Insurance Priorities

Yesterday, I was headed from my home in Middlesboro, Kentucky to my job in Barbourville, about 40 miles north, when a pickup truck driven by a woman with a baby in her back seat sheared off my front bumper.

I won't bog down this column with the details of how the accident occurred, other than noon rush hour traffic undoubtedly played a factor. I was not cited, and to my knowledge, neither was the other driver, whose truck was damaged worse than my PT Cruiser. And fortunately, neither driver nor the baby were seriously injured, although it was obvious that all of us were very shaken up by the experience.

It's hard to say what one's first concern is in such a situation --- I remember trying to operate a new cell phone and call 911, but I was too disoriented and shocked by the events to make it happen. Fortunately, an EMS squad happened to be driving near the scene so everyone involved was immediately attended to. I had no cuts, no bruises, knew what day it was and could move my fingers and toes, so it was left up to me as to whether I would appreciate a trip to the hospital to be checked out.

I hesitated. In the early 1990s, I experienced a series of whiplash injuries to my neck and upper back, caused by a pair of falls and another automobile accident, and they still aggravate me with stiffness and pain. Back then, I immediately sought medical attention. My employers provided adequate insurance coverage which covered emergency room visits.

But yesterday, which would have been my next-to-last day at my current phase of employment --- I start a new position with the same company on Monday --- I did not have health insurance. If I went to the hospital and let them X-ray my neck and back and prescribe painkillers "just in case" I experienced pain, the payment would come out of my own pocket.

And so, I declined the young EMS man's offer to transport me to the hospital --- it was an offer I couldn't afford this week. As it happens, if the accident occurred next week, when I start my new job, I would be covered by my employer's health insurance plan, as I will be stepping up into a new category that allows that option. It will be a relief as I will be able to afford the increasing number of medications that the aging process is bringing into my life and I will be able to afford an emergency room visit should I ever be able to restore my car and let some woman in a pickup truck hit it again.

Sadly, what I am experiencing right now is pretty much what a lot of people in Appalachian Kentucky --- and much of America --- are going through. Some people have to make a daily choice between tending to the health of one's car, putting food on the table, getting the utility bills paid and going to a doctor for preventive or cautionary health care. In some of the worst cases, it becomes a matter of food vs. gasoline vs. prescriptions, and some people can only afford only one of these, if any.

The New York Times recently published a lengthy report (accessible at http://www.blogger.com/) about what an editorial in the Lexington News-Herald described as "the deplorable state of dental health in Kentucky." Seems the folks in the Empire State had just noticed the gaps in the teeth of their hillbilly cousins down in the Commonwealth of Kentucky and realized that the cause had a lot to do with lack of access to and inability to afford proper health care.

No big news in Barbourville, which was a central focus of the Times article --- heck, all I have to do is look around at the gaping holes in the smiles of several of my co-workers and I can see what growing up without being able to afford regular visits to a dentist can cause. Likewise, improper nutrition contributes to poor dental health, as can certain untreated childhood illnesses. When these problems go on for generations, a tendency toward dental problems becomes a hereditary issue.

It would seem that improving health care access would be the perfect starting point for the state government, which just elected a new Democrat governor last November after four years of incompetence from an inept Republican administration. While the state legislature's two houses remain divided in party leadership --- the House majority is Democratic; the Senate's is Republican --- it still is obvious that health care should be a bipartisan concern, one that should be put at the forefront of all other issues.

Consequently, it was very disappointing to discover that two of the state representatives from Kentucky's poorest districts --- Richard Henderson and Ancel Smith, both Democrats --- decided to look away from more important health care issues and do some election-year posturing on the Republican issue of health care for the domestic partners of state universities.

In December, Henderson and Smith, with a lot of Republican backing, chose to become the primary sponsors of a renewed effort to legislate prevention of state universities' right to decide will be offered health care accessibility. Some universities --- particularly the University of Kentucky and the University of Louisville --- already offer health care inclusion to the domestic partners, gay or straight, of their employees.

Henderson and Smith, and their co-sponsors, which sadly include Rep. Rick Nelson from my own House district, claim that the issue is a moral one because it does not reflect the religious interests of the conservative Christians in their districts. Henderson, in particular, claims to have received thousands of calls from constituents, which would mean the people of his district are obsessed with denying health care benefits to unmarried couples far beyond their concerns about general health care, educational needs and jobs, and certainly at a rate well beyond most other House districts.

My personal opinion is that Henderson, a freshman representative wanting to impress the voters in an election year, is, shall we say, "exaggerating" the number of calls received.

I have written to Rick Nelson about my concerns over his co-sponsorship and am awaiting a reply. It seems odd for a man who represents a district where the general health care issues are so obvious that they gained the attention of a nationally-circulated New York newspaper to be focused on an issue that boils down to DENYING people health care access.

This week, in the Lexington News-Herald, there was published a letter supporting the Smith-Henderson bill and taking issue with the News-Herald's opposition to it. The letter-writer, a Terry Thornsberry of Martin, Kentucky, described himself as a small business employer of 25 people and described what sounded like legitimate concerns about the rising costs for people like himself who are responsible for insuring their employees.

My response to private employers with similar concerns is this: My employer, which has many more than 25 workers, offers full coverage for its employees, but additional coverage for family members --- including domestic partners, under certain circumstances --- requires co-payment from the employee. This seems like a satisfactory arrangement that deals with the concerns expressed by Thornsberry, i.e., "Who watches the bedroom to determine who is a legitimate partner and who is an uninsured friend?"

The answer is that when some of the cost of adding an insuree to an employee's health care plan comes out of that employee's paycheck, the unlikelihood of abuse decreases, rather than increases.

And so, as I go off to deal with getting a new front bumper on my car (and don't even start on the subject of affordable car insurance --- I have liability only), I console myself with two thoughts: My own domestic partner, an employee of a state community college, has his own insurance plan which, at present does not include me. And next week, I will be covered so that if my past back injury starts acting up, I can afford to see a doctor about it.

I just hope a little aspirin will get me through the weekend.