In most developed countries, health care coverage is a right for all citizens, not something that is an option for the wealthy. Those I know who have not had health care coverage here in the US have somehow considered it a “freedom” to avoid having to pay for it when they believe they can’t afford it; those individuals have blamed Obama’s Affordable Care Act for requiring Americans to purchase coverage or pay a penalty. That’s quite a sales job we’ve done, convincing the poor that they are more free because they choose to be uninsured! Taste the freedom!
I was talking with a church friend recently about our own health care situations. In 2013, after decades working for large corporations with access to the health insurance they provided, my husband and I decided to start a small business together. The Affordable Care Act was new, and there were very few health care providers willing to offer plans in Arizona due to how many old people live here. Given the limited options, we ended up with a very bad health care plan that had high deductibles and no max out of pocket. Despite paying $12,000 a year in premiums to our provider, very little was covered. We are pretty healthy people, generally speaking, but during that plan’s coverage, I had a melanoma that required outpatient surgery and stitches as well as follow up appointments. I paid hundreds of dollars for each procedure, office visit, and test that was done. Still, I was pretty healthy overall. I just paid it all, along with the premiums that didn’t cover much; it was a big financial drain, particularly since our earning potential as a new business was about 25% of what we used to make in corporate.
Last April, I had two severe migraines. Since I am not a migraine sufferer, I went to the doctor. She ordered an MRI (that cost me several hundred dollars out of pocket). The scan revealed that I had something called a cavernoma, a cluster of blood vessels in my brain. These aren’t apparently that rare, although I had never heard of them before; 1 in 200 people has one. Many people only discover they have one when it leaks into the brain, causing brain damage (e.g. you wake up, but your arm won’t work or you suddenly have aphasia). I was referred to a neurosurgeon who recommended a craniotomy to remove the cavernoma as a way to ensure I wouldn’t have future brain damage. I began the process to schedule the procedure. They took my “insurance” information, and said the various departments would contact me to tell me what my payment obligation would be. By the first call, I knew I wasn’t going to be having the surgery while on this insurance plan. The doctor’s fee for the surgery was going to be $60,000 out of pocket (not counting the $24,000+ my insurance would cover). That amount didn’t include the OR staff, the ICU stay, the anesthesiologist, or the MRIs to verify the procedure was successful; all of these would be additional costs. The woman from the billing department was appalled at how bad my coverage was. Ultimately, she recommended I just agree to pay, then default and go bankrupt. I have never contemplated bankruptcy in my life. Should I ruin my credit rating forever or risk brain damage? Should I get a second mortgage? Should I risk the next four decades, hoping the cavernoma doesn’t leak?
Prior to the Affordable Care Act, this cavernoma, which was suddenly a pre-existing condition, would have made me ineligible for insurance coverage for life. I would have to live the rest of my life waiting until the day I would wake up with irreversible brain damage. Thankfully, the Affordable Care Act made it so that I could not be denied coverage. Our business had grown to the point that we finally had a few employees interested in insurance coverage. In the past, they had always declined coverage because they didn’t want to pay their portion of the premiums, and we were too small to get good enough rates to pay for more than 50% of their premiums. We had recently acquired a second location with additional employees. so we were able to change insurance companies mid-year. Our premiums for our family were around the same as they had been on the terrible plan we had been on, but on the new plan we had HMO coverage with a modest co-pay for office visits and procedures, and a max out of pocket under $8000 per year per person. I knew I was going to blow right past that max amount.
My surgery was complete in November, and with a new plate in my head and 30 staples holding it all together, my recovery process began. Two weeks later, on Thanksgiving, I realized that my left leg was swollen and I was having a hard time walking. I had a DVT (blood clot) during my first pregnancy in 1995, and while this was less severe, I knew that’s what it must be. I went to the emergency room and was immediately put on blood thinners. Two weeks later, my leg was much worse and swollen again. My doctor ordered an ultrasound, and we discovered that the blood thinners I was on hadn’t worked for me and now I had several clots instead of just one. I knew from my 23andme DNA test that I have a genetic predisposition for blood clotting, and major surgery can trigger clotting. Since the medication failed, they put me on abdominal shots twice a day of a different blood thinner. While this medication worked, it left me covered in bruises all over my stomach and legs. I begged my hematologist to switch me to something in pill form, and he agreed.
