By Caitlin Kelly
If you move to the United States from any nation with single-payer government-run healthcare, you might be gobsmacked by what you encounter here.
You’ll learn new words and phrases like:
“pre-existing condition”, “co-pay”, “annual deductible” and “usual and customary.”
If you get a full-time job with benefits, you will be mostly preoccupied with how much medical coverage it offers you and your family, at what cost, and with what amount of deductible — i.e. how much more money you have to shell out after already paying a monthly premium for what is supposed to be full coverage.
It’s a bizarre, byzantine way to handle healthcare, because it puts millions at risk, as anyone following the current, bitter political debates over repealing and replacing the Affordable Care Act, (aka Obamacare), well knows.
If you work full-time for an employer who can afford to offer it, you’ll get health insurance through them, often heavily subsidized.
If not, welcome to free market capitalism!
My husband worked 31 years at The New York Times, as a photographer and photo editor. He retired from there, although we’re both still working. As a retired former staffer, he pays $400 a month for his health insurance. That, we can easily handle.
The company decided to save money by refusing this same subsidy to retirees’ spouses — so I pay $1,400 a month for the same plan. That’s $20,000 pre-tax I have to earn just to avoid medical bankruptcy — the single greatest cause of personal fiscal disaster in the U.S.
I’m a reporter, so as I debated choosing a much cheaper plan I queried the billing managers for two of our physicians. Both said: “Hell, no! If you like what you’ve got, keep it.”
They know better than anyone what a crazy and costly mess you can face if your cheap-o plan doesn’t cover something like — oh, you know –— the anesthesia for your four-hour surgery.
That surprise bill could be high enough to knock you out cold once more.
My first steps with my new left hip, February 2012.
As an aging jock with orthopedic issues that have required multiple surgeries and a lot of physical therapy — the co-pays alone costing up to $60 a week — not having excellent coverage is a gamble I’m not willing to make.
As more and more Americans are forced into the “gig ecomomy”, i.e. self-employment or precarious, poorly-paid contract work, we’re forced into free-market pricing for our most precious possession — our health.
Yet I find it almost incomprehensible to read this, in the liberal New York Times:
When Representative Mo Brooks said it was unfair that healthy “people who lead good lives” should have to subsidize the insurance of unhealthier ones who presumably don’t, he bluntly raised an often unspoken question that runs through policy debates in Washington: Who deserves government aid and who does not?
Such proposals can be — and often are — couched in the language of economics, with advocates and critics calculating the efficacy of incentives, returns on investment and long-run savings. As Ben Carson, the Trump administration’s housing secretary, commented last week while touring publicly subsidized housing in Columbus, Ohio, “We are talking about incentivizing those who help themselves.”
But the judgment of who is deserving — as opposed to what is most effective — is at heart a moral one.
In pushing for repeal of the Affordable Care Act last week, Mr. Brooks, an Alabama Republican, suggested that people with pre-existing conditions deserved to pay higher premiums, because they had not “done things the right way.” That could include a cigarette smoker’s lung cancer — or a newborn’s congenital heart disease.
Couching this as “government aid” completely distorts the larger issue — are you really happy living in a country where you’re just fine — but millions of others aren’t?
This kind of self-righteous garbage, the “deserving”, makes me so angry.
Yes, those who live in a single-payer system do pay the costs of treating other people’s cancer (some are smokers!) and diabetes (some are obese!) and people who injure themselves while high or drunk or are torn to pieces by a dangerous, distracted driver.
No one admires or wants to support stupid, careless behavioral choices.
But I’d rather know that everyone can get good care quickly than smugly snuggle into my personal bubble, knowing for certain that others live in terror of losing their insurance or access to the drugs and care they need.
I grew up in Canada, to the age of 30, never once seeing or paying a medical bill. Nor have my parents, who still live there, in two different provinces, despite multiple surgeries and, for one, months of big-city hospital care.
I’m no fan of endless taxation. But a vast percentage of the U.S. federal budget goes to defense, waging endless wars against often undefeatable enemies.
