First Draft of My Letter to Sen. Wyden

meowser-48.jpg posted by meowser

Right now, this is about as brief as I can make it without leaving anything out. I haven’t sent it yet, so if you have any feedback for me, I’d love to see it. If you were going to cut, what would you cut?

****

Dear Sen. Wyden:

I am a constituent of yours from Portland, and I have been following the healthcare reform fight with great interest. I am in my 40s, am diagnosed with Asperger syndrome (a form of autism), and I also have polycystic ovarian syndrome (a metabolic disorder that affects an estimated 5% of American women) and take psychiatric medications for severe, life-threatening depression. The drug I am on is the only one that has ever worked to keep my depression in full remission, and in combination with my metabolic disorder, it has also ensured that despite a high-quality diet and moderate activity level, I am teetering on the borderline of “morbidly obese.” I am told by my doctors that this is more common than not for people taking this medication and, keeping my PCOS in mind also, they do not blame me for my weight. I am grateful for this.

However, what these conditions mean is that I am umbilically dependent on a job to give me health insurance, since there is no way on earth I could possibly qualify for individual coverage with my pre-existing conditions, even if I were to (improbably) become “normal” weight. The job I have is one that is being hunted to extinction — I telecommute for a national medical transcription company editing speech recognition files and doing transcription. My bosses and coworkers have, in fact, never seen me in person. These jobs, at least in the U.S., are becoming more and more obsolete as “front end” speech recognition (edited by doctors themselves) and offshoring the work to overseas transcriptionists who are grateful to do the work for pennies on the dollar compared to what they must pay U.S. workers, and even more so because American workers depend on their jobs for healthcare. I am not particularly confident that I will make it to “Medicare age” without having to find another way to secure myself insurance, and with my disability and age, the number of insurance-providing jobs I can qualify for is vanishingly small. Therefore, I hope with all my heart that we can figure out a universal healthcare solution that is affordable and accessible for all, and I admire the work you have been doing to try to make this a reality.

This is why I was particularly dismayed to see that you supported Sen. John Ensign’s amendment to the healthcare bill that would allow companies to charge an insurance rate differential of up to 50% (with HHS approval, which would be no obstacle that I could see) for people whose “numbers” — weight, cholesterol, blood pressure, etc. — fail to meet their standards. It’s pitched as a “discount” for people who “take care of themselves,” but in practice, with most companies having yearly open enrollments for insurance, it amounts to the “good” (i.e. genetically luckier) people being allowed to pay the old, lower rate, while the “bad” people (who drew the short stick for DNA) are charged the new, higher rate.

And yes, the way I see this, it does also add up to punishment for “bad” genes. Surely you understand that there is a huge difference between people who can, for example, lower their cholesterol 30 points just by switching to soy milk, and people who have to go completely vegan plus take three statins (which are risky drugs in themselves) to lower it by even 10, yet both are expected to meet the same numerical standard. And if even one number is “off,” one gets dinged the same as if all the numbers were “off,” leading to disincentive to make any positive changes at all if merely being “imperfect” is going to cost them just as much as being overtly self-destructive (the latter of which is, I think, relatively rare). It’s also worth noting that people who are lower income (and nonwhite) are more likely to have numbers that are “off,” and that “living a healthy lifestyle” as promoted by mass media is largely a prerogative of the financially comfortable.

This hardly seems just, and if the goal is truly to get people to take better care of themselves (as opposed to taking the opportunity to squeeze more money out of employees), it is likely to backfire. People who have less money in their paychecks have less money to invest in fresh fruit and vegetables and high-quality whole-grain products, and people who have less money also have increased stress, which in itself is known to be deleterious to health. And those who must take second jobs or work longer shifts to make up for the shortfall in their paychecks — which would be common for people who work low-paying jobs such as retail — would have much less time for physical activity and cooking.

I know Sen. Ensign’s amendment provides for a waiver in case of medically documented inability to “make goal,” which I would likely get with my history. I also understand that companies are currently allowed to charge up to a differential of 20% for “good” numbers, and that 30% (the allowed differential without the HHS approval) does not sound like much of a difference. But 50% certainly is, and would almost certainly tempt many more employers (like the one I work for now, which currently charges no differential) to start testing everyone’s blood and urine and saliva and weighing and measuring them in order to save money. Even if I qualify for a medical waiver, I can see no good coming of having to tell my boss I have Asperger’s and PCOS and depression bad enough I was once hospitalized for it in order to get that waiver. It seems like a great deal for them to hold over my head.

