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.