Before I start this blog post, let me thank everyone who contacted me in one way or another over last week’s blog. I can’t tell you how grateful I am for the response. Since I was teaching, I was unable to respond to the comments, but I did read all of them. And now I’m a bit overwhelmed by the sheer number of them to even know where to begin. (I’m still behind on my e-mail from last week, let alone writing or blog comment responses.
If you haven’t read the comments, please do so. My experience wasn’t unique. There are a lot of us who have been through this kind of darkness for a variety of reasons.
I’m tired this week, so I’m going to go in a different direction here. Next week, I’ll be back on track and I’ll try to be a bit more global-centered than some of my last posts have been, given that the post will appear on the US national holiday, the Fourth of July.
And now on to your regularly scheduled blog post.
Recently, David Farland did all writers a favor by blogging about the terrible direction his life has just moved toward. Not only has his sixteen-year-old son been horribly injured in an accident, an accident so serious that for days the doctors expected him to die, but Dave’s family has no health insurance. (Dave’s son has improved but as I post this is in intensive rehab. The family still needs a lot of help, and you can find out how you can contribute (or buy a book!) here.)
I know most of you Canadians and Europeans check out when American bloggers start talking about health insurance. You’re covered, and wow, do I envy that. Yes, I know, you have complaints as well, but what Dave described in his blog cannot happen to you. And frankly, it should not happen to a successful professional in the richest country in the world, either.
Stick with me, readers from outside the US. I promise I’ll get to something that does have an impact on you, long before the end of this blog.
When I found out that Dave, of all people, had no health insurance, I was stunned. Dave is not just one of the best writers I know, he’s also one of the best businessmen I know. Surely, I thought, he should know the risks of going without insurance.
Actually, he knew them better than I did.
I’m linking to his blog. Please go read it now. It’s short.
For those of you too lazy to click on the link, here’s the situation in a nutshell. Dave and his family had insurance. They had purchased the best insurance they could for a freelancer, back when they lived in California.
Dave’s daughter had a health crisis in 2004, and Dave and his wife spent an extra $40,000 to make sure she had the right care. Then the insurance company denied her other coverage.
Dave’s family lost everything: their home, their car, their savings, and their children’s college funds. Everything, even though he had done everything right.
Things went from bad to worse. After moving back to Utah to be near family and ultimately losing that initial insurance coverage, he discovered that in Utah—one of those Western individualistic survive-on-your-own-or-don’t-states—he couldn’t get insurance coverage at all for himself or his family, because he’s a diabetic, even though his diabetes is under control. Dave is handling all of this with amazing grace. His family is resilient. But resiliency isn’t everything. At some point, we all need help.
Oregon, where I live, is also one of those Western individualistic survive-on-your-own-or-don’t states, but off and on over the last decade, we have had a governor who is a doctor. He (and several others) got us started on health insurance when he was a state senator in the early 1990s and fought the fight long before Barack Obama even thought of running for President. If Dave had moved to Oregon, he would have had coverage. Maybe not good coverage, but coverage all the same.
Dave thought he and his family could hold out until the new federal law went into effect in 2014. Sadly, events proved otherwise. His son’s injuries, severe and life-changing, had to be dealt with immediately.
When Dave posted that blog entry on April 29, 2013, less than three weeks after his son’s accident, the bill for his son’s care was $700,000. I know it has continued to rise, and will rise all year.
Health care in the United States is extremely expensive. It is the major cause of bankruptcy in this country, even for people who have insurance. One catastrophic accident, mixed with co-pays and things that are not covered (as happened with Dave in 2004), and a family’s assets disappear.
Yet I can predict the comments on the first 700 words of this blog. The Europeans and Canadians will be incredulous, and thankful that they do not live here, despite the problems in their systems. A handful of tough Americans will claim they’re too healthy to worry about this. And a few comments, which I will moderate (and maybe reject), will argue both sides of the political debate that continues ad naseum in this country.
Dave does not mention the biggest problem that writers face, probably because he has already rejected it as an option. Writers who declare bankruptcy lose all future earnings in their work.
Remember I told you that we don’t sell stories. We license copyright. Copyrights are property. That’s how they can get stolen, that’s why they’re leased, that’s how they can be purchased. Your novel might be a baby to you, but to the courts, it’s an asset.
And if you have to declare bankruptcy, the bankruptcy court will look at all of your assets. If your novel is earning money, then it is a viable asset, and one the court will take to pay off your debts. You will transfer the copyright in a bankruptcy. (and if you don’t understand any of this, buy Nolo Press’s Copyright Handbook now.)
Dave and other big name writers cannot afford to declare bankruptcy. Early on, Dave’s fans helped him with these expenses by running what they’re calling “book bombs,” trying to get Dave’s independently published titles higher and higher on bestseller lists so people who’ve never read Dave’s marvelous work will find his work and contribute to his family’s income. Other such efforts have continued into June.
These things are Dave’s only hope of paying this huge bill off. That, and negotiating some of the government regulations, with the help of knowledgeable people.
If you live in America, and you are one of the legion of uninsured people, then please go and buy insurance right now. If you believe you can’t be insured, then find someone called a Health Insurance Broker, Agent or Producer. Most states have them. These people must be licensed, and they need to get their commission from the insurance carrier. Have that person help you. If you need to move to a more insurance friendly state, please consider it.
The new law will be augmented piecemeal, with bumps in the road. But you need to be on top of it. Dean and I have had insurance for our entire lives, during our marriage and before we met each other. Even when we were the most broke, we paid the insurance bill first, even before rent. In his post, Dave calls that bill ridiculously expensive, and at the moment, in the US, it is. But to do without it is to take a gamble that will not pay off.
Here’s the problem: We all end up using health care. I had emergency gall bladder surgery in 2003. The surgery itself cost my insurance company $35,000. It would have cost more, but the company had agreements with the hospital that kept some prices down. I paid $3,000 of that because Dean and I have a deliberately high deductible on our policy.
Dean had a stroke in his eye in 2011. He lost part of his sight. We did not have to take him to the emergency room. All of our dealings were with eye doctors, and hence came out of our pockets. But had that stroke been elsewhere, had it hit his brain instead, my superman would have been in the hospital for days, maybe weeks, and we would have racked up the kinds of expenses that Dave Farland’s family is.
This very thing happened to the writer Peter David in December. He had a stroke, and he’s recovering. He had insurance but, as his wife wrote on his blog in January:
Even though Peter has health insurance, there are co-pays and the like, and since this stroke fell at the end of the year, there are all new co-pays to deal with, and there are things that the insurance company just won’t cover. So we are at the beginning of what is going to be a very expensive year.
If you want to help Peter through this expensive year, please click on this link and follow the instructions.
What this blog post doesn’t mention, what Dave’s doesn’t mention either, what Dean and I barely discussed after his stroke, was the other problem. Yes, the bills pile up. And yes, if you’re a writer who has a lot of product—books out, some indie books published, etc—you might continue to earn money.
Or you might not.
(Okay, Europeans and Canadians, you can rejoin the conversation now. This rest of this post also applies to you.)
Most writers work piecemeal. We write, then we get paid. The new world of publishing is slowly changing how quickly we get paid. It’s also changing the need to work continuously to get the checks in the door.
But, we are all one accident, one stroke, one major crisis away from losing months, if not years of our work. And if the accident/stroke/crisis is bad enough, we might never write again.
Have you planned for that?
For months now, I’ve been writing blogs about how your estate can survive after your death. But what happens if you’re still alive and can’t write? What happens if you’re still alive, can’t write, and can’t think well enough to manage your business affairs?
