USA Today / March 13, 2019
Early one recent Sunday morning, my kids woke up not feeling well. Due to a health notice from their school, I knew I needed to get them to urgent care for medicine right away or they wouldn’t be allowed to go to school the next day.
I am a single mother. I am also an entrepreneur, working in women’s leadership training and consulting. Keeping my kids home from school for a day means I can’t work. As the sole financial supporter of my children, not working is not an option. My family is insured through the Affordable Care Act and I pay $1182 a month for our insurance through Blue Shield of California. I expected that a doctor’s visit and getting the medicine we needed would be quick and easy.
I couldn’t have been more wrong.
Getting medicine shouldn’t be this hard
At 8:00 a.m., we arrived at urgent care. All three of us needed antibiotics. The doctor called a prescription in to the pharmacy across the street.
When I arrived at the second pharmacy, my son didn’t show up on my insurance. The pharmacist told me I needed to get the clinic to process the prescription through insurance to fix this. Between the pharmacist, the urgent care staff, and myself, this took five phone calls.
Once that was resolved, the pharmacist informed me that the prescribed antibiotic wasn’t covered by my insurance. If I wanted to purchase the one pill out of pocket, it would cost $533. My jaw dropped. The pharmacy faxed urgent care to ask for a substitute and I called the clinic to confirm. This took six more phone calls back and forth.
By this time, it was approaching 1:45 p.m. My children were sick and miserable. I was at my wits’ end. Finally, the substitute prescription came through. But, more bad news: The second pharmacy didn’t stock the substitute antibiotic.
On top of that, according to our insurance, the out-of-pocket cost for the antibiotic was $80 for my daughter, $280 for my son, and $138.73 for me — for the exact same drug, in the exact same dosage, for three people in the same family on the same insurance plan.
I burst into tears. To acquire basic antibiotics so that my kids could go to school, I could work, and my family could be healthy, I’d have to pay nearly $500 out of pocket, with insurance.
Why bother having health insurance?
While I stood at the counter, my daughter was screaming for lunch and my son was wildly racing around asking why this was taking so long.
The second pharmacist finally found a third pharmacy that carried the substitute antibiotic. That pharmacy, however, had half doses of the antibiotics for the three of us — not even whole doses, meaning I’d have to do this again in a few days — but only if I was willing to pay the outrageous and inexplicable price.
I got my kids back in the car to head to the third pharmacy. In the parking lot, I collapsed into sobs over the steering wheel. One kid asked me, “Why is this happening, mom? Why is this so hard?” I couldn’t get out an answer beyond, “I don’t know.”
When we finally arrived, I paid $498.73 for three half doses of the antibiotics we needed, took my kids home, fed them and ate a bowl of cereal for dinner.
That evening, I posted the story of our day on Twitter. Almost immediately, it went viral. In response, people shared similar stories of fighting with insurance companies to get medicine to survive, of irrational price structures, and medical bankruptcies. I cried more than once reading stories of cancer patients and parents of disabled children who regularly endure what I went through that Sunday.
The next day, I got a phone call from our insurance company. Blue Shield of California did not dispute that the same prescription had cost three different prices for the same drug. They did not offer me a refund. Instead, they asserted that I am responsible for both a family prescription deductible and an individual deductible and this combination is somehow to blame. The only remedy they offered was an appeal.
I do not expect to get a dime of that $500 back.
Our health care system punishes the sick
I studied abroad in France as a college student in 1991. I got sick while there and a doctor came to my apartment, examined me, and handed me an antibiotic from his bag. The whole thing cost me about $13 out of pocket in French Francs.
But the cost of my family’s experience amounted to more than money. What could have been a cheery Sunday on the couch getting better vanished into a war with a behemoth insurance company and impacted our security in ways I won’t soon forget. I am stressed routinely now, knowing that I can’t count on our insurance to cover unexpected medical needs. My children watched their mother break down twice, just trying to get basic care for our family.
Our health care system is broken. It punishes all of us, regardless of income, for getting sick, and it punishes the poor most of all. My story is the story of a single mother with insurance and a solid income. Yet I still had to spend an entire day chasing basic medicine at outrageous cost. It is infinitely worse for those without my privileges.
Health care should be about quality care with dignity for all. Our current system is anything but that. It reduces us to mere numbers, competing payers instead of human beings. It requires us to fight for care when we’re vulnerable.
No one should be put through this simply for getting sick. We cannot be a great nation unless all our citizens are cared for. But, in practice, we have a health care system creates more suffering, not less. It’s time for health care reform that works for every one of us. Honestly, it was time for that a long time ago.