage Foundation and enacted first by Mitt Romney in Massachusetts. With a progeny like that, it was bound to be deformed. And with the sort of partisan enmity tripping its congressional midwives (not to mention the Obama administration’s own pitiful administrative failures so well embalmed by the failed web roll-out) its infancy couldn’t help looking like one of those diseased and malnourished African children.

And yet, somehow, a few crucial elements the Heritage version would have never dreamed of, but Obama did, made it into law. Thanks to Obamacare, the insurers could no longer treat customers only as cash cows, or discriminate between customers so they could pick and choose who to cover, which had previously made a mockery of insurance. Here’s how it was for us.


Pre-Obamacare, my wife and I had insurance through Humana. We paid a $536 premium every month, which is OK: even though we were self-insured, it was roughly what we paid as our share for family coverage when I was at the News-Journal and was supposedly benefiting from employer-provided insurance (and heavily government-subsidized insurance, at a cost to us taxpayers of over $150 billion a year).  But with our self-insured policy we also had a $6,000 deductible each, a $700 deductible for prescription drugs, and a $3,500 out-of-pocket limit each. MRIs and pet scans were not covered, and our policy had a rider the excluded any coverage for my quarry of kidney stones.

With all that, before Obamacare, Humana could have kicked me off its policy the moment I was diagnosed with cancer, as I was in January. I’m not sure you could really call it insurance as much as it was our contribution to one or two Humana executives’ nice annual vacations in the South of France.

With endless doctor visits and $3,000-a-day cancer treatment ahead we were looking at pretty steep bills twice over, since we’d run up a few before the end of the year. Put simply, we’d have been ruined. We decided to switch and go with something through the federal marketplace.

In comes Florida Blue. We now pay a premium of $581 a month. We picked an expensive one because we knew we’d need it. Our individual deductible is a mere $850, and the out-of-pocket limit is $2,500. The insurance company cannot deny me coverage for any illness. It cannot kick me off the policy no matter how many cancers I develop, as I’m sure I will (I blame the political climate and this site’s comment section). It cannot, as pre-Obamacare policies did, limit my lifetime benefits. I could choose the doctor I wanted, get treated where I wanted. My treatment cost me roughly $150,000. Between what Florida Blue is covering and what Shands in Gainesville wrote off, because they have a terrific financial aid system, my wife and I are facing less than $4,000 in bills, which we’ll be happy to pay off over the next 18 months or so, even though neither of us makes much more than minimum wage.So we could still afford the $2.99 Trader Joe’s wine bottle we had tonight (my first full glass of red since my taste buds were radiated back to Trinity).

No mystery: We would never have managed without Obamacare.

A couple of caveats: I’m well aware that Florida Blue is about to jack up our premiums. We’ll probably end up paying $100 a month more. I’m the sort of policy-holder to blame: sickos like me are driving up the prices, and the lack of healthier, younger policy-holder who’ve yet to sign up is making matters worse. But insurers are jacking up prices that steeply not because they have to, but because they can. The same demographics apply in other states. Some increases too, but not as steep as in Florida. The reason: Our delightfully caring Legislature, where you can’t cough up a cancerous lung without hitting a Republican, in the last session made it illegal for the state insurance regulatory office to regulate prices, as it did for decades before. Obamacare bears some of the blame for the higher costs, but our compassionate Republican Legislature bears at least equal blame for that screw up. It bears full blame for waging war on Obamacare from Day One (Florida was among the states that sued to declare the law unconstitutional, and lost, at the Supreme Court), most notably by stopping the state from expanding Medicaid rolls and taking in $51 billion in federal dollars over the next 10 years. That would have helped the actuarial tables and slowed premium cost increases. On balance then, the GOP takes the majority of the blame for those cost increases.

I should also address the fact that my premiums are affordable because the federal government puts up nearly half the amount, and that none of the benefits of Obamacare  matter to the militants who reflexively bugle that subsidies are sucking the system dry. And it’s true, we are eligible for around $450 a month in government subsidies, at least as long as some of those court cases that declare them illegal in states like Florida, which don’t have marketplaces of their own, don’t win the day.

