Is Rape Insurance Worth It?

(or, what I do when I’m bored on a Saturday morning)

Insurance, n.: coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril.

There has been a lot of talk lately about what has been dubbed the Rape Insurance law in Michigan, which recently went into effect. The law came about because sincere pro-lifers did not want to be party to abortions through paying their money into an insurance pool that covered them.  The idea was to separate the insurance pools for pro-life and pro-choice supporters.  Those who believe in supporting choice for others, or who believe they would/could make that choice for themselves, could elect to purchase the abortion coverage rider, and those who believe it is wrong in any circumstances would be comfortable that their money was not paying for any abortions. This is not a bill having anything to do with insuring against rape. It discusses insuring against the need for an abortion.

There are some gray areas.  Situations where the mother’s life is in danger are in one possible gray area where even some on the pro-life side believe a woman should be able to have a life-saving abortion.  Situations involving miscarriage are another: A procedure known as a D&C is commonly used when a woman is diagnosed as miscarrying, and some have classified this as a kind of abortion and used that classification to deny service or payment.  As far as I can tell, the “rape insurance” bill covers the first gray area with an specific exemption when the mother’s life is in danger. I have not been able to find any evidence that it covers the second gray area mentioned above, but the only reports I’ve seen are from opponents of the law claiming that it “could” prevent payment for medically-necessary D&C procedures; without evidence, I have to discount that claim.  So the only thing left to discuss at the moment is what everybody generally considers an abortion: ending an established pregnancy that does not appear likely to end on its own and does not threaten the mother’s life.

We’ve defined the bill; now let’s define insurance.  What we call “insurance” when it comes to health care today really isn’t.  The “insurance” we now all are required to carry is more of a health maintenance plan, a payment plan, a way to distribute all health care costs among the population.  Insurance, on the other hand, is like a bet between the insured and the insurance company: the insured is betting that they will require expensive medical care, and the insurance company is betting that they will not require this expensive medical care.  If the insured is right, they get back more in payments for health care than they paid in premiums.  If the insurance company is right, they never have to pay more for that health care than they received in premiums.  Both parties are in it to make money, essentially.

Remember that nobody who has not bought into the insurance pool is covered for any procedure whatsoever.  You can’t say that your premiums are going to benefit another person who can’t pay because that person has to pay, or they aren’t in the pool.  So I just had to wonder: would it be worth it to me purchase the rape insurance rider, so that my health insurance would pay if I needed or desired any procedure resembling an abortion?  (Assuming that I felt this was a path I could ever take, of course.)

The only cost I’ve seen so far suggests that the rider would be 32 cents per month, or a total of $153.60 for a 40-year reproductive life from 12-52 years of age.  (Since there would never be a need for an abortion before menarche or after menopause, obviously purchasing the rider during these periods of life would be a losing proposition for a woman.)  This would provide insurance coverage for an abortion equivalent to other insurance coverage.  With my own health insurance plan, this means that I would pay 100% for an abortion before meeting my deductible, 10% if I have met my deductible but not my out-of-pocket cap, and 0% if I have met my out-of-pocket cap for the year.  We usually meet the deductible by April, and about half the time we hit the cap before the end of the year.  Depending on when my need for abortion would occur, 25% of the time I would pay 100%, 63% of the time I would pay 10%, and 12% of the time I would pay nothing at all.

The average cash cost of an abortion in Michigan, pharmaceutical or surgical, appears to range from $300-$700, so I’ll take the median of $500 for my calculations.  With my insurance coverage, I might have to pay all of that $500, or only $50, or nothing at all.  Assuming my abortion need would be equally likely to occur at any time of the year, my statistically-probable cost for the abortion is $156.50.

Statistics say that I have a 25% chance of being raped at some point in my life.  Only half of my life includes reproductive years, though; any rapes occurring outside that 40-year span could not result in a pregnancy.  In addition, there are only about 5 possible fertile days in each menstrual cycle, and each sex act during a fertile period has only about a 25% chance of resulting in a pregnancy.  Assuming that I never use birth control, and discounting any time that I spend actually pregnant, postpartum, or in lactation-induced amenorrhea (which for me this life was actually a total of 6 years), that leaves me with 2400 fertile days over an 80-year (29,200-day) lifespan, or 8.2% of my life.  I have about a 0.5% chance of suffering a rape that results in a pregnancy.

I’m going to discount right here the possibility of having a pregnancy where the baby was sure to die after birth.  I have disabled children already as well as children who had a pretty good chance of dying at birth, and I can’t personally imagine not giving any child every possible opportunity to beat the odds.  That’s not to mention that I just don’t participate in most of the testing that would result in that kind of in-utero diagnosis.  So I’m going to save myself the math on this one.