When I went to fill the prescription, I was told that the insurance company wouldn’t agree to the dosage, so they would have to give me fewer pills than I needed. I was gobsmacked. Why does the insurance get to override what the doctor prescribes? To carry me through, I had to beg for a free sample from the doctor’s office to make up half the difference. Then I received another call from the pharmacy saying the insurance company wouldn’t allow them to fill the prescription until the end of the month. I explained that I would be dead by then if I wasn’t on the prescribed blood thinners. That was apparently the pharmacy tech’s mistake, but given the hoops I was being told to jump through, I was ready to believe the insurance company was capable of anything.
I have lived in two countries with public health care available: Spain and Singapore, both of which have socialized health care. Singapore is a far more expensive country than the US, but its health care is not (unless you use the available private option). I am not afraid of socialized health care as I’ve seen firsthand that it is much more straightforward than our approach with a corporation inserted in the middle to arbitrate what medical professionals recommend. Mitt Romney famously said “Corporations are people, my friend,” a legally true statement, but they are pathological people obligated to turn a profit to stay alive. They are not obligated to provide a public good or to act morally, but they are obligated to protect their interests by making money. They make money when healthy people pay more than unhealthy people cost. Friends, that’s already socialism; everyone pays so that everyone benefits. The problem in our country is that healthy people bank on staying healthy, and they don’t want to buy insurance, and they for sure don’t want to cover medical costs for the poor. We all think we’ve earned our health and good fortune, and that other people’s problems can stay off our lawn. Add to that the fact that people are living longer, running up health bills, rather than dying off (which would benefit the insurance companies), and you can see why the model gets dicey.
I was talking with my friend about this ridiculous encounter over the blood thinning medication when another church friend joined us. She hadn’t heard our conversation, and she said she was really worried because she and her husband have great insurance and “the Dems” want to take it away and install government-run death panels to prevent them from getting the care they need. I said to her, “The insurance companies are already death panels! I was literally just explaining how they can override my doctor’s recommendations and deny coverage even though I’ve always paid my premiums! I’m dealing with death panels today.”
The first friend I mentioned was talking to me privately later. She and her family couldn’t afford their own insurance, so they chose to join one of those Christian affiliation programs. I mentioned to her that when we considered those, 3 of the 4 available required us to sign a belief statement that was intended to exclude religions like Mormons (and JWs, for example). She was running into the problem that the cost for office visits was so high and not covered that she wasn’t willing to get a problem she was having looked at because her daughter had already been to the doctor that month and used up their budget. Her injury would have to wait.
Needless to say, it was galling to me to hear Trump lying at the State of the Union that he was fighting to protect people from being dropped for pre-existing conditions when the Republicans are in fact fighting to overturn that protection that was legislated in the ACA. This issue is very divisive in the US right now with Republicans fighting to save the insurance company model and the freedom to be uninsured and Democrats fighting for at minimum more government oversight up to full socialization of health care. Where do you sit? For those who already live in a socialized health care system, please share your views!
- Are you bothered that access to affordable health care is tied to employment for a large corporation? Is this a problem with the system we have?
- Do you believe insurance companies should be allowed to refuse to cover pre-existing conditions as they used to be before the Affordable Care Act?
- Should “healthy” people (or others) be allowed to opt out of health care coverage, even if that means their bills will go unpaid if they incur a high medical cost?
- How do you feel about affiliation groups as an alternative to health insurance?
- Should health care companies be able to refuse coverage in contradiction to doctors’ orders? If so, how can this be prevented?
- Do you favor socialized health care? If not, what do you favor? If so, how do we get there from where we are?
- Why do so many people fear socialized health care more than they fear the insurance system?
- Have you had any health care horror stories you care to share?
Discuss.
Most Brits love ‘their’ NHS, as do I.My son has just finished his masters in PA studies in the UK, and we are a family who had been fit strong and healthy, and been prepared to work for that until the past few years, so this is a lively topic in our house.
I’ve had numerous small surgeries and my husband’s life has been saved, and my daughter faces a lifetime of ill health moving forward. As you get older you start to discover that there are whole alternate cities of the sick in hospitals and that we all die of something. You, yes you, are going to get ill and need medical care.
We have of course been in the privileged position of experiencing no anguish whatsoever about how we can fund this care, which necessarily affects one’s ability to earn, and that care has been excellent. There is however creeping privatisation which many fear will increase with trade deals outside the EU now.
