The Things That Keep Me Up at Night
I turned 26 this August, a week after I started my new job. My coverage under my father’s health care plan ended September 1st. The company he works for is so massive that even having turned 26, I was able to sign up for a COBRA with their insurance provider until my new employer’s insurance kicked in after my trial period. This was a massive relief, as I had spent quite literally the entire first six months of 2018 consumed by what the fuck was going to happen once I was outside the protection of my father’s company.
When I first moved to New York in June 2016, I was 23 and my first six months were consumed by finding continuing care. The first priorities for me were prescriptive: I needed an OB-GYN and a psychiatrist. I hadn’t had particularly good luck with therapists in D.C. so I decided that finding a psychologist could wait. Until I couldn't. October 2016 found me barely able to work or get of bed and my mom had to fly in and stay with me for a week. Medication alone is better than nothing, but ultimately, I found that I also need talk therapy to manage my depression.
Finding the right therapist is hard, finding the right therapist who will take your insurance is harder. I found out later that many therapists have a quota of the number of patients they’ll work with in-network. Out of the three therapists I called, only one called me back. I was incredibly lucky: something about her made me trust her immediately in a way I never had with any other therapist. I finally found a perfect fit.
I’ve been in and out of therapy for clinical depression for over a decade, but that’s kind of like saying I’ve been dating for over a decade. I have, just with different people, and you start over every time. Like first dates, first sessions are often awkward recitations of the basics, just scratching the surface of what it will take to build a relationship. You may click, you may not, and whether you have a second session is entirely up to you. Whether you’re going to pursue this relationship is entirely up to you, and that is what therapy is, in the end. A relationship. Your therapist has to know you for you to do the deep work.
And, like a romantic relationship, frequent and open communication is incredibly important. My therapist only works with clients that can come in once a week. When we first starting working together, I was a little skeptical (but in such dire need of help that I went along with it). Now, having gone from seeing someone once a month to once a week, it’s a wonder that I found a monthly session effective at all. So much happens in the space of week, let alone a month. You can’t unpack a month in 45 minutes.
This fall, my therapist was away on maternity leave for ten weeks. It coincided nicely with my father’s coverage ending, and as we’ve been working together for so long, I didn’t think it would be prudent to see another therapist in the meantime unless there was an emergency. It would be a good test, I told her, to see how I did without therapy, see how I could function on my own. I was looking forward to seeing what independence would look like.
I did well the first month. I was distracted by a new commute and a new job, changes at my yoga studio. I was traveling a lot too, which I loved, and my schedule was packed. But the sudden changes compounded with the traveling eventually wore me down. My enthusiasm for anything—work, yoga, sex—was dulled, still there but cloudy. I was struggling to get out of bed more. I thought I was just tired, but it lingered. One tired week became two, became three, and then a month. It was manageable, but I knew that I probably only had a few more weeks before I had to call for reinforcement. I made the first available appointment with my therapist after she returned from leave.
The first appointment was a blur. Ten weeks spilled out, barely coherent. It was a shock to realize how little I had processed, how much I carried into her office that evening, how much had happened in such a short span of time. For all my yoga and “mindfulness” and “meditation” and taking “time for myself” and “resting,” I had simply shut down. There was so much shit to shift through.
My new employer’s health insurance will kick in on January 1st. With small companies, you get what’s called an HMO or a Health Maintenance Organization. It offers no coverage beyond a PCP and an OB-GYN, or for providers outside of network. Once I’m enrolled, I can file a pre-authorization through my PCP, which I will also likely need to do for my psychiatrist, who is covered by my provider but only through a PPO (Preferred Provider Organization, something that is only is offered at larger companies). I have no idea how much or even if they’ll cover any of what I am dependent on in order to be a functioning person.
Of course, I’m incredibly lucky. For the time being, my father has agreed to offset the costs. That I have parents who are both willing and able to give me a safety net is a privilege, one that I know many don’t have. It’s also infuriating. Despite mental health being the third most common cause of hospitalization in the U.S. and suicide being the tenth leading cause of death, mental health isn’t covered by a basic health care plan. And that’s if you can even afford it: it’s estimated that over a quarter of homeless adults staying in shelters live with a serious mental illness. That there are so many people left unable to get help is disgusting.
I often marvel at people, usually people my age, who say that they would prefer to opt out of health care. There is a part of my brain that gets it: hundreds of dollars I could save and invest for myself while I’m living on a salary you could expect a girl in her mid-20s to be making in New York. There is another (bigger) part of my brain that is absolutely livid: in order to make health care affordable for everyone, everyone has to pay. It’s kind of a no brainer, investing into a community to make it more healthy. And yet...
Here’s the thing. No matter who you are, one day, you are going to need that health care. The expensive kind. If not you, a loved one: an accident, an illness, a tragedy always happens eventually. Sometimes they’re livable but chronic and slowly rack up thousands of thousands of dollars. Sometimes they’re urgent and time-sensitive and you blinked and there’s thousands of dollars in medical bills waiting for you at the check-out. Tragedy and suffering are non-discriminatory. The question is whether you can afford it or not.
I suspect many of the people who will open this letter can afford it or, like me, are struggling to afford it but will one way or another get some amount of coverage. If you are like me, you probably already know that it takes a village, that health care in the U.S. is something that even many people with above-average income can’t do on their own, that those of us with that above-average income need to do what we can to help those who don’t have that safety net, that we need to be that safety net. If you can afford it (and have always been able to afford it), I hope that maybe this helps you understand why we advocate for universal health care. And for those of you who still need health insurance for 2019: the deadline to get covered is this Saturday, December 15. Here’s the link.
All my love,