Martha Kaplan and I are both depressed.

This is the first in a series of conversations about depression and money.

Logan Sachon: So we’re here today to talk about DEPRESSION and how it affects our MONEY.

Martha Kaplan: Not well. It has what I would characterize as a “negative effect.”

LS: Yes. I think you are right about that. We both have some personal experience with this. I’d say.

MK: I would say that also.

LS: So we’re going to talk about this. Martha Kaplan is not your real name, though maybe it should be.

MK: Yes I have requested to be anonymous because of my job. It’s hard to be taken seriously in your place of business if it’s widely known that one, you are a lady, and two, you sometimes have trouble getting out of bed. Either of the the two is problematic. But in combination it’s disastrous.

LS: … 

MK: I’ll give you the breakdown on my “issues.” So I’ve probably always been somewhere on the depression spectrum. But this got particularly bad during college. There was a week-long period my sophomore year when I didn’t really leave my room. I mean, I got some food, occasionally, but I mostly didn’t go to class. I definitely didn’t wash my hair. I didn’t really see people (probably part of that was shame because of the state of my unwashed hair).

This was maybe right around the period when I started putting vodka into my coffee before going to class. I was, in general, not being the best Me I could be.

But anyway, at a certain point I came out of that, and I started seeing a therapist who I didn’t end up liking that much, but I was diagnosed then with a mild bipolar disorder. I eventually went on a couple medications: Lamictal, which was originally for seizures, but has a secondary use as a mood stabilizer for manic depressives who can’t be on antidepressants because that would make their mood too elevated, and also Concerta, which is essentially time release Ritalin, which I basically got because I wanted to stay up all night writing papers, because I always wait until the night before to start doing things. So that was less related to my “illness” or whatever.

LS: BUT WAS IT I WONDER? (I do that, too.) (Wait until the last minute.)

MK: I mean, my inability to do shit certainly is related to my anxiety re what I’m producing not being good enough. If you self-sabotage, you can blame that for the low quality of the product you make. You set yourself up for failure, so you can avoid larger, failure of SELF. We’ve talked about this. I think we both do it.

LS: Yes. You recently re-reminded me that I do it—many a therapist has told me I do this! And my mother! But I forget.

MK: Self-sabotage. It’s very trendy and helpful. Anyway, I spent a lot of time not being in therapy or on medication; but I’ve been seeing someone for about seven months now, and it’s been a pretty big game changer. Her diagnosis right now is generalized anxiety disorder, though I think I cycle through high and low moods with some intensity and frequency, which is a mark of bipolar disorder (like, also of life, and having feelings). But it’s probably not serious enough to be diagnosed. Bipolar disorder is SERIOUS.

Anyway. I’m managing my shit with talk therapy. And no medication at the moment. And it’s going okay. Probably my best friend, to whom I often write panicked emails and or have very teary conversations with, would disagree to a certain extent. So that is my deal. What is YOUR DEAL, Logan?

LS: Like you, my first experience with pretty intense therapy and an actual diagnosis and medication came in college. I saw two therapists in high school, but only for a few sessions each, and both times it was understood, at least by me, that I was just seeing this third-party adult to talk through some hard times. But my third year of college, everything was going great on paper but I was anxious and miserable all the time and also could not get out of bed. I eventually dragged myself to student health—it’s funny, that seems like such an easy thing to do, but I remember it being this huge internal debate, mostly because I felt like if I just tried harder I could figure this out. But something eventually made me go, and I went.

Pretty quickly I  had a talk therapist and a psychiatrist and a prescription for Prozac. I say sometimes that the Prozac saved my life, which is an exaggeration in that I wasn’t suicidal, but the difference between before I was taking it and after was incredible, for me. My diagnosis at that time was mild obsessive compulsive disorder, but all the docs I’ve seen since then—and it’s been several—have said it’s really more just clinical depression. I’ve taken myself on and off medication and in and out of talk therapy a lot in the past eight years. Sometimes because I felt like I was CURED, sometimes because of the expense, sometimes because my prescription ran out and I didn’t refill it, sometimes because I read an article or got deep into an internet hole about how anti-depressants are a government conspiracy to poison our brains and turn us into zombies, and sometimes because I moved and couldn’t deal with finding a new doctor.

MK: Feeling like you’re cured is a problem. I feel—and this is a dumb comparison—that it’s a little like being on a diet. Like, you lose 20 pounds, or feel mentally stable and you’re like OKAY DONE SOLVED IT. And then you stop eating just pressed fruit or taking your medication or going to therapy and your body is like, guess we’re off the hook and just goes back to doing what it does best, which is hating itself. That is obviously a glib comparison, but it has taken me a long time to accept that I’m never going to be done dealing with this. I have to live my life in a different way forever to be healthy/happy/not sobbing uncontrollably and never leaving my bed.

LS: Right. I went on and off medication several times and then three years ago I was like, okay, I’m going to give this one more try. I’m going to go off it and do it right, and see what happens. And so I weaned myself off with the help of a doctor. and I was off the meds for a year, and during that time I worked out several times a week, I swam laps, I ate good food. I saw an acupuncturist once or twice a week, I made sure I got enough sleep. I did all the things that you’re supposed to do. And I thought I was doing so well, I thought I’d figured it out.