What if you will never be able to manage those affairs again?
Have you even asked those questions? Or better yet, have you answered them?
Because the readers of this blog come from different countries with different laws, I’m not going to go into detail about solutions. Even here in the United States, the laws vary from state to state, and so what works in Oregon might not work in Mississippi.
You need to figure out a plan for your life and your writing estate. You also need to take a good hard look at your support system. In some ways, Dean and I are lucky. We’re both writers and we understand the writing side of things.
But that also makes us unlucky. I can see a serious drop in my output in the last part of 2011 and the early part of 2012 as I struggled to continue writing, deal with maintaining every part of taking care of our home, and for a few months (off and on) helping Dean with things that had to do with his health. All of that took time. He gave up writing altogether from the day our friend Bill died in August 2011 to the day that the estate closed in March of 2012. Dean suffered the worst flu I ever saw him get, complete exhaustion, and that stroke in the middle. It’s taken him time to recover.
We had the financial resources to deal with it, although it got dicey at times. The emotional resources were harder. We have a good friend support system that I probably did not lean on as much as I should have.
But since all of this occurred, we’ve been having serious discussions about how we would handle a catastrophic illness, the kind that so many other writers are dealing with at the moment. Since 2011, we have set up systems that will allow our backlist to continue getting published. We have set up our financial affairs that they’ll continue as well, unless Dean and I both die or get severely injured at the same time. That’s one reason I’m slowly writing the estate articles, so that Dean and I have done the research to prepare before we go to the attorney. Hell, before we hire the attorney who will actually work with us.
I have friends who are attorneys, friends who are judges, and so does Dean. We also have two attorneys who handle most of our business affairs. But we’ll be hiring an attorney that specializes in wills, estates, and trusts to handle this part of our life. We’re aware that it’s complicated, and we’re aware that doing this will take some time.
We have a CYA will in place—not good, but adequate should we die tomorrow. We have Advance Directives done to handle the medical care. We have enough covered that things can/will/might continue if we don’t. We are pretty well set if one of us gets catastrophically ill.
But I’ll be honest: we have benefitted from the new world of publishing. Our backlist will drive the books already published, and those monthly checks from e-commerce sites, POD books, and audio will continue, even if we’re laid up for months on end.
However, if we were still traditionally published, the idea of losing a few months to a few years would be as catastrophic as the accident/illness. Here’s why:
Writers who work for traditional publishers get paid only a few times per year. The writers get their advances, usually split between signing of the contract, acceptance of the manuscript, and publication of the book. Some, although not many, writers get royalties, which are paid twice per year.
But traditional publishers work on what I call the produce model. The books “spoil” and disappear out of shelves and out of people’s consciousness within a few months of publication. Readers forget the writer exists, and the publisher does not do any further promotion to goose sales of existing titles until a new title comes out.
I italicized that last part because it’s very important. If there is no new title, the writer gets almost no attention from the publisher. If the writer gets no attention, the books get no attention, and sales flatline. They might flatline at a reasonable level, but still, they’ll be much lower than they would if a writer kept to the usual pace of a book or two every year.
That means the royalties go down. Worse, it may mean that the writer may not have received most of the advance from the new book under contract. Look again at the terms: an advance these days is often (although not always) divided between payment when the contract gets signed, payment at the time the book gets accepted, and payment when the book gets published.
If the writer gets hurt or ill between signing and acceptance, the writer has only received 1/3 of the advance. So suddenly, because of the accident/illness, the writer’s income for the next year goes down by two-thirds, just as the expenses go up.
Can you handle this? Even if you live in Europe or Canada and you don’t have a lot of medical expenses, can you sustain a two-thirds loss of income in one year, and maybe, just maybe, a loss of even more in year two?
And what happens if your spouse needs to care for you? Can your spouse handle that and maintain her job? If your spouse is a writer, I guarantee that caretaking will hurt your spouse’s writing time. Caretaking has an impact on caretaker’s real world job (whatever that might be), on the caretaker’s health, and on the caretaker’s state of mind.
If you’re not married or don’t have a significant other, what will you do in times of serious illness? Who will help you and/or manage your finances? How do you make sure that the person whom you chose to help you doesn’t help himself to your assets?
That very thing just happened to Harper Lee, the acclaimed author of the classic To Kill A Mockingbird. She was in an assisted living facility, recovering from a stroke, when the man her original agent had put into place to take care of his clients stole her copyrights from her. He had her sign documents she could not read at the time, transferring her copyrights to him.
These things happen all the time, especially when you give someone else power of attorney or the ability to handle your affairs unfettered by your oversight. And sometimes you’re too ill to maintain that oversight.
You need a plan for all of that, a way to take care of yourself in these tough times. On a writing business level, this is especially important for you writers who are traditionally published only.
Take, for example, the thriller writer Greg Iles. In March of 2011, he nearly died in a car accident. His Audi S8 was T-boned on the driver’s side on the blues highway near his home. He lost a leg, had several major surgeries, and had a life-threatening tear in his aorta.
The publishers of his upcoming book moved the publication date to December of 2012, a date that got missed. The book will now appear in different form in early 2014, followed by two more. But, interestingly (at least to me), he has changed publishers. Did the old publisher cancel the contract for non-delivery? Did something else happen? Iles doesn’t say, but the long silence and the changes speak volumes about what can happen to a career in the middle of a serious crisis.
The accident happened more than two years ago. Iles is a #1 New York Times bestseller who has had a few movies made from his books, but a gap like this in anyone’s income is painful. And just because someone is a #1 Times bestseller does not mean that person is rich.
Much as I love his work, I don’t know Iles personally, so I have no idea what struggles he’s been through. Painkillers interfere with the creative process and rehab makes writing hard, just from the sheer exhaustion of it all. Even if Iles has a gold-plated insurance police and a disability rider over all of it, he is still suffering serious income loss. He’s also dealing with the frustration of trying to regain his health while trying to maintain his writing.
All because he happened to be on Highway 61 going from Mississippi to New Orleans on March 7, 2011. Had he taken a different highway, had he waited fifteen minutes, he might be just fine and several novels down the road.
It doesn’t matter how well you take care of yourself. You can eat perfectly, exercise everyday, have great health check-ups, and still end up in a two-car crash on a highway in the middle of the night. Or, as happened to another writer friend of mine, get hit by a bus while crossing the street. Or, as happened yet another friend of mine, break both of your arms and your nose as you trip going up an unfamiliar curb.
Things happen, my friends. Those things might not happen to you directly. They might happen to your spouse. But they will take time from your writing, and it will have an impact on your life and on your finances.
We can’t prevent every accident. We can’t stop fate from finding us. But we can prepare. We can have the best insurance we can find. We can have a plan for those moments of disability that will happen to all of us. We can let our loved ones know what to do.
All of those plans will be as varied as the loved ones who help us. Or the business partners who need to step in.
I can’t guide you through the minute details. What I tell my friends here in Oregon is different than what I’d say to friends in London. But I can tell you to prepare yourself. Guard yourself financially as best you can with insurance. Save your money. Pay off your house. Have a plan in place for the days when you will need help.
And use that powerful imagination of yours. Imagine what it would feel like to be in David Farland’s shoes right now. He has to keep earning a living and take care of a very ill son, all as the medical bills pile up. Imagine what it feels like to be Peter and Kathleen David, both writers, struggling to deal with their young family and their writing in the aftermath of his stroke. Imagine what it feels like to be Greg Iles, two years behind on a book, his life irrevocably changed by a collision that happened in less than ten seconds.
