Wednesday, August 13, 2008

Marriage and Health Care Costs

This story made the front page of today's New York Times:

Health Benefits Inspire Rush to Marry, or Divorce

Though money and matrimony have been linked since Genesis, marrying for health coverage is a more modern convention. For today’s couples, “in sickness and in health” may seem less a lover’s troth than an actuarial contract. They marry for better or worse, for richer or poorer, for co-pays and deductibles.

Sometimes people are actually divorcing in order to afford healthcare-- read this sad story:

Other couples, like Michelle and Marion Moulton, are forced to consider divorce so that an ailing spouse can qualify for affordable insurance.

Ms. Moulton, 46, a homemaker who lives near Seattle with her husband and two children, learned three years ago that she had serious liver damage, a side effect, she believes, of drugs she was once prescribed. She is trying to get on a transplant list, but the clock is ticking; her once slender body has ballooned, and her doctors say her liver could give out at any time.

Mr. Moulton, a self-employed painting contractor, maintains a catastrophic coverage plan for his family, but its high deductibles and unpredictable reimbursements have left them $50,000 in debt. Without better coverage, a transplant could add unthinkable sums.

Two years ago, Ms. Moulton looked into buying more comprehensive coverage through the Washington State Health Insurance Pool, a state-financed program for high-risk patients. She found the premiums unaffordable, but noticed that the state offered subsidies to those with low incomes. As their debts and desperation multiplied, it occurred to Ms. Moulton that divorcing her husband of 17 years would make her eligible for the subsidized coverage.

“I felt like I had done this to us,” she said. “We had worked hard our entire lives, and if this was all the insurance we had, we could become homeless. I just said, ‘You know, we really need to sit down and talk about divorce.’ ”

Mr. Moulton would not consider it — at first. “From a male point of view, you want to be able to fix things, you want to be able to provide,” he said.

“Then you start looking at what things cost and what someone with no assets can get in terms of funding, and you have to start thinking about it.”

The conversations ebbed and flowed with the family’s financial pressures. They talked about the effect on their children and where they might live. They weighed the legal and financial risks against the prospects of bankruptcy.

The debate continued until this summer, when Mr. Moulton’s father offered financial help. “I know we don’t take charity from anyone,” Mr. Moulton told his wife, “but I’m not going to divorce you and I’m not going to let you die.”

Though grateful for the lifeline, the couple remains unsettled by how close they came.

“Nobody should have to make a choice like that,” Ms. Moulton said. “What happened to our country? I don’t remember growing up like this.”


Anonymous said...

I worked in transplant for quite awhile - and divorce is something we suggested on the sly so that pts could get Medicaid. Even if they could afford the transplant with just Medicare for example, we reminded them that at that time anti-reject liver transplant drugs cost $16k a year out of pocket.

Divorce was also considered if there was a chronically ill child who was denied on the parents' group health insurance plan due to pre-existing conditions.

Couples would divorce, then stay "married" in all appearances. I hope social programs don't investigate.

The article's couple is another example of people who do the "right thing" are the ones to get screwed.

Gord said...

In Canada, we don't have to worry about costs too much provided the care is a drug or other therapy that is covered. Unfortunately, in our system, some of the newer drugs take an incredibly long time to be approved. The other thing we worry about is the long, long waiting lists. On the whole, it's a better system but as the boomers get older and older it's getting more and more expensive to care for them with fewer and fewer taxpayers. There is no easy solution, but prevention and choosing healthy lifestyles will certainly help. When that isn't enough, hopefully the system will take care of us.

Anonymous said...

The state of our health care is disgraceful... Too many people are uninsured because they simply can't afford it and eat and have a place to live at the same time. Even those who do have insurance receive nasty surprises - and huge bills! - when they actually need to use the insurance they've paid premiums on for years, if not decades...

And don't get me started on the pitiful state of public education.

All this while the gap between the obscenely wealthy and the rest of us ("upper middle class" to middle class to working poor to poverty) grows exponentially - seemingly daily - now that the economy is apparently imploding.

I wonder if we, as a country and as a people, will ever get our priorities straight?

mOOm said...

We have free government health care here in Australia AND the government doesn't spend any more as a share of GDP than the US does (taxes are higher as our government runs a surplus instead of a deficit). People are encouraged to get private insurance to lower the burden on the public system through tax incentives. But private insurance is very cheap by US standards.

I'm still puzzled how we manage to combine a small government sector and free health care here, but the US can't do it.

Adrienne said...

This is why Kucinich should have won.

S said...

In America the Healthcare Industry is in shambles and we all know that, but I do not see any instant changes anytime soon even with an upcoming election. Just not feasible in this country with such a disparity between the views of the two parties. While the tug of war continues, more people suffer, its very sad.

Anonymous said...

The State of Healthcare - It is what it is because of all the people who feel they are worth an MRI every time they have a headache, or who decide to get pregnant in their 40's and want every available known form of "help" getting pregnant, then give birth to a preemie who needs millions of dollars of care to make it to 6 months of age.

No one wants to pay for this, but everyone wants to have it available to them.

There is even a blog about a couple, she has CF is in dire need of a double lung transplant and guess what, she gets pregnant. People are insane and in serious need of psychological care.

Lily said...

Generic medications are a great way to keep your prescription drug costs down. I’ve seen ads on TV for Caduet. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18 for this new drug! The unthinking public is going to pressure their doctors into giving them something just because it’s new, when something old or generic would do the job for cheaper.