broadsideblog

Why getting sick in America is a really bad idea

In aging, behavior, business, family, Health, life, Medicine, politics, US, work on June 28, 2012 at 2:42 am
May_30_Health_Care_Rally_NP (641)

May_30_Health_Care_Rally_NP (641) (Photo credit: seiuhealthcare775nw)

One element of living in the United States sickens me to my core — the persistent inequality of access to affordable quality health care, something citizens of virtually every other developed nation take for granted.

Today the U.S. Supreme Court will hand down its decision on the constitutionality of what’s been called Obamacare, a mandate requiring all Americans to purchase health insurance. A CNN/ORC International poll released this month showed 43% of Americans favor the law, 37% think it too liberal, and 13% oppose it because it is not liberal enough.

I grew up in Canada, where health care, paid for through taxes, is offered cradle-to-grave by the government. Yes, it has some deficits, but everyone can see a doctor and go to the hospital without fear of medical bankruptcy, common here.

From this week’s New York Times:

When Wendy Parris shattered her ankle, the emergency room put it in an air cast and sent her on her way. Because she had no insurance, doctors did not operate to fix it. A mother of six, Ms. Parris hobbled around for four years, pained by the foot, becoming less mobile and gaining weight.

But in 2008, Oregon opened its Medicaid rolls to some working-age adults living in poverty, like Ms. Parris. Lacking the money to cover everyone, the state established a lottery, and Ms. Parris was one of the 89,824 residents who entered in the hope of winning insurance.

And this, on how confusing and frightening it can be to receive a fistful of enormous medical bills:

With so little pricing information available, expecting people to shop around for quality care at the lowest cost — something that’s not always possible in emergency situations — is also asking a lot of consumers. “I have always found a bit cruel the much-mouthed suggestion that patients should have ‘more skin in the game’ and ‘shop around for cost-effective health care’ in the health care market,” said Uwe E. Reinhardt, a health policy expert and professor at Princeton University, “when patients have so little information easily available on prices and quality to those things.”

President Obama’s Affordable Care Act, the health care overhaul law passed in 2010, tries to make some improvements (though the Supreme Court is expected to rule whether all or some of the law is constitutional this month). But while the law’s changes help you shop around for insurance policies — specifically through its new HealthCare.gov Web site, a one-stop shop that lists all of your insurance options in one place — it’s still unclear how effective the law will be for anyone comparing medical services.

On February 6, 2012, I had my arthritic left hip replaced. Thanks to my husband’s job, we have excellent insurance coverage, but I knew enough to do plenty of questioning, and negotiating, long before that gurney wheeled me into the OR to avoid nasty and costly surprises later. For example, I needed to make sure the surgeon would accept whatever fee my insurance company offered — decisions and prices I have no control over — but which would come bite me on the ass if I didn’t plan ahead.

I also had to make multiple calls to find out:

1) what the anesthesiologist would charge (about $3,800);

2) what my insurance would pay (about $1,000);

3) who would be on the hook for the difference. Me. (I told the billing manager I’d send my tax return to prove my income; $2,800 is a very big number for me.)

Jose, my husband, offered to look at the medical bills as they arrived, as they would only freak me out, not helpful post-surgery. The hospital — for a three-day stay, with no complications, charged $90,000. No, that’s not a typo.

Did they collect it? Probably not, but they routinely try for whatever they can get.

Then my surgeon billed $25,000. (Our insurance covered it all. Thank God.)

But…what if, like millions of Americans, I had no insurance?

Like my friend R, who is young, broke and lives without it. He recently slipped and fell on a wet sidewalk, needed an ambulance and needs physical therapy then surgery. Worst case, he’ll be paying off a huge bill for years, maybe a decade.

In my 24 years in the U.S. I’ve never lived one minute without health insurance; my mother has survived four kinds of cancer and I live an active and athletic life that also puts me at greater risk of injury. How ironic that being active, (fighting the great American scourge of obesity), can put you at risk of losing your shirt financially…

The cost of buying my own insurance, as a freelancer, left me with few additional funds for fun stuff like travel or nice clothes or shoes or replacing things in my home — air conditioner, dishwasher, computer — I needed and relied on. By 2003, it cost me $700 a month.