So, I have 0.5% chance of needing a procedure that is likely to cost me $500 without insurance and $156.50 with the insurance.  The insurance will cost me $153.60 over my reproductive lifetime, which means that if I need this procedure once, I will likely pay $310.10 for it with the insurance coverage, possibly as much as $653.60 if I need it at the wrong time.  If I choose not to purchase the additional coverage, and I instead place that 32 cents into a savings account every month like the one I currently have, I would have $156.71 at the end of 40 years (boy, do interest rates suck these days!).

I have to say, that’s a tough call.  I have very, very, very little chance of personally requiring an abortion, and I can’t see a circumstance where the cost of the abortion would be prohibitive, especially knowing there are places that operate on a sliding scale or payment plans for times in my life when cash was tight.  The odds are in my favor that I will come out ahead by not purchasing the rider, and the insurance company has a strong incentive to offer this rider because they are likely to come out ahead on anybody who purchases it, especially considering that anti-discrimination laws and people who just don’t pay attention mean that the rider will probably be purchased by more people incapable of getting pregnant that by those who are.  Recent reports state that most insurance companies were not planning on providing this rider as of the time the law went into effect; however, I suspect that most were simply waiting to see if the law was going to be killed before going into effect, so they could save themselves the paperwork and programming to implement the special rider.  I can’t see most companies forgoing this opportunity to make more money, so I expect most companies will be adding this rider to their available policies very soon.

The Kender Report

Kender has had a busy week. On Monday, he went under anesthesia for an eye exam, which showed nothing new. Dr. Trese said we could start backing off one of the three eye drops Kender takes every day, which is happy news.

The bigger event was Wednesday, when Kender went under anesthesia again, this time for dental work.  At five years old, Kender has never had a successful dental exam. Until just last year he wouldn’t even let us clean his teeth regularly. Since we started using a spin-brush and singing a song, he lets us brush his teeth so well that the dentist could find no fault with our cleaning job.

The damage of years past was already done, though. Dr. Meyers gave Kender eight filling, four caps, and one baby root canal. The root canal in particular means he’s probably been in pain from his teeth for who knows how long. How exciting that we found and fixed yet another source of pain for him, and sad that he was in pain at all.

Two surgeries in one week were a little rough on Kender. He was droopy for a couple of days, much slower to wake up than usual, and one evening he even ran a brief fever. Today he seems to be back to his usual self.

I am so excited about the potential developmental leaps Kender may make now that his teeth are fixed, much like the incredible progress he made in 2012 after his eye pain was relieved. I want to say I see changes already, longer speeches and more paraphrasing replacing straight mimicry. In reality, it’s probably too soon to see any definite improvement, and I need to sit back and relax. A hard thing to do sometimes!

Blind Binarism

This post has been sitting in the back of my mind for a while.  It started with a post about disability binarism, the idea that everyone is either completely disabled or completed abled.  On its face, most reasonable people would agree that this idea is as silly as the idea of people being only black, white, Hispanic, Asian, etc., when it comes to race, when obviously you have a ton of people who are some mix of two or more races.  However, that question that keeps popping up on surveys and forms and the census and seemingly everywhere these days asking everybody to quantify their race with only one box shows that black-and-white attitude toward race obviously still exists.  The same is true when it comes to disability, and especially to blindness.

What do you think of when I say somebody is blind?  For most people, the image that comes to mind is somebody who is completely blind and can’t see a thing, even light and dark.  What if I told you that the vast majority of blind people I have known actually have some vision?  There two legal definitions: “Visually Impaired” is a best-corrected acuity of 20/70 or worse in the better eye, and “Legally Blind” is a best-corrected acuity of 20/200 or worse in the better eye.  There is a huge spectrum between legally blind and total vision loss.

Someone with partial vision may be able to read normal print held in their hand, but unable to see the blackboard in a classroom.  They may be able to walk around, avoid obstacles, and recognize faces, but not be able to read the menu at McDonald’s.  They may able to see during the day but not at night, or vice versa.  They may not have stereo or color vision.  They may see the world as if through a permanent fog, or through a broken glass, or in a funhouse mirror.  They may be able to see the sidewalk but not the curb, the countertop but not the steps, the table but not the chairs.

Blind binarism and ableism come into play when a person seems on the surface to be able to negotiate the world as well as a sighted person.  Binarism says that this person is, therefore, “not blind” and does not need the tools and skills of a “real” blind person.  This is a big deal because this attitude exists not only among the general non-blind public but also among some of those very people whose job it is to educate and train our children in the skills of blindness so that they can become independent, functional, and productive adults.  Every month, sometimes every week, our blind homeschooling community welcomes a new refugee from the government school system, a family that has been told their child doesn’t need Braille even though they can’t read regular print, that their child doesn’t need to learn to use a cane even though they trip over every curb and step, that their child doesn’t need to know the skills of blindness in the kitchen or around the house even though they might injure themselves or be unable to live independently if they don’t.