You can’t prevent the accident. You might be able to prevent a stroke by keeping your blood pressure under control, but you might not. You can’t always prevent your teenage child from doing something teenagers do. (I’m lucky: I survived the accidents I was in as a teenager (some of them car accidents) with only minor damage and no hospital stays. And I shudder to think what could have happened with five or ten seconds difference on dozens of nights when I or someone I was with was doing something no adult should ever know about.)
You can mitigate the risk with a plan and with insurance.
Please do so. It’s important, not just to yourself, not just to your family, but—as your writing grows—to your readers as well.
This blog is part of what I write every week, despite things happening in my life. I try to have a few blogs stored away for weeks when I’m tired or out of town, but I’m sure one day there will be a Gone Fishin’ sign here because of a life-changing event. I’ve been lucky: I’ve managed to publish a blog post every Thursday since the first week of April 2009.
I do this in part because of you folks. I know that for many of you, I perform appointment-blogging. The blog does take time from my more profitable (and durable) fiction writing. So if you’ve gotten something of value from this blog in the past few weeks, please leave a tip on the way out.
And don’t forget to click on the links for David Farland and Peter David. If you can only donate to one thing, please click on one of their links listed above.
Thanks so much.
“The Business Rusch: “Life-Changing Events” copyright © 2013 by Kristine Kathryn Rusch.
Here’s a stealth one that got my spouse denied insurance in our state: sleep apnea. He has a CPAP machine, uses it every night, and has gone from Zombie Spouse to Yay, Functional Spouse… But no, completely managed sleep apnea means that after he retired? They didn’t want him.
Fortunately, our state also has a high-risk pool, so he could pay more and get himself covered (while I and our kid are on the less expensive plan that bounced him), and hopefully things will change in another year… But there wasn’t any indication that CPAP machines/sleep apnea were even a “trigger,” on the insurance paperwork! He mentioned it to the insurance guy by chance… Which is probably good, because at least we didn’t pay and then have them discover his Sekrit Sleepz Apnyah and revoke coverage or something.
One of the little things that authors — who probably don’t write well when being zombies — need to keep in mind if they get diagnosed with “oh, hey, you stop breathing at night, huh!”
Under my day-job identity (not this name), I spent nearly a decade looking at back-end data from the slow-motion train wreck that is health care in the USA. At one point, I began the process of qualifying as an actuary.
Nothing like getting the trade rags to let you know just what you’ve signed on for. A decade before, I’d been told I had a talent for anti-personnel weapons design, but opted out of that. The chief difference between the American health insurance industry and the land-mines industry is the lack of NGOs tracking the kill rate.
So, yeah, current day job earns me a whole lot less. I sleep better, though I wake remembering what kind of country this is.
I hope that I can follow up on Kris’s excellent advice above, to do that most un-American act of looking the Grim Reaper in the eye(sockets), admitting my mortality and vulnerability to the fates, and making some prudent plans for the Inevitable.
When I retired from the Postal Service, I kept the insurance that went along with the job. With a chronically ill wife, it’s what kept us from having to live under a bridge all these years. Between that insurance and Medicare, almost all her medical expenses are covered.
It’s also good insurance for me. But my broken arm, joint replacement surgery and following treatment would still have cost abut $10,000 out of pocket if the accident hadn’t taken place at my post-retirement job’s workplace and been covered under Workmens Comp.
So I’ve been damn lucky. (I would have been even luckier if I hadn’t broken the arm in the first place, but relatively I was lucky.)
The ironic thing is that it’s only been since that accident that I’ve finally gotten back into the writing swing enough to complete several short stories, after a long hiatus of about six years. I’m hoping I’ll be able to keep that up even when I go back to work.
My husband and I have been married 15 years and have had medical insurance less than half of the time (I actually qualified for a YEAR at my most recent job before someone mentioned that my company offered it–I worked at a gas station. It was terrible insurance, but it didn’t cost me a lot and saved us a grundle when we had an ER visit and same-day surgery, if only because they made the hospital charge less for their services.)
Since we’re both self employed, my hubby checked into health insurance but just for the two of us, on Obama’s new insurance plan, we couldn’t come close to affording it last month. If my sales stay steady, we will be able to afford it in a little while, but it’s going to be more than my mortgage. For just two of us. We have supplemental insurance for business owners that’s a pretty good deal, but it’s only if we get hurt (think workman’s comp) not if we get sick.
My parents have only had catastrophic insurance their whole lives, and never used it for like 30 years, but when Mom had cancer a few years back, it covered EVERY PENNY of their expenses once the co-pay was covered (which they had to pay twice, of course, since she was diagnosed in November). Those monthly payments have been a major burden over the years, but it paid dividends when they needed it most.
We’ve been super lucky that we’ve had insurance when our biggest health issues have come up, but it would be nice to have the peace of mind that we were covered for illness now. Especially with the rising costs of health care.
Oh, Kris, this is such a important post. I’m going to link this on my Facebook page. So many people who dream of being self-employed don’t give any consideration to some of the realities.
Back in 2006, when I was trying to decide whether or not to leave the university and jump to full time writing, our health insurance came from my job. My editor at Roc actually asked me, “Will you and JC be able to afford private health insurance?” Of course we were already running numbers. Our private health insurance turned out to be our second largest bill (after the house payment), but like you, we know that Americans cannot be without it.
I hear writers say all the time, “I just can’t afford it. I spend every day wishing I lived in England or Canada . . .” And then they go off expounding the virtues of socialized healthcare . . . of which I am well aware. I would LOVE it if America had a sane healthcare system. However, we don’t. Yet . . . the fact remains that JC and I live in America, which means we need to buck up and accept that we MUST have health insurance. People cannot live in America and be without it.
As Kris knows, I have been in a similar position to what Dave is facing, with one important difference: I had good insurance. No, I had GREAT insurance, and good benefits at my day job. We still have our house, our cars, and our intact credit rating. BUT…
My husband is a free-lancer. When I was put in an ambulance last July (90 miles with lights and sirens) our world stopped. Just stopped.
I had the luxury of paid time off, which helped, and the insurance paid a lot. Even with GREAT insurance we paid between $8 and $10K out of pocket. Savings? Well, we used to have some. And lots of hidden expenses that you don’t realize until you’re standing in the drug store buying $150 worth of dressing supplies.
But the money was the least of it, as Kris points out. From that day to this, nearly a year later, neither of us has resumed writing at anywhere near the rate we were. I tired too easily for months, and Steve had to shoulder so much more of the day-to-day chores, in addition to being my caretaker, that he was constantly a hair’s-breadth from exhaustion.
We effectively lost a year of our lives, a year of writing and publishing that didn’t happen because of a medical emergency.
The bottom line is: WE WERE DAMNED LUCKY. Very damned lucky. We *only* last a few thousand dollars, spent several months living at unimaginable stress levels, and lost a year of productivity. That is a loss from which we can recover, and we consider that a happy ending, a GOOD outcome.
And even being damned lucky cost us a lot; even when we were prepared and had reserves this knocked us down for a long time.
Pay attention to everything Kris says here, people. Do everything you can to mitigate the consequences, because there will be emergencies and consequences. It’s not a matter of “if,” it’s a matter of “when” and you need to be prepared.
