Cigarettes, cable and personal responsibility

"Go ahead caller," the radio host announced.

"My wife got breast cancer and died because the insurance company wouldn't give her the medicine she needed," the caller bluntly stated.

Convinced his insurance company caused his wife's death, the caller lashed out at the radio host … while expressing his desire for a government-controlled system, one he feels will keep others from experiencing his tragedy. The host quickly learned that discussing health care often becomes an emotional moving target where participants rapidly move from tears … to panic … to blind rage. 

The caller's grief notwithstanding, the insurance company did not pick her name out of a hat and condemn his wife; she died because of a merciless disease: breast cancer. Long before she became ill, the insurance company's policy was signed by all parties; everyone knew what was and wasn't covered, but life often throws curve balls that extend beyond "reasonable and customary" charges. In those cases, grief can ignore the details and instead rages in hopes of somehow creating comfort – by placing blame.

I understand his fear and the feelings of helplessness driving his rage. This week, my wife, Gracie, underwent her 73rd operation since having a devastating car accident as a teenager in 1983. Not only did the accident eventually claim her legs, but she lives with a staggering amount of pain from the massive trauma to her body. For more than two decades we've fought insurance company policies, worked with three dozen specialists, spent uncounted nights in hospitals and learned the American health-care system from the inside out.

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Can this system be survived by "regular people," or are we inevitably dependent upon political solutions?

Without any government assistance, including disability payments, Gracie's nearly $9 million in medical bills are paid. Through constant vigilance, we two music majors (who never took "Insurance Reimbursement 101") continue to hold the feet of insurance companies to the fire, making sure every bill is paid. Though Gracie's insurance company (a common insurer covering millions of customers) regularly covers claims, we still must meet a deductible and co-pay beginning every January. Taking a nearly $2,500 hit at the beginning of every year is not easy, but we do it by eliminating things in our monthly budget like cable television and other unnecessary items. We also are responsible for monthly prescription co-pays, each ranging from $4 to $50 (depending upon the drug), heaping sometimes as much as an additional $5,000 per year. Media hype would make it seem that without government help only the wealthy could afford such a thing. Yet the bills are paid, although for more than 20 years our family's annual income averaged less than $65,000.

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Like the caller, denials also arrive in my mailbox, yet I appeal each one. If her doctors say she needs a drug or a procedure, I can't take "no" for an answer; her ability to walk, or even live, is at stake. 

Can appeals be won by everyday citizens?

To date, I have never lost an appeal. Last year, we won an appeal that continues to cover $10,000 monthly in prescription drugs. Although facing tough opposition, we succeeded. I'm unsure if the heartbroken caller chose that option, but hopefully others reading this will be encouraged to challenge the system.

Another flashpoint in the health-care debate is covering the "uninsurable." Can individuals with catastrophic medical issues obtain private health coverage?

Although classified as such, Gracie has changed policies six times since her wreck – each without an hour's gap in coverage. Her initial policy expired within three years of her accident, so I made career choices that put her coverage ahead of my ambition, and chose to work at large companies offering group policies with provisions for Gracie. On several occasions we experienced overlaps on the policies and paid two monthly premiums while Gracie fulfilled a waiting period due to pre-existing conditions – but after wait times ranging six months to a year, we successfully transferred coverage to the new company and dropped the former policy. 

Although the system requires improvement, it has a good foundation, and through sacrifice and responsible decisions, "regular people" can live within the current system, even without the government. America created plans to help the elderly and disabled (Medicare), the poor (Medicaid) and our military (VA). A smorgasbord of private-sector insurance policies is available to those who make responsible decisions for themselves and their families before getting ill or hurt. So why is it in a mess?

Excessive lawsuits, politicians using the system for their own gain, greed from all parties, rising costs and people refusing to make responsible choices all led us to this point. Obviously, there are no quick answers to these issues. We didn't get here overnight, and we have challenging years ahead of us … if we truly want to provide solutions instead of political trophies. 

But this is America. We've confronted many seemingly insurmountable challenges. We freed ourselves from an empire; brother fought against brother to free slaves; the Greatest Generation fought and stopped one of the darkest evils ever to spread; and when the towers fell, we rose as a nation.

This "crisis" is redeemable, but it requires sacrifice from everyone, not just the rich. Just as everyone gets sick and needs care, everyone must participate in this solution. Though this battle is not against an outside force, health-care reform will test our courage and character all the same.

The solution is not complicated, but it is challenging. As my family does every day, our country must sit down with the checkbook and ask tough questions:

• Do we, yet again, allow politicians to throw our money at a problem simply to shore up their political front? Or do we demand politicians put aside self-interest and serve their bosses, the American people?
• Should we limit lawsuits?
• If a Medicaid recipient can afford cigarettes or cable television, shouldn't they be required to pay a modest annual deductible and a nominal co-pay for their prescriptions?
• Should I (and people with similar circumstances) be forced to subsidize individuals unwilling to make the same responsible choices I continue to make?

Although just one voice, I'm asking you to join with me and explore these questions. Ours is just one family daily facing brutal health challenges – but we prevail.

The question is: Will our nation do the same?

Peter Rosenberger is president of Standing With Hope Inc., which is the nonprofit prosthetic limb outreach he and his wife, Gracie, founded in 2002. Peter and Gracie, along with their two sons, have been interviewed by various organizations including People magazine, the "Today" show and the Associated Press.