This is a story about healthcare, about choices and circumstances and how everything can fall apart in an instant.
It began with my first job after graduate school, which was awful and paid poorly, but came with solid gold healthcare coverage, fully paid by my employer. The insurance included no co-pays, no deductibles, and no co-insurances. And I used it — I filled prescriptions, went to the doctor, did everything I had been taught while I was still my parents’ child, covered under my father’s work policy.
Then they fired me and my next job had no health insurance, paid or otherwise. For the first time, I had to choose between paying my rent or buying insurance. At the time, the cost was about $150 each month for the almost solid gold plan. This new, individual policy didn’t cover quite as much as the old, but it paid for itself as I continued to see physicians and buy prescriptions.
After a year, the price rose to $165 per month, and that, plus my rent, left me with about $400 per month to pay for food, clothing, electricity, phone, charitable and entertainment. I used public transportation; a car was beyond my means. Banks offered me credit cards and I started to carry small balances to cover my monthly underfunded expenses.
Every year, housing and healthcare costs rose far faster than my income, the banks were oh-so-generous in increasing my credit limits, and I fell further into debt. But hey, it was all okay, because I bought a condo in 1984, and the growing value of that offset my accumulating debt. I used the extra cash from a mortgage refinance to pay off my massive debt, and saddled back up on the merry-go-round, always having slightly less income than expenses, always knowing that I could finance the life I wanted to lead with credit cards and that someday, my income would actually match my worth, and I’d pay off the cards.
Along the way, I married and had a child. My husband and I had employer-based health insurance available to us, but as each year passed, the plans became less solid gold and more tarnished brass. Costs increased, as did co-pays, co-insurances, and worst of all, our premium contributions. When we moved to Vermont in 1999, we paid $600 every month out of our pockets for my husband’s family plan, which didn’t cover much. Our co-pays were high, the physician network limited. My husband’s job searches (I was now self-employed, and individual coverage was unaffordable) revolved around how much benefits cost, rather than how interesting were the jobs.
But we managed. My husband, an R.N., changed employers regularly, always searching for elusive dollars and comprehensive benefits. We were keeping our heads above water, just, and were even saving a little each year.
Then the wheels came off. My husband was injured at work and became permanently disabled in 2010. His employer let us remain on their group policy for two more years at our own expense before they cut us off. Now, I needed individual coverage for my family, and once again, I turned to credit cards to cover the gap between our reduced income and our increasing expenses. By 2014, our family insurance premiums had mushroomed to $1,375. In 2019, with only two of us now covered, our health insurance ballooned to over $1,500 every month plus approximately $500 of co-pays, co-insurances, deductibles, and non-covered expenses. Our healthcare costs exceeded our housing costs for the first time, but because I could not afford the co-pays, I only saw a doctor if I was close to death, or my prescriptions needed renewals.
In a nutshell, this constant struggle to pay for health care is a major part of my life’s story over the last 40 years. Like most people in their early 60’s, I have some chronic, pre-existing conditions, but I am generally healthy. My husband is disabled but stable, so his costs are predictable. However, by early 2019, it was clear that the sheer price of our health care had mushroomed to a point where we could no longer afford to live in the U.S. The last four years have left us in massive debt which, not surprisingly, aligns almost exactly with the amount we have paid for healthcare over the same period.
We moved to Costa Rica this past June. The biggest driver in our move was not the beauty of the country, or our desire to learn a new language, but rather finding a location where we could access quality healthcare at a lower price. Our combined insurance premium is now $203.10 per month. It doesn’t cover everything, but our cost, including out-of-pocket expenses, is a small fraction of what we were paying. Yes, there are waiting times, but those existed in Vermont, too, even with platinum coverage. What I can’t put a price on is my peace of mind. For the first time in 40 years, I know I am fully covered for emergencies, and I can afford to pay privately for anything else I might need.
Moving to a tropical paradise should be this story’s happy ending. After six months here, we are loving our new life, and both of us feel much better physically and mentally without the constant money worries. Our total debt figure is whittling down, and I can see a way forward where one day, our income will exceed our expenses by a substantial amount.
At this point, I was hopeful that I’d be able to say, “And they all lived happily ever after.”
Now President Trump wants to make my husband’s Social Security disability payment vanish, which will finally plunge us into poverty from the middle-class existence we have so tenuously clung to all these years.
Today, I’m not sure how our story ends; this fresh uncertainty may be the scariest ending of all.