Saturday, November 08, 2014

How would you describe a healthy romantic relationship?

I was just asked how I would describe a healthy romantic relationship. taimproblem doesn't ask me any easy questions, now does he?

There are people who think romantic relationships are an entirely different animal from friendships; that the two cannot coexist with one another. This is a thing that proponents of the 'ladder theory' ascribe to - that you are either friend material or relationship material, not both. I think that's bullshit, personally. Friendship is the very foundation of relationships, to me. Without it, sure it may be POSSIBLE to build a romantic relationship, but it's gonna be mighty rickety and unstable.

There are people who think romantic relationships - the good ones - are all about finding 'that person that completes you'. As if. As if you are a partial being; 50% of a whole before you cleave to another person. If that were the case, every ending would leave you torn and bleeding out. It may feel so, but you will heal. You will not die from lack of another, however much you may wish you would for a time after the end. No, a really good relationship isn't about finding 'your other half' but finding another whole person that, when their 100% is added to your 100%, makes the two of you more than 200%. There are many perfectly fine relationships that 100 + 100 = 200, and that is fine, but to me, the best ones are always more than that. And never, never settle for a relationship in which 100 + 100 < 200. Either you are losing part of yourself in the process, or they are, and neither are good.

In my experience - both personally lived and vicariously observed - a healthy romantic relationship starts with friendship and trust and respect. If you don't trust them, all the love in the world won't let you relax into their arms completely; you'll always be looking for the cliff, the knife, or the betrayal. If you don't respect them, how can you value their opinions - including those about yourself and how they feel about you? It all works the other way around, as well. If they don't trust and respect you, how can a relationship possibly exist in any meaningful way?

Friendship, trust, and respect. There's your base. But there are plenty of friends that you can trust and whom you respect but for whom there is no romantic attachment, so what else? This part gets murkier. Everyone seems to have different opinions on what should or should not be considered, but I'll give you my particular view on it here.

I can tell that I'm 'in love' with someone in a romantic way via a bit of a macabre fantasizing. You recall how I said you wouldn't die from an ending, but that you might wish you would? I know that I do, and that's my test. When I think I've 'fallen' for someone, I take some time to think about what it would feel like if they suddenly died. If, for some reason, they were laid out before me and I knew that I would never again feel their arms around me again, never again feel their breath against my neck while we were cuddling, never again hear their voice saying my name - how would I react? In every case where I've really been in love with someone and had strong romantic feelings for them, my reaction is immediate tears and a feeling of tearing pain in my heart.

Romantic love is very much like friendship love, but more so. I trust my dearest friends; I trust them with my heart, my mind, my fortune. My beloveds I trust with my body and with my life. I may be perfectly okay with random cuddles with close friends, but I don't expect it. With romantic partners, I expect cuddling and physical intimacy as a matter of course. To be clear, I am NOT talking about sexual intimacy here. I'm talking about the fleeting hand on the shoulder as you pass by the chair the other is sitting in; the kiss pressed to top of the head as you pass in the hallway; the casual leaning against one another while watching a movie. All of these things could be absolutely okay in a strictly-friends sort of relationship, but they're not as likely to be expected parts of everyday interaction.

My friends all know about my health conditions, including most of the ways they might need to step in should things go south. My romantic partners must know all the ins and outs of my health and how they must step in when I cannot advocate for myself. Even the people I'm closest to (but not romantically entangled with) don't know everything about what is going on in my life - there are just some physical things that you don't want to share with someone unless there is a particular level of intimacy shared between you already. When I finish a shower and my blood pressure is bottoming out and my heart rate is skyrocketing, I'm shaky and pale and parts of me are turning funny colors. My friends may know that this happens, but only people that I've got a higher level of physical intimacy with are going to see me sitting on the side of the tub, clutching the wall as I try not to pass out when they bring me a glass of cold water and sit there to watch me until I'm steady again.

So this all details what I think is part of a romantic relationship, but what makes it a healthy one?

It goes back to that same base again. Are you friends? That is, no kidding, a question to ask periodically. I've had a romantic relationship last longer than the friendship it was based on, and it was not a healthy relationship anymore once I realized I wouldn't be friends with this person if we met then. Do you have enough in common to bond over? Enough difference that you aren't stepping all over each other constantly? Do you respect each other? Not just respect each other as people, but - on the whole - respect their decisions, actions, and dreams? You don't have to agree with them all, but you should at least respect their ability to make these choices for themselves. Do you trust each other? Do you trust them not to hurt you? Do you trust them to stand up for you when you can't stand up for yourself?

That is the heart of romantic relationships, for me. Love, certainly, but without a solid base of friendship, trust, and respect, the love doesn't carry you very far.

Wednesday, March 19, 2014

An ACA (and Medicare) success story

I've been disabled for several years now - closing in on the 10 year mark, come to think of it. I've had Medicare for the duration and, for much of the time, have dual qualified for state Medicaid - the combination of the two making me eligible for Special Needs Plans with insurance companies. Basically, I could have kept the Medicare and Medicaid, and had to do a lot more oversight on the billing of my claims, and not had dental and vision, or I could choose to take an HMO plan with a private insurance company and let them handle most of the work + give me more benefits than the federal and state plans would on their own.