Health care is a right, not a privilege. We will all get sick or fall down or suffer a complicated labor or discover a tumor or suffer a heart attack. None of us is immune.

Many Americans cannot even purchase health insurance because they have — in that exquisite euphemism — a “pre-existing condition.” If you’re already sick, tough shit!

Seriously?

Life is a pre-existing condition. Americans, and their elected officials, must deal with this reality more effectively.

  1. A blogger after my own heart. I hear arguments like “socialist” and “not reforming the system” and “putting pressure on Americans” and “worsening our debt”. What don’t these billionaires get? Our health is something we shouldn’t have to worry about like we do everyday.

    • Socialist this, I say. No one, ever, anywhere, should have to avoid seeing a physician or nurse or put off tests results or treatment because they are too broke. It’s an obscenity that poverty = death for poor Americans.

      • oh, tell me about it. when I hear the verdict on the law today, i’m writing a post either praising or condemning the Supreme Court, depending on the verdict.

      • This is also so weirdly American. Why is the Supreme Court involved in this? (I know, but…) WE NEED AFFORDABLE CARE. It’s so pathetically American to turn this into an issue of jurisprudence instead of practical solutions for millions of desperate..oh,yeah…voters.

      • Ah, the idiocy of our gov’t. you know our country is the only country on earth that hasn’t done a major revision/re-edit of their constitution since its inception? it’s nuts.

  2. Woman, do NOT get me started on the crapride that can be American health insurance. I have been extremely fortunate thus far, and had jobs that provided it. But holy freaking Christ, insurance companies are a for-profit industry. So of course they’re not going to give a rat’s ass about anybody they cover. We’re just numbers on a page and if you’re too big a monetary risk, screw you and sorry you have to live in pain/die/whatever. It’s unconscionable to provide healthcare through for-profit industries, and it’s especially unconscionable that those same industries send lobbyists to DC.

    Here: http://www.reuters.com/article/2010/06/23/us-usa-healthcare-last-idUSTRE65M0SU20100623

    And that about sums it up.

    • Hell, yeah! No one should HAVE to be fortunate. This is one place that naked greed, $$$$$$$ lobbyists, anti-government propaganda and corporate profit are ruining thousands of Americans’ lives. Don’t get ME started! :-)

  3. Oh, and PS–SCOTUS is for sure going to screw us again, just like they did with Citizens United. GRRRRRRRRRRR.

  4. PPS–”LIFE is a pre-existing condition.” I like that. Nailed it.

    • Ain’t that the truth? I cannot believe what a disaster the “system” continues to be for so many people. Those are OK just don’t seem to care — or to understand it might actually be one of them in dire need someday.

  5. Hell, one more thing. Found this piece in the Globe and Mail about the implications for the SCOTUS ruling for Canada. Thought you might find it interesting: http://www.theglobeandmail.com/news/politics/second-reading/why-the-obamacare-ruling-matters-for-canada/article4373592/?cmpid=rss1

  6. Thank you for this well-researched and well-lived informative piece on health care. I was better taken care of with public health care in Europe than I am now paying over $1000 a month with a $3000 per person deductible… my former teaching salary (masters plus 5 years) wouldn’t even cover my current out of pocket insurance costs (dec, plus premium, plus expenses). The stifling economic and social effect this must have on a country that touts its entrepreneurship and creative genius can’t even begin to be understood or measured because we continue to waive our rights to healthcare for the privilege of so-called private enterprise. Millions of people are stuck in jobs they hate, being unproductive just to keep their health insurance. We have our heads up our asses in the US with regard to healthcare and other so-called “social programs.”

    • Holy shit…That sort of cost, which is not unusual (as we know), is so shockingly punitive to me. The irony of pundits and policymakers wringing their hands about how America relies so heavily on ingenuity and entrepreneurship and go-get-em-ness — but, hey, only if you’re REALLY successful so you can actually afford to get sick and be healed when necessary like the other people, the ones with subsidized benefits.