And then I went home to visit my family, and I can still remember my mom saying, “Yeah, you can get out of bed, but you are not you. You are not thriving.” And it was then that I realized that my life was PERFECT, basically, at that time I had a good job and great friends and great house, and I should have been feeling so much better than “getting by.” So I saw a new doctor and went back on meds and I haven’t tried to go off of them again. But here’s the other fun thing.

MK: Tell me the fun thing.

LS: Is that even though I’ve accepted and decided and even embraced that I need medicine to just be at a normal functioning level, THAT’S NOT ENOUGH. Because three times since then I’ve had to change medications because what I was on stopped working. “How does that work?” UNCLEAR. Psychiatrists don’t even really know how antidepressants work, and they don’t know how they don’t work. So those periods of trying new meds are always really, really terrible.

MK: I guess this is a good time for me to say that I am not super pro-medication, at least not for myself. There were a series of terrifying articles in the NYRB about how doctors literally have no idea how antipsychotics or antidepressants or any of that shit works, and how they change your brain, and how it’s impossible to ever go off them because of that. And that scares me. (I’ve also never had very good experiences with medications. The Lamictal made me feel like my head was filled with cotton balls. I felt functional but very, very dull.)

Though obviously everyone has to do what works for them, and as your friend, who cares about your mental health, I’m really glad you have found medication that works for you. You are typing right now, but I also want to remember to go back to that thing that you said about just getting by, just functioning because I think that’s really important AND has to do with how this kind of shit affects the way that we spend our money.

LS: The “yes meds or no meds conversations” isn’t a conversation I’m interested in having any longer. I’ve accepted that they work for me and I don’t care to explore that further. I’m not going to try to convince you to go on them. Okay that’s not entirely true. I have tried to convince you to go on them.

So basically we are two women. Two women who sometimes suffer from depression (I hate that phrase. Have depression? Can be depressed? Have a diagnosed disease called depression?) We are just trying to figure out the best ways to get through our days.

MK: Trying not to self-sabotage ourselves into an early grave, or bankruptcy.

LS: So to start out, with the money talk. Just going to doctors and therapists is expensive.

MK: Oh YES IT IS. When I was in college, my mother paid for not only my therapist BUT ALSO a psychiatrist I saw every couple of months, for the medication, because my psychologist was not a doctor/could not prescribe meds. And I … did not feel as guilty as I should have about this. I think insurance covered some part of it, but not all of it.

But now I am a grown ass woman, with a job and stuff. And so when I decided I needed to see a therapist again (“decided” = more like everyone I knew was like GET HELP WE CANNOT DEAL WITH THIS YOU ARE SO UNHAPPY) (and I was like a MACHINE OF SELF PITY) (and then finally I was like, “Hey guys, you’re right”), I was determined to pay for it myself, which, ugh, was/is hard.

The first person I went to, who I FELL IN LOVE WITH, was this tiny old woman on the Upper West Side (obviously). We had three consultation sessions, which thankfully I did not have to pay for, because this lady was $300 per session. WHICH IS BONKERS. That was like my entire income, basically.

LS: Did you know that before or after you went to see her?

MK: I found out during session two, which was crushing. But she was very nice and recommended someone. BUT this woman was also very expensive, because I lied about how much I could afford, because I am awkward talking about money. So for two months, I went to the woman I now see. And she was charging me her full rate, and that was … $200 a session. And that was very hard. I essentially took a second job to cover it. And my mom ended up paying $200 total over that two month period.

But finally my therapist, who is not a dumb lady, was like, “So, um, how are you paying for this? How much money do you actually make?” And I was like, “I actually cannot afford this AT ALL thank you for asking.” And she cut her fee in half, which was amazing. And THEN I went through this really rough period. I didn’t go to work for a day, because of the SADNESS. And she was like, “This happens a lot, when you start delving into stuff. It sometimes gets worse. If you want to get through this faster, maybe two sessions a week?” And I was like, “I cannot pay for that.” And she, being an amazing human, was like, “What if the rate was the same? Per week?”

So I’m now paying $50 a session, still kind of working a second job, but making it work and not relying on my mother for dollars, which I think is good for me. I think if she was paying for it (which she would totally do), I wouldn’t take it as seriously. I blew off appointments a lot when I was in school, because, like, whatever, not my money (also because I was sad and she was not a great therapist).

LS: I’m not seeing someone right now, but have an appointment next week to see someone, a consultation appointment. We haven’t talked money yet, but I know the friend who referred me pays a discounted rate, though that might not mean anything. You can only afford for so many people to not pay you your rate, right? So his sliding scale spots might be filled. So I’m preparing myself for that. But, like you and your UWS lady, you just need somewhere to start. If I can’t afford him, I’ll get names from him.

I also cannot really afford to be going to therapy, but … I also cannot really afford NOT to go to therapy. My parents have said they’ll help me, and they’ve helped me in the past, but like you, it’s not something I want to get into. Even though I’ve been to five zillion therapists, finding a new one and starting with a new one is always a big step, a positive step. This annual or biannual or whatever it is acceptance that this is not just a funk I’m in and I can’t just pull myself up and snap out of it. So making this appointment was big, and it’s something I want to do on my own.

