When my grandson was three, he picked up a raisin that someone had stepped on. It was flat and round. He held it by the edges with the tips of his fingers, turned it like a steering wheel, and said, “Dwive, dwive, dwive. Dwive, dwive, dwive.” He was annoyed at how long he was going to have to wait to be old enough to get his license. I was sympathetic, because I’d been waiting much longer to be old enough for something that I wanted even more: Medicare.
For more than forty years, I struggled to get decent health insurance. My first grown-up job, as a fact checker at a weekly magazine, came with a medical plan, but my wife and I were in our early twenties and therefore didn’t think of that as a benefit. My take-home pay was less than the rent on our apartment, so I quit to become a freelance writer, and for months after that we had no insurance at all. Then my wife, Ann Hodgman, got a job at a book publisher. When our daughter, Laura, was born, in 1984, Ann’s policy covered most of the cost of the delivery.
We moved out of the city when Laura was one, and Ann became a freelance writer, too. A magazine that I regularly wrote for put me on its health plan, but some time later the magazine’s insurance company discovered that I wasn’t an employee and threatened to drop the entire staff. I switched to an individual policy from the same insurer, at a premium I remember as about a hundred and fifty dollars a month. The magazine reimbursed me (until I stopped writing for it).
In 1990, I wrote the script for a single episode of a network television show, and, as a result, got a year of health insurance through the Writers Guild of America. The policy was so comprehensive that it practically covered toothpaste and deodorant. That year, Ann, Laura, our son, John, and I addressed every health issue we could think of. A surgeon removed a small cyst from my scalp, and, while he was at it, I had him slice off a couple of moles, what the heck. We also filled and refilled as many prescriptions as we could. We didn’t have another bonanza like that until sixteen or seventeen years later, when John and two college friends were planning a trip to India. Before he left, he needed several vaccinations, including a three-shot rabies series for what I was told could be as much as a couple of thousand dollars. I gulped, and asked our veterinarian if there was a less expensive option—but went ahead, of course, after finding a doctor on Martha’s Vineyard who could administer the third shot while we were on vacation. Miraculously, though, John’s college health plan covered all but a fifteen-dollar co-pay.
When my Writers Guild year ended, I could have kept the coverage going for another eighteen months by paying for it myself, under the terms of the federal cobra law, but the premiums were higher than we could afford, so we went back to the policy we’d had before—which I’d actually kept paying for, because I was afraid of losing it. A couple of years later, I did lose it: the insurer stopped offering individual plans to anyone, and we were on our own.
People who have jobs with decent benefits may not realize how tricky life in the United States is for people who don’t. Ann and I went to see a local insurance agent, who described the individual medical policies offered by a couple of big insurers. But he told us that, when we filled out our application forms, we would need to lie: Ann was seeing a therapist and taking Prozac, and, he said, no insurance company would agree to write an individual policy for someone like that. Lying to an insurance company carries a risk, because if you get sick and the company finds out that you deceived them, your coverage could disappear and they could sue you to recover claims they’ve already paid. The issue was moot, however, because both companies we applied to turned us down. (Individuals are riskier than groups.) As it happened, a college classmate of ours had (reluctantly) ended up in the insurance business. He recommended a policy from a company we hadn’t heard of: American Republic. It had a reasonable premium and a relatively high lifetime payout limit—enough to cover at least a car accident or two—and, significantly, it agreed to insure us. Several years later, the guy who pumped our septic tank (his business card read “It May Be Sewage to You, but It’s Our Bread and Butter”) mentioned that diabetes and a heart condition made it impossible for him to get health insurance. I put him in touch with our old classmate, and American Republic insured him, too.
The main problem with American Republic was that I wasn’t the only one who hadn’t heard of it. Some of the doctors we used wouldn’t deal with it; they classified us as “self-pay” and charged us more than the fees they accepted from companies that regularly reimbursed them—big corporations like Aetna, Blue Cross Blue Shield, and UnitedHealthcare, which negotiate prices with medical providers. (Negotiated prices also vary significantly from insurer to insurer.) Occasionally, I was able to negotiate on my own. When John was ten, he broke his wrist after a soccer game by falling off the roof of a baseball dugout. The office of the orthopedist who put the cast on his arm looked as much like an accounting firm as a medical practice: there was a huge open workspace filled with desks covered by piles of insurance forms (plus a few small examination rooms, way in the back). I asked the receptionist if she would give me a discount if I paid right then, with a check, thereby sparing the clerks behind her the nuisance of having to find out that I hadn’t met my deductible. She knocked a couple of hundred dollars off the bill.
Not long afterward, I learned that negotiation has its limits. Ann had hand surgery, performed by a doctor who, amazingly, either had an agreement with American Republic or was willing to operate for what it was willing to pay. A few weeks later, though, the doctor’s office manager called to say that, because we hadn’t met our deductible, he was going to ignore the negotiated fee and charge us full retail. In addition, he said, there was the matter of certain “operating room” charges, even though the surgery hadn’t been performed in a hospital. I already didn’t like this weasel; now, I thought, Aha! I’ve got you! But, when I called American Republic to report what I assumed was insurance fraud, the customer-service agent said I was wrong and that the doctor could charge whatever.
American Republic’s premiums eventually rose so high that I decided we might as well try to sign up with an insurance company that we (and our doctors) had heard of. One turned us down because I’d had Lyme disease a year or two before. (We live in Connecticut, where ticks bite even people who never go outside.) Another agreed to insure me but not Ann—Prozac again. She ended up in the state’s “high-risk pool,” for people who were otherwise uninsurable as individuals. Her premiums, from a company I’d also never heard of, were double mine.
If you have bad insurance or a high deductible—and we had both—you don’t necessarily seek all the medical care you should. Contemporaries spoke of their colonoscopies mainly as nostalgia-inducing drug experiences that they were eager to repeat. When Ann called our local hospital to inquire about costs, though, the person she spoke to was vague: probably something like four thousand dollars, but more if they found polyps. John was born in the same hospital in 1988, in its brand-new “birthing center,” which had soft lighting, comfortable furniture, and a nice big private bathroom. But the birthing center was a money loser. The hospital’s owners closed it in 2013 and later turned the space into administrative offices. They still do colonoscopies, though (“It May Be Sewage to You . . . ”).