I have not had insurance since I quite a full-time job at Group Health in 2006. Cannot afford it. I am a temp / part-time instructor / designer with no available benefits. I am single with too capricious of an income to afford anything or to qualify for anything. I am also considered pre-existing for several reasons. But what I also discovered is that in so many ways, insurance seems primarily designed to get money out of you and give you only the right to have to pay more money than you can afford for services, tests, healthcare products, and services that are not covered that nobody can/will tell you about, get your consent for, and will consistently mis-label and overcharge. All I can do is hope that when the accident or stroke happens is that die. I hope that the Affordable Care Act really does offer possibilities and a realistic/affordable sliding scale, but given that private insurers and overblown healthcare costs are still involved (it’s all about profit), I am not counting on it.
This post hit home for me. I live as a single parent with three of my five sons (the others are adults and off and gone) and at the moment none of us are insured. The problem is that insurance is so expensive. Someone mentioned above that insurance for a whole family might run about two grand a month but it’s worth it. But what do you do if it’s hard to find work and your combined family income is less than two grand a month? We are looking into certain government programs to at least insure the younger ones.
But having lived both on the Indian Subcontinent and in Italy and Greece for extended periods of time, and having traveled in many other countries besides, I have to say that I have never seen such an insanely expensive and dysfunctional insurance and medical system as that of the United States. The expense has gone way beyond crazy. The medical system has become the realm of the wealthy, and God help you if you get sick when you’re poor. That’s why medical tourism is becoming more popular. Indian, for example, has excellent doctors and hospitals, well trained and polite and concerned, for a fraction of the cost of the U.S. And Greece may be going down the tubes economically both for bad decisions it has made in the past and exploitation by certain more affluent European powers, but at least it takes care of its citizens medically at prices they can afford. I can’t help but think that any attempts at reforming the present United States insurance/medical system is like sticking band-aids on cancer. It’s corrupt and inefficient and exploitative and greedy and it’s getting worse all the time.
To be honest, this was my biggest trepidation about returning to the States, when I decided to do so for the sake of my sons, who could find no employment or opportunities in Greece: the fact that it would be very difficult to get medical insurance. It’s like walking a constant tightrope, hoping you don’t fall off. Millions who can’t afford insurance are in the same boat. In some states there are programs to at least partially help, but when I tried to apply for inexpensive state-aided insurance here (Washington) I discovered there was an indefinite waiting list and no funds to expand the service.
I have no answers, but I do know that in most of the world medical services and insurance are far less expensive, and perhaps we need to look for models abroad, outside our own hopelessly tangled backyard, for a solution to the problem.
Oh yeah. I know all about life-changing events. Last fall, my writing and releasing year was derailed for the last six months by my own life issues and health. This year?
Mother suddenly diagnosed with stage IV GBM brain cancer. She’s doing well, they believe they got 98% of the tumor out, she went through a month of radiation and chemotherapy, and next week we find out if it’s started to grow back. No health insurance, with a year to go until she can get on Medicare.
It’s been a horrible experience. But, the doctors and hospitals have been trying to help us. It can happen to anyone at anytime. Someone said above that it takes only one stray mutated cell? That’s what happened with my mother.
My writing, of course, came to a screeching halt. I’ve been fortunate, though, in that Mom has done remarkably well and has only a few side-effects from the brain surgery. I switched to revision, to revise the 5 books of a series she loves, to get them done while she’s well enough to read and enjoy them.
With her cancer, there is a high probability of it growing back. We don’t know how much time we have left with her, so we’re making the most of what we have. My writing diverted towards that, as I want her to read some of my work while she can (I’m chronicling this on my blog under the “Mother Hen String Weaver Project”).
Insurance? The family, including myself, still do not have any. Not since the economic downturn nailed our area. I still do not have a full-time dayjob, and while I make enough from my writing to buy my allergy meds (I have a lot), there is not enough for insurance.
We’ll see what 2014 brings, both on the family side and US healthcare shifts. It’s going to get interesting.
P.S. Give extra hugs to your family tonight!
I’m sorry to hear this, JA, but it sounds like–on the writing level at least–you’ve figured out how to cope. And I will go hug my family now.
I’m from a country, which has universal health and care insurance, so I don’t have to worry on that regard. However, the first insurance I ever bought (aside from the mandatory health, care and car liability insurance) was private disability insurance. Because if you happen to be left unable to work at a relatively young age, the state disability payments are often so low to leave you dependent on welfare. And since state disability payments are tied to the state pension system and I have been a freelancer for most of my working life and therefore didn’t pay into the state pension system, I would get next to nothing. So the first thing I did was get private disability insurance. I’m always surprised how many people have life insurance (which is essential if you have a family to support, but really required for childless singles), but not disability insurance, even though the latter is so much more important.
And yes, even in a country with a very good healthcare and pension system you can get hit by sudden disability. This happened to my cousin who had a near fatal heart attack at the age of 40. He pulled through, was put on the transplant list and left permanently unable to work (he used to be a chef, which is a high stress job he will never be able to do again even if he gets a transplant). So now he’s forced to live on state disability payments (which are tied to state pensions, which are tied to wages, and chef is a badly paid job over here, hence they’re very low). Then, just as my cousin was recovering, his wife was diagnosed with bipolar disorder so severe that she had to be hospitalized and was unable to work for almost a year. So suddenly you had twon adults (and a teenager) reduced to low disability payments.
So if you can at all afford it, get disability insurance. I don’t know how it works in other countries, but mine works like a life insurance policy. If I manage to work until age 65, I get a payout. It’s less than what I paid in, of course, but I even get some of my premiums back.
Thanks, Cora. Great advice.
Cora,
My heart goes out to your cousin. My husband was diagnosed with bipolar disorder years ago; one of the reasons why he quit his decent job so suddenly. When both of us were working (no kids), we could afford to take an annual vacation, but once this happened, those vacations were over. A lot of people don’t realize how devestating income-wise (not to mention health-wise) a mental illness really is.
And thank you for pointing that out about disability. The med plan I just got back on has disability as part of the plan, but this will be one of the things I’ll talk about with an insurance broker if left without med insurance again.
As on Dean’s site, Kris, I’ve learned so much! Thanks to Kris and all the commenters. 🙂
Kris,
The statistics are that you are 5 times more likely to become disabled before retirement than to die before retirement – and yet most people have life insurance, and few people have disability insurance.
My employer supplied a disability benefit (in addition to SS disability); I have been living with disability for 24 years. It has kept us middle-class.
One additional feature: if you possibly can, pay for the disability insurance out of pocket (instead of getting it from your employer) because if YOU pay for it, it is tax free when you are paid the benefit (check details). If your employer paid for it, it is NOT free of income taxes when you get a monthly benefit when you become disabled. I wish someone had told me.
Also, ALL private disability policies will require you to apply for (and reapply for every 3 years if you are denied) SS disability income; it is how they keep their costs down. But realize that if SS turns you down, your PRIVATE company may put you through more wringers (because they think you can work if SS turns you down).
And up to 85% of SS disability income IS taxable, depending on your total income.
Final, MAJOR problem for me: SS considers being able to write and self-publish PROOF that you can work – I haven’t found a way, in two years of looking and consulting SS and attorneys, for me to self-publish more than a single memoir of my illness ‘not originally intended for publication’ that won’t be considered proof I can work.
In general, you work x hours, get paid y per hour, and they can calculate your income and decide IF you can work.
Since that correlation is impossible with the new world of publishing – I put something up on Amazon and whatever I earn is NOT attributable to $y/hour – I can’t publish.
Also, if I should lose SS disability because I earned a few $ self-publishing, my PRIVATE disability (which doesn’t allow me to earn ANY money ‘working’), would also stop, and stop immediately.