And the outrageous rates I pay are giving health insurance executives’ massive salaries. I find that disgusting.
I believe healthcare is a right, not a rare privilege only granted to those who someone decides is “deserving.”
43 thoughts on “Health care is a right, not a privilege”
We were strongly encouraged to switch to a new Health Savings Account plan this year. I’m not happy with it and feel like we are paying more for care. Have you written about these plans?
I wonder sometimes what would happen in our economy if health insurance costs paid by employers was instead paid by the government in a single-payer system. Wage growth? Fewer complaints about corporate taxes?
I haven’t…Not even sure how they work…?
I have a strong bias about why employers are still paying for health insurance — it gives them enormous bargaining power in the job market! Many people take and keep jobs they hate just to get decent medical coverage for themselves and their families. Those of us who work freelance are only as “free” as we can afford to be — given how incredibly expensive many good plans are…which pushes us right back into FT employment, even if we’re much happier and better suited (and creating jobs!) on our own.
I’m an American living in London for the past 1.5 years. I was always exceptionally lucky in that, in Utah, I had employers who paid 100% of my heath insurance premiums (mostly). But the thought of going back now is scary. So I’ll stay here while I can, thanks.
Exactly! I hate how this “system” ensnares everyone here, benefiting some handsomely — while totally screwing others.
It fits into the American paradigm of individualism and “every man for himself” but I hate this greedy aspect of it.
I sympathize with the frustration that so many feel about an overpriced health care system AND limited means of providing access. While there is no simple solution here, I absolutely agree that the foundering (corrupt?) attempts to change things up will do much more harm than good for those who might need access to healthcare. I’ve already dubbed this the “Leave the unfit behind” policy.
But I did chuckle a bit when I saw your reference to anesthesia costs. If I remember correctly, fees are still assessed BY THE MINUTE. So I can only imagine the surprise when the bills arrived (not nearly as funny).
One of the most bizarre moments of my life was calling the anesthesiologist’s billing manager (!???) ***before*** my hip replacement to find out how much time/attention was “usual and customary” for my procedure. This struck me as crazy.
Having grown up in Canada and living in France for as many years, I’ve experienced two different systems of socialized medicine and the high costs that go with them. I’ll take that any day over the extreme meritocracy, where the simple fact of falling ill is a reason to be blamed and shamed. I was raised a Catholic, and although I’ve since renounced religion in all its forms, I am struck by the disconnect between the American obsession with ‘Christian’ values and the unbending attitudes towards the weak and the poor.
Tout a fait!
I’ve long planned to retire to France and/or Canada for that reason. On verra…
i could not agree with you more –
I had both my hips replaced – the result of an accident many years ago – very efficiently. The first one was done within one month of my first visit to the specialist. It took three months to see him, so it was a wait time total of four months. Sometimes I hear ads from US specialists who are courting Canadian customers because of our wait times and shake my head. It took an American friend of mine more than a year to get in for a knee replacement, to say nothing of the additional costs and lost income. When Canadians complain about wait times, I wonder at the entitlement. Our system isn’t perfect, but it’s good.
I was amazed that my father — then 86 –got his hip replaced (in a regional hospital) within a few months as well. Having had my hip replaced here in NY at our small (and v good) local hospital, it was interesting to note the differences — everything from no art or photos on the hospital walls (no, it doesn’t matter but it creates a warm and welcoming atmosphere for us here) to a MUCH less personal experience; we never even met (!) his doctor. That would never happen here.
So I wonder how soft and American I’ve become. 🙂
That’s interesting. I saw the specialist twice before and twice after each surgery. Not meeting the surgeon is, well, wow. And not in a good way. I also had a nice (for a hospital, anyway) room during recovery. This was the Foothills in Calgary. But you’re right about the decoration – very utilitarian. I also have to say that everything seemed to be done according to a timetable that was very locked in.
Indeed! It was a very significant contrast to our American experience…and we wonder how different it would have been for my father had the surgery been done in a major Toronto hospital…?