My daughter is in the US and now fears returning to the NHS having somehow been persuaded that she can only receive the best care in the US, which is keeping her poor and exploited as she has a long term condition, and I can’t begin to explain how enraged that makes me. I understand that the NHS delivers one of the cheapest systems of care per procedure, and whilst it has it’s faults and is placing it’s staff in often desperate employment situations routinely overworking shifts with inadequate support, to me it is one of the marvels of modern civilisation. It’s what happens when the more part of the people choose good. It’s true, you don’t get treated like a princess, but you do get treated like a citizen.
Here in The Netherlands, we have healthcare insurance and an excellent public healthcare system. Hardly any waiting lists….top notch (I am a PA-GP myself). I pay for 2 adults and 4 kids under 18, 200 euros per month. Then for me and my husband each 350 euros own risk when we need something done outside of the GP (which is for free).
THAT IS IT! Whether or not I need a super expensive 100.000 euro treatment….it falls under the insurance and will cost me only my own risk of 350 euro’s.
I don’t understand why the US is still so reluctant to embrace healthcare for all, I really do not understand! Obama was SO right!!!
Angela—Wow. Sorry to hear all you’ve been through! Your story is a valuable example of what is wrong with U.S. healthcare.
Wendell Potter, a former insurance exec, has tried to warn us about the expensive junk policies insurance companies try to peddle.
Why woukd we want to live in a society where healthcare is only a right for those who can afford it? To a certain extent we pay for those uninsured or underinsured when we go to the hospital. (One factor in high costs in hospital billing is “cost-shifting” —charging high rates for things in order to collect more from insured pts to compensate for those who can’t/don’t pay.)
Implementing a national healthcare system doesn’t need to mean the end of private health insurance. (many retirees have Medicare and a and a private supplemental policy. . It was really disappointing when the ACA passed that we did not even get a public option.
I share office space with the biller for our PT clinic. Medicare is very straight forward when it comes to billing. They require certain things and pay up when you adhere to the requirements. Private insurance can be a cat and mouse game, where they tell you one thing and then later tell you, “sorry, we won’t be compensating you for that patient’s visit.”
(Now we have Republicans trying to unwind the ACA without having offered or developed any alternative).
No. Healthcare is not a right and to even begin to suggest such demonstrates a fundamental misunderstanding of the definition of a human right. Healthcare requires the services of others. If healthcare is a right then those capable of providing healthcare can be compelled to provide said service to those in need and that is just silliness and insincerity.
The real discussion to be had regards the most efficient means to finance healthcare. In the US we have an abundance of available healthcare but zero cost transparency. In nations with socialized medicine, individual protestations to the contrary, the data show that much of the cost containment is the result of restricting the availability of healthcare (look at the wait times to visit specialists in Canada alone compared to the US). I don’t know that anyone really knows the most efficient way to provide healthcare because governments have actively discouraged experimentation so we are stuck in this silly argument that postulates a binomial choice between fully private care and fully socialized care. When Romney-Care was passed in Massachusetts I was intrigued (I worked as a data scientist for a large health insurer at the time) and I hoped that the Feds would step back and a bunch of other states would experiment as well but then the ACA passed three years later and screwed up the experimentation.
Were I to experiment I would try a regime similar to what a lot of states do with auto insurance. Define a minimum requirement for coverage (one that included high deductibles but would make the maximum out of pocket equal to the deductible) and force all adults to purchase the minimum. I would also require providers to purchase “under-insured” policies to cover their individual gaps in collections. High-deductible plans force consumers to be more cost conscious and the under-insured policies will force the providers to be more cost conscious themselves. It could all be a win-win.
For clarification, prior to the ACA, the determining factor with respect to covering preexisting conditions was determined at the state level and at that time there were 17 states that required underwriters to cover pre-existing conditions or provided state funded alternatives for coverage. Your initial post is misleading on the subject. If the ACA goes away there is no evidence that states would not revert back to their prior status.
I’m self-employed. We went without insurance for a while. After I finished school I was unable to find a decent job outside of my self-employment (this was back in 2012) but my wife did, and she worked for a while, despite the fact that we had two young children and she would have rather stayed home. After several months of working she was able to get insurance through her work.
Once the Affordable Care Act (Obamacare) was passed, she was able to quit her job because we no longer had to worry about insurance. She’s been able to stay home and take care of the kids. The Affordable Care Act gave her that option, and we’ve been grateful for it.