Things to consider: get disability insurance to protect your earning potential during your working years, and read the fine print extremely carefully for all possible worst case scenarios.
Thank you for all of this. I hope people read it. It’s important.
Thank you for this, Kris. I have much of this in place, but I need to do more, and this is a great reminder.
In particular, I need to better organize my contracts. I’ve just scheduled myself hours of time on consecutive Saturdays to go ahead and just do it.
Kristine there are provisions in the bankruptcy code, chapters other than chapter 7, that protect against seizure and/or liquidation of copyrights. Chapter 13 being the most common. This may not be useful in the instance spoken about but it is worth considering instead of tossing out the bankruptcy option wholesale.
Good points, Jo. Bankruptcy is personal like everything else. Writers need to remember that their copyrights are property and subject to all the things that property is subjected to, rather than get surprised by that halfway down the road to a bankruptcy or whatever.
This is slightly misleading, but its general substance is correct.
(1) There are provisions in the Bankruptcy Code, and even in the law of respective states (because titles to intellectual property may, if properly documented, qualify as part of excludable personal property), that can keep the copyrights, royalty streams, and other interests from being disposed of in bankruptcy. You need a specialist attorney to assist you with this if you are ever contemplating filing bankruptcy. There is no substitute for a specialist attorney in this area.
(2) Those provisions have little to do with which chapter of the Bankruptcy Code governs your filing; they are about who is managing the filing.
US bankruptcy comes in several flavors, only three of which* matter here: chapter 7 (liquidation), chapter 11 (reorganization, ordinarily for business entities), and chapter 13 (so-called “wage-earner” plans). The key difference in a consumer or small (<$1m debts) business bankruptcy is the role and activity of the trustee. It is the status of the debtor that determines what exemptions and exclusions may be available; it is the trustee (or, when contested, bankruptcy judge) who determines whether particular attempts to characterize something that is potentially capable of earning money to be distributed to creditors will be treated that way or "abandoned." As you can imagine, this gets rather technical rather quickly, but the major friend for many authors is the concept of "administrative costs." The trustee will be loathe to retain otherwise-retainable assets for which the costs of administering the assets in relation to their anticipated revenue in the next twelve months for the estate are unlikely to significantly exceed those administrative costs.
Here's an example from the Byron Preiss Visual Media bankruptcy, with the serial numbers filed off: Works J1, J2, and J3 were done as WFH by Anne Author. J1 and J2 were out of print; J3 had earned a grand total of $740ish for BPVM in the immediately preceding two royalty periods, and given the royalty rate substantially less for Anne. Using the actual data provided, Anne demonstrated to the Trustee's satisfaction that the cost of administering this title for the forseeable future would be comparable to the potential benefit to the BPVM's bankruptcy estate by showing the past three years of data regarding J3 and the last three years of data of J1 and J2 for while they were in print. If you're self-publishing, you can probably see how the process would work for your own efforts.
That's what it's going to take: Not pleas that your copyrights deserve the same status as your grandmother's wedding ring (look, those can be won, but they require some pretty damned good — and expensive — attorneys arguing in the right factual context), but demonstrating that administering the assets will cost too much compared to the benefit to creditors. That's not just the trustee's expected fees, either; that includes promotional costs, sales taxes, and everything else.
Last note, and this is actually the most important: If you do go through a bankruptcy and there are copyrights involved, ensure that those assets are properly scheduled and resolved by the bankruptcy proceedings (and that the final paper gets recorded at the Copyright Office). The second-largest cause of “copyright orphans” appears — and, ironically, since it’s a recordkeeping failure that’s the best we can say! — to be failure to schedule ownership in bankruptcy so nobody knows where they went. This is particularly bad for older (pre-1978) works and in H’wood; as an example, everything you know about the ownership and creative credits of the Sam Raimi Spider-Man films is wrong, traceable directly to three botched H’wood bankruptcies. At what the law firms involved were charging, there was only one excuse for those three botches: Bad recordkeeping meaning that everyone was guessing.
* I’m ignoring farm bankruptcies because I don’t know enough about the special aspects of them to comment separately; for our purposes, family-farm bankruptcies are treated, so far as I can tell, as chapter 11 reorganizations.
I second the recommendation of an insurance broker. It’s their JOB to read all the details of all the insurance plans, and you’ll be amazed (I certainly was) at how quick, efficient, and helpful they are at figuring all this out. One of them got a friend of mine coverage that paid for brain surgery and rehab thereof on a pre-existing condition! They can squeeze you in through the loopholes.
We are currently doing the dance with COBRA (and that is a bad acronym for something that’s supposed to help — but it really fits, as those of you who’ve had it can attest). I still got a Dave Farland book, and more Peter David, b/c I can imagine the slightest amount of their problems, and there but for the grace of God go I.
Thanks, Sally. A good broker is an amazing person. I know a few, and they’re wonderful, efficient, and on top of everything. I’m very impressed.
Sally,
Thanks for the info about your friend with the pre-existing condition.
Whenever this temp assignment ends, and if I’m left dangling again with no medical insurance, I’m going to look into finding an insurance broker.
Another invaluable blog post Kris. As a Brit ex-journalist I would say that insurance is vital. I had a policy, was unable to continue it – in part because my family refused to help (as they had too much capital tied up in land etc!!). Then I got multiple sclerosis and ultimately was forced to give up work. If only I still had the health insurance… Now I have a disease which restricts what I qualify for, here in the UK. Just have to ensure that my wife & her children (in the US) benefit from my belated writing career.
Kris, thank you for this post. I haven’t spoken about this problem, but you’re right: Bankruptcy isn’t an option.
Dave
Thanks, Dave. I hope some folks have come over to your site. There but the grace of God go we all.
Thanks for this, Kris. I had a beloved aunt die all too early (twenty years next November) from ovarian cancer. It’s easy to forget that all it takes is one mutation in a single cell that takes hold to screw everything up.
Re: insurance, I haven’t read the new health care law in its entirety (I’d still be reading two years from now, I think), but I’m thinking there has to be a way to set up an insurance group for writers, right? Spread the risk, etc.?
Amazing how tied the “safety net” is in this country to having a traditional employer who provides it, even as employers continue to roll up those nets for their employees daily.
A lot to think about–thanks again, Kris.
DJ
Thanks for this, Kris. In my day job I see people every day who haven’t planned for emergencies and people who haven’t gotten around to drawing up a will because they don’t want to “dwell on that morbid stuff.” It saddens me, because I know when the inevitable comes they will be completely unprepared and they or their families will have to deal with the consequences. Personally, I would hate to leave my wife and children in that situation.
I want to reinforce two things in Our Gracious Hostess’s well-considered plea here. They’re both clear enough to me, but not necessarily clear enough to a nonlawyer.
(1) If you own substantial intellectual property, or anticipate owning substantial intellectual property (such as that you inherit from your much-more-famous Author Ancestor), do not rely on a trusts-and-estates attorney to get that aspect right. Ensure that he or she consults with an IP lawyer on the parts of the will and estate plan that deal with these issues, such as how to deal with 17 U.S.C. § 203 and that fact that Congress says that your choice of heirs may not matter for your copyrights… unless you take some very specific steps that I can guarantee are outside the expertise of a trusts-and-estates attorney. If you want a truly awful example of this problem in action, consider Andre Norton.