Healthcare a basic right? You betcha. I can’t understand the US system (and the government attitude to that system) at all. New Zealand’s hospital system has been – broadly – operating at public expense since 1938, when the government of the day declared that no New Zealander should suffer through circumstances not of their own making. There are also hefty public subsidies for essential medicines and subsidies for doctors’ visits for certain groups, especially children. It creaks a bit and has been whittled away over the years, but it’s worked fairly well, and the country has neither been impoverished nor its social fabric destroyed as a result of what the system’s creator, Michael Joseph Savage (PM 1935-40), described as ‘applied Christianity’. I rest my case.
You know I agree! 🙂
The arguments here against it are:
1) enormous population (more than 300 million), so all smaller nation examples are dismissed out of hand because of scale; 2) current HUGE and hugely profitable industry of health insurance companies, all their employees (i.e. potential job loss and displacement fore them; 3) fear of the “gummint”…which is overwhelming here, despite everyone’s reliance on and appreciation for single-payer Medicare (only available to those over 65.) 4) American individualism — everyone is one their own and anything collective smacks of (OMG) socialism or worse.
It’s a mess. Some people are very very well served and others utterly screwed.
I fully agree. “Healthcare is a right, not a priveledge”. In 2002 I worked for a Transportation Company, in a Satellite office, in Minnesota. There were 3 types of toxic mold in that building. My life has forever changed. I filed bankruptcy in 2005. The employee and employer paid insurance company decided all my medical bills were pre-existing conditions, including my yearly gynecological exam and mammogram. All these bills were not paid by insurance.
As we age, EVERYTHING IS A PRE-EXISTING CONDITION.
If you aren’t concerned about how this will affect you, let me be your example. When you have loads of stress, physical issues, which in turn add the additional mental issues (mild depression, and anxiety) it’s nearly impossible to hold down a job. Life is expensive in the United States, and other places as well. It’s been an uphill climb. I’m still climbing. If I lose my healthcare, and the pre-existing clause goes back into affect, I’m dead in the water.
As an American Citizen, born and raised, I am not proud to be an American. Corporations and their profits mean more to this Country than the People. “WE THE PEOPLE”, don’t matter. Unless of course you’re in the top 1%. Collectively we can make a difference. Stand up for your rights, to protect them for the well being of All Americans.
Thanks for sharing your story — and sorry to hear what an ordeal you’ve faced already.
The American political system remains wedded to free market capitalism and deep suspicion of, if not hostility to, government offerings. Neither of these are as powerful in other nations, who have mustered the collective political will to make the change to single-payer.
The real problem is single payor. The healthy cover the sick. That’s how insurance works. What we really need is a plan where; like car insurance you pay a standard rate for basic coverage (car=liability). Add ons for Vision, catastrophic, etc. There are many who rarely if ever seek medical help. I was one of them for many years, and I will become one of them again.
I started acupuncture 2 weeks ago for the chronic pain and allergies. It’s helping. Natural medicine, and mind over body (meditation) helps as well. Our bodies have an innate ability to heal. Feeding our bodies less processed foods, fast foods, refined sugar, saturated fat, chemicals, and giving our bodies the proper nutrients is a step in the right direction. Exercise, It all works together. Make better choices, to promote good health, and live a longer more fulfilling life.
Thanks for weighing in.
Yet I disagree entirely — as the daughter of a woman who has suffered from multiple cancers, (thyroid, breast, brain), and survived them all into her late 80s.
None of us can control every possible ailment, injury or disease by simply living healthily — much as I admire that and agree with you, in principle, these are smarter choices.
But what of the people now endangering every single one of us by texting while driving, or driving high or drunk? I can make every possible “smart” decision about my own health, and be paralyzed or lose a limb due to someone else’s selfish decision to drive under the influence.
There are also compounding issues of food deserts and a lack of affordable access to healthier foods and safe, accessible places to exercise — or the time in which to do so consistently. If you’re living in poverty and working two or three jobs with long commutes, you have little to no time or energy to exercise or focus attention (albeit necessary) on choosing and preparing the healthiest foods.
