Wednesday, March 28, 2012

Take one and call me in the morning...

It seem to me that alot of people, have alot of opinions about women's reproductive health, how women's bodies work and who should have the final say as to what is standard of care and what isn't. I have even read lately that many insurance plans, employers and legislatures do not actually feel that pregnancy is a medical condition and that many female problems don't actually warrant coverages. (do these men actually have female partners, daughters or sisters?)

Let me start by telling you a story:

Once upon a time, there was a young woman. Her monthly cycles started around age 15. By the time she was 18, having very painful menstrual cramps, cramps that interfered with normal activities were increasingly the norm.

For a period of time in college, her cycles were not regular and honestly thru self medication (Mary Jane was the drug of choice) she managed to keep the worst of the cramps at bay. After a pregnancy scare and traumatic break up, she invested some time in herself, sought professional help and stopped self medicating.

By her senior year the first ten days of her cycle (the 4 for the actual menstruation and then the following 6 were blissfully pain free.) Immediately prior to ovulation and the days following, the pain was so amazingly intense, it became common place for her to vomit in between classes or as the months went by to flea class to vomit and come back. She carried a tooth brush and saltines in her backpack. (Doesn't everyone?)

Luckily her school had a health center and there was an actual OB/GYN on staff part time. Otherwise you were stuck with a GP or family medicine doctor. Dr. R in the beginning of the fall semester senior year diagnosed dysmenorrhea or menstrual cramps.

Armed with pamphlets and proper Motrin dosing, she resolved to cut out caffeine and exercise more (which is hard when one is vomiting regularly, but she was an ever determined one.)

Dr. R had floated the idea of the birth control pill. Studies at the time where showing it to be very effective in regulating and lessening the severity of menstrual cycles. The girl rejected this idea. She had a strong family history of hypertension, blood clots and stroke and was very much convinced that natural therapies would be better. Plus the pill can cause weight gain and the girl had worked very hard to shed her freshmen 15 and was very vain to the point of obsessive about her weight.

The Motrin was slowly eating a hole in her gut and the exercise and other non-chemical treatments weren't working either. At about the same time she was becoming intimate with her now husband, her painful periods were so bad that she was missing classes regularly, in too much pain much of the month to actually think about sex and weighing less than was advisable. (Not to mention that regular vomiting can cause electrolyte imbalances and is very damaging to the teeth. Google bulimia if you are curious.)

It might be important to mention that her roommate was often not actually at their apartment. He had a boyfriend in the closest big city and spent almost all of his non-class time there.

One night, she awoke to the most gut wrenching pain ever. After depositing the remains of her dinner in the toilet and dry heaving for what felt like an eternity, she passed out on the bathroom floor. Dehydrated and feverish, this is where her roommate finds her, when he runs in before class on a whim, to check his stack of mail. It is 10 am. When he tries to help her sit up, she screams in gut wrenching pain.

He takes her to the health center on campus, because according to the insurance coverage, all care must begin there. Luckily the OB/GYN can see her and immediately calls for transport to the local hospital.

After a trans vaginal ultrasound and a regular pelvic ultrasound, it was determined that she had a larger than normal normal functional ovarian cyst and a newly ruptured functional cyst. She also had what appeared to be endometriosis.  While it appeared that the ruptured cyst had not caused any permanent damage, she might not be so lucky the next time. Also vomiting to the point of passing out regularly had inherent risks also.

Now it gets fun.

She went back to the health center doctor for treatment, as the insurance would only pay if she did that. In the short term she got shots of a synthetic narcotic, two in the ass, please and thank you. She also got a stern talking to about the risks of letting either condition going untreated, even though neither had any solid treatment options.

Long story short she went on birth control pills. These as a matter of fact. Luckily they were on the health centers formulary and they were a low dose, low hormone pill, which were generally tolerated by women with family history of high blood pressure and heart disease.

The doctor also wanted her to have a second opinion at the hospital in the nearest big city.

A very expensive prospect. You see, this girl did not have mommy and daddy's money paying for school. She was paying for school, borrowing some money and then working 2-4 jobs, in addition to shouldering a full load of classes.

The copays and "out of network charges"  alone would equally nearly what she paid in rent for 2 months. After some pavement pounding she located her father and he agreed to cover the medical costs.

The second opinion agreed, yes she had cysts, yes she had endometriosis and yes the only really viable treatment was birth control pills.

She could obtain them at the health center for $10 per pack. She was able to get a few extra packs prior to graduation.

Now this girl was a "lucky" girl she landed a job and a job with benefits. Comprehensive coverage the HR rep had claimed.