MK: I think this is a totally acceptable thing for your parents to help you with if that’s possible for them. Like, it’s possible for me to make this work financially without help. But if you can’t make it work financially without help, I don’t think that’s a reason not to do it. Because so many other things, including your financial situation, will improve if you get help on this thing. And you are 28, so you will probs not be a dick like I was in college and not take it seriously.

I think this is a good transition to: how does being depressed/anxious make you spend more money? Because I really, really think it does and not just on meds/doctors/etc. at least for me. I am, right now, wearing a “panic sweater,” a sweater I bought while having a small panic attack. (I also bought a cardigan.) (They’re both great.) (But I DID NOT need them / could not really afford them.) But the brain situation was so crazy for me at that moment that I HAD TO PURCHASE SOMETHING to take my mind off it.

LS: It really is a beautiful sweater. I’ve been admiring it all day.

MK: Why thank you. Being panicked apparently makes me a discerning shopper. Who knew. That must be why shopping at large malls during the holiday season is so productive. (JOKES)

LS: Yeah I am wearing sad jeans, bought when I was sad. They aren’t that great. I am a bad sad shopper. Which is also one of the reasons I don’t have any cool stuff to show for all my credit card debt. It’s more like, this is a shirt, that’ll work, cha-ching, ten minutes of … not misery.

MK: I’ve made bad sad shopping decisions. Once I flew into a panic because I was going on a date and was too sweaty. So I bought an entirely new outfit, which included a tiny short-sleeved sweater, which I never wear because it is SUPER hideous. I think part of the problem is when you’re depressed or anxious, you don’t feel like it will ever be better. You believe you will exist in that state forever, and if there’s anything that you can think of that will make you feel better, you just fucking do it. Including buying tiny sweaters and sad pants and pounds of macaroni and cheese.

LS: Yes. It’s very much about what will help me NOW. For me, depression has a lot to do with stasis. I stayed in bed most of today. Reading. Watching TV shows. Napping. And I knew, theoretically, that if I got out of bed and took a shower I would feel SO MUCH Better, but there was also this part of me that was like, but what if I don’t? I’m miserable now, but at least I’m comfortable and miserable. And if I’m out in the world, it’s like, well I’m miserable, but if I buy something, at least i’ll have a cute outfit and be miserable. Or an ice cream cone and be miserable. I don’t ever think about future me. I’m really mean to future me. Only nice to this moment me.

MK: Being depressed is a lot about just surviving. It promotes a subsistence lifestyle. You were talking earlier about going home and your mom noticing that you were just “getting by,” but not doing well. I think if you’re depressed or anxious and you’re not treating it, you just do a bunch of shit in order to just get by. And the fear is, if you don’t there will be no future you. Not that I’m saying you would have killed yourself if you hadn’t bought those sad pants or I would have killed myself if I hadn’t bought that tiny sweater. But it’s true that my feelings felt unsustainable, and feelings are facts. (I stole that from a friend, but it is The Truth.)

LS: Oh that’s good. That’s really good.

MK: It’s hard to argue with them. They’re worse than facts, because they don’t respond to logic. They only respond to impulsive purchases, and massive amounts of cheese, or whatever it is that you’re doing in order not to rip your own face off. If you’re facing a choice between harming yourself financially and harming yourself physically, it seems pretty clear to me that price of a tiny sweater is not such a high one to pay.

LS: ON THAT NOTE. This has not been a terribly uplifting little chat we’ve had.

MK: No it has not been. I think we need to do more. But I have a birthday dinner to go to now.

LS: Oh, we’ll do more. So much to cover, so much to share. But for now, you’re going to leave, and I’m going to go back to bed.

MK: Do what you got to do. Seriously. The other options are kind of terrible, and it’s helpful sometimes to remember that you could be a lot worse to yourself, to future you AND present you, than going to bed. Or buying some jeans.

See also: How to Lose Four Months to a Depression/Spending Death Spiral

Martha Kaplan lives in New York.

Like many young, college-educated people, I have been an ardent supporter of universal healthcare and widespread socialism without really knowing what either of those things are. In fact, I could have gone my entire twenties unquestionably supporting my pinko-liberalism without a first-hand experience with what socialism might look like. But, as fortune would have it, I was given the opportunity to test-drive government run, tax-funded, universal healthcare two years ago. It came in the crucible of a rabies scare.

Like many young, college-educated people, I studied abroad when I was an undergraduate. But I missed my own university’s deadline, and I had to scramble to patchwork a new plan through another college. My choices, of which there would have been hundreds if I just made that deadline, distilled down to four—and it quickly became clear that only one would work at all. Paris, France required French fluency, which my five years of French studies had impressively managed not to bring to fruition. Ulm, Germany required German fluency, which despite never having even one lesson, was on par with my French talents. And Uppsala, Sweden required a steely resolve to be visited by the icy specter of death at any moment in a sparsely populated Arctic hellscape. So Copenhagen, Denmark it was.