      Very few people with true creative genius are going to make $$$$$$ from the very start. I’d love to know if (and for how long) Bill Gates, Mark Zuckerberg or Jeff Bezos lived — at the start of their multi-billion $$ firms — without insurance.

      What I cannot understand…???….is why it never changes. Why there is not ever a sufficient groundswell of public support to say “Yes, I want govt-supplied health insurance and I will pay higher taxes and stop worrying.” It will never happen here, will it?

      The United States loves the mythology that it’s all about the individual taking care of themselves. Fine. Make it affordable!

      • My German husband works as a healthcare business consultant keeping American hosptials in the black. We live these convos over dinner every night. On a deep level this issue goes back to lack of education in the US. We have for so long underfunded education and so long “taught to the test” that Americans are seriously lacking in critical thinking skills to reason through these issues. Likewise, I think American families are running to keep their heads above water with health, unemployment, etc. Those that have work are working their assess off just to keep afloat right now.

        Add to this our military-industrial-complex/America-as-world-police way of approaching the world, the bubba complex of “ignorant and damn proud/too proud to be American” and people become very myopic and xenophobic about ideas that come from abroad. God forbid we have a “social” program that gives our people a hand up… that’s too European… that must be related to “socialism.” If people did their homework /and/or had been taught reasoning skills, there are large-scale benefits to social programs if appropriately administered.

        Fold in our dysfunctional government—aka—the two party system, where one party tries to make the other look bad even if it was their idea to begin with: take the individual mandate in “Obama-Care” that began as a Republican idea, but damn the torpedos—the R’s are skewering Obama right now b/c of it—to shine their own apple in an election year. Ironically, they will have to create something to take its place if it fails… BUT, it will have an R by the process and not a D.

        And, b/c we’ve become so polarized, we can’t have national let alone individual discussions about this. I spent hours on FB posts engaging in civil discourse trying to make these points—to get called Pinko, Commie, Socialist, Anti-American. It’s okay… it was great sport in some ways, sadly due to the inability of your average American to carry on a civil conversation that’s not based on political sound byte. We would be better off if we had more political parties or none at all and focused on what really mattered. Imagine that?

        Because of my ire at all this, my kids and I have spent a number of 115 degree afternoons voicing our displeasure on the Arizona legislature’s lawn. And in fact, one of my more innocuous writing projects has some legislators not happy with me—a little-old-soccer mom–right now. My girls are learning that democracy is a slow slog and you’ve got to be willing to play the game to “be the change…”

        These are—IMHO–the layers that create national dysfunction and frankly, I’m not taking it quietly anymore, because I’m sick of it.

        Ps – thank you for your awesome insight on this. I forwarded it to my husband’s corporate email. There are points he and I differ on, but I am also sick of spending days calling around to get quotes for healthcare… which is a new thing with our recent personal insurance change.

        And don’t even get me started on the doctors flooding out of AZ because they can go to jail now if they perform an abortion… and our law is now based on conception defined as a woman’s egg during it’s fertile phase… WTF—technically that makes it illegal to have a hysterectomy. They are insane!

      • Your comment is a much better analysis than my post. Thanks for taking the time…!

      • Thank YOU. You made my day!

  7. Excellent piece! The thing that has kept me in my job (though I have no hope of promotion, advancement, or even any substantial increase in skills) has been the crippling fear of losing medical insurance. I didn’t go off to London with J., even for a few months because I wasn’t willing to lose the income, but even more than that I wasn’t willing to risk the slings and arrows of outrageous fortune. We’re both really healthy people but the thought of what could happen (heck I take accident reports every day!) scares me!

    Even with insurance, I work for a religious university which means a lot of so-called “feminine health” (as if it’s pre-exisiting condition or medical abnormality, instead of the reality of half the human race…) isn’t covered fully or at all.

    • Thanks, C…high praise from you! You are (which is insane) a perfect example of why America’s slavish devotion to the free market, in health care, is killing a lot of hope and possibility for smart, talented, ambitious people.