There are no guarantees in life. Yes, multitudes of things can happen. Accidents occur on a daily basis everywhere. If you live your life, trying to control everything, including the multitudes of things beyond your conyrol, it becomes a life filled with frustration and impossibility. We can only control ourselves, and how we react to what challenges we come accross.
The food we eat is only as healthy as the environment it is grown in. Protecting the environment to sustain life, should be at the top of everyone’s list. Unfortunately, most human beings are ignorant. As long as they can go to the market, buy the foods they choose to eat, they don’t care.
Some health issues can be prevented. Chemicals in processed foods, eating too much sugar, salt, hydrogenated fats are proven to be unhealthy for our bodies. Life is a balancing act. Pharmaceutical Companies are getting wealthier since we desire a quick fix to our health issues. Take one prescription pill, it leads to 3 more within a year or two.
I got off track. You and I can agree we have similar, and differing ideas. Cancer and most diseases are preventable. Learning how the physiology of the human body functions at peak capacity and following the protocols to help your body heal itself is the key. Our bodies don’t function the way they were designed to, because we don’t put the proper nutrients in. We eat too much, exercise too little. Taking control of your health, by doing whatever IS in your control, is the first step.
Of course, taking the best care we can is obvious. I have no patience when people are too lazy to bother — if they are working poor, that’s a different challenge, and many Americans now are.
I am one of the working poor. Eating healthy food is a choice, I choose to make. Eating fresh fruits and vegetables, spices.. cutting down on meat, sugar, saturated fats, additives, chemicals, and hormones is a challenge many of us would greatly benefit from. The other part is cutting out processed foods, all of these are slowly killing us. The cheaper alternative costs more in the long run, what we eat affects our health.
Pride keeps many in the United States from getting the help they need. There are food shelves, churches that sponsor Loaves and Fishes, which provide healthy balanced meals. Low income Senior Citizens get a monthly box of food with staples like Rice, canned Meats, Cereal, Juice, Cheese. There are programs out there, perhaps moreso in the Farming States, where I am fortunate enough to live.
Plastic and it’s chemicals like BPH, should be a primary concern as well.
Agreed. Good for you for making the effort.
This is also cultural — I grew up in Canada to age 30, and we are much less inclined to pop a pill or take the easy way out than Americans. I always have to TELL my U.S.doctors (accustomed to patients who want a pill or fast solution) that I prefer the least invasive solutions every time, including medications or pills.
Yes, access to healthcare definitely should be a right for all. The thing I find difficult to understand is the prevailing American attitude towards social healthcare — socialism seems to be a dirty word. Obviously, I’m generalizing here and not every American feels this way!
Unfortunately, the system here is becoming increasingly Americanized, with government funding cuts leading to overstretched medical staff, outsourcing to private companies who are buying up contracts because they can undercut NHS providers, hospital bed shortages and chronic levels of understaffing.
In my opinion, considering the people in power here, things are only going to get worse. I have no optimism for the outcome of the general election next month. http://www.newstatesman.com/politics/june2017/2017/05/what-does-election-mean-nhs-doctor-im-worried
Socialism IS a very dirty word to many Americans. There is also a very very deep national ethos/mythos of “do it yourself!” and the notion of relying on any government entity to “take care of you” is seen as weak and weird.
It’s a huge impediment culturally and it’s rarely understood as that.
My healthcare (OHIP) isn’t perfect and there are gaps. The wait times can be long, some drugs aren’t covered and even an ambulance ride isn’t fully covered (if I remember correctly). It’s still better than individuals paying for their own medical care.
My Dad lives in Ontario, so I’ve seen the gaps…but not ever fearing bankruptcy or denial of care is worth something.
As a Canadian living in France and a year of two in England, I’ve never known anything other than subsidized health care. I agree, that word “deserving” is morally offensive.
Did you see the video of Ivanka Trump in Germany (you can find it on YouTube). When she shamelessly said that her father was “a tremendous champion of families”, she was booed and hissed at by the crowd.
It IS morally offensive!
I enjoy my life in NY and am glad I made the choice to move here — but the way the poor or needy are treated here is disgusting.
Yes, I know about Ivanka. I try to avoid all mention of that family. They are an embarrassment — at best.