The cost of healthcare in the US is inexcusable. It can and should be brought down. But as far as I can tell, the best ways to bring it down is by more government intervention into the healthcare system. Healthcare is different type of a commodity whose pricing doesn’t and cannot possibly function like the pricing of other commodities in the market. Consumers can shop around for the best cell phone to get and thus create competition for cell phone producers and thus create incentive for producers to bring down the price of cell phones and increase the quality at the same time. However, if I need emergency heart surgery, I can’t just go shop around for the best and cheapest heart surgeon. Arguably it is the longstanding privatization of the healthcare industry (not entirely bad) that has driven up the price in the US. The government has more bargaining power and it can build and manage its own hospitals and clinics as a public option to compete to bring down costs in the private market. A big problem is 1) healthcare profiteers who actively lobby against bringing down costs because it would negatively affect their yields and 2) a strong culture of libertarian paranoia in the US that is obsessed with this idea not only freedom (which of course is a good thing), but the idea that freedom is only attainable in the form of freedom from government, never recognizing the basic fact substantiated by lots of cases and evidence that individual freedom can and has long been increased and maximized because of the government. Government intervention can limit freedoms in many areas, for sure. But by all observable data in other countries with large government control of healthcare in the developed world strongly suggests that individual freedom vis-a-vis healthcare is maximized by pretty strong government intervention into the system. There can and should be space for private insurance and private healthcare. Private options have become more popular in Sweden and other countries with long socialized healthcare systems so that patients can avoid long waits and have more choice of doctor and quality. But in the US, we need to reform the system beyond Obamacare by bringing the government more greatly into the areas of insurance and healthcare provisions.
Republicans and conservatives don’t seem to have plans with what to do with healthcare. About everyone supported getting rid of pre-existing conditions, but this never would have happened with Republicans in control. And just to get rid of pre-existing conditions required greater government intervention into the system. I can’t imagine a plan that could feasibly get rid of pre-existing conditions without the three-legged stool of the individual mandate, community rating, and subsidies which Obamacare provides.
I hope you’re doing well, Angela.
Back in my 30s, I spent several years working full-time without benefits, making just enough money to be ineligible for assistance, but nowhere near enough to pay for any serious medical issues. The stress was horrible, relentless, and left me feeling quite angry. Currently I have what is called a platinum healthcare plan through my employer. It offers me a lot of buying power and a sense of well-being. (Though, every year benefits get renegotiated based on shifting fiscal reality.) All my adult experience with healthcare leaves me convinced people’s beliefs are based almost entirely on their current situation, and how they perceive any proposed changes helping or hurting.
I just want to throw out a book title: “America’s Bitter Pill” by Steven Brill. It’s been on my to-read list since it came out in 2015. The reason I’m plugging a book I haven’t read is because Brill gave a great, thought-provoking interview about his findings to Fresh Air on NPR. Brill’s perspective is worth seeking out. He actually doesn’t put all the blame on insurance companies. He is very critical of them but sees them being in the same boat with us consumers, desperately trying to keep up with out-of-control pricing. In short, if we can’t rein in the insane costs, it won’t really matter which system we use.
My baby brother is an emergency room doctor here in the US and he has horror story after horror story about dealing with those who can’t afford insurance. The hospital emergency room has become the de facto doctor’s office for the poor and homeless. Often by the time an individual is sick enough to go to the ER they are in the late stages of an illness that could’ve easily been treated if the individual had had health insurance. This also goes for dental insurance. Besides having to give them the bad news that their illness is now untreatable and giving them something to deal with the pain there is little that ER doctors can do in such situations. If they are lucky enough to live in a community that provides hospice care for the poor and homeless they can also recommend that option to the individual. It’s shameful that the system is often rigged against us being our brother’s and sister’s keepers. In stark contrast to this grim picture here is another scenario. I was in the French Alps a few years ago when my husband’s band was playing at a jazz festival there when a member of our group badly sprained her ankle on a hike and because of where we were a medevac helicopter was sent to transport her to a hospital in Grenoble. All she could worry about was the cost of the helicopter ride to the hospital and the visit to the ER. Both she and the rest of our group were flabbergasted to find out that these services were free-even for foreign visitors. What is wrong with a country that considers guaranteeing decent health and dental care to all of its citizens “dangerous” and “ the slippery slope to socialism”. These same citizens have no problems with public schools, libraries, fire departments, police departments, etc. What, pray tell, is wrong with granting every person the right to a healthy life? How is this wrong?