      The notion of “feminine health” is so 17th century…If women stopped caring for their reproductive systems (let alone the other bits of us) there would be no (**&^@!$%&))$! men to make these appalling rules. Hmm…..

      One of the many sequelae I see in young Americans — in contrast to my experience leaving college in Toronto — was this terrible tethering to shitty jobs and national borders that you are living. I was free to travel as far and as long as I wanted (did 4 months solo in Europe, age 20) without that fear,. Then that fear of leaving can only feed into further ignorance of other cultures and their (wiser) policy choices, which promotes further American exceptionalism. Holy hell.

  8. Seems you’ve it a raw nerve here, Caitlin! I just thank my lucky stars I didn’t fall in love with the States and decide I had to live there!

    Every time I read about the debate, or hear stories of the American system I lose heart, really. The land of the free? Sounds more like the land of the free to gauge people in their most vulnerable state. The whole system seems to be geared to the vaunted free market – hospitals, doctors, insurance companies, pharmaceuticals industry … $90,000 for a new hip joint? Shattered ankle wrapped in an air bandage?

    It’s the wild west … and inconceivable when considered against the wonderful things America is, and does.

    • I have often wondered what would have happened to me had I stayed home in Canada. I was simply too ambitious…Canada is a very small country (30 m people) with much more limited job and career opportunities. So it was that, as much as the man I first married, that brought me to the U.S. Why have I stayed? Same reasons. I’ve seen my friends lives and careers in Canada and thought, no, it’s worth it to me to stay and deal with the bullshit.

      But this healthcare greed is really the worst of the bullshit…the flip side? I have been lucky enough to afford, and to receive, excellent medical care and physical therapy (4 surgeries since 2000) for which I am grateful. I now watch the Canadian system very closely and am seeing flaws and problems there that disturb me enough I’m not thrilled about retiring there.

  9. I’m so grateful I live in Australia where we have universal healthcare. In the past month both my parents have had to go to hospital (for different reasons) by ambulance. My dad is still in hospital and is about to be moved to (government subsidised) aged care. We will not have to pay a single dollar for either of their treatment costs.

    My hubby & I still have private health care insurance, but everyone has the opportunity to receive fully subsidised health care. You may have to wait your turn (if you need an operation such as a hip replacement), but we do have that benefit.

    I feel so sorry for those who live in the US & have the worry of having enough insurance to cover medical events in their lives, and having enough money to pay for the medical insurance & their day-to-day living expenses.

    • Canadians have a very similar system….my mother spent 4 months in the hospital and needed two major surgeries…not a penny in bills.
      But I will also say I was NOT impressed — and very upset with — the rudeness and condescension of the medical staff. As her only child, I had plenty of questions and was told repeatedly that “doctors don’t return phone calls.” Why, yes they do!

      One of the biggest cultural shifts I have made in 24 yrs in the U.S. (and won’t be shifting back anytime soon from it) is being consumerist about my care — I demand and expect excellent care, responsive doctors and clear explanations of what’s happening to me; Canadians have been trained not to. I see this in the care my father, 83, is getting….he was told recently that he will not get a colonoscopy because he is over 80 (83 and in fantastic health.) After driving 90 mins. into Toronto, twice, and waiting 2 hrs for a lost appt. he is likely coming to our guy in NY (for $1,000 or so) to get it done. Now that is equally absurd.

  10. $90F000 for your new hip? Egads. . .not that you’re not worth it, but who affords that without insurance?

    I love it when critics of universal care find some example from the UK where someone waited “weeks” for surgery. That might happen, as an anomaly.

    What is not anomalous in the U.S.? Medical bankruptcy, just as you point out.

    Only in the U.S., where we seem to think that treating ourselves well should be against the law, could major emergency surgery cost you your home.

    The Supreme Court is not going to help us.

    • But I know, for sure, the hospital would not possibly have collected it..it was an opening bid, common in the industry.

      The problem is that there ARE some very serious waits within other systems and they are normal…BUT the other side of the coin is that urgent/emergent needs are seen very quickly in most instances. Americans have traded the comfy speed of the fully insured (gambling they will never ever lose their coverage) for the HORRORS!!!!! possible changes required under a govt-run system that would save everyone trillions…

      The word “government” in America seems to weaken everyone’s knees.

