Sunday, November 10, 2013

A Civilized Society

Years ago, when I first filled my prescription for my bipolar medications, I looked at the retail price and thanked God I had a $60 copay. 

At the time, there was no way I could have afforded the regular price - around $3,000 for three months of incredibly necessary medicine. I was on my parents' insurance plan through the Howard County Public School System, and I have to tell you, that plan was a life saver. It doesn't matter how affluent you are, $3,000 is a lot of money. And it feels like even more when you're paying for the proof of (and hopefully, the solution to) your mental shortcomings. 

This year, I encountered something new - my husband's insurance doesn't cover one of my meds. And boy, it stings - muddling through finances while dealing with insurance companies and prescription plans has been a challenge. Fortunately, G's company has many options for health insurance, and we are going over the open enrollment process with complete attention because we absolutely cannot continue this way; we are lucky that we can cover these costs, but shelling out the kind of money which could pay for rent on a studio apartment? Awful. 

And it's awful not only financially, but on principle, and it's shaming. 

I feel so pitiful when the people at the pharmacy do a double take when they ring up my meds. I know, intellectually, that they are shocked by the price (and I am, too), but I often walk away with my plastic bag of pills feeling like I am the one who is shocking, like I am always the oddity, the problem, sick. I know how lucky I am to have these meds, and I know I am doubly lucky to have found the right blend of pills on the first try, seven years ago. That's almost unheard of when it comes to bipolar disorder - so many others have had to endure countless adjustments to their regimen because medicines don't work, or stop working, or cause worse problems than the symptoms they're trying to manage. So the look of horror on the pharmacist's face is probably worth it - but I come away from the experience feeling like that one little shard of shame, that reminder of how strange I am, the bitter icing on the cake which is bipolar disorder, is terribly unfair. 

People with mental illnesses - we don't need to be told that we don't fit in. We already know. 

If you want to show how healthcare in America is failing, there's no end to the examples, the proof, the stories of individuals and groups who have poor access to minimal care. The systems we have in place - what my stepmother rightly described as insurance companies getting rich off of sick people - aren't adequate, and more often than not leave mentally ill people without appropriate care. Again, I am lucky that (for now) we can afford my meds and my quarterly trips to my psychiatrist, but so many people cannot. I know that when I went to group therapy last winter I might have been paying $200 a day without insurance - and how many people don't have any kind of insurance? I met men and women who had been in the hospital and had no way to pay their bills, and the partial hospitalization program was a bandaid on the wound of being poor because they were ill. 

I'm going to say that again: American citizens are suffering financially and emotionally because they have health problems. American citizens are drained dry - of their money and their pride - because of something they cannot change. 

How can we call ourselves civilized when our health care system leaves us uncared for? How can we survive as a nation when we care so little for our neighbors? How can I accept any idea of equality or the American dream when whole groups of people are marginalized because of the chemicals in their brains?

I read Jezebel regularly, and often find myself scrolling through the comments. The overwhelming consensus of non-American readers is, what the hell is going on in America? They list the prices they pay for the same services I receive and boy, it sure sounds great - I'm so envious that in the United Kingdom or in Canada, someone with bipolar disorder doesn't have to break the bank to get access to care. I read their experiences and question why other civilized countries can afford to help everyone while America, seemingly, can't. What are we doing wrong? Why do we spend so much on healthcare in this country to get so little? It's as if paying for insurance in the US is a massive scheme, a manipulation, a rip-off and a lie. We are paying into a system which does not work. 

I have hopes for the Affordable Care Act and for the recent announcement that mental health and addiction services must be treated the same as physical services. I know there are problems with any new program, but it would be great if America could wake up and take notice of the flaws, the cracks we slip into, the huge populations of the under-served. It would be fantastic if we learned how to be compassionate rather than exclusionary. 

Mentally ill Americans don't need to be reminded that we stick out and need specific care - but we do need that care, and I believe adequate services for everyone benefits society as a whole. I'm sure I don't have to describe the inevitable articles after mass shootings which paint the perpetrator as struggling with mental illness - and while I absolutely do not enjoy being lumped in with murderers I have to admit that an untreated mind is an unstable one. Poor care, financial insecurity, and the knowledge that society doesn't value you? That's a perfect storm of isolation and shame and, sometimes, anger. 

Where do you turn if society looks down on you? What do you do if you're struggling and have nowhere to turn? How can you manage an illness if you can't afford your meds? 

Of course, as usual, I don't have the solution to the problem or many answers to my questions. For now, I'm just trying to find out if there is any insurance plan which will address and cover my needs. I'd like it - no, I'd love it, and it would be a miracle - if we could funnel our money into a down payment on a house rather than on my psychological maintenance. I'd be so happy if I could feel normal, feel recognized and respected, feel like my bipolar disorder is just one part of me rather than my definition. 

I don't need to be told that I am weird. I don't need to get shocked looks from behind the counter at Wegmans. What I do need is to be treated like everyone else. 

What we all need is a civilized society - a society where healthcare is a human right and not a luxury. 

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