My Most Dangerous Year
How I discovered our entire healthcare system is a mess.
While the mob-style assassination of United Healthcare CEO Brian Thompson last December was a shock to most of us, a surprising percentage of the population cheered on his assailant.
In my view, whacking corporate CEOs isn’t an acceptable method of solving grievances. But perhaps the Bonnie-and-Clyde-esque idolization of someone seen as striking a blow to the system is a symptom of capitalism run amok.
In any event, the conversation surrounding the state of the insurance industry, healthcare in America more broadly, and now the possible gutting of Social Security, Medicaid, and Medicare, led me to reflect on my decades of experiences with an industry that repeatedly falls short when we need it most.
In retrospect, one of my most heated workplace disagreements occurred on a trading floor, not over the economy or a bond trade gone wrong, but over whether or not healthcare is, or should be, a human right. My coworker believed the government had no business providing a safety net for citizens without insurance, even if their health was in jeopardy. I took the other side of the argument.
“What if you get sick and lose your job?” I asked. “You won’t have insurance, so what then?”
“You can pay for it with COBRA,” he countered.
“But COBRA is expensive,” I said. “With no job, how would anyone afford it?”
His response was something to the effect of, “Then I guess they’re shit out of luck.”
The conversation surrounding the state of the insurance industry, healthcare in America more broadly, and now the possible gutting of Social Security, Medicaid, and Medicare, led me to reflect on my decades of experiences with an industry that repeatedly falls short when we need it most.
We never came to a meeting of the minds that day thirty years ago, but I remember thinking how fortunate I was not to live in the dystopian world my coworker seemed to advocate for.
I was shocked by the fact that my coworker seemed fine with leaving sick Americans to die like so much discarded trash. Determined to have the last word, I ended our heated conversation by saying, “Ok dude, but just wait until one of your parents gets sick!”
***
When I left that job in 1994 to start a small business, health insurance was the last thing on my mind. That was one of my biggest mistakes as an entrepreneur. Unlike my former employer, which was large enough to offer group health insurance, mine was a small startup company, which meant my options were limited. After much searching, I selected a plan offered by Mega Life Insurance, a company that ostensibly catered to small businesses. The plan I chose was more expensive than that of my previous employer, but it was the least bad of the choices offered.
My first claim through Mega Life was a prescription for an Albuterol inhaler for my asthma, a condition I’ve had since childhood. The company’s underwriters determined this was a preexisting condition not covered under my insurance policy. The claim was denied. So was my next claim. And the next one.
As it turned out, Mega Life operated a lot like Great Western, the fictional insurance company in The Rainmaker, the film based on a John Grisham novel. It's about an insurance company that never pays its customers’ claims.
The entire time I held a policy with Mega Life Insurance, the company never covered a single one of my claims. After a year or so of paying monthly premiums, I decided to drop my coverage and take my chances. Fortunately, aside from my asthma, I was young and healthy.
But that wasn’t the case almost twenty-five years later, the day after Christmas in 2018. That was the day I almost died.
A relevant health insurance claim denial scene from John Grisham’s/Francis Ford Coppola’s The Rainmaker:
***
In 2018, a few days before Hurricane Florence hit the North Carolina coast, I learned my one-year contract as Director of Business Development at the University of North Carolina at Wilmington’s biopharma accelerator would not be renewed.
To be honest, I wasn’t that upset about being laid off, even though I liked my job. After running my Arkansas startup for five years, I spent more than a decade as a trader on Wall Street before moving to North Carolina in 2012. By the time my contract was up, I’d concluded my decades in finance rendered me unsuitable for the slow-paced world of academia.
On top of a two-hour round-trip commute to work each day, my state-sponsored insurance plan cost well over $1,000 a month. In fact, insurance was my largest expense—even more than my rent.
After the hurricane, North Carolina’s unemployment system was so overwhelmed, the state’s online platform was broken. I ended up driving to an unemployment office an hour away to file my claim in person. A month later, my application still hadn’t been processed.
As it turned out, Mega Life operated a lot like Great Western, the fictional insurance company in The Rainmaker, the film based on a John Grisham novel. It's about an insurance company that never pays its customers’ claims. The entire time I held a policy with Mega Life Insurance, the company never covered a single one of my claims.