And while I have never smoked, and I understand the rationale for banning smoking at work since that affects the health of others, I fail to see how testing people’s saliva to make sure they have not had a cigar in the privacy of their own living rooms of late is going to accomplish anything except further eroding trust between employees and employers. It seems obvious to me that top-ranking executives will not be subject to these interventions, and thus my suspicion that this is merely a way to justify pay cuts among the rank and file — no more, no less — is especially keen. Given all this, I hope you will reconsider your support of this amendment.

Sen. Wyden, I am not in the habit of writing letters to politicians; you are my first. I know your reputation for considering all sides of an issue and being open to new ideas, and in considering the impact of the laws you work to pass on people who live lives very different from your own. This is a rare commodity in a Senator, and I treasure it. I also know that people are coming at you from all sides regarding the healthcare issue, and I realize that some people might regard the things I have written about here as mere trivia when considering the “big picture” of reform. However, I also would like any healthcare law that passes to actually be a help to people like myself, rather than a hindrance, which is why I am raising these issues with you here. Thank you very much for your time.

Sincerely yours,

Meowser

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15 Responses to “First Draft of My Letter to Sen. Wyden”

  1. Deeleigh Says:

    That is an excellent letter and I hope he has an opportunity to read it personally.

  2. Trabb's Boy Says:

    It is an excellent letter, Meowser, and I don’t think it’s too long. You could cut out a bit about your job in the second paragraph — just say you’re a transcriber and that this work is almost all being sent overseas, but that would cut, what, a sentence? All your points are important and powerfully written. Just put a stamp on the thing and send it.

    Oh, and thank you for writing it!!! You know, I moved up to Canada seventeen years ago, and looking at the American health care debate from a universal health care country, it all seems like madness laced with evil. Why should anyone’s boss get to know about their health history? Why should anyone have to stay in a certain job to keep health insurance? Why should anyone be making a profit off denying health care? Why should anyone get to decide how you live your life based on the current hate-fad? It’s grotesque! Anyway, thanks again.

  3. Maggie Says:

    I agree completely with above comment. Thank you. I agree with every word.

  4. noceleryplease Says:

    This is a lovely letter.

    Alas, speaking as someone who has written quite a few letters to various representatives, I can tell you that they will have an aide or intern (or software, if you email it) scan far enough down to figure out a) the topic and b) your yes/no stance, then send you a form letter (which IF YOU ARE LUCKY will correctly identify the issue and yes/no stance and provide some kind of pandering, vapid, non-committal response that assures you your elected official is LISTENING to you and CARES DEEPLY about whatever it was you were talking about that they couldn’t be bothered to read.

    But I’m not bitter…

  5. Meemsq Says:

    This is a great (and very important) letter. Thank you for writing it. I’m one of those people with “bad” genes that predispose me to high cholesterol, regardless of weight. My thin (bmi of 20-21) father has high cholesterol; my average weight (bmi around 24) mother has borderline cholesterol. Both are active and eat a nutritious, low saturated fat, high vegetable/fruit diet. You can’t override genetics.

  6. returnofconky Says:

    Wonderful! I’d love to cosign that as a fellow Oregonian. I didn’t elect him to discriminate against me!

  7. occhiblu Says:

    It is long, but it’s also well constructed and concise, given the breadth of the topic. I usually skim blog entries and then go back and reread more carefully if they interest me; I read your letter word-for-word on the first reading, because it really drew me in.

    In other words, I wouldn’t change anything. (And I say that as someone who worked as a professional editor/copywriter for a decade!)

  8. Blimp Says:

    The motive of the whole health care reform push is fascist fiscal austerity, cutting the flesh and bone out of the budget, killing granny and others with chronic illness, just like Adolph Hitler did, and as the U.K. is doing now, for the purpose of continuing and expanding the fascist bank bailouts. The letter errs in assuming that President Obama and all those in Congress who are not dead-set opposed to him have any motive that is not the most vile imaginable. This is not to imply that Obama’s opponents do not also have ulterior motives; they way you differentiate them is to ask: (1)Are they willing to abolish HMOs, PPOs, etc. and (2)Do they call for massively increasing the budget for Medicare, Medicaid and Hill-Burton (funding for public hospitals)? and (3)Do they denounce Obama for blaming the budget deficit on health care expenditures rather than bailouts, lawlessness in the markets, outsourcing, mass unemployment, and the continuing criminal mis-deployment of our military in Iraq and Afghanistan? The answer to all 3 should be a very loud and public YES!