Jake: I’m doing really well right now. Definitely haven’t had any long-lasting effects from the surgery or even the blood clot since things were caught early on. My head still has no feeling where the surgery was, but maybe that’s normal. Brushing or washing my hair feels weird.
Wayfaring Stranger: My MIL broke her arm in 9 places when we were on vacation in Spain, and we took her to the nearby hospital ER. Because we weren’t citizens, they apologized and said she could pay with a credit card, although it took a while for them to figure out how to charge someone as they didn’t get that many non-citizens. The cost? $108 for an ER visit with a team of very competent doctors. When I went to the ER near my house with the blood clot, my out of pocket cost was over $400 after my insurance coverage.
Living in France with my family. Doctors visits are 25 Euros, specialists can be more, around 50 to 60 Euros. The mandatory national insurance reimburses 80% or 90% of the doctor’s visit depending on which region you live in. If you are hospitalized, coverage is 100%, including hospital, doctors, anesthesiologist, etc. Mandatory employer health plans cover various amounts of the 20% or 10% remaining. These secondary plans can be quite good. Mine pays the remaining part so net out of pocket is 0 Euros for health care for myself and my family.
I am now around 50, and I do everything I can to be healthy. I am a vegan eating a high nutrition diet, I run regularly, do some strength training. I take a bike to work. When the day comes when I will be sick, at least I will have done my best to reduce the health care costs others will bear.
France spends about 11% of its GDP on health care. Because it’s per capita income is lower, French people are getting a much better deal overall than Americans.. Health care is one of several reasons that people live longer in France than the U.S. I consider lifespan to be the main metric for the success of a society.
Every country has its problems and the French health care system will face an aging population with fewer young workers. This will lead to lower quality care. I hope we will accept these difficulties gracefully for the sake of the future generations.
Chiming in from Canada, I was the type of person who rarely if ever went to see the doctor because I never had any issues. Starting in 2012 I had a series of health challenges that resulted in numerous trips to my family doctor, and then specialists. I had multiple kinds of tests, MRI, x-rays, biopsies, double hernia surgery, endoscopies, etc. Out of pocket cost to me? $0 (except for parking at the hospital).
I will comment (and I mention this as your U.S. election cycle is firing up….or does it ever stop?), that when I hear politicians in the U.S. talk about “free healthcare”, or especially “free healthcare in Canada”, this is beyond deceiving. There is no such thing as free healthcare, someone has to pay. Universal healthcare yes, in that we all have coverage (but not because everything is covered, because it’s not). In Canada we pay through much higher taxes, but that is the social contract we have made as a society. I paid into the system for years and never needed it but other people did. When I needed it, the system was there for me, and I am thankful for others who paid into it. It is not a perfect system, and we debate the merits and costs of it endlessly, but at the end of the day it is far superior to the alternative.
I am scheduled for a colonoscopy tomorrow (no issues, just preventative in nature due to family history). Out of pocket cost to me for the visit to my family doctor, referral to the clinic, pre-screening consultation and the procedure itself (would you like to be sedated for the procedure Mr. Talon? Yes please!) will be $0 (except for parking at the hospital…..sorry, I’m Canadian, we don’t have much to complain about so we like to complain about how the healthcare system sticks us with the bill for parking).
“That’s quite a sales job we’ve done, convincing the poor that they are more free because they choose to be uninsured! Taste the freedom!”
This also obtains when aforementioned poor persons runs his Harley off the road at 84mph and smashes his head open because he wants to be free from a helmet, too; then after ER he needs 3 mo in the hospital just to stand up and, because his brain injury is permanent, the rest of his life in some kind of tax-supported care facility.
Makes perfect sense to me!
Talon: Americans do love to worry about the high tax rates in other countries that have socialized health care, but paying $15K per year for my family to a private insurance company is pretty much the same thing. This ends up being an itemization discussion. Also, there are many Americans who fear the government’s incompetence without acknowledging the problems with a profit-making company being inserted into the process. They see the crappy service provided by the VA, but they don’t realize that the fact that the US underfunds the VA is an indictment of how much the US cares about its vets.
I’m sorry you had to face those health concerns, Angela. And I’m sorry you had all that needless stress added to your concerns.