That December, I applied for health insurance coverage under the Affordable Care Act, more commonly known as Obamacare. There were only a few weeks left in the year, so I opted for a plan with a high out-of-pocket rate and no premium. I figured that since the year was essentially over, a plan with no premium and a $5,000 out-of-pocket cap seemed worth the risk. It wasn’t.
About a week before Christmas, I began to experience what I thought was an allergic reaction to the live tree in the house. That’s one of the side effects of asthma, so didn’t give it much thought. But by Christmas, I could barely walk through our house without stopping to catch my breath. It was the worst bout of asthma I’d ever had. But I was so sure it would pass, I never considered seeing a doctor.
The day after Christmas, I was home with my two teenagers when I had what I thought was an asthma attack. It was so difficult to breathe, I couldn’t call for help. My son saw me as I crawled into the hallway and screamed for his sister. I can remember the panic on their faces like it was yesterday.
I’ve heard it said that everybody gets religion when they’re on death’s doorstep. Believe me, it’s true. Even though I’m not particularly religious, I started praying, “Please God, not like this. Don’t let me die in front of my children.” Fortunately, my wife's job was close by. She rushed home and drove me to an emergency room.
What I thought was an asthma attack was actually the result of a heart condition called atrial fibrillation, or AFib. Aside from an irregular heartbeat, a side effect of AFib was an accumulation of fluid in my lower legs and lungs, which was why I had so much trouble breathing.
My condition also set off a domino of other health problems. I was diagnosed with congestive heart failure. My weight ballooned from around 250 to almost 375 pounds. My kidney function was at only fifty percent. So much fluid was in my lower extremities that I developed edema. To top it all off, I also became diabetic. So instead of being treated for an asthma attack in the ER, then being sent home, I was admitted to the hospital.
For the next week, doctors tried to fix me. The first thing they did was put me on Lasix to help get the excess fluid out of my system. The dosage they recommended was so high it could only be administered intravenously. By the time I checked out of the hospital on New Year's Day, I’d dropped more than twenty-five pounds.
I felt a little bit better, but because my insurance policy had a high out-of-pocket cap, the week in the hospital left us with thousands in medical bills. I’d been unemployed since September, so the timing couldn't have been worse.
The next day, the last of my late mother’s siblings, an aunt who was like a second mother to me, passed away. I was too sick—and too broke—to travel to Arkansas for her funeral. All I could do was watch the livestream on Facebook. I remember thinking, “What a shitty way to start the new year.”
***
The first few months of the new year in 2019 were a nightmare. North Carolina was still recovering from Hurricane Florence, so dozens of businesses shut down. On the island, every other home in the area was either being repaired or demolished. I’d survived the worst part of my health scare, but I was still in such bad shape I couldn’t walk ten feet without stopping to catch my breath. My unemployment lasted only a few weeks, and there was no way that, even if I found a job, I could work.
Every week, I went to a wound clinic 25-miles away in Wilmington to have my legs wrapped in bandages to address the fluid seeping from my legs. A nurse came to my home once a week to change my bandages. I was also seeing a cardiologist, a nephrologist (a doctor who treats patients with kidney disease), and my general practitioner every couple of weeks.
I was also taking a dozen different prescription medications. While my insurance premium through the ACA was almost zero, my prescription drug deductible was around $300. Even after covering that, I was still spending over $100 a month on meds. Which was tough to afford, given that I was still physically unable to work.
The only positive, albeit bittersweet news, was that I’d inherited money from my aunt who passed away. It wasn’t enough to make me rich, but it was enough to help with a down payment on a new house. But her estate had yet to go through probate, so it would be months before I saw my inheritance.
I’ve heard it said that everybody gets religion when they’re on death’s doorstep. Believe me, it’s true. Even though I’m not particularly religious, I started praying, “Please God, not like this. Don’t let me die in front of my children.” Fortunately, my wife's job was close by. She rushed home and drove me to an emergency room. What I thought was an asthma attack was actually the result of a heart condition called atrial fibrillation, or AFib.