This attitude also affects how blind people choose to function in the world.  Should I carry my cane into this new place so that I can be sure of not falling over something, or should I wing it so that I won’t be identified as blind?  Or, conversely, should I carry my cane into this place that I know well enough not to need it just to spare my family from being berated by somebody who thinks we don’t need our handicapped plates?  Do I use Braille on a daily basis for those things for which it makes sense, or do I struggle to use declining vision so as not to appear disabled?  Do I fight for the accommodations I need in the workplace to function on a level with my peers, or do I settle for lower wages and substandard employment and a government check?  There is a lot of pressure on “high partials” to pass for sighted, to blend in with the sighted world and not cause trouble.

All the visually impaired people in my family fall along this spectrum.  I have one daughter who is not legally impaired but has low vision in one eye, another daughter who is not quite legally impaired but can’t see well enough to drive (that cutoff is usually around 20/50), one son who is impaired but mostly functions as sighted since he is not in school, and another son and husband who are partially sighted in one eye and have no functional vision in the other eye.  None of them look blind when people first meet them, unless they notice my husband’s or my son’s deformed eyes.  All of them are impaired to some extent, though, and benefit already from using various skills of blindness at various times. All of my impaired children are being taught the skills of blindness, as their condition can be suddenly degenerative, and they could need these skills later in life.

It’s not all or nothing.  There’s a lot of gray.

DNR

An article over at the New York Post on end-of-life care caught my attention this morning.  You really have to read through the whole thing to get the full impact of it.  The issues raised here resonate with me, in both my experiences and my beliefs.

There was a time when I would have told anybody to do anything necessary to keep me alive.  I think we all do at same point, as we go through that phase of feeling immortal.  I even left that instruction behind, along with others, the last time I went in for surgery.  I would not say that any longer.

Back in 2007, my grandmother died.  Her last years were spent in a flurry of progressively invasive medical care as one body system after another failed.  I thought for several years that she would die any time, and I would expect to get that phone call saying, “Your grandmother is dead. She died in her sleep.”  Instead, I would hear that grandma had a heart attack, spent time in the hospital, got more drugs, and went home.  Now grandma is in congestive heart failure, she had another hospital stay and got some different drugs.  Now her kidneys are failing, so she needs dialysis and more drugs.  She had strokes, mini-strokes, illnesses that turned severe.  It was one thing after another, and I’m glad that I was out of state at the time and couldn’t see her regularly.  The thought of my feisty, crafty, Betty Boop-loving, gumbo-cooking grandmother reduced to that state of living past her body’s time limit makes me very sad.

At one point, Grandma got so sick with what I think was a respiratory infection that she ended up in the ICU on a ventilator, and the doctors weren’t sure she would make it.  She did make it that time, but as soon as they extubated her, she said, “Don’t you ever do that to me again!”  (I wasn’t there, only hearing about it second-hand, but I can just see her face and hear her tone of voice when she did it…Grandma was PISSED!) I talked with my mother about letting her go, about letting her die peacefully instead of trying to fight it so hard.  It wasn’t our decision though, and I have to accept that my grandfather was not about to let go of one second with his beloved that could be gained by intervention.

I have other stories I could tell.  I could speak of the things I saw done to my mother when she was in Critical Care during her chemotherapy treatments, the indignities she suffered, the way every doctor seemed hell-bent on treating her as a statistic in their own subspecialty instead of as a whole woman with integrated body systems, the way it was so hard for me to get the information I needed to make decisions for her when she was incapable.  I could speak of the stories told by my friend Angel back in Texas about his experience with cancer in his teens, what it felt like to be resuscitated by paddles after cardiac arrest, how he never again wanted to be saved or rescued or placed in intensive care.

Ultimately, though, the stories will never be enough.  All of this comes down to our attitude toward death as a culture.  We have removed ourselves from death, banished Her from our perceptions thoroughly.  We mourn and cry at the deaths of those who have lived full lives and died at their due time, as if death does not come for us all in the end.  Death is never natural anymore; it always has a cause, and that cause is always preventable.  No death is ever acceptable.  We live in a padded-room society swaddled in rules, regulations, safety precautions, and securities, determined that life-everlasting must be possible if only we do all the right things.  Then, even after we die, we embalm, we entomb, we fill the bodies with chemicals and then enclose them in expensive, waterproof concrete grave liners, maybe even steel-lined graves, in the expectation that at least the body will never rot even after the spirit has left.