But first, remember that if you’re enjoying that holy grail of employee-provided health care, you’re in a glass house: that system is heavily subsidized by being tax-free. Second, my government subsidy is not the price of Obamacare. It’s the result of refusing to adopt a single-payer system. My $1,000 in total premium would not be anywhere near that amount if, as with Medicare, which has the lowest overhead of any insurance system in America, I didn’t have to pay for my insurer’s overhead. It wouldn’t be nearly that amount if I didn’t have to feed my insurer’s profit margins. And it wouldn’t be nearly that amount if I didn’t have to subsidize the ingrained inefficiencies of a society with more insurers than booksellers. So I’ll agree that those subsidies essentially pay for waste and  profits more obscene than deserved. But it didn’t have to be that way if the Medicare generation didn’t keep the rest of us from benefiting from what it has.

I still think Obamacare is a wretched system compared to what we should have had as a universal health care system in a civilized society. But compared to the alternative–what existed before, or the black hole of an alternative Republicans pretended to propose–it’s at least something we can live with, quite literally.

But enough facts for one day. I know how that can get some people sicker than cancer. Of course, Obamacare covers those sicknesses, too. You tend to find that out when you need it most.

Pierre Tristam is FlaglerLive’s editor. Reach him by email here. A version of this piece was broadcast on WNZF.

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32 Responses for “Warts and All, Obamacare Saved Me From Bankruptcy”

  1. Ms Shaw says:

    Thank you for this story. I have had employee paid health ins all of my life.
    Sadly I had to use it over the years. $2,000,000 in claims later I have
    a spouse who is still walking around and a daughter with extensive health
    needs from a horrible car crash still with us. I feel your pain but we are all
    still insured thru a major corporation… just saying.

  2. Kendall says:

    One of your best. Enjoy as much wine as Cheryl will allow.

  3. Binkey says:

    Congratulations on being able to have a glass of wine.

    My cancer treatment is billed at $17,000.00 every two weeks for 6 months. $204,000.00 for just the chemo. I bet my insurer would have dropped me if it could. Cancer is expensive.

  4. Sandra Reynolds says:

    Good to hear you received top rate care without breaking the bank. Just today my family was discussing my nightmare with our insurance company regarding reconstructive surgery after my diagnosis twenty years ago. The company, (can I say the name Aetna?) almost drove me to a nervous breakdown. But I stuck to my guns and demanded the best medical care possible. They picked on the wrong woman this time.

  5. paying my own way says:

    Pierre, I really feel sorry for you, not because of your diagnosis but because of your total ignorance of what made your life saving treatment possible, namely, American medical innovation and drug research second to none in the world. I had intended to write a lengthy rebuttal to your mindless editorial but then I realized there will always be those who survive at the expense of the efforts of others and those who assume responsibility for themselves. How very sad you are.

    • Barb says:

      @ “Paying my own way”: I think you are the “ignorant” one. What the hell does medical innovation have to do with Pierre Tristam finding an affordable health care plan? This is apples to oranges.

    • Diana L. says:

      Actually, if you would do a little research, you will see the ranking of our health care system and that second to none comment is not correct. Also, your comment about those who survive at the expense of others , is not only insensitive but disgusting. In fact , I think it is YOU who is sad.

    • NortonSmitty says:

      Yea, because mo other country in the world has ever invented anything in the medical field. Except for the fact that most all of the drug and medical device companies in this country are European. Maybe pay your way to a library next time for a little research before spouting off a condescending, mean-spirited pat yourself on the back, church-lady strutting screed again. And by the way, regurgitation what your handlers on Fox News put in your head and calling someone else s post “mindless” was a nice touch too.

    • John Smallberries says:

      That’s right man, if you can’t pony up the cash the minute you get sick then you should just die.

    • The Truth says:

      What good is “innovative health care” if you can’t afford it?

    • John Smallberries says:

      In the name of libertarianism we really should drop the minimum employment age altogether, that way premature babies can bootstrap themselves into better jobs and thus afford the care that they need instead of just sponging off of everyone else. Useless deadbeats.

  6. Steve Wolfe says:

    What a writer! In the equivalent boxing match, I would be pummeled, of course. But let me come out of the corner for just a moment:

    Obama compromised? With whom? He had a majority of lock-stepping cronies to push his bill through. He could have passed a total rewrite of the Constitution in his first two years if he chose to.