  11. I admit when I was younger I had no idea about insurance and what a big pain in the ass they are. My mom never mentioned it, even when I broke my arm and had to go to the hospital overnight (that probably wasn’t cheap). Then 6 years ago I was diagnosed with cancer. It’s in remission and everything’s swell. My mom’s insurance covered most of the bills, but if they hadn’t, good God. I was taking shots daily to keep my white blood cell count up (since chemo kills your immune system) that were $1000ish each. Each! I don’t even want to know how much the rest cost. It made me think. I mean there were people in there with no money, living with relatives and nearly nothing to their name, so their kid could get the treatment she needed. It’s just really sad, you know.

    Sorry for the rant, but I just really hate our healthcare. And I hate that people want to keep it the way it is now.

    • Thank heaven you are doing well!

      Another piece of this — yay unbridled capitalism — is the “cost” of those drugs. Those costs are arbitrary, to some degree…as they are MUCH less expensive in some other countries. Drug companies, like people selling jeans or Coke or candy, charge whatever they think the market will bear. Because we are not “the market” (although we are the end user, which is very weird and confusing), we have no say in it, just have to pray we are well-covered when we need it.

      Yup, I hate it too.

  12. I’m all for more affordable health care for all. There are areas of life and the economy, specifically food and health care, where capitalism does not necessarily the best outcomes for the largest amount of people.

  13. And yet people keep voting in politicians who make no effective changes. Therefore…?

  14. I am astonished, though pleasantly so, that the Supreme Court has upheld the ACA. As I write this, the Republicans are already gearing up for yet another fight against it. Meanwhile, my kids, grown (one employed in a job with no benefits, the other finishing some extra schooling) can stay on their father’s insurance.

    There was a time when I could only afford catastrophic coverage and had to go to the emergency room. While my out of pocket was still crazy expensive, it was so much less than it would have been, had I not gotten the negotiated rate — less than half. I also learned recently that some people don’t honestly understand what insurance costs. One guy pays about $50 a month through his employer, and he actually believes that’s the entire cost of the insurance — so of course, he doesn’t see what the problem is!

  15. I wonder what would happen (not that I wish this upon you personally) if everyone in the nation who has access to health insurance lost it…for even one day. Kind of a reverse Rapture. I cannot see any other way to get the ideological toxins out of what is an obvious conclusion — a nation with millions of residents who are terrified of getting sick or injured makes a mockery of a nation devoted to freedom and liberty and justice for all.

    And you make an excellent point; many people have no idea what their insurance is nor how heavily subsidized it is…until they get canned and, by law, can buy it under COBRA at a legal rate hike of 100% Nice. Just when you can LEAST afford it, time to pony up.

    Seriously?!

  16. Thank you for posting this! With all the other crap information floating around out there, it’s nice to read a very informative piece. Isn’t it sad that my boyfriend and I have repeatedly said to each other, “We should just move to Europe if we want good healthcare.” In addition to all the beauty of Europe or Canada, they have healthcare right – it’s something that should be provided to all people at a reasonable cost. Period.

    • Thanks…The “let’s just move” thought is tempting indeed. The reality is that higher tax rates pay for that stuff in Canada and the salaries are often lower. It can be quite an adjustment, depending on your wants or expectations. I pay close attention to the medical systems in Canada and France because I want to retire to one, maybe both, of those places. At this point, France looks better in this respect.

  17. I agree with your statements and the passion behind them. I also feel so strongly about this issue but I often feel helpless to effect any change about it so my angry feelings dissolve into inertia. which probably happens for many of us marginally healthy working stiffs! and thus I end up part of the problem. BTW I’ve really enjoyed your last few weeks of posts. I keep meaning to comment but it’s hard to choose a favorite. (:

    • Glad you’re enjoying the blog!

      I agree…it’s hard to know what to do or say. It all feels like something way out there far beyond our control as voters. Which is depressing.

