Vic --

I know that some people just play the system, and, may have done so for all of their adult lives. But, many of us with MS have spent many years employed, and paying taxes.

If it seems to make financial sense to you to dump the insurance, it might not be as complicated an ethical dilemma as you originally perceive it to be. Your taxes have helped to pay for others who needed affordable medical care. Maybe, it's just your turn to receive.

I read, with interest, what Debbie wrote regarding how the rug can be pulled out from under us. That can be true with insurance, or with employment.

I know that I wonder that about applying for SSDI, too. I wonder whether I really could look for another job, and whether I could continue working.

But, when I read what my doctors write about me to SSDI, I think that maybe I am more disabled than I am admitting, even to myself. Even if I could obtain another job for a little while, I expect that I would lose it, like I've lost 3 others within 6 yrs, because of of flares and absences. Perhaps your situation is similar to mine; it might just give more stability to be accpeting money from the government than counting on something that we might lose.

I guess that I don't really have an answer for you. But, you did not choose MS for yourself, and you would be glad to pay for insurance if you didn't have other issues that complicate this whole thing.

~ Faith

I know this has not been easy for you financially. My questions are really about how your level of care and services might change when you are not privately insured.

Would you still be able to be on tysabri? Would you still be seeing the same medical providers? I had heard in the past from family members that there were limits on how many patients a doctor would take from certain systems, and that appointment times were less convenient for folks on alternate systems.

I had to look hard to find that red line, which of course it at the very bottom.
From the chart perspective it seems like the public program is a no brainer, but my concern for you is the quality of care, if you have a choice.

Thanks for the reply, Missy. I am sticking with the insurance even though the question is one that everyone needs to consider.

Kathy, I agree that financially we would be better off by dumping the insurance, but the possibility of leaving my wife with a huge debt if something horrible happens to me (like being hit by a bus and in stuck in a coma for instance) is what is keeping me writing checks monthly.

Cindy, I was not referring to any specific form of assitance, but rather getting public assistance in general even though the personal money is there to cover expenses without the public assistance.

Completely understandable. That is the value of the assistance, and the appropriate use of it. I am glad that it has helped! Getting it on other terms is what is driving this question of ethics which I have posted.

I agree, even though it would save me tens of thousands each year.

The red line is along the bottom of the graph, and is so low that it is hard to see.

I am keeping it. I do not have the ethical right to take public assistance when I can scrape up enough to pay for the insurance. There may be a time when that changes and I am broke, but until then, I will just keep on subsidizing the health insurance industry.

You have asked a very good question, and I think that everyone who reads this should consider your experience in Canada.

You bring up very good points that everyone should also consider. (1) Am I as healthy as I thin I am (my physicians do not think so); (2) I have paid into the system since I was 14 (28 years).

Let's all keep addressing this question. It is important to everyone.

The reason I was asking about medicaid or medicare specifically, Vic, has a lot to do with what Starfish said. In MI, one must be at or below the poverty level to qualify. This means no liquid assets to speak of, no incoming resources, and no expectation of future financial resources.

Many physicians here will not accept the standardized portion paid by the system and therefore send a bill for the remainder directly to the patient. Dental and optical are pretty much out of the question, and progressive MS treatment is a battle.

Ty is flatly refused based on probability, they'd rather gamble that a patient won't need long-term primary care and if it is needed, patients are at the mercy of the state-funded warehousing facilities.

The ethical portion, for me, boils down to need and availability. If you feel that you honestly need the assistance, it is there for that purpose. Once you step away from your insurance, it will likely never again be available to you. Ty would most likely be out of the question (assuming you won't be footing the $20k+ monthly bill yourself).