Seemed like a good option, so I've done that and it's worked out pretty well for me.

When I attempted to reenter the workforce a few years back, I lost that dual eligibility for awhile, and regained it when I was no longer working. At least, I regained it for a year. Going back to work made it so my Social Security payments increased ('cause I spent a year paying more into the system - that's how this stuff works, you get back money in relation to how much you've paid in over your lifetime working), and that increase took me just above the cut off line for dual eligibility.

Well, crap. Time to find new insurance, since I have a lot of medical expenses and basic Medicare a) doesn't cover medications unless you buy a part D plan and b) only covers 80% of costs, which will bankrupt me if I have to pay the 20% on things like, say, IVIG treatments ($40,000 each x 20% = $8,000 out of pocket for each treatment). But hey, my husband works and I could go on his insurance, right?

Theoretically, yes.

Except, this is his first week at a new job (close to home! better hours! full time status! yay good things!) and that meant his insurance had to change, too. No problem, we'll both use the insurance at the new place, it'll be fine.

Oh. The insurance at the new job is terrible. Crap again.

Okay, it's not objectively terrible, but it's terrible for us. It is probably a really good plan for people who are generally healthy and don't require a lot of specialist medical care. I have a ridiculous amount of doctor appointments on a routine basis, 10+ medications to fill a month, intermittent IV treatments that are very expensive, and monthly lab work to see if I need the treatment that month. My husband has a few medications he takes routinely and which require monitoring by a physician, and needs to see a specialist every now and then, himself.

If we took the insurance through his job, it would be $163/2 wk pay period, or $326/month, for coverage that largely wouldn't start covering anything until after the deductible was met, and even then might still be only 80-90% covered. On top of that, there are copays that don't even apply to the deductible. For a generally healthy person, this wouldn't be an objectively bad option -- indeed, it'd be better than most of the plans on the Insurance Exchange. But again, not good for us.

So I started researching. I figured that if I could find something better for even $100+ more a month, it'd be better than taking coverage that didn't fit our needs.

Turns out, people with chronic illnesses and disabilities are pretty much going to get screwed when it comes to finding insurance that covers all the things they need, as much as they need, and for the doctors they need. When I was looking for options for my needs, I wasn't finding much. But then I realized that I wasn't constrained to just the Insurance Exchange because of my eligibility for Medicare.

Ah! Medicare Advantage plans - perfect! There are ones that have a $0 premium, but don't include prescriptions, up to plans that have just about everything you could need for a substantially bigger monthly premium. I ended up finding one that is with my current insurance company, and covers basically all the same things just with the addition of some copays that my SNP insurance doesn't have, and won't require any change in my doctors. (I live in Pittsburgh, and Highmark and UPMC are still duking it out over which insurance will be accepted at which hospital system - I've got doctors at only 1 of the two, so I don't want to risk getting a plan with the other company and having it go badly for me.) My premium per month? A whopping $2.60, so $31.20 per year.

Excellent, that covers me, but what about my husband? He doesn't have the same needs I do, but he still needs a better insurance plan than his job is offering. Back to the Insurance Exchange I went.

With my needs taken care of, I realized that what I'd budgeted for insurance (that $326/month that his employer-offered plan would cost for both of us) now offered me a lot of leeway when it came to getting a plan for 1 adult. I dropped the bronze and silver plans off the results and kept the gold and platinum plans. Surprise surprise, I found a gold level plan that was far better for my husband's needs than the plan he would get through his employer, and that would still keep our costs down. The cost for just him through his employer would be $136/month, but for coverage that wouldn't fit what he needed. The plan I found on fits basically every need he has, keeps routine costs low with copays instead of coinsurance or 20%-after-deductible amounts, and covers all the doctors he sees or might need to see. It is in the other insurance/hospital system, but he doesn't have any doctors in the system that I do, so there's no reason that he has to stay there.

The cost per month for this awesome plan? $197/month, or $2,364 per year.

We'll get truly excellent dental and vision coverage through his employer (go figure), and our health insurances privately and separately through Medicare Advantage and the HIE, and our total cost per month will be $240.50, or $2,886 per year.

If we went with the employer plan, it would be $326/month, or $3,912 a year. This means we're saving an average of $85.50 a month or $1,026 a year in insurance costs. I was fully ready to pay more per month for better insurance, and instead we're saving money. That's a whole lot of win, in my book. I have better insurance and a better cost, on account of being legally declared disabled, but the HIE made it possible to find insurance for my husband that wouldn't have been available to him before the ACA took effect - and even if it was available, preexisting conditions would have barred him from it! Also, please note that all prices here reflect no tax credit - because my husband's job offers at least a bronze equivalent plan, we don't qualify for assistance.

If you don't have insurance, you've got about a week and a half to check out and see what you can get for yourself. Please, take a look and see if you can be as pleasantly surprised as I was.