Her health insurance cost her $65 a pay or $130 a month.

Imagine her surprise when her comprehensive coverage did not cover her pills, her OB/GYN visits or her annual pap smear.

Her insurance cost her $1560 a year or 8% of her annual salary and it did not cover any of her medical concerns. Beyond these pesky "female issues" and seasonal allergies, which she did not take medication for, she was basically healthy.

Her local Planned Parenthood only offered birth control subsidies if you were at a certain income level or unemployed. Sadly, she made too much and had a job.

Ironically the pills cost more in 1995 as they do in 2012. Today 3 months cost $60. In 1995 she paid around $36 per month.

So while she is paying 8% of salary towards an insurance policy that covers basically none of her health care concerns (I guess the older, white men, who owned the business were just padding the insurance pool at the expense of healthy young women, their health concerns were covered and hers were not.) Then and now it sounded like a money grab to her.

She now also has to spend, out of pocket and post tax, $36 a month on medication, that she takes to stave off debilitating cramps and heavy bleeding, hopefully staving off the spread of the endometrial tissue, which will damage her future fertility and functional cysts, while they seldom do damage, can and a damaged ovary is a useless ovary.

For the math challenged - $36 a month is $432 a year or 2% of her annual salary. Not to mention the cost of the doctor's visit to obtain the RX.

She didn't feel this was very fair. Why should this medically recognized treatment for a very real chronic medical condition get special treatment? Is it really any less of a disorder than say diabetes, high blood pressure or thyroid imbalance? Are the possible long term health consequences really any less impactful?

Because this very real medical condition only affects women. Because women's health issues aren't really medical issues, they are "female problems." Because the only known treatment happens to be hormonal treatment which also happens to prevent pregnancy and we all know that preventing pregnancy is wrong, sinful and/or unnecessary.

This girl got a second job. In part to cover her out of pocket medical expenses.

Shortly thereafter she quit all together, what good was a job with a medical "benefit"  that did not cover her medical issues. She made more at her second job in one night than she did all week at her fantastic career building job with "benefits."

Then she got a job, which had a health plan, which covered "female problems."

As it turns out she could have kept her first job and petitioned the partners to cover her medical condition-- if they felt it was warranted? After she asked around and found out only young women seeking birth control had to submit to such nonsense was around the time she told them were they could shove that job. Any other medical condition seemed to be covered.

You know this girl. She is me...

I was lucky, I had already at 21 a ton of work experience, I started working when I was 15 years old. I was a hustler. I worked hard.

And yes, I was poor, I was less than one paycheck away from being homeless and that first year post college, I doubt I could afford the USDA basics at the grocery on a regular basis. I get it that a lot of people mistake my current home address and my manners and the experiences I have with that old money. Sorry, but no. I grew in a pink collar/blue collar household. We could afford a middle class lifestyle until my parent's marriage imploded.

Then I woke up 19 and holding a big ass tuition bill. I went from working for book and spending money, to working for the whole nut. I shelved dreams of graduate school for that career building job with f-ing benefits BECAUSE I HAD BEEN SO VERY VERY SICK. I was being a responsible adult -- only to get slapped by the hand of misogyny pretty damn hard.

Trust me it wasn't the last time either.

I do however think it was the MOST unfair.

Our medical system only truly serves those with insurance. It is easy for a simple injury to nearly bankrupt a family with out insurance. Not having insurance, unless you are very poor is simply not an option. That second opinion at the BIG medical center. I had to pay cash up front before the doctor would see me. He didn't want to get stiffed and the hospital had a payment plan for the tests, he did not.

On top of that... workers in the US have zero say in what their insurance covers. That is bullshit. It is not a benefit if it does nothing for you and you have to pay for it. If it were 100% funded by the employer, then yes, they can pay or not pay for anything they desire. That insurance policy at my first job cost me 8% of annual salary and did nothing for me. I was literally flushing money down the drain, no wait, that would have been great... at least it would have been my choice. Instead I was funding some partners diabetic medication, high blood pressure meds, when trust me he could afford those on his own. Talk about getting fleeced.

It isn't a benefit if it does nothing for you.

I am not convinced that ObmaCare is going to fix that. I am convinced that we are starting to see some people's true colors. Birth control isn't just about women being empowered to have sex. It is about their ability to control their fertility. This girl's story could have turned out a different way. She could have lost an ovary or had so much scaring in her fallipian tubes that she would never have been able to have the babies - which she treasures above anything else. What if she had made a choice so many young women make and forgo treatment due to cost concerns?

So next time you feel like siding with those who are waging war on women and their health care choices. Please remember, I too am ONE OF THOSE WOMEN.

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