After some hasty research, I became incredibly excited at my de facto choice. Denmark boasted liberal ideology, beautiful people, and one of my favorite talking points: universal healthcare! Little did I know how useful this last attribute would factor into my stay.  

Shortly after my arrival in Denmark, I received an email recommending that I pick up my Civil Personal Registration (CPR) card, which is essentially a social security card for Danish citizens. This would allow me to access government services, open a bank account, and apply for a library pass. While my card did say “visitor” on it, I was afforded many of the rights that born and raised Danes receive. I was even assigned a doctor. I took solace knowing that if I plunged into the beautiful Pelbinge Sø after a Tuborg-soaked stumble home from the bar, the Danish government and its beautifully cheek-boned taxpayers would cover me. Fortunately, I never incurred injury in Denmark.

Malady, however, was waiting in the wings upon stepping off the plane in Sofia, Bulgaria—the land of the rabid dog.

Let me get off on the right foot with this publication’s extensive and proud Bulgarian audience: Bulgaria is a beautiful country, and the people I met there were incredibly warm. The cuisine is delicious. I definitely enjoyed my time in Bulgaria—save for about 20 seconds of it. My sister had come to visit me in Copenhagen, and we travelled east together to visit her Bulgarian then-boyfriend, Nikola, who was visiting his mother in Sofia, the capital. Having a local guide improved our experience tenfold, and having an old Bulgarian woman with a lifetime of recipes cooking dinner for us was quite an asset, especially the amazing homemade sarmice (to this publication’s extensive Bulgarian audience, you know what I’m talking about).

On the final evening of our stay, my sister and Nikola decided to go to dinner together,  so I planned to spend my evening seeing a movie. We looked up the theater and it turned out it was right next to the apartment where we were staying. In fact, it should have only been a five-minute walk. But the misty Bulgarian night had other plans.

A little bit of explanation here: Sofia is teeming with stray dogs. They are everywhere. You see them walking around in subways and on sidewalks or just laying down wherever. They are integrated into the culture and benignly get along with their human counterparts—typically. But as in any dog-infested city, things don’t always go perfectly.

I set out for the theater with misplaced confidence that I knew where I was headed. After walking the wrong way for twenty minutes and asking for directions twice, I decided to head back into the dense mist whence I came. Two extroverted stray dogs had the same idea. It started out innocuously enough—they barked at me. I hadn’t yet observed that during my trip, but a barking dog is not exactly cause for concern. But then the pair started following me, and fast. The braver of the two hounds trailed me by only about a few paces, and I began to worry. I hastened my stride and yelled a few desperate go away!’s but nothing was deterring this bloodthirsty beast. Without warning, the dog lunged and grabbed my pant leg. In a moment of sheer bravery, I ran away. This sufficiently tore the dog free by fraying my pants, but I knew this defeat would simply redouble his efforts. As I ran down the dark alley, I thought of my sister having to identify my body, still with her doggy bag full of telesko vareno, how it would put a damper on her evening.  But as quickly as they came, the dogs retreated back into the night. I was alone again, save a few errant barks coming from somewhere in the shrouded street. I was free. I would live.

Or so I thought—a further investigation of the wound revealed two bright red circles on the back of my ankle: blood had been drawn. It didn’t hurt, but I knew the bilious saliva of the mad dog would beset soon enough. Was it rabid? It hadn’t been foaming at the mouth, and it gave up on the hunt a little too easily for a disease-addled killer. But why would it attack at all? I decided the best course of action was to just find the theater. I didn’t want to ruin my sister’s dinner, and I definitely didn’t want to explain my dog attack to an old Bulgarian woman with no English language fluency. Upon entering the movie theater (which, as it turned out, could be seen from the apartment), I immediately headed for the bathroom and, carefully positioning my ankle underneath the foam soap dispenser, I deluged the fetid wound with heaps of aerated disinfectant. While I was pleased with this improvised first aid, I wondered if it would be enough. It was perhaps only in my head, but the bite began to feel weird. Hot, and itchy. I tried not to pay it any mind. I was worried, but things were about to get much, much worse: The only movie playing in the next half an hour was Tron Legacy 3D.

I felt faint.

The only thing less comforting than spending two hours in a dark room by yourself worrying that you have rabies is spending that same duration watching Tron Legacy 3D. Plus, I couldn’t be certain that the mangy dog wouldn’t come to finish the job. I began to panic, thinking about how my fate would be inextricably linked to Tron Legacy 3D if I succumbed to rabid fever in that theater. The movie was spent in the unlikely combination of fear and utter boredom. Against all odds, my foot remained firmly attached to my leg for the entirety of the film.

Later that evening, I  soberly recounting my dog tussle tale to my sister, who, like every good older sister, worried about it.  She immediately got Nikola’s mom (via Nikola) on the case, asking questions and getting answers. We of course had a flight back to Denmark the following day. Would I make it that far? As luck would have it, Nikola’s mother worked as a dental hygienist in a hospital. She was friendly with many of the doctors, and assured us (via Nikola) that we would be able to see one tomorrow. And that is exactly what we did.