(2) Don’t forget that your estate plan includes more than just a will and an advance-care directive. I’m currently dealing with one of those now; it just last week moved from the world of “I have a new kid — an 84-year-old who thinks it was Friday the 32d last Thursday” to probate administration. This man did have a valid, properly drafted will, and an advance care directive. He did not, however, have an adequate “advance financial and business affairs” directive… and when dealing with IP, the mere limited conditional power of attorney proclaimed as sufficient by the trusts-and-estates bar isn’t; it’s not even close.
* * *
Finally, I want to make one side comment on an implication of something Our Gracious Hostess raised: The problems with bankruptcy. Don’t forget that some of the people you, as authors, deal with can go through bankruptcy, too… and that the most-common cause of litigation in bankruptcy proceedings is inadequate recordkeeping. You don’t really think that publishers — given their little problem with royalty records — are immune, do you?
My point here is that part of advance planning (whether for an estate plan or otherwise) is a clear set of comprehensive records, even of your self-publishing efforts. One of my long-time clients is both a lawyer’s dream and a lawyer’s nightmare in this regard: He has his records. Indexed by work, by publisher, and by publication.
Back to the 1950s.
In the course of some litigation earlier this century, the opposing party demanded to see copies of all of his publishing contracts (both as harassment and to try to prove that he had valued certain rights so low, as a business practice, that there were no damages from that company’s acts). We offered to make them available for copying, if they’d bring their own copy machine. All 30,000 pages. The key point is that disclosing the fact that we had the records forced the company to entirely drop that “defense”, because it made our damages calculations non-speculative.
The same principle goes for the management of an estate (whether a probate estate or a guardianship/conservatorship estate over someone who is not competent to manage his/her affairs). Don’t just file the contracts and royalty statements by date, and maybe by work. Index them as you go along. Your lawyer will later thank you.
C.E. Petit,
If I may ask, how in the world to you even begin to do all this? It seems like there are a hundred different things to do to get things in order, but what is step one? I know it may or may not be different in Canada (though I’m still American) but all the same, I know I need to begin this while my body of work is relatively small and I haven’t made and REAL money yet.
And thank you for sharing all this. This has been to say the least, extremely educational.
Ramon, I’m not sure which “all this” you’re referring to, so this is going to be cursory…
The first “all this” is when you’re getting your estate plan in order, and you tell your lawyer that’s doing the estate plan that he/she needs to consult an IP lawyer on handling the IP interests. You’re the client; this is your right, no matter what nation you’re in.
The second one is simple: Again, tell the lawyer preparing your estate plan that you need this. Unfortunately, most “do it yourself” package aren’t sufficient for this situation. A business entity structure might be… but it depends too much on the kind of entity and the jurisdiction to say more than “might”.
The third one is rather easier. Set up a spreadsheet and index away. Every line is a different contract, with columns for work, date, reversion, publisher, editor, payment, and so on. You should have this for your taxes anyway; adding a document index number is just one more column. And it takes less than a minute each time a contract comes in or status changes to update it.
Thank you, CE. For the moment I’m only my on indie press, so things are a little simpler without the contracts. It’ll be good to start now while things are simpler and there isn’t a ton of money involved.
Thank you for taking the time out to list all this. 🙂
Ramon, you still have the user agreements you’ve made for the various sites that you’ve uploaded your work onto, and anything you’ve done through Dreamstime, etc. So you still have contracts. Just not 20-page contracts from traditional publishers.
Thanks, C.E.
C.E., #3 makes so much sense, but I haven’t been doing it. So I’ll start now and work backwards. Kris, thanks for this and for pointing out that I should include my distribution and stock photo contracts/agreements.
I might be missing something with #2. To me, it looks the same as #1: consult an IP attorney while making up your will/estate plan.
Speaking of which, do you recommend any particular estate lawyers in Ontario? Or do you think any local estate lawyer will be fine, as long as you get an IP lawyer to manage your copyrights?
I know one of my local estate lawyers was like, “How much are your copyrights worth?” so she could put a number value on it, but didn’t seem interested beyond that, so I’d asked the Passive Guy if he’d work in tandem, but do you think I need a Canadian IP lawyer as well?
C.E. or other lawyers, if you don’t have a great literary/general executor candidate in your family, would you name a firm as a backup? For me, that would be one that handles my investments and offers other services for doctors–a high MER, but I know that when my MIL died, my husband, the executor, dragged his feet until his father and sister flew up to finish the job a year later. Might be a good alternative while I wait for my organized 7 y.o. to come of age.
Lastly, I know I’m late to the party and no one will probably read this, but as an emergency doctor and a generally paranoid person, I’ve never felt immune to life rolls. I feel lucky to live and work in a health care system that’s accessible to everyone, even though it has its downsides, like any system.
Even so, I’ve bought insurance up the yin yang. So I feel for the people trying to meet their basic payments, but for those who can afford other insurance types, definitely look into disability insurance. I have disability insurance only because they come courting med school graduates, but one of the lines was, “If you had a money-making machine in your house, would you insure it?” (Yes.) “Then why don’t you insure yourself?” It made sense. We also have life insurance for the kids and medical insurance.
In case no one’s mentioned it, there’s also critical illness insurance, so that if you’re suddenly unable to work (heart attack, cancer, etc.) and your disability won’t pay for 90 days (that’s me–keeps the monthly fee lower), you get a lump sum payment. (“Oh no, I have cancer. Well, at least I get $30,000.”)
And there’s also long term health insurance, so that you don’t have to bankrupt yourself or your heirs for a nursing home, which I was going to get, too, but the agent gently told me that usually people don’t buy that until your term health insurance is up. Evidently most people worry about your kids now and dementia later.
Thanks again. Love the Business Rusch, especially the estate stuff.
Ghoulish Melissa
Good post, Melissa, and I hope the lawyers answer you. As for the Ghoulish part, I think we’re brought up to think discussion of anything negative is ghoulish, not constructive, and it leads to all of the denial that’s a subtext here. So, I, for one, am glad that you mentioned all of these things and don’t find it ghoulish at all.
Thanks, CE.
Kris, now and then you shock me. Something I never thought of was the idea of losing my copyright if I had to file bankruptcy. I’ve been self employed but not as a writer for a long time–so such things never occurred to me and this is something big enough to have a chat with my day to day bill paying husband.
I feel very fortunate that as I pursue this career path that I do have someone to lean on for necessities like health insurance, but as an alternative healthcare provider, I continue to have little trust in the companies. You don’t want to get me started.
As someone who works in the non-clinical side of Health Care and supports his two older but not quite elderly parents I have two suggestions for folks in the USA on health insurance.
1) Talk to your local county. It can be as easy as googling ” Health”. You may be surprised what they have to offer.
2) Next suggestion is a little more sneaky but can get you to the same place. Find the more well-to-do hospital in your area and walk in the door. Most hospitals are very skilled about finding a way to get money for the services they provide, the more well-to-do hospitals are better at this than your local county hospital. Tell them you do not have health coverage, live in the area and ask for assistance. They will have a list of local, low-cost providers, charities, urgent care centers and other services that you can use.
Oops that should be: It can be as easy as googling “*county name* health”.
Thank you for this, Christian.
Well, I went and donated anyway, in addition to buying one of Dave’s book. How could I not?
Thanks, Nancy.
Kristine, thank you so much for this post. As a U.S. writer who lives with congestive heart troubles, and who has a spouse surviving with Stage IV breast cancer, I see far too many writers who go without insurance, who don’t even think about potential health problems. Again, thank you.
Thank you so much for this post, Kris. I’m Canadian, and I have the feeling that what I’m about to say is not quite what you expected.
One of the most important things you’ve repeatedly tried to do with these types of post is tell us to ‘take care of business’ while we’re in a position to do so.
