One Athlete’s Struggle to Get Healthcare in America
Marc Peruzzi—a small-business co-owner, the parent of a child with a congenital heart defect, and avid skier and mountain biker—on what Trumpcare could mean for outdoor athletes, and the healthcare travails his family has already faced
“Have a nice baby.” That’s how one of my witty colleagues at Outside broke the tension and wished my wife Sarah and I luck before we headed to the hospital for the birth of our first child. A few days later, another friend came by the house to visit our newborn son, Jake, in Sarah’s arms. “You can cut the bliss with a knife,” he reported back to the staff.
This was July 2001. A few weeks later, on a routine checkup with our family physician and obstetrician, the doctor held a cold stethoscope to Jake’s chest and detected a rhythmic clicking and light rumble emanating from his heart. Follow up visits with the pediatric cardiologist revealed that Jake was born with aortic stenosis, a narrowing of the aortic valve, in this case due to a slight malformation in the valve doorways from a glitch in his DNA.
Mild aortic stenosis—one of the real pre-existing conditions—requires lifelong monitoring, while more serious cases may require a valvuloplasty procedure in which specialists expand a balloon in the valve via a catheter inserted in the femoral artery. The most severe cases require open-heart valve replacement surgery. At best, Jake would need expensive testing—echocardiograms and EKGs—once or twice a year until early adulthood. But our doctors assured us that, with proper medical attention, Jake would live a healthy and long life, and possibly never show a symptom.
Then, as Jake turned three months old, we made what could have been the most tragic blunder of our lives. With newborn Jake at home, Sarah took maternity leave from teaching school to underprivileged kids in Santa Fe, New Mexico. I left the editing desk behind and started life as a full-time freelance writer. In October 2001, I left Outside and signed on the government's interim insurance program known as COBRA, which lets you carry over coverage as a stopgap. We never thought about insurance until two months later when we started shopping for a new policy. In the unregulated insurance market before the Affordable Care Act, insurance companies were free to reject anybody with a pre-existing condition. One by one they did exactly that with Jake. Actually, there was one policy that would cover him. The quoted price: $2,600 per month, just for Jake. Around this same time, our doctors informed us he would indeed require that balloon valvuloplasty within the next 18 months—a procedure that, in 2001, cost upwards of $25,000.
Scrambling, I took an editing job with a Time Inc. division in Colorado, largely for the blue-ribbon health insurance that came with it. Because Time Inc.—and all large companies—negotiate massive contracts with insurance companies, Jake’s pre-existing condition no longer mattered. The deductible for an individual was less than $1,000. And unlike most plans at that time, there was no waiting period to clear the pre-existing condition. At 18 months, Jake underwent a successful procedure. And for six years, we enjoyed the type of health care that members of Congress receive. Routine check ups with tiny co-pays. Low out of pocket expenses. The chance to see any doctor we wanted. Sarah gave birth to our daughter, Ada, without a huge hit to our savings. And never a day went past when I wasn’t grateful for the premium coverage. Then, in 2008, a multi-national corporation bought our division and eventually I was downsized out of a job and out of our insurance.
This time, however, an early enactment of Obamacare on June 23, 2010 meant that companies were outlawed from rejecting those with pre-existing conditions. We could finally insure Jake on a private family plan. Still, the $1,900 a month policy was expensive and the Great Recession hit freelance writers hard. As the recession stagnated in its nadir, our family joined the many millions of American in the ranks of the uninsured for five months in late 2010. We, too, were simply priced out of coverage and were forced to drop it.
By the time Obamacare fully kicked in, a contract business I’d started with a few former business partners from our Time Inc. days, had grown into a small media company. We offered health care to all our employees as soon as the paperwork was finalized.
But here’s where the other fatal flaw in U.S. health care reared its head: runaway costs. Every year since we incorporated, the cost of the insurance we buy has gone up while the benefits have gone down. Today, the only health insurance a small business like ours can afford to offer is a catastrophic policy. For a plan that costs our business $37,000 per year and covers two families and one other employee (everyone else wisely signs on with a spouse), our insurance offers a $15,000 per family deductible; $7,000 for an individual.
Last year was particularly hard on my family. I was diagnosed with a heart arrhythmia. Within a six-week window, I spent all of my $7,000 deductible, and Jake, because he’s growing rapidly, needed not one annual checkup at the cardiologist, but two. That was another $6,000 gone. Throw in co-pays, and our grand total came to $14,000 in out of pocket medical expenses. That’s not a rounding error to us—that’s an existential hit to our income.
Now we're facing the impending threat of Trumpcare, the first iteration of which recently passed the House in a party line vote with only a few Republican holdouts. The first thing many of us sniffed out: the ability to reject those with pre-existing conditions is back. Those of us painted with that brush will go into so-called high risk pools where we’ll pay exorbitant premiums for substandard coverage. As an example, NPR reported the story of a Minnesota man diagnosed with pancreatic cancer who was in that state’s high-risk pool before Obamacare outlawed the practice. He paid $18,000 a year in coverage. House Republicans claim that the $25 billion they set aside for subsidies will help cover those costs, but a non-partisan research group says that will fall $153 billion short of needs.
But there’s another threat lurking: now your pre-existing condition can include your recent ski accident. As an outdoorsperson, you know that Alabama Congressman Mo Brooks was wrong when he recently hinted that “people who lead good lives” don’t have pre-existing conditions. Sarah and I have had three ACL reconstructions between us. My arrhythmia might be exercise induced. My collarbone surgery sure was. That chunk of meniscus floating around in your knee from a ski crash last year is a pre-existing condition. So, too, that balky shoulder from whitewater boating. Good living comes with its share of problems.
Before Obamacare, you’d have to wait two years to surgically fix one of those nagging sports injuries if you were adopting a new private insurance policy. The reason for that was clear: insurance companies need you to pay for a chunk of the services through your premiums. It will likely be the same under Trumpcare, unless you’re lucky enough to work for a company that offers benefits. Your trick knee will put you in a high-risk pool, which, fundamentally, requires you pay for the procedure up front through your premiums and deductibles.
There’s a better way. I once had dinner with a roomful of professional big mountain skiers in Austria. Recognizing a postoperative ACL brace on one woman, I asked her what happened. A Swede, she’d blown the ligament in a competition in Germany, but because both countries (and almost all of Europe) enjoy the benefits of nationalized single-payer health care, there was reciprocity between nation states. At least in her case her treatment meant no pre-authorizations. No scheduling weeks or months out. A few days after her diagnosis, before she even went home, German surgeons repaired her Swedish ACL. Europeans spend less on health care than Americans and reap better outcomes. According to the World Health Organization, the average Swede pays $5,228 per year on insurance (mostly through taxes); the average American (before Trumpcare) spends $9,451. The Swedes rank 9th for life expectancy; America, 31st.
Under Trumpcare, our outdoor pursuits—and just doing our best to raise healthy kids—have the potential to ruin us financially. My family doesn’t buy new cars. We don’t buy expensive vacations. We don’t buy fancy dinners on the town. More than anything, except for rent, we buy health care.