  18. I often look at stories of high medical and hospital costs in the U.S. and wonderhow those costs can be justified. I also look at how these costs result in millions of low-paid or unemployed being unable to have medical treatment.
    Then I look at the campaigns against the introduction of a general medical insurance scheme and wonder who the hell is behind them. Surely, it can’t be the ones who are desperate for treatment; surely it can’t be those who have to pay exhorbitant amounts for medical insurance. The only logical conclusion is that it must be the medical industry itself.
    Here, in Australia, as Jane above mentioned, we have a universal health scheme. It is not a free health scheme though, as we pay for it through our taxes. Those who wish to can, and many do, pay for extra health coverage through insurance companies. This extra coverage means you can get non-emergency treatment, operations, etc, more quickly. But that doesn’t mean the poor don’t get them – they just have to wait longer.
    For life-threatening conditions, everyone is treated the same – and there are no huge bills at the end of it.
    The Australian government covers the cost of the health system, but it is funded by taxation. The rate of taxation is 3% of income. Those who earn above a certain income have to pay an extra levy if they do not belong to an insurance fund. Those who do not earn an income are covered, even though they do not contribute.
    When I had an operation and follow-up treatment for breast cancer a few years ago, a combination of Medicare (the national health scheme) and our private insurance covered everything. We would otherwise have been in deep trouble.
    For the cost of a 3% levy on our taxable income plus under $300 per month for private insurance, we get good, immediate health care. What’s not to like about that? Compared to the situation in the U.S. we are in paradise!!
    I am so glad the Supreme Court ruled in favour. What needs to happen after this is to make that health insurance affordable, to stop the rip-offs by the insurance companies.
    Your excellent blog entry sure has stirred up comment!

  19. As you can see, this is truly one of the most pressing issues in American life…the recession here is still very tough for many people who cannot get a job and therefore can neither afford to buy insurance and cannot get it through their work…because all it does is add an additional cost burden to the employer, which makes NO sense either.

    Think of the word “government” as the word “high voltage rail” — no one wants to have anything to do with it. If you touch it, you’ll die! (not. ) But this seems to be the underlying antipathy to any sort of government-run scheme. The absolute greed of every possible corporate solution (supported by millions in lobbying fees for the American Medical Association and the health insurance industry) is somehow still (?!) seen as preferable to anything affordable offered by the public sector. The devil you know vs. the devil you don’t.

    This article says the pharma crowd spent $6 m and the AMA $4 m. That’s only two groups and in only one year…

    As another wise commenter points out, there is TREMENDOUS ignorance here about how a government-run system can work well and affordably and lobbyists just play into all that stupidity and fear. Thank God for my Canadian passport.

    http://voices.washingtonpost.com/health-care-reform/2009/07/health_care_continues_its_inte.html

  20. [...] what sort of healthcare do you think our neighbors to the North have, you adorable hysterics?  See Caitlin Kelly for further [...]

  21. Yay, SCOTUS! Now to watch the weird “where’s my freedom?!?” freak-outs. Sorry, scary fellow Americans. I don’t want to be free of healthcare and maybe we’re on a road to affordable care. (a girl can dream)

  22. Amazing.

    How much of this do you think is caused by costs for liability in damages to people injured by doctors? My information is twenty years out of date, but I understood then that the doctrine of “informed consent” in the US basically meant that anyone injured could be compensated, the doctor bore the risk of the procedure, where in the UK the claimant has to show that loss was caused by a mistake which a competent doctor of the same type as the respondent would not make. How much is it in the interests of the insurers to keep costs down? Basic Adam Smith theory would tell you that they would compete on the basis of cost: why might that not be true?

    And- you need an NHS over there. Obamacare “Socialist”? What?

    • Tort reform (which is what you’re referring to) is an issue, but I don’t believe it’s THE issue here at all…Doctors in the US pay INSANE malpractice insurance rates; my ob/gyn told me she was paying $160,000 (!?) a year because American women (in the hyper-affluent town in which she practices) expect birth and babies to produce only perfection. It’s a combination of American litigiousness, American expectations of excellent care meaning no mortality associated with care…The crazy costs are bound up with this, but I don’t think it is the driving element, only one.

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