Yours truly, on the harbor in Petersburg, Alaska

What single payer means to an Alaskan fisherman with breast cancer

By Malena Marvin

If you haven’t had a chronic illness while self-employed, the term “single payer” might not mean much to you. Let me explain what it means to me. Grab a cup of coffee and put your feet up, this is going to take a few minutes.

My life under “Multiple Payer”

Just before sitting down to do some marketing work for my fishing business today, I opened a letter from Moda Insurance letting me know they wouldn’t be paying my cancer-related medical bills from last December, when I started chemotherapy. The letter did not explain why, it just said I was “ineligible” for service and that an $1100 bill was headed my way.

This is the fourth time in my 18 month battle with cancer that Moda has sent a cryptic letter to tell me I was on the hook for thousands of dollars. The previous three times I was able to show the expensive “mistakes” were Moda’s, not mine. I accomplished this by spending many, many, many hours talking on the phone with hospital billing departments and with Moda while pacing around our house snorting like a wild horse. But trying to snort calmly. Because cancer patients are not supposed to stress out.

But when I saw this letter today, I felt enraged even though I’m not supposed to. I knew from experience that resolving the issue would be frustrating and time-consuming. Still, I hoped I could clear it up by stepping away from my job to call in, wait in a queue behind 28 other callers, and then patiently explain myself to a customer representative who may or may not be in the mood to help me. I hoped that as before, if I just repeated this process every few days for a few weeks the charges could eventually be dropped. But as with the previous three times, I was also scared. With all of the travel and treatment I’ve had to do for cancer, we just don’t have too many $1100 checks left for the fight. I was also tired and nauseous, because I am on chemotherapy.

A typical letter from Moda. No explanation. Super cryptic.

Nevertheless I persisted.

The customer service rep (I got a kind one today, yay!) explained that my coverage had been revoked after I “failed to pay” a November premium. In actuality, Moda’s auto-pay had misfired - the auto bill-pay I set up with an agent on the phone in October had not gone through. This had already happened twice in 2016, so I wasn’t surprised. After the first time I retroactively lost insurance due to an issue with Moda’s bill pay software (in March 2016), I had called in, volunteering to back pay premiums because I noticed they still weren’t coming out of my bank account. The smug fellow on the line assured me that this time future payments would be auto-deducted and I could ignore any additional paper bills that came out.

(I am belaboring this point with lots of italics to capture for you the essence of our multiple payer system. Sometimes the payers don’t pay and so they try to get you to pay but in fact you’ve tried to pay so you feel you shouldn’t have to pay but you still have to spend a lot of time trying to get pay happening so you don’t have to pay.)

Because Moda did not cover the hospital in my remote Alaskan community as in-network I had had to travel away from home to begin chemotherapy shortly after that call in October 2016. In November and December I was focused on recovering from a mastectomy, making difficult cancer treatment decisions while away from home, getting ready to have a chemo port surgically implanted, and beginning a 6 month chemotherapy regimen.

Oh, and I almost forgot. I was also spending many, many, many hours on the phone trying to get Moda to cover charges for my September mastectomy. Though I had called before the surgery to ensure my hospital in Seattle would be “in-network” and had received confirmation, Moda had removed them from my network without warning the day after I called and then billed me $15K as if I had decided to get an out-of-network mastectomy. The funny thing (ha ha) was that I had purposefully called to confirm network status because Moda had already done this exact same thing after my lumpectomy the previous year. Both times, before the surgery they told me my hospital was in-network. Both times, after the surgery they told me my hospital was out of network.

Both times, before the surgery they told me my hospital was in-network. Both times, after the surgery they told me my hospital was out of network.

Oh, and in addition to attempting to reverse those out-of-network charges, I was also spending time re-enrolling in Obamacare because Moda had left the Alaskan market and I needed to start with Premera, the only corporation now available to self-employed Obamacare participants in Alaska (and whose premiums, by the way, were twice the national average after having risen 90% over the previous three years). And in case you are worried that I was still not spending enough time or money dealing with health insurance, I was also placing many calls with the state of Alaska, who had inexplicably auto-enrolled me in Medicaid and was threatening to have my private health insurance tax credit revoked for being double enrolled.

Now, I would have happily used Alaska’s Medicaid, except that it wouldn’t cover services OUT of Alaska. You’ll remember that I had already initiated services outside of Alaska because Moda wouldn’t cover me IN Alaska. Damned if I did and damned if I didn’t. When I eventally reached the Alaska Medicaid help desk in December, I was informed there was a 6 month back log and they wouldn’t even be able to review my case until the following spring. Would I receive the Obamacare tax credits I was depending on to help with my $700/month premium? Unknown. I tried not to worry about it, because again, cancer patients know they shouldn’t stress out.

But. I. digress.