Given the situation, we had to make some tough decisions. But after being unemployed for months, I didn’t have much of a choice. I found a company that would advance the money I stood to inherit, but it was extremely expensive. After their fees, a chunk of my inheritance was gone. I also decided to file for Social Security disability. Given my condition, I felt I stood a good chance of being approved.
“Why does it take so long to get a decision?” I asked. The case manager was sympathetic. “I understand,” she said. “A lot of people are living in their cars by the time they get their first disability check.”
The Social Security Administration’s application process is about as old school as it gets. For starters, there is a five-month waiting period from the time a person becomes disabled until they are eligible to apply for disability benefits. The final decision is made after a hearing before a judge. If you get approved, you’ll get benefits retroactively. Instead of an online form, I had to print out a lengthy application and complete it longhand.
A few weeks after I mailed in my disability claim, I called the local Social Security office to find out the status of my case. The person I spoke with explained that it would be at least six months before my hearing. After that, it could be several more weeks before the court rendered a decision on my claim.
I explained that I’d been sick since December of the previous year, and out of work for months before that. “How can it take so long to get a decision?“ I asked. The case manager was sympathetic. “I understand,” she said. “A lot of people are living in their cars by the time they get their first disability check.”
Because of my age (I’d turned 61 that April), she advised me to apply for regular Social Security benefits in the meantime. I followed her advice, and in the summer of 2019, received my first Social Security payment. Most of my inheritance was spent by then, and I still didn’t have a disability decision. Finally, I hired an attorney to help move things forward.
That October, I received a package from the Social Security Administration, not with my hearing date, but with forms requesting my educational background, work history, and a list of my professional skills. It was as if they were trying to figure out some type of work I might be able to do, regardless of how sick I was.
***
When the pandemic hit in early 2020, I was still so sick, I rarely left home anyway. For all intents and purposes, I’d been under a lockdown since the day after Christmas in 2018.
One day, I got another letter from the Social Security Administration. They’d come up with two jobs the determined I was qualified for, based on my experience: the president of a bank, or of a brokerage firm. The idea that I could just walk into a bank and apply for a job as its president was so ridiculous, my wife and I laughed about it the rest of the day.
***
One day in 2021 I got an email from Blue Cross Blue Shield, my insurance company at the time, with a proposition. They’d partnered with Virta Health, a company that specialized in diabetes reversal and sustainable weight management. If I was interested in participating, they’d cover the cost of enrolling me in Virta’s program. I decided to give it a shot.
I decided to file for Social Security disability. Given my condition, I felt I stood a good chance of being approved. “Why does it take so long to get a decision?” I asked. The case manager was sympathetic. “I understand,” she said. “A lot of people are living in their cars by the time they get their first disability check.”
On March 21, 2021, about two years after filing my claim, I finally had my disability hearing. By then, my doctors had my atrial fibrillation under control, and my kidney function was almost normal. I even was able to ride a bike around the neighborhood. Thanks to a year in the Virta program, I’d lost over a hundred pounds. On the flip side, Blue Cross Blue Shield decided to stop partnering with them. Virta said that if I wanted to continue, it would cost me about $1,500 a month. Needless to say, that wasn’t an option.
A few weeks after my hearing, I received a decision from the Social Security Administration. My request for disability compensation was denied. I’m not sure why, but the judge didn’t believe I was as sick as I said I was. He even suggested that since I lived in a beach town, he was sure I’d been well enough to swim in the ocean. (I wasn’t.)
My attorney filed an appeal, but it went nowhere. When all was said and done, it was as though my brush with death, the hospital stays, the doctor visits, never happened. But there was a silver lining.
At least my family and I didn’t end up living in our car.
Previously, Marlon Weems took The Oldster Magazine Questionnaire.
 | A guest post by
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It's unbelievable how Americans have been told this lie about how we are the greatest country on Earth and then we are (with nearly full support from both parties of our sellout so-called democracy) ripped off from the cradle to the grave. Jobs stolen, houses stolen, rights stripped. Homeless veterans, teachers, seniors, and families. American Greed is the American Way now. It was already horrific, but the current administration seems to be engaged in a looting spree on steroids. What will become of us? I am so worried for my children. Thank you for sharing your story.
Oh, Marlon... I can't even imagine... I'm so glad you are still here.