After talking in Bulgarian for what seemed like forever (for some reason, “can you please hurry up with the pleasantries? I am slowly dying from a rabid dog bite” was not present in my Bulgarian phrasebook), the doctor examined my ankle. His immediate response was equal parts surprising and troubling: He laughed. Out loud. And then rattled off some Bulgarian. “A scratch,” Nikola translated for us. “It’s just a little scratch.” Now everyone was laughing. The doc splashed on some alcohol, gave me a bandage and shook my hand. I was cured! I thanked him profusely, a condemned man just a moment earlier I suddenly had the zeal of new life.

But of course I did not have health care arrangements in Bulgaria—only Denmark. Nikola and his mother conferenced outside the room and decided that we must buy him something from the hospital gift shop. This next part sounds too stereotypical and downright offensive to be true, but I can confirm it happened, even if a man who was bitten by an aggressive dog is not the most reliable narrator: We bought the doctor a bottle of vodka. The hospital gift shop was flush with alcohol choices and Nikola’s mom pointed out a brand that the doctor preferred. He was very pleased with the token of gratitude (and before this publication’s extensive Bulgarian readership accuses me of slander or malign, I want you to know that during my four days in Bulgaria, I went to Plovdiv. That’s right, Plovdiv. No Americans go to Plovdiv. So you know I know I’m telling it to you straight). Nikola’s mom explained to us that gift-giving was a big custom in Bulgaria, and that when things went well for you, you were supposed to throw a party and buy everyone else drinks and gifts, which kind of makes a lot more sense than the inverse way we do it in this country. The doctor had given me good news, and I had bought him a mini-party. It was a beautiful, boozy sentiment.

Diagnosis in hand, I was feeling pretty good about my little scratch. But upon our return to Copenhagen, my sister rightly urged me to get it checked out again by my Danish doctor. Plus, my doctor was free and I was kind of itching to give Danish care a try so I could proudly brag to all my college friends upon returning that I had tried universal healthcare and be anointed socialist King of Pennsylvania. This title seemed too good to pass up.

My assigned doctor had an office right near my apartment, so my sister and I popped in to make an appointment. I was able to be seen later that day. Dr. Jørgen Jensen, as it turned out, spoke perfect English as a result of spending some high school and college years in Texas. He examined the wound and, like his Bulgarian colleague, he was not impressed by the breadth or size of the bite. He redressed it and then consulted some literature on his desk about dog bites. He told me it was unnecessary to get rabies shots as the disease had been eradicated in Western Europe, a place Bulgaria was considered part of. He hesitated when he said that, as if he was going purely off nomenclature and not intuition when including Bulgaria in the West (this publication’s extensive and esteemed Bulgarian audience, sorry but come on you know it’s sorta true. Get the stray dog situation under control and we’ll chat).

But he reaffirmed his answer. As luck would have it, the appointment after mine had been cancelled, so Dr. Jensen had some free time. He clearly didn’t see Americans much, and he relished his time talking to us and recounting a few choice memories of his Texan youth. After about ten minutes of chatting, he abruptly stopped the conversation and said he had decided to call over to the hospital to double-check about his rabies/Bulgaria assertion. As in Bulgaria, my sister and I were left out of this Danish diagnosis. At that point, I had been in Denmark for five months and could pick out “afternoon” and “dog,” but that did little to give me any indication of what he would say when he hung up the phone. What he said was this: There had been three reports of rabies in stray dogs in Sofia over the past year. This meant I had to go further down the universal healthcare rabbit hole. My life had been spared by a sick Dane canceling her appointment in a random twist of fate. I would live.

Hvidore Hospital is not in Copenhagen proper. In fact, it’s over an hour bus ride away. In early January, Denmark has about ten minutes of daylight and snow whipping in your face incessantly, so getting to the hospital was a trial. The facade of universal healthcare was beginning to crack. Why couldn’t I have gone to a closer hospital? This is the only one with rabies treatment, I was told. I was instructed to ask for a certain doctor to attend to me upon reaching the emergency room front desk. This desk is where I was informed that I was an hour late, and he had already left for the evening. The wait would be ten hours to see the next available doctor. Universal healthcare was quickly becoming not the utopia I had imagined.

But then luck visited me once again. The doctor’s assistant was still there, and he would see me in half an hour. Sleeping in a chair turned into just sitting in one! My night was improving, which was good because my sister was leaving the very next day and I felt bad that I had dragged her on this Sisyphean ordeal. The assistant explained to me that I would have to receive six shots in all. Four in the first week and two in the second. My desire to briefly dip into universal healthcare for the socialist badge it would emblazon on my chest forever was being lengthened into a trial. However, I quickly did the arithmetic and decided being alive was worth the six, hour-long trips to this distant hospital. I was earning my socialist stripes the hard way. To pile on, the assistant then told me that he couldn’t find the rabies antidote and couldn’t recall the last time anyone in Denmark was administered one. He assured me that he would have some delivered in two days, and instructed me to not die until then. Weary, but thankful, my sister and I got back on the bus and went back to my apartment.

Over the next two weeks I returned to Hvidore to get my shots. The second one had to be in a buttcheek which led to a really bizarre experience where I was instructed to drop my pants while facing a large window that looked into a different part of the hospital. I don’t know if I should chalk that up to carelessness or a general lax Europeaness, but I definitely showed my gentials to scores of sick Danish people. The other shots were thankfully in my arm.