    “Fair” in the vernacular = other people’s money (OPM). All of our governments have wasted tons of it over the years. And central-control or single payer is not better than market-driven solutions. The profit motive (more evil than even cancer) develops innovation that government cannot duplicate with bureaucracy. The “selfish” appellative also applies to those bureaucracies which consume inordinate amounts of OPM in pure self-preservation. I submit that if the market were truly unleashed to develop insurance products, there would be a plethora of alternatives to any Federally-administered cluster- — stuff.

    Keep in mind the distrust of a government with a history of bankrupting all benefits programs and poorly administers nearly everything it lays hands on. Who is watching this giant monopoly called the U.S. Government? (Yes, it is supposed to be us.)

    The carcinogenic political climate that sickens you also keeps you working. It’s just like the pest control business: if there’s no bugs, you can’t eat. But I think you are also secretly entertained. To some extent.
    Also, you will remember that the same comment section that drives you nuts also had a huge outpouring of true concern and even love for you. Make no mistake, you are endeared to us.

    Now here’s something that really disturbs me: I would love to have brought a fine bottle of red to share with you and Cheryl to celebrate your first full glass in a while. Don’t hesitate to drop me a line when you get the taste for a glass or two.

    As for price controls, I thought that we were in universal agreement that Nixon’s practice thereof was a flop.

    As for Medicare’s overhead, the one thing that still sucks about it is that the cost is borne by taxpayers, which in itself is not a “fair” system. Nearly half of the working population doesn’t contribute a fair share to taxes. http://taxfoundation.org/article/what-do-americans-really-pay-income-taxes I know, there are also payroll tax withholdings for Medicare. http://www.medicare.gov/about-us/how-medicare-is-funded/medicare-funding.html But all the funding is held in the U.S. Treasury, where all the other tax revenue is held. They don’t hesitate to write checks that never bounce to buoy other Federal budget necessities. The retiring baby boomers are going to reduce payroll contributors, resulting in both more general revenue contributions and higher withholdings. And don’t forget the entire under-the-radar population that receives without giving. No, not just the illegal immigrants, but all the cash-only business conducted in the U.S., which the pool of illegals are not singularly responsible for.

    Notice that I said this without vitriol (this time).

  7. Steve says:

    This column is so candid and so truthfully prevented that all the Fox News/GOP anti-Obamacare propaganda won’t be able to put a dent in it. The “horror stories” we were fed by the handsomely-paid Obama-haters were fiction. Yes, there were some people who lost their insurance initially because their bare-bones policies did not meet the new, more rigorous standards. But in nearly every case they were able to buy new, better policies.
    We live in what is still the richest country in the world, and good health and access to quality health-care professionals should not be confined to those who can afford it. As Pierre has written, the health-care legislation signed by Obama was weakened and diluted by his capitulating to the usual moneyed interests. In fact, the insurance companies had a significant role in writing the law. So be it. It’s better than what we had before, yet a far cry from what the people of this nation–rich, poor and in-between–deserve.
    Pierre’s cancer ordeal, and his return to health while his family remains financially stable, is one story. But telling one story–one true story–is the way to respond to those who insist that the problems of our country are too big, too overwhelming to address. This president whom so many despise set out to close a shameful, gaping hole in our social safety net–that an individual or a family could spiral into bankruptcy and financial ruin simply by getting sick or suffering a serious accident. Obama’s solution is imperfect, but he spent whatever meager political capital he once had to get a law passed that will ultimately benefit millions. For those who have a hard time wrapping their minds around the millions whose lives will be better for this law, try thinking of it as just Pierre and his family. Perhaps that will move you to send an email to your senator or congressman, urging him to work to make the law better, not destroy it.

  8. Lin says:

    Congratulations that you are still kicking
    You could have given the happy news Obamacare worked out for you without kicking yet again a whole generation and calling them most selfish and lowest taxed. I hope your generation does not pay a high price for the deficit and unbridled spending. I’m proud of our accomplishments and sad you had to throw us under the bus to make the point.

  9. Barb says:

    Pierre: my favorite part was you blaming the comment section. SORRY!! I wish you the best and a full recovery.

  10. Pogo says:

    Mr. Tristam,

    Glad to hear the good news; hope you – and your good work – live long and well.

    As for your critics and their depraved indifference to other human beings, the history of the human race, or any facts or evidence (e.g., Google “timeline of medical discovery”) it’s easy to demonstrate that they don’t care about other people, standards of honesty or even the smallest part of common human decency.