What amazes me as an American is how our insurance and our government control the medications our doctors say we need. I have several diagnoses and my insurance decided that I did not need one of my medications (there was no generic) and they would not pay. A year later they decided there was a second medication I didn’t need. At over $1500/month for these two meds, I can no longer afford them, even though they are the only two medications that are specifically for my bladder condition. Now with the so called “opioid epidemic” I am afraid that they will take away my Percocet which is what allows me to be a productive member of society. I have post herpetic neuralgia and trigeminal neuralgia as the result of having shingles 5 years ago. If you look them up, they are some of the most painful conditions known…worse than the labor for my 3 children ever was. I take Percocet when I need it, to keep functioning, to keep my job and to be an adult, rather than being curled up in bed, crying in pain. I am not addicted…if I don’t need it, I don’t take it. The regulations have become so stringent in NJ, that I can no longer get post dated prescriptions from my PA, only from my pain specialist. Why is Chris Christie determining how MY pain should be controlled? It’s so frustrating…and it’s an hour drive and a $40 copay every month to get my prescription. I feel like a junkie sometimes, and don’t know what I will do when they stop allowing the pain doctors to write prescriptions. Really…Tylenol is going to help this pain? I think not!
This is horrifying.
I ‘m so sorry to read this — and I know about those conditions and they are brutally painful indeed. A neighbor in our apt bldg recently had shingles and she still walks with an altered gait. Very very scary….I might ask our MD about this (i.e. a vaccination) when I have my annual exam this summer.
I assume (?) you have also tried things like TENS, acupuncture? I do know what it’s like to live in daily/24-7 pain after my hip bone was destroyed by taking steroids. I was too scared to get it replaced for 2.5 years until I couldn’t bear one more minute; like you, I took very few painkillers.
I hope (?!) you have raised this issue with your elected officials and Christie’s office.
Please ask your doctor about the vaccination. I recommend to everyone I know. I was too young to get it when I had shingles, so it wasn’t an option for me. I have raised this issue, but have gotten nowhere as I am one opposing voice in a tide of irrationality. Fortunately I have a wonderful pain doctor who will stand by me as long as he is able to work within the parameters of the law to treat me in the way we agree is best. I’m sorry that you went through the pain you did, it’s horrible to live with it every day.
Thanks. Scary stuff!
Thank you, and I will check into it!
Thankfully, I still had my Medicaid last night. Had an insect sting, sitting inside. It’s been cold and rainy in Minnesota where I live. I called Health Partners Nurse line, which I might add is a free service Regions Hospital Provides. The nurse called 911 for me, as my sympoms rapidly changed. The Police, EMT’s, and myself did not recognize the insect that stung me. I’ve carried an Epi-pen for many years due to pharmaceutical allergies, and never had to use it, until last night. And oh, what an experience it is. The rush of adrenaline makes your body quiver and shake. It raises your BP and pulse. When I arrived at the Hospital my pulse was 97. After 2 hours of observation and Benadryl it was in normal range 64. The Epi-pen injection site today, is more painful than where I was stung. I am very thankful to have had on hand, what I needed, to prevent a life threatening event from occurring. I carry an Epi-pen not because of Insect Sting allergies, rather Medication allergies. I never know what’s going to affect me next. I don’t take meds, including Tylenol. And apparently I am now extremely allergic to insect stings. Life is an interesting challenge♡
That’s scary — but yes, epinephrine would indeed be a powerful stimulant.
With Trump in office things will get worse.
Why should millionaires, and billionaires care about healthcare? They don’t, because it doesn’t affect them. If we continue as American Citizens to just sit back, and let the chips fall where they may..we are no better than sheep. Waiting to be sheared of our hard earned paychecks, and eventually sent to slaughter. Corporate America will be the only thing Trump makes great again. The rest of us don’t matter. Very simple. Fight for your rights.
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Agree that we should have universal health care in the US, but unfortunately don’t see it happening any time soon. Your essay was excellent, thanks for posting.
VERY frustrating for so many desperate and frightened people.