My DH has medical and health insaurance through his company, yes it would be great to keep the amount we have to pay for the difference between family and individual but we have access to great doctor and care, low co-pays, etc. It does cost X amount a year, but the two years I got a DMD monthly for nothing, good doctors for all of us at $15 a visit, when DD pulled her shoulder out, wemnt to ER, had several follow-ups with a good doctor, well worth it. The power chair I'm getting has more bells and whistles I want than Govt. would give me. I know I'm lucky in my situation, see my cleaning woman, single mom with 2 kids can't afford it, but the quality of care she must accept from system for her and her kidsis not very good in my opinion. Unfair? Dreadfuuly. But since I can do it, will do for us, especially the kids.
When bad things happen or chances at working against the MonStter come up, want to be econically able. Hold on to making it mote possible. Not fair, but private insurance makes me believe that's possible. A friend had what I thought a terrible unethical doctor for his drug addiction who I feel prescribed things unethically, without proper needed supervision, and set him up 100% (in a low sucess rate area) for failure. Private insurance enabled me to concieve which cost big bucks over 15 years (nobody allows it now, considered Elective and unnecessary but was covereded way back then) and I consider myself lucky. If we can afford it, I want private insurance right now.

AMN brings up some good points. With many public health systems your choices are limited as to which dr to go to, what meds are available, what facilities you can get treatment at, etc.

As an example, when I was 1st diagnosed the neuro wanted me to take Provigil. The insurance company would not approve it. We tried 3 times to get it approved and they just wouldn't. So, no Provigil for me (well, except for the samples they gave me). In my case, it was ok as it did nothing for my fatigue.

Additionally, my choice of neuro's is very limited. In fact, only 1 MS specialist is on there. I did go to her for a while, I ended up switching as she was ill herself and her partner left much to be desired (I had dealt with him for years on a professional basis and then as a patient once. He was just as temperamental and hotheaded in his treatment of patients as he was the professional staff). The neuro I now go to is listed as taking care of MS patients. My PCP tried to get me in to another highly recommended neuro (MS specialist) that was not on my insurance but the prior approval got denied as there were others that treated those with MS.

Dental and optical are not covered by public insurance for adults. That is an out of pocket expense for me. However, should I have trouble with ON again, I would get approval to go to a neuro ophthalmologist. As for dental, instead of going twice a year for teeth cleaning, I now go once a year as that is all I can afford.

Even though I am on Medicare now, Medicaid still requires prior authorization even though they are my secondary insurance. It is still a pain.

The great thing about the public health insurance is that my kids get awesome care. They have more choices of drs., prior authorizations go through quickly, they are covered for dental and optical, etc. The system really takes care of kids needs.

It's not $20K a MONTH, is it?

Your meds, treatments, surgeries, hospital stays, etc. ... probably add up to much more then what you are paying for your insurance premiums, don't they? Your insurer would likely be more then happy to drop a client like you, to bring the "pool costs" down. More profit for them.

I don't feel as guilty being 'on the medical dole' because I don't cost the system very much either. My only med is $20 a month, I've had one MRI in almost 18 yrs, and I visit my neurologist once a year (and do that only because that is mandatory for insurance purposes). Any other medical costs I incur are par with most every other "normal" family in Canada . . . so I'm not costing the system much due to my specific health issues.

These are social safety nets, meant for those in NEED. I'd have much rather paid in for the rest of my life, and have not NEEDED them, but unfortunately that's not the way things worked out. I do feel guilty about getting Canada Pension Plan (similar to SSI/SSDI). Yeah, I paid in about $2,000 a yr for 30 yrs . . . but since I am dependant on it until death now, I'm definitely going to be getting every penny back (that me and everyone else in my family ever contributed), plus heaps more.

Cherie

Hi Vic and Everyone,
My thoughts on this are the same as my thoughts on financial aid for college, subsidized veterinary care and any type of program that is set up to help those in need. I have been bashed on the topic of financial aid with regard to people that quit working while in college because their income was too high to get aid. Perhaps my favorite is the couple of single mothers that didn't marry their live-ins until after we graduated because it would cut off their financial aid. I'm sorry but no argument in favor of that sounds fair or honest to me.


As long as I can pay for myself I will. The no brainer reason for me is that I would feel horrible getting assistance when someone truly in need, living off only disability etc. would not get all they could to help them. What I keep coming back to is that these funds are finite. No matter how you look at it, how much I may have paid into these funds etc. there are X amount of dollars to help X number of people.

I am not suggesting that anyone who has no other choice be too proud or feel guilty for accepting public assistance, just that if you can care for yourself please consider doing it.

LOL, it might as well be, the best average I can find says $5,200 which is just as ludicrous to consider as a monthly out-of-pocket expense.