    A good antidote to your critics and their fact free ilk:

    http://critiques.us/index.php?title=Critiques_Of_Libertarianism

  11. THE VOICE OF REASON says:

    Sorry to hear about your health issues. I hope I didn’t contribute too much to them.

    But glad the safety net was there for you.

    Enjoy your wine. And any other guilty pleasures you’re up to.

  12. Charles Ericksen, Jr says:

    “”Geezer”‘… I resemble that term…

  13. Marlee Stanley says:

    Pierre,
    Thank you for this well written, easy to understand piece on your experience with the health system and the Affordable Health Care Act.
    This is a great article for me to forward.
    Marlee

  14. Carl says:

    Yes thank you Pierre ,I lost my three of my family members to cancer , and they all dies broke in debt leaving people calling my house years later wanting to talk to my deceased family members no matter how many times I tell them they have passed away please stop calling and asking for them , its very upsetting , and my G?F is going through head and neck cancer now and if not for ObamaCare she`d be in the street her job fired her a before her diagnoses , leaving her with no insurance and 870 dollar a month Cobra payments till ObamaCare finally became available ,Rich people who didn t have to worry about pre existing conditions are still fighting this law , babies born with inherent deceases are no longer having to rely on the charity lottery , its time the people that have money and supposedly work for WE THE People stop trying to kill us off by taking life saving health care away from the less fortunate , we weren t all born trust fund babies , losing our jobs is devastating,so try and think about others and lets go back to corporations and the rich paying their fair share , as for the Gov`s like Rick Scott , MR three hundred and twenty seven million dollar man , expanding medicaid wouldn t cost the state anything for a few years and like any other group insurance , the more enrolled the cheaper the rates , you`d be saving people money .

  15. Genie says:

    You have warts??????????

  16. Sherry Epley says:

    Dear Pierre,

    This is truly an excellent article. . . Thank You! Sending our very best wishes for your continued recovery.

    I just want to say that I am a “baby boomer” and grateful to be on Medicare. BUT. . . I also campaigned hard for the single payer system. As you know, there are many, many liberal Democrats over 65. . . thank goodness! Being lumped in with the hard core Republicans of my generation is very painful. Please have faith in us older progressives, we are trying to help move our country towards a higher civilization and a more healthy future.

    To those who think the USA leads the field in medical research and offers the best health care. . . come now, do your research. . . You are way off base! France has been ahead of the USA for providing quality health care for some time now. . . and those are not FOX “freedom fries”. The untainted TRUTH will set you free!

  17. Dennis Byron says:

    I am sorry about this gentleman’s illness but just so he understands, IF he had had Medicare when diagnosed with cancer — which seems to be his preference — he WOULD have lifetime limits on any hospitalization-related treatment and there would be no limit on how he could spend on all types of providers out of pocket every year. He seems to think Medicare is better than what he had before from Humana and what he has now from Blue Cross.But Medicare is dramatically worse. It is so bad that over 95% of us “selfish people” on Medicare make other — mostly private — arrangements to protect ourselves financially from the risk of bankruptcy due to health care costs.

  18. GEEZER says:

    It would get very dark here, very fast, if Pierre wasn’t getting better.

  19. w.ryan says:

    Great to see this article and how you are schooling the FOX audience about the facts! Everyone should be about what’s most beneficial to their health and economics instead of the party line. I also wished for the one payer system but I have to accept that Obomacare is better than what we had before. We’re so happy that you are doing great! That’s the hit over the wall scoring a run winning the game. The bottom line!

  20. John Bozzo says:

    Glad to see your physical and fiscal health preserved Pierre. I’ve been on disability for more than two years, so I qualify for Medicare. I buy a supplement and the prescription medication plans through Florida Blue, which cost me more than your premium, but which i consider essential. My opinions coincide with yours. I do believe Medicare for all could have been sold by pitching it to the Least-Tax Generation as necessary to preserve, extend, expand and possibly lower premiums. Doctors are the most resistant. They don’t want the government setting caps on treatments, or switching to outcome based instead of treatment based billing.

  21. A.S.F. says:

    I think you are right, Geezer. Pierre, my best to you and your family.

