I think Em wants to die. She's not actually suicidal; she just can't afford to keep living.
Em's a breast-cancer survivor with a chronic leukemia that she's been living with for several years now. Research has stayed a few steps ahead of her, and new medications and treatments (and a lot of luck) have kept the condition from tipping over to acute phase.
Surviving cancer and chemo left Em susceptible to other illnesses. Her bone marrow just doesn't work quite right; it doesn't reliably store the components she needs to produce healthy blood cells. So she's often sick, picks up pneumonia once or twice a year, and has crappy pulmonary function. But you'd probably have a tough time noticing she's not in prime health, and she always bounces back from each setback.
It's not Em's body that's losing the game for her; it's her team: Blue Cross Blue Shield. And now there's a new ball in the game: a brain tumor.
She works for one of the largest employers in her state, but even they can't keep up with the spiraling costs of health insurance and health care. This year Em's employer had to stop offering dental and vision insurance. Copays went up, deductibles went up. And what's "standard and allowable" treatment under the one insurance plan that her employer still offers has decreased considerably.
For the past few years, Em's been working two or three jobs to get by. Her second job is with a small business that cannot afford to offer insurance to its employees. But it was ok; Em just used her wages from that job to pay for her copays, deductibles, and noncovered costs.
Em would qualify for disability but, as she points out, she's not disabled -- she just cannot afford to continue working much longer.
A few months ago, Em and her college-age daughter sold their second car. They've also sold some of the antique furniture that was passed down from Em's grandparents and great-grandparents. After sorting through some other things and deciding which child and grandchild wants what, Em sold some of her family's heirloom jewelry, too. She takes a medication in the middle of the night that makes her jumpy, so she stays up a bit in the wee hours and makes jewelry that she sells and does some freelance editing for a marketing company in India.
Even with help from pharmaceutical programs that subsidize her medications and the docs who provide some pro bono care, Em can't afford to keep her house very well-heated in the winter, and repairs have been backing up a bit. The neighbor kids have been helping out with her yard this summer, and her daughter's friends come over on Sundays to pitch in with heavy housekeeping. (Her other daughter, an Iraq war vet, is disabled and homeless right now; Em couldn't afford to help her this summer as she's been doing for the past four.)
Em will need to have this tumor removed, but her health insurance benefits have already capped out for this year, so it'll have to wait for next year. She says with a confident grin that she leads a charmed life and things will be fine.
But her house is growing a little emptier lately. She's selling things, giving things away. She's made note of her safe deposit box, but one thing that isn't it that box anymore is a medal she received from a former Chairman of the Joint Chiefs of Staff a few years ago: she recently presented it to a friend who investigates war crimes for the United Nations.
I think Em's giving up. I think Blue Cross and Blue Shield aren't. I think they're not giving up one inch or one dollar.
And I think we've got to reestablish the rules of this game.