I left Europe alive with a story to tell of two healthcare systems—one paid in booze and the other in hour-long bus-rides to the desolate Danish countryside. Neither cost me anything (my sister had covered the vodka), and I was always treated well and with good-humor.

When I returned to America, I finally had a little substance for my socialist screeds, a bit of ethos for my undying devotion to the throne of liberalism.

Previously: “The Cost of Not Dying from Rabies“

Matt Powers lives in Brooklyn. 

Yesterday on Twitter, musician Amanda Palmer asked her Twitter followers to answer four questions: 1. What country did they live in? 2. What did they do? 3. Did they have insurance? 4. How much did they pay? She had people tag their answers #InsurancePoll. She received thousands of responses from around the world. Here is a sampling of some of the responses from the U.S. (For more in-depth responses, check out our mini-survey of friends from May.)

In Ohio on Thursday Mitt Romney told The Columbus Dispatch’s editorial board  that “We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack.’ … We don’t have people that become ill, who die in their apartment because they don’t have insurance.” Rachael Acks, a former EMT, writes that actually, we do have people dying in their homes because they don’t have insurance. Her essay is powerful. An excerpt:

“Sometimes you get a call out to one of the little trailer parks, because people do live here even though no one really wants to, and it’s for chest pains, possible heart attack. It’s an older man in a uniform (you decide what kind) pale and sweaty and shaking, his face like dough. He’s got a crocheted afghan in a startling color combination covering his lap, and his wife (you guess she’s the one who made it, she’s got that look) wrings her hands nearby. She’s the one that called you. He’s as mad as he can manage when he can barely breathe.

“The paramedic hooks up the EKG.You don’t know how to read the bouncing lines, but even you know it’s not good. Okay, let’s go. We need to get you to the hospital.

“‘No.’”

The spring semester of my second year of law school, I had the worst abdominal pain of my life. I’d been having similar issues on-and-off for the past year or so, including dramatic weight loss caused by the uncontrollable urge to vomit every time I ate. Multiple visits to student health services yielded nothing but instructions to take antacids.

One weekend in February, though, the pain that had been mostly tolerable became unbearable. I assumed I had a stomach bug (it was going around campus!), but when Monday rolled around and I still couldn’t eat or move, I went to student health services once again. They gave me fluids, observed me, and, after a few hours had passed and I hadn’t improved, put me in a cab and sent me to the ER.

I didn’t leave the hospital for nearly a week. At the ER, an X-Ray and an MRI showed that my appendix and intestines were severely inflamed, and I was admitted and put on IV antibiotics, steroids, and fluids while the doctors tried to figure out what was wrong with me. One CT scan, one colonoscopy, and countless episodes of SVU later, I was diagnosed with Crohn’s disease, a type of chronic inflammatory bowel disease that causes symptoms in the GI tract and beyond.

The grand total for this five-day hospital stay was 13,246.53.

This sum included: four nights in the hospital; consultations with surgeons, hospitalists, and gastroenterologists; IV steroids and fluids; one MRI, one CT Scan, one X-Ray, and one Colonoscopy. Of the $13,246.53 billed to me, once insurance paid what they allowed, $1,094 came out of my $1,800 deductible and $1,745 went towards my $3,600 coinsurance maximum.

You want to talk insurance? Let’s talk insurance. My insurance coverage is a combination of my school’s mandatory, basic insurance ($930/year) and my mother’s insurance (at the time, she paid $2,300/year to add me to her work plan). The school’s insurance covers basic services at student health services with no co-pay, but prescriptions aren’t covered. My mother’s insurance is a great and flexible PPO. But with my 26th birthday this month, I was just kicked off my mother’s insurance, and so I had to decide if I want to be insured primarily through the school ($3,038/year) or keep basic services with the school ($930/year) and pay for COBRA through my mom’s insurance ($410.06/month, including dental). Through COBRA, I can continue my coverage for up to 18 months. Ultimately, I decided to go with COBRA, since my doctor is not affiliated with the school and so my visits with him would be capped at three for the year, or I’d have to pay out of pocket ($$$) for those visits.

Since my diagnosis at the beginning of the year, I’ve had two more hospital stays (12 days in total, for which I was billed $56,932, $73 of which went towards my deductible and $1,854 of which went towards my coinsurance maximum), along with several office visits ($160 in co-pays). I switched doctors and medications along the way, and have had half-a-dozen MRIs, a few more CT scans, and a drain put in my abdomen through a non-surgical procedure. At the moment, I’m taking a pretty aggressive medication called Remicade (It’s made with mouse antibodies! Modern medicine.), which has worked well on me for the past few months. It’s delivered by infusion every 2 months, and costs $4,000 per infusion. I’ll likely stay on this medication for several years if it continues to work, or, if it stops working (which is somewhat likely), will go on equally expensive peer medications. Interestingly, all these medications are technically biologics, not regular drugs, so they likely won’t go generic as quickly or as cheaply as normal medication. I also take a daily medication called Imuran that costs $20 for one month’s supply.