I have a wonderful friend, now in her early 70’s. No, she’s not a writer, but she was married for forty years to a painter. They lived a nomadic existence which precluded having children. They were both happy. She’s been a widow for five years now, and up until two years ago was a vital, dynamic person, – and a notorious procrastinator. She’s never made a will despite mentioning often that she should get around to it. She owns a country property that she’s been wanting to sell for about 3 years but never got around to doing…etc. Unfortunately, over the past 2 years, she’s begun to lose her memory and I think even worse. She has no family at all. I try to keep in touch by phone but there’s little else I can do. I’m not mobile and cannot visit her with any regularity. The last time we planned a visit from me, no one answered the door. She forgot and went to sleep.
As her friend, my hands are tied. I’m not acquainted with any of her other friends, if she has any left. The only thing I can see happening is that at some point the Provincial Curator will step in, take over her affairs, and institutionalize her. And I won’t even be able to find out where she is to visit her, or talk to her. So no, this post is not just for writers.
All I can say is, “People, please take careful note of everything Kris has written here. None of us knows what’s going to happen from now until tomorrow. And if you don’t take care of your own affairs, you just might end up having them taken over, taken away, and at best, being taken care of badly by some government institution.”
Thanks again for this post, Kris.
This happens a lot, Bea. The laws that prevent us from taking advantage of others sometimes prevent us from caring for those who need the help. My ex-mother-in-law (a great woman) taught me this when she stumbled upon an elderly woman who wasn’t paying her bills, and who was living in filth. My ex-mother-in-law tried to get the family involved; they wouldn’t help, so she had to call social services, which broke her heart. And didn’t really solve the problem. Sad and awful and something I have thought of for years. Just the efforts she went through to get this woman care were heartrending–and they hadn’t even known each other before those unpaid bills.
Thank you for the post.
Great post with lots to think about. I’m from Canada so I am grateful that we have healthcare even though we complain about it sometimes. My husband and I also have life insurance so if anything happened to with one of us there would be money coming in. It’s scary alright. None of us knows what we might have to face in the future.
Fantastic post, Kris, and one that bears re-reading a couple times over and just as soon as my anxiety levels out, particularly over that little brain-bomb about bankruptcy and copyright. I knew it, but I didn’t KNOW it, if you catch my drift–and I’ve got Nolo’s book. Smart people can be stupid and just as deep in denial as anyone else, and I think I’m responding on two levels: the whole global catastrophe thing–our life smashed in seconds–and the personal, my writing, which you’ve forced me to think about more carefully.
See, I worry about this–about getting wiped out in a heartbeat–just about every damn day. My husband drives 90 minutes to work each way; he spends hours on the road. He does everthing right; he’s a careful guy; I nag him to program the hands-free for his phone if he gets paged–or better yet, pull off the damn road and answer the page–but every morning, I watch him pull out of the driveway and wonder . . . what if? What if this is the day? Because there are a bunch of not-so-careful people or there’s weather or a blow-out, or a careful person, just like my husband, whose attention might wander for a moment–or that deer and his buddies who just have to cross the road and can’t wait another second. It’s like Joan Didion said: life changes in an instant.
As someone who’s inhabted both sides of the divide–as a doc and a patient–I know the importance of insurance, and you bet we’ve got it. As someone with a chronic illness that I can do nothing about even though I do everything right and for which I fork over a healthy slug of cash every month so I can function . . . it would be ten times worse without prescription drug coverage–which is only okay and no great shakes and my husband’s on the staff of a medical college, fer crissakes. We’re also lucky because, if there’s an illness or accident, we both understand the implications and possible directions for treatment, a luxury that a lot of folks don’t have. The downside: we understand prognosis, too.
But we’ve also watched our coverage get worse as time goes by. I remember the days when docs treated one another and a doc’s family pretty much pro bono, as a professional courtesy; I also remember that we’d insist on paying what insurance didn’t cover because we know how much doctors eat in costs. But those days of pro courtesy are long gone, too. Everyone’s scrambling. Even with insurance, I’ve held off going in to see a specialist at the husband’s medical center because of the cost. Sure, there are perks to being able to diagnose yourself, but there are some procedures I just can’t do, not even with an extra set of hands and a good mirror.
Still, I *thought* we’re about as prepared as we can be: living will; advanced directives; insurance; an executor and lawyer. We’ve got savings and disability insurance to boot; we pay obscene amounts to maintain all that, too. (Our families wonder why we don’t take vacations often, or travel too far, or opt for lower-cost trips? That’s one of the reasons why.) I keep my medical license current because you just never know.
But what I never stopped to think about were my books as assets of any kind to be protected the same way I might insure a painting or my house–or my health–probably because I don’t depend on them to eat, and my career’s just kind of starting to move. I don’t have the estate you and Dean do–not that I wouldn’t mind trading up for those problems, but you know what I mean. If the wriiting went away, *I* would be upset, and yes, our income would take a minor hit, but we wouldn’t lose the house. Thing is, I want to be in that position, in the sense that I continue to churn out product and the product sells. I want to build up that kind of estate.
What your blog forced me to do, yet once more, was think of the reverse: not only what might happen to me if I get really sick or hurt, but what might go down if something happens to my husband. Emotion aside, being as coldly analytical about this as I can, I know that, all of a sudden and even with disability, our income takes a real dive. Time disappears, too, because I’ll be taking care of him, wrestling with paperwork and insurance companies, and there’s all that distance between us and hospitals and treatments. (And vice versa: something happens to me, he can keep working, but it’s not like he can run home if there’s a problem.) And I know my writing will go away, too, at least for a while–or maybe for good. If, God willing, I *have* built up some kind of literary estate . . . I sure as hell don’t want that to evaporate either because, just maybe, that income helps keep the lights on.
So the take-home is dead on: if *you* don’t plan for this, no one will. When you’re sick or injured, the last thing any doctor can afford to think about is how much it’s going to cost you. When you’re tanking, the doc doesn’t really think much about tomorrow. For a doctor, your future’s measured in tiny increments: from minute to minute, or over the last hour, the previous shift, the fifteen seconds between that IV push and what you’re doing–what the instruments are saying–right now. It’s the what-if of tomorrow that’s the problem, and something only I–we, as individuals–can tackle. Even when you do, you still worry, but at least you know you’ve done what you can. All the survivalists out there have bug-out bags and stuff. So . . . this has to be part of a writer’s bug-out bag, is all.
Thanks, Kris.
Thanks, Ilsa, for giving a writer and doctor perspective. Much appreciated.
Kris and Ilsa have hit the target on more levels than I can count. I cheer you both on and hope everyone who reads this blog sits up and pays attention.
I’ve had a career in medicine from being certified in outdoor emergency care when I worked on Ski Patrol to managing large medical practices. In 1993 I was all set to go to medical school and didn’t because I knew too much about how our healthcare system operates and I’d seen first-hand the ugly truth from an insiders perspective.
Most of the people who practice medicine are healers who want to care for people, but despite their best efforts our system is broken. We spend more in this country on healthcare than any other nation and we have a very poor outcome, ranking number 55 in mortality rates. Why? Because money is funneled away from patient care and into the coffers of big business, e.g. health insurance and medical delivery systems.
Back in 1997 seventy cents on every dollar spent on healthcare went to insurance companies and/or the processing of insurance claims – NOT for the treatment of patients.