    American health care today is all about unfunded mandates and lying about the cost, and driving more and more Americans, even many who qualify for Medicare or Medicaid, to seek additional insurance with an HMO, with real private insurance being driven out of business. The lying about the cost is driven by lying about the state of the economy as a whole and the effects of the policies of free trade, deregulation, perpetual war, and mad environmentalist policies such as the biofuels mandates, penalties for CO2, and prohibitive obstacles to nuclear power, evil policies which the liars aim to protect. A “budget-neutral” health care policy is thus either an unfunded mandate or a Nazi “kill granny” policy. However, if we were to return to the law prior to Nixon and outlaw HMOs and similar schemes, we would find a huge amount of money presently tied up in the administration of these monstrosities returning to the economy, and it would not be difficult to collect sufficient taxes to allow public hospitals, Medicare and Medicaid to provide better services than the HMOs used to provide with the same money.

  9. meowser Says:

    Blimp, I am putting you on notice that I am not going to approve any “kill granny” or “Hitler” types of comments from you in the future. I am not going to ban people for disagreeing with me, but I think you can make the same arguments without the inflammatory language.

    And “Hitler”? Really now? How on earth is providing funding (that’s where the “shall” comes in, for the funding) for the option — the option, not obligation — for doctors to have meetings with patients to discuss updates to advance directives anything close to saying, “Okay, you’re 70 years old, time to put the pillow over your face”? (Since, you know, you might not feel exactly the same way about being full code when you’re 80 and suffering from your third different kind of invasive cancer as you felt when you were 50 and healthy. If you do still want to be full code, you put it in writing so everyone knows.) Surely you know that private insurance companies are already funding advance directive talks, and in fact, go a step further than that, by refusing to fund life-saving or pain-relieving measures they consider too expensive for them to bother with?

    And unless you’re rich and can pay for treatments out of pocket (an option that will never, ever disappear in America, you can bet on that), no from an insurance company means NO, you are not getting treatment, go away. There is no other insurance company you can go to if one turns you down; you now have a preexisting condition and they won’t touch you, or if they do, they will refuse to pay for anything pertaining to the preexisting condition, anything they can possibly weasel out of. (I once had an insurance company refuse to pay for a Pap smear because I had PCOS. Same body parts, you know. I wish I was kidding.)

    Everyone else, thanks so much! I’ll probably let it rest overnight and then see what edits I might make.

  10. Emerald Says:

    Great letter, Meowser. As a Brit I probably don’t understand the issues as well as I might, but I do know from the many Americans I know (a number of whom work in the healthcare field) that the situation over there is pretty crappy if you come into the large category of the ‘uninsurable’. That amendment – no, call it a premium – sucks big time. (It hits home for me because I’m a would-be emigrant to the US, with personal and health circumstances that might put my position, were I working over there, somewhere close to yours.)

    I won’t go into detail about our NHS – it would make this comment way too long. But, it started as a public health system that would provide for everyone regardless of the cost. Where it sticks to that ideal (so far as is now possible with a larger, older population and far more sophisticated treatments than when it started), it works. Where it’s veered away from that ideal to try and be ‘cost-effective’, it’s ended up doing things like tell people over a certain BMI that it’s not medically ‘safe’ for them to have a knee replacement – when, like one local lady (yes, my area is in one such NHS trust) they can, if they have the money, go get it done perfectly safely by a private clinic in Belgium. Saying some people are ‘untreatable’ to avoid spending money on them is typical, I believe, of a private system, not a public one. If the US is going to make a public system work, it needs to be a public system and not sneak in the ‘untreatable’ idea by the back door.

    Also, I’m with you on end-of-life care plans being for exactly that – how to best care for someone when their life is at an end, not bumping them off before their time. Often misunderstood, which is unfair to those of us who’ve dealt with such situations in our own families; the care of elderly relatives is a fraught issue anyway, without that kind of implication.

  11. Tracy Says:

    Nice letter. I admire that you’re writing one.

  12. Lindsay Says:

    I think the letter is great as it is — it’s long, but doesn’t seem bloated at all, and frankly your senator might need a lot of this stuff spelled out to him in great detail.

    Good luck! Hope he reads it 😉

  13. Well, I Dood It « fat fu Says:

    […] Comments Lindsay on First Draft of My Letter to Se…crookedfinger on First Draft of My Letter to Se…littlem on Anyone Else Planning on Doing […]

  14. annebonannie Says:

    I would like to see the last paragraph as the first, and the first paragraph as the last. People are always more engaged when you are talking about them and this probably applies to Senators too. That you praise Wyden’s ability to consider all sides of an issue, you prepare him for a different side of the issue, your (our) side.


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