Back to today’s issue. Because I was away from Alaska and sorta busy in November of 2016, I didn’t receive Moda’s paper bills right away. When I did get my mail forwarded and see the bills I was preoccupied enough to take the October Moda rep at his word without checking: I could ignore paper bills because auto pay had been set up. I then received yet another paper bill when I got home to Alaska in March and I paid it, figuring that they must need it if they were still billing me for November in March.

Blissfully, the woman on the line this afternoon was able to corroborate my story based on their notes from my previous calls. Still, she said, “I can’t guarantee we can cover your expenses in December.” There was a pause while I felt the usual feelings of confused guilt on top of my nausea and fatigue — I must have somehow screwed up and been flaky. I wasn’t handling cancer treatment and personal bills as well as I could have. There must have been something I could have done better to avoid these extra charges. The rep seemed to sense my confusion and so she added, and I quote, “You’ve done everything you can on your end. It wasn’t your error. I will try to make your case clear to the people who will decide on it.”

Is single payer starting to make sense yet?

Here’s how single payer works: You pay a little more in taxes and you don’t pay premiums. All doctors and hospitals are in-network. The end.

Here’s how single payer works: You pay a little more in taxes and you don’t pay premiums. All doctors and hospitals are in-network. The end.

It doesn’t matter where you live. You don’t have to travel to other cities to be in-network. You don’t have to spend weeks on the phone resolving billpay issues that aren’t your fault to begin with because there are literally no bills to pay.

But wait, you heard me say “more taxes” and you decided single payer was for communists, even if it’s easier for citizens. Let me explain. You pay a little more in taxes and YOU DON’T PAY PREMIUMS, CO-PAYS, or DEDUCTIBLES. The economics have been calculated on this like a hundred times. You pay less in increased taxes than you currently do for your healthcare. And you don’t have to deal with bills or calling the insurance company three thousand times just to avoid getting ripped off.

I know. I know. Sounds too good to be true. You’re wondering: how is this level of healthcare nirvana even possible? Well, when you stop paying people to send letters and answer phone calls about broken auto-pay systems and trumped up out of network charges, turns out you save a little money. (Plus don’t get me started on health insurance corporate CEO bonuses in the tens of millions of dollars).

As we see in many other countries, single payer quite simply expands coverage to everyone while reducing costs per capita. The US has the most broken system in the developed world and we pay more for it, both in dollars and in stress on people like me.

The Rep. Don Youngs of the world

So, I get that unless you have cancer and are self-employed, all of this might not be foremost in your mind when you hear the phrase “single payer.” This is why I make a hobby of trying to explain it to people, through mega long explanations like this one, and if you’re lucky, in person.

My quote in the Petersburg Alaska “Pilot” newspaper.

My (only) Alaskan Representative Don Young came to my community last week. Since there is a Medicare-for-All bill (HR 676) currently introduced in the United States House of Representatives with 93 (now up to 110!) co-sponsors, I brought it up at our community meeting. Why, I asked Congressman Young, if you just said you support lowering costs and improving coverage, are you not interested in HR 676, the only plan that actually does so? His response, and I quote: “If you want that, go to Canada.”

As a commercial fishing family working to invigorate a rural community with a value-added small business, we have trouble understanding why our Representative would want us to move to another country so that we can get healthcare in peace. Plus, I totally like America and I want to keep living here! It’s my home!

As a commercial fishing family working to invigorate a rural community with a value-added small business, we have trouble understanding why our Representative would want us to move to another country so that we can get healthcare in peace.

I left that meeting feeling like I have no representation in Congress. Like my “representative” has no interest in hearing my story (though I’ve called his offcie and explained it on many occasions). I felt like Don Young, spoiled by his 44 years of cadillac coverage on the taxpayer dime, has absolutely no idea what private business owners go through just to get healthcare in Alaska.

But, you dear reader, if you’ve read this far, can see that I have a point. Don Young will never read this, because, honestly, he doesn’t care about me. But if you care about me, or you care about anyone you know who struggles with insurance and chronic illness at the same time, you will call your representative right now and explain why we need single payer in America. If anyone tells you this is “unrealistic” you will calmly explain that multiple polls have shown 60% of Americans believe in government-funded universal coverage in the United States. You will sit them down and explain that countries more “economically free” than ours, such as Singapore and Germany, have universal coverage for all citizens and they pay less than we do. You will note that WE ARE THE ONLY DEVELOPED NATION ON EARTH that doesn’t guarantee healthcare to its citizens as a right, and that our broken system means we pay more per capita THAN EVERY OTHER COUNTRY ON THE PLANET.

You will start using all-caps to talk about this because you, friend, know that when we say trouble with health insurance “lowers outcomes” we mean people are dying because America can’t get its healthcare act together.

Single payer now. Please.

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PS. If you just read this and your first thoughts were along the lines of “healthcare is a privilege, not a right” you are actually just a mean person. Mean. If you concede that healthcare is a basic human right but worry that single payer doesn’t work in other countries, I invite you to review the data on their higher healthcare outcomes and lower healthcare costs.

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