Before I was diagnosed with Crohn’s disease, I (somewhat shamefully) didn’t pay much attention to my health insurance numbers. I rarely visited the doctor, and the random flu shot or pap smear could easily be handled by student health services. Insurance plans are definitely now more in the front of my mind as I consider future employment. I have a severe pre-existing condition, and, once I graduate, my insurance coverage and costs and my salary will be important in ways I hadn’t anticipated before I decided to attend law school. I’m so incredibly lucky to have supportive parents who have done a lot of the financial heavy lifting since I was diagnosed, but I can’t be dependent on them forever.

I wish I could say I have a plan for how I’m going to keep paying my medical expenses once I’m unable to be on COBRA anymore, but at the moment I’m just concentrating on getting through classes and learning to live with this challenging illness.

The author is in law school. 

Anthony Hecht at the Portland Mercury relays a quick story he observed last night. A man—possibly mentally ill; the police were involved—was being strapped to a gurney and taken to the hospital “for his own safety.” Hecht reports the man “really became terrified and kind of lost it,” yelling repeatedly, ”I do not have the money to pay for this.”

“The right to refuse medical treatment is universally recognized,” however: you must be deemed conscious and competent. A dive medic—handle, “divemedic”—from a 2008 forum on ExpertLaw (lol) explains it really well: “There are certain circumstances where you can be treated and transported against your will. Alcohol intoxication, head trauma, and certain other conditions allow the EMT or Paramedic to rule that you are not competent to understand the medical consequences of refusing medical care, and therefore the law not only allows the EMT to treat you against your will, but requires him to do so. In such a case, you would be responsible for the bill.”

At BoingBoing, an artist’s rendering of what it was like to open the $67,373.81 hospital bill for her thyroid cancer surgery. (And please note, that figure is what she owes after the $28,874.49 “uninsured discount.” Wanna guess what country she lives in!??!)

BoingBoing’s Xeni Jardin has breast cancer, and she is just killing it everyday on Twitter with her insights and discussions with other survivors and their families (she live-tweeted the mammogram that led her diagnosis and has been going ever since—unbelievable).

She compiled the following conversation about cancer costs on Storify four months ago. She shares some of her own costs (“When I walked in to the chemo clinic, before they hooked me up to my drip I was presented with a bill for more than a thousand dollars: my out-of-pocket, after insurance. I get a bill every two weeks, each time I go in for an infusion”). Others share their stories, too (“After my fiance’s diagnosis, we ended up losing our house and are now in bankruptcy. And we had ‘good’ insurance!”)

The conversation is months old but still relevant—and so important. Obamacare may prevent some of these crises, but it won’t take care of all of them. Our healthcare system ruins lives, even in instances when it successfully treats disease. 

The home test should be available in 30,000 pharmacies, grocery stores and online retailers by October, said Douglas Michels, OraSure’s chief executive. The price has not yet been set. But he said it would be higher than the $17.50 now charged to medical professionals because the company will do more complicated packaging for the home kit, open a 24-hour question line, and advertise to high-risk groups, including gay men, blacks and Hispanics, and sexually active adults. Still, he said, it will be kept inexpensive enough to appeal to people who might want to buy several a year.

—These will make a great gift. I mean it. Pregnancy tests are also a great gift. You think I’m joking, but I’m absolutely not joking. Here’s how it’ll go down: You’ll be like, “Here, happy birthday! Happy graduation! Take these HIV tests! Look I wrapped them up so pretty with a bow! I’m either implying that you have too much sex or not enough sex by my gifting of them! Hilarious!” And then your friend will be like, “Oh, ha! That is funny! You know me, totally celibate/totally not celibate! Ha!” Your friend will keep them in her dresser for a long time and then one night she’ll make a sexual decision that maybe doesn’t involve protection or maybe she’ll break up with her boyfriend of several years and then decide she doesn’t trust anything about him, including the fact that he was HIV negative, as he had previously claimed.

And your joke gift of HIV tests will SAVE HER SANITY, because it’s not that big of deal! She’ll just swab her gums and wait 40 minutes and then she’ll know! You saved her weeks waiting for an appointment and then hours having to sitting in a waiting room. Well done. (She’ll also be glad in three months that you got her a second one because it takes three months for the antibodies to show up, but I, with all of my medical and psych degrees—I don’t have these—think taking one right away is good, too, mentally.)

The only question now is how much these HIV tests will cost. The current home test, which you have send to a lab, no thanks, is $58. Will it be less? Will it be more? I think $19.99 would be a great price point but what do I know (not much).

The following conversation took place on gchat, and has been edited by both parties for punctuation, capitalization, general readability, and intent. Some failed jokes have been taken out (some have been left in).

Logan Sachon: Jill. First of all, I’m not using your last name because you asked me not to, but the deal was that you had to explain why I can’t use your last name. Why don’t you want Google to know you are getting your tat removed at the free clinic?

Jill [Redacted]: Um, because it’s been a real pain and process to get this thing off my body, and I don’t want it permanently associated with me on the Internet now that it’s finally going to be gone.

Logan: Okay, I’ll allow it. So You used to have a tattoo, and now you almost don’t have a tattoo. How did that happen?