I may not be the gothiest goth you ever met, but I have regarded myself as goth for a long time for one simple reason: I accept and embrace death and the darker things in life.  I wish that society could come just a little over to the dark side with me, enough to bring balance back into our culture.  I’ll grant you your padded-room life if you want it, as long as you don’t impose it on me and my family.  In return, I’d like to have some respect for the end of life, the expected end we all face.  I still want to rage against Chris’ death and expect to spend a long, long time still coming to terms with it.  But I want grandparents to die at home, in their beds, surrounded by family, not in hospital filled with tubes surrounded by medical professionals and beeps and lights.  I want it to be easier for a terminal patient to say, “Enough!” and stop treatment, going home to die or even choosing to hasten death on their own terms.

And when old people die, I want to celebrate their lives and share memories with those still alive, not be expected to cry and mourn over something that is a perfectly natural part of life.

My mother told me that she wants me to scatter her ashes from the top of the Mt. Crested Butte ski lift when she dies.  I like that idea.  Myself, I think I want a green burial somewhere quiet and peaceful, or maybe an illicit burial in my kids’ backyard with a tree planted on top (then I can be a vicious libertarian rule-breaker even in my death!).  I plan to celebrate all the wonderful parts of my mother’s life when she leaves us for good, and I hope somebody throws one helluva wild party when I go.  No crying allowed.

Well-Meaning Advice

There is little more frustrating in life than to be given advice that has already been tried, maybe even failed.  It happens all the time.  New mothers get it in truckloads, advice for breastfeeding, sleeping, feeding, comforting, walking, toys, that advice never ends.

It also comes in difficult situations.  Chronic pain.  Disability.

Or what happened last week.

Those giving the advice mean well, I know.  You can’t really get upset at them for trying, because all they want to do is help.  They’re thinking that maybe they’ve got the one little piece that you just haven’t heard yet, that maybe they’ve got something that can finally help.  I know.  I’ve been on the giving end of this exchange many times, and it’s always because I just want to help, and sometimes I do know things others haven’t learned yet.

batslapTo be on the receiving end of this exchange, though, is to feel like screaming and throwing things in frustration.  Sometimes hearing that well-meaning advice feels like a knife wound, because you’ve done that, you tried that, and then the feeling comes that maybe you didn’t try hard enough, maybe you didn’t do it right, so it really is your fault anyway.  Sometimes you want to yell at the person in question, give them that Batman-Robin smack and say, “But I DID that already! It doesn’t work! Don’t you listen?!”

Those of us in chronic pain have generally tried absolutely everything we can get our hands on legally (and maybe illegally, too).  We’ll chase down the craziest rumors in the hopes of finding that one magic trick.  And yet we still have to listen to the litany of the same recommendations every time somebody new finds out about our pain, from Advil to stress management to “get more sleep.”  We hear it over and over until sometimes we’re afraid to tell anybody about our pain, we stop getting any help at all because we’re so frustrated at getting what seems to us like the same useless help all the time.

I have a five-year-old son who has never pooped in the potty.  Believe me when I say I have tried everything I can dig up or think of.  He’s blind and autistic, he just hasn’t made the connection, and I can’t figure out how to make the connection for him.  It’s the same as with pee, and with that what I had to do finally was force the issue and reward him for being on the potty, and he got it.  It’s not control, it’s not power, it’s not a game or a joke.  We’ve done the dolls, we’ve tried books and movies and tablet apps, none of which he interacts with.  We’ve talked, we’ve demonstrated, we’ve tried all of that.  More than anything, I would love to find that one person who has the magic secret that will fix this, but every time I reach out about it, I get the same advice.  So I don’t talk about it much.

Then there’s Chris.  The level of frustration here is overwhelming, because it’s not just pain, it’s not just cleaning excrement off the carpets or making baby food.  People frakking DIED, and those of us left behind feel like we failed somewhere.  Again, we get all kinds of advice, not for Chris obviously but to try out next time we find ourselves supporting someone like her (which I hope I never have to do again, but I will if I see it, I will).  The same frustration goes through my mind when I hear the things that we did recommended to us as something that might have stopped her death.  Did we not do it right?  What gaping hole did we leave in the shield wall we tried to build for her?  And if it wasn’t good enough for Chris, maybe it won’t be good enough next time, and I’ll have to watch it happen all over again because I didn’t do it right.

To those on the receiving end of this kind of advice, know that you are not alone, you are not the only one fighting this frustration.  You are under no obligation to those who give you advice, not in whether you take it or how you take it, but just remember that most people give advice out of a genuine desire to help.

To those giving this kind of advice:  Try to understand when we lash out in frustration, and know that it is not really you, we don’t want to push you away, we’re just expressing the turmoil we feel in not being able to find a solution of our own.  Give us a little space, and then please…come back and try again (maybe without more advice, though).  Be there for us.  We need your support even when we can’t use your advice, even when we go turtle and hunker down and try not to bother anybody with our pain.