When I had just moved to Corpus Christ I got a bad headache. I went to the ER. Four hours later I walked out with the headache and a bill for $15,000. I demanded an itemized bill only to discover that their fees were inflated up to 1200% (that’s not a typo). A CBC costs about $3.00 to run, I was charged $525 (from a lab or doctors office it would have cost me $25). A single view chest x-ray in town runs about $53. The hospital charged me $603. A chest x-ray for a headache? That’s another story. The list goes on, but you get the idea.
The hospital soon learned that it’s a real bad idea to piss-off a writer.
I went toe to toe with the head of their admin department and got the bill reduced to $2,500. As I walked out of the office, I passed people in wheel-chairs, people who were frail and sick and dying and I ached for them. It would never occur to them to negotiate, even if they had the skill set, which most of them didn’t.
I’ve watched patients die because of the greed – not on the part of doctors – but from a big industry that puts making money over what patients need to return to or maintain their health.
It has only gotten worse. Take a look at the documentary “Escape Fire” – http://www.escapefiremovie.com/ – I know you can get it on Netflix. I guarantee it’s a wake up call. I know first hand that everything they expose in this film is true.
My latest novel to be released September 1 was written because of horror stories like Dave’s and other ones I could tell you about that were much worse. The story delivers high entertainment, but the underbelly or the heart of this novel bites at the truth of how our healthcare system is failing us.
OMG, Kris, this post really brought it home for me. (I just bought one of Dave’s non-fiction titles soon after starting to read this.)
This has been my life for the past 5-6 years.
In 2007, my husband was diagnosed with bipolar disorder, this after he suddenly quit his job. And it was a good job. With it went the extra dought to pay for certain things. Thank goodness I was an employee at the time with insurance, so I put him on mine.
Fast forward to 2008. I had a brain aneurysm. Like you said, thank goodness I had insurance. As it was, my entire stay (2-1/2 weeks) plus the surgery (a technique that’s minimally invasive, that literally “lassoes” the clot out of the brain), came to about $100,000. Insurance paid for most of that.
Most of that. And we had lost a ton of income because of my husband’s, um, “decision.” Anyway, there was still over $10,000 that needed to paid back to the hospital and surgeon. Fast forward to 2012, and we’re still hanging on, by a thread, paying back credit card debts even while my income, which now consisted (and still consists) of temp jobs. They don’t pay anywhere near what I was making in 2008 (that job went south in 2009, BTW).
Hurricane Sandy happens and my husband’s manic energies go into overdrive. I won’t get into details, but he’s no longer in the house with me and never will be again. I hate even saying that after 20+ years of marriage, but I can no longer trust him.
In December 2012, I declared bankruptcy. Fortunately, I guess, none of my writing was making a hell of a lot (I still have to get more out there), so I was able to go through a Chapter 7 – wiped out all my debt. Yeah, this will be on my credit for 10 years, but I had no choice, due to circumstances beyond my control. And I was without medical insurance since Hurricane Sandy rumbled thru (no damage to the house or anything like that, thank goodness, since I don’t live anywhere near the Jersey shore) up until now.
Why? I was getting it through the temp agency I work for, but when my last assignment came to an end, they offered my COBRA for my vision insurance not for the medical insurance, which I thought strange. You’re right that going without and hoping for the best – esp. in my case, with a condition that a lot of insurance companies would have me paying thru the teeth for – was foolish on my part. I did do some searching for insurance, but the rates I saw were astronomical – and selling my house at that point would have left me without a roof over my head PLUS having to pay what was left on the mortgage.
I would have taken even a bare bones policy if NJ had offered one. Alas, AFAIK, NJ doesn’t have anything like that.
I will say though that I’ve emerged pretty well from the bankruptcy and everything else. I’ve got a credit card again after going 5 or 6 years without one, I’m managing to pay the mortgage and the few other bills I have, as well as buy some ebooks from time to time.
Life isn’t so bad right now. 🙂
I’m glad things are improving, Nancy. Thank you for sharing.
Maybe others will see that no one intends for these things to happen. They just do. 🙁
You’re right, Kris. Things DO just happen, a lot of the time, completely out of the blue.
Kris, thank you for writing this and I hope people take the planning you discussed to heart.
Speaking as a Canadian, though, I have to say that I do not tune out when Americans talk about their insurance. I care deeply. Many of us do, but we must bite our tongues when the discussions begin, because if we say how appallingly inefficient, unjust, and frankly barbaric your medical system is, we get attacked.
Stories like David Farlane’s are especially heartbreaking because we know what his situation would be if he were Canadian.
I can’t very well go without talking about insurance here in the US, can I?
Politics in the US has become ridiculously binary at this point, but even in a black/white system, the way government relates to huge corporations isn’t so clean-cut. Big companies like insurance companies have people in DC getting laws passed that will help them make more money. And where does that money come from? The insured, and the medical system (in the form of reduced payments). Follow that with the stories of how hard insurance companies worked after hurricanes Katrina and Sandy to avoid paying on claims, or to delay payment beyond any reasonable time, and you can see how insurance companies care nothing about peoples’ well-being.
(Please don’t take this as a slam against all people involved with insurance. Insurance, as an industry, is closely tied to the political system that regulates it, which seems always to lead to corruption and unethical influence on policy.)
And I can second Kris’ point that you cannot prevent health disasters, only minimize them. My dear cousin lost all three of her daughters, ages 10, 8, and 8, in one car accident caused by a stranger. You can exercise and eat right, but you can’t stop teenage girls from texting and driving.
I think the real shame in Dave Farland’s situation is that he had great insurance, and then the company decided it wouldn’t pay. Isn’t this the horror story we all keep hearing about? That someone paid into an insurance policy for years and years, then when they needed it, they found themselves caught up in a massive legal battle (because it was cheaper for the insurance to pay the lawyers than the doctors?) Dave did everything right, but was wronged by the insurance company. This is the kind of thing that should be fixed first, before anything else.
As someone with asthma who lived in the states and now lives in Canada, I’ve experienced first hand what not having medical insurance is like. Every system has flaws, but it’s nice that I’m not denied insurance because of a pre existing condition that I have well under control. This is something that has been on my mind, and I’m really thinking it’s time to start figuring things out for the future. Thank you for posting this.
About 18 months ago my mother had a stroke that damaged her ability to feel sensation in her hands. As a professional musician she had to retire.
Same thing would happen to a writer who got hit in Broca’s region. They might be fit and well otherwise but it would probably end your ability to work as a writer forever.
I found for months after my mothers stroke I couldn’t even read, let alone write. (Very strange for someone who often reads two or more books in a day) .
That same thing happened to me after my father died, Thomas. Six months. No reading, no writing. Just thinking (and the occasional movie). I was as stunned as you are. I hope things are improving.
Yes the death of my dad was traumatic. Even though he was in his 80’s at the time. As Kristine notes it was several months or more like a year before I fully started being creative and productive again. Its a strange experience to turn inward like that.
When my father crossed over I didn’t write for several years. After my mom joined him this past December, it took me seven months to finish a 130k word book that I’m just now editing. I totally know what you mean.
I can’t even remember anything from the first six months after my mother died. From what I’ve read since, this is pretty common. Be gentle with yourself.
Just because one doesn’t tend to be accident-prone (or illness-prone or robbery-victim-prone) doesn’t mean that guy driving 40 mph down the street isn’t. He just fell asleep because of his late night, the car ran off the road, and conveniently crushed your right arm and left leg. Or worse.
That’s what medical/health and life insurance are good for. While you might be very healthy, you’re still gonna die sometime. While you might be very healthy, someone else could still run you over. How many drivers (not you, of course) drive blithely around without a dime of insurance?