Jill: Well I got the tattoo when I was in law school. It is/was a huge celtic knot on my lower back. And I think I researched laser tattoo removal a few years ago, and found that it was way cost prohibitive. It was something like $400 per session and would take at least ten sessions.

Logan: Which is $4,000 total.*

Jill: Right. Which was way too much.

(* For cost comparison purposes, I called up The World’s Most Famous Dermatologist Who Has Incredibly Tasteful Ads On Every Subway In New York But Who I Am Not Going To Link To, and queried about the cost of tattoo removal. The lady was totally nice, but said she’d have to see it to give me a price, and to see it would cost $100, but that if I did get it removed there, that $100 would go towards the treatment cost. Which, fair. She didn’t want to give me any numbers without seeing it, but I begged and told her about “my celtic knot the size of a baseball on my lower back” and she said that if she had to guess, she’d say that it would be between $475 and $575 per session. Which. Is A. Lot. Of. Money. Obviously.)

Logan:  Do you remember how much it cost to get the tattoo itself?

Jill: I got it when I was twenty, so fifteen years ago. I think it was between $75 and $100.

Logan: After you figured out it was $4,000 to get the tattoo removed, what’d you do?

Jill: I just forgot the dream for a few years. And avoided looking at my lower back.

Logan: Until ….

Jill: Until I found out about Project Erase. It’s through Outside In, which is a Portland free clinic, and it was originally started to help ex-gang members get their tattoos removed.

Logan: Did you front that you were an ex-gamg member to get your tattoo removed?

Jill: Nooooo. It’s open to the public now. It it did feel kind of weird, but it’s totally legit. You pay on a sliding scale depending on your income, $25 to $50 an appointment, which is WAY more affordable than other clinics or doctors or whatever.

Logan: Did you tell the truth about your income?

Jill: Yes, and that’s when I felt weird being at the free clinic.

Logan: Because you make a not-small amount of money.

Jill: Right. But they were very cool.

Logan: That’s good. Usually when I think of the free clinic, I think of STDs.

Jill: Oh this clinic has those services, too. It’s one-stop shopping.

Logan: Take care of all your mistakes in one visit.

Jill: Yes.  So I have had seven appointments so far.

Logan: At $50 a pop, I’m assuming.

Jill: Yes, exactly. And I think I have four more to go. It HURTS, so I had lidocaine prescribed to me to help with the pain.

Logan: Oh fun! (Fun?)

Jill: Well, I put it on two hours before the appointment and cover it with saran wrap and tape it up so it really soaks into my skin. I have someone at work help me, and I always feel shady going into the bathroom with saran wrap and a co-worker. No big deal!

Logan: AWESOME. But not for recreational use, really. No resale value.

Jill: It’s true. Not in this case anyways.

Logan: And did your insurance cover that?

Jill: My insurance covered it except for $10 out of pocket. But maybe I shouldn’t say  that because I doubt my insurance knew it was for tattoo removal.

Logan: So: Does the tattoo look $350 plus $10 in drugs gone?

Jill:   YES. I am soooooo happy knowing that it will be gone soon. The other thing is you can only schedule an appointment every six weeks, so it takes over a year for it to be totally removed. And it really hurts. People ask if removal hurts more than getting the tattoo, and it does waaaaaay more.

Logan: What does it feel like?

Jill: Like tiny hot needles stabbing my skin really fast. And it smells like burning.

Logan: Oh yikes. Do you go to the bar after? Or to bed.

Jill: Bar. Bar bar barrrrrrrrr. But now with the lidocaine it’s not so bad. And it’s fast. It takes about 1.5 minutes for the doc to go over the tattoo.

Logan: OMG that’s it? That seems like nothing.

Jill: That’s it, but it feels like an eternity when it’s happening. I have to squeeze stress balls, and remember to breathe.

Logan: So if you could go back in time, would you still get the tattoo? Did you get your original $100 worth out of it?

Jill: NO. NONONONONONONONOOO. NO. Def no.

Logan: But you liked it for a little while, right?

Jill: Ha, I mean, I guess I probably liked it for awhile. But I have hated it for so long it’s hard to remember the good years. And then Wedding Crashers came out and “tramp stamp” became part of pop culture and ughhhh. And I have to say that I DO like some tattoos. Just not mine.

Logan: Will you get another one?

Jill: Duh. I’m getting a butterfly on my ankle.

Logan: You like getting your tat removed so much, you’ll get another just to keep going. Which, I bet there are totally people that have done that. You know, for like, the attention.

Jill: OMG I hope not. They are sadists or whatever for pain if they do that.

Logan: What’s that disease called? (It’s called Münchhausen Syndrome - ed ) Where you go get medical stuff done even if you don’t need it? I saw it on House. And Grey’s Anatomy.

Jill: I think I saw it on Nip/Tuck. No, I’m thinking body dysmorphic disorder.

Logan: Which one is that?

Jill: When you are constantly getting plastic surgery because you think you are ugly.

Logan: That costs more than $50 a pop, for sure. Unless the one-stop clinic covers that too? Cheap nose jobs, but only if you don’t actually need it.

Jill: Obamacare!

Jill [Redacted] is a soon-to-be-tattooless lady in Portland, Oregon.