  22. Obama 2014 says:

    The most selfish and lowest-taxed generation of the last hundred years, has led the battle against universal health care.

    Greatest sentence ever written on this website, however selfish and lowest-taxed should have been bolded.

  23. Charles Ericksen, Jr says:

    I keep hoping that someone actually recognizes, some of the bigger culprits in in run-away premiums, but they have been spared any mention or accountability.. You blame every one, except those who generate the biggest portion of our premiums- THE PROVIDERS…here’s some examples as to how they increase costs, that will be passed back to us in our premiums.
    1. With Obamacare, each insurer was charged by the government a fee ,or a % , of the premium,( up to 5%) to be paid back to them, because the insurer used the system created by the government.. This is like FPL , charging us an additional fee, that will be passed back to the City. . Or our garbage collector , Waste Pro being charged a fee by the City for use of the streets, which is in our bills, and the $ going back to the City
    2. Lab services… It was only a few years ago, that when you needed blood tests, we were billed as a “”bank of services””, or one fee, Now, they have broken the bank down into parts, and charge for each and every test.. Thus increasing costs 100% or more.. Just like someone who steals a cars and cuts it up in usable pieces. It’s worth more chopped up…Physicians also do this, they hire consultants to tell them, how to bill more for the same services.
    3. Anesthesia.. A “”true anesthesiologist “” used to be present, right next to you in the past, as surgery was performed. NOW IT”S A NURSE THERE.. yes, The MD sits back and monitors each of the nurses attending to you at surgery,, BUT, everyone gets billed at an MD level.
    4. Just about every hospital has it’s own “”miracle operating/surgical machine(s)/computers ” They are expensive multi-million dollar investments, They don’t or won’t coordinate with hospitals , within 10 miles, to have all patients go to one location, thus reducing costs.
    5. Hospitals mention the large share of “free care rendered” and the ensuing loss. But you can bet, the “losses” are included in next years R&B and incidental rates…How many of you have had multiple MD’s visit your rooms or say they did, when you were hospitalized..? Remember many are paying no taxes..
    6. MD’s submit billings for services never rendered or received, (YES) Big item in Medicare billings, They only prosecute a few.. Very few questions are asked, as most of your billing goes direct to INS co, and you never see them .
    7. Patients take an Rx and go to multiple pharmacies for filling. most likely sell the extras
    8. Insurance companies have tried for 30 years to establish better, standard reimbursement levels, but guess who stopped all of this? The providers and their ATTORNEYS
    9.. Do I qualify as a “Humana Executive” as I went on vacation in Spain twice in a matter of 16 months?
    10. We all share in the present trouble with healthcare…and Government is not the solution.. How do you like Social Security? Medicare? IRS? CIA? Congressional results and their pay? a balanced budget? Oil prices? Oh, and let’s not forget the Post Office and Amtrak.

  24. confidential says:

    Hi Pierre, first of all I want to thank you for your editorial and congratulate you for your recovery hope is long lasting while enjoying one day at the time. Probably your good times along with a glass of red and the family by your side are greater than ever now. Some of the negative rhetoric above… ignore it please as He said, ” “Father, forgive them for they know not what they do…”

  25. Liana G says:

    Pierre, just wanted to wish you a full recovery and share this article on the benefits of lemon to cure or reduce the side effects of cancer drugs.

    Glad Obamacare is working for you but for our family it is driving us to bankruptcy with the added cost of having to purchase expensive and mandated insurance we cannot afford. This is the most we’ve ever paid for insurance and with the most crappy and least amount of coverage. In addition, our household income has decreased instead of increased over the past 15+ years despite so-called better jobs through promotions/advancements. The fact that your cost is rather expensive despite yourself and Cheryl making “just above minimum wage” is proof that Obamacare is a major fraud.

    —-

    https://ohbeautifulguyana.files.wordpress.com/2014/08/benefits-and-uses-of-some-fruits-and-vegetables-of-guyana.pdf

    The surprising benefits of lemon! Lemon (Citrus) is a miraculous product to kill cancer cells. It is 10,000
    times stronger than chemotherapy. Why do we not know about that? Because there are laboratories interested in making a synthetic version that will bring them huge profits. You can now help a friend in need by letting him/her know that lemon juice is beneficial in preventing the disease. Its taste is pleasant
    and it does not produce the horrific effects of chemotherapy.

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