I’ve lived in a couple countries with national health. My husband, my kids and I have used it in British Columbia a number of times for things as simple as respiratory infections & childhood vaccinations, for emergency cardiac care and as part of a provincial effort to stem the advance of the hepatitis I was exposed to in a health food restaurant (of all things!).
I have nothing but good things to say about how comprehensive it is, how proactive and how based it is in community service & wellbeing.
I could tell specific stories of how our hit-and-miss health delivery system fails to compare from our experiences over a period of 2o years or so but it would take all day.
My first experiences were back in the 70s when Americans were still quaking fear of “socialized medicine”. When I returned to the States and checked in with my own doctor and asked his opinion he completely stunned me by responding “best medical records in the world!”. And it’s true. IF we had a wish to have a healthy population not subject to contagion of all manner of diseases, who were productive in their family and employed lives, and whose lives were not pitched into chaos by medical emergencies and end of life care, we’d get to work figuring out how to transition to a national health system.
One plan that was advanced several national election cycles ago was to allow people to choose between a private insurer and the same provider that US federal government workers get. This would force the private providers into completion with a more efficient single payer system. It makes sense to me. And so does the Canadian system of demanding that elected officials use the same services that ordinary citizens do.
Again, sorry you’ve seen the ugly side of medical insecurity. Glad to hear that you’re emerging from the crisis.
Angela, you hit the nail on the head with your statement “They see the crappy service provided by the VA, but they don’t realize that the fact that the US underfunds the VA is an indictment of how much the US cares about its vets.” What is to stop government from underfunding healthcare in general? I am not opposed to universal healthcare and I do think our current system is broken, but I do not trust our government to do what it says it will do. I do not believe our current political system has the ability, nor the will, to hold people accountable to their promises. The VA is a prime example of bureaucrats lying about procedures offered to vets in order to save their jobs and increase funding. The waste that exists in government with no accountability to the taxpayers make it hard to get on board with giving that same wasteful government the ability to control my healthcare.
Another difference from the US and other countries is our cultural insistence on doing “everything possible” with the threats of lawsuits when futile care is not provided. Until there is tort reform to mitigate lawsuits, we will continue to have a medical culture that provides tracheostomies and feeding tubes to terminal patients in order to buy them a few more hours or risk being sued by their families for not doing everything possible. A few years ago, we had a number of British healthcare officials tour our long term ventilator unit. They were all amazed, because such a unit would not exist in England. The families would be responsible to care for their ventilator dependent loved ones. It would not even be an option. We have a culture that does not want to accept death and we ask for an inordinate amount of resources to be expended in order to keep people alive who would die without expensive intervention. If we don’t get that care, we sue.
Mix the two, an unaccountable bureaucracy and a lawsuit culture, government healthcare could end up a disaster. It is a risk I would not vote for. At least now, those with no insurance still have access to the ER and hospitals cannot deny lifesaving care by law. Most non-profit hospitals have charity care policies to write off charges that cannot be paid (the hospital I work for is up to 4 times the poverty rate – so a family of 4 making less than $90,000 a year can have their bill reduces or even wiped clean as a charity case).
I don’t think you see how you are contributing to the problem. You had a known condition that required at least $84k (plus the other services) in costs and you knowingly walked right in and secured coverage with very little premium outlay. Of course such an abused system will be broken — and just because it was broken in a way that benefits you doesn’t mean you didn’t contribute to it breaking.
Insurance is designed to cover the unknown and the catastrophic — I get why you want the coverage but $1k per month and $8k per year in order to demand nearly $100k in services doesn’t work. If the system is broken, actions such as these contribute to the reason it is broken. And so, in order to recover, the insurance company decreases coverage and raises premiums and others flee. That’s the death spiral.
You may say that you are fine with that because you ‘deserve’ the health care, but there must be a functional way of distributing that care (capitalism is the worst economic system in the world except for all of the other systems). Take the emotion and the personal bias out of this, and your story becomes a clear example of the problems with the ACA — not its benefits.
By just about any measure, the healthcare system is a catastrophe. The only way it is not a catastrophe is in terms of profits for hospitals/healthcare systems, insurance companies, pharmaceutical companies and some healthcare IT companies. Almost all in that group are making obscene profits.
Many of the previous comments touch on the problems with actual service delivery and insurance coverage. Consider, also, that healthcare threatens to bankrupt the nation. Healthcare spending in total is approaching 20 percent of GDP and our failure to bend the cost/spending curve seems to indicate that it will exceed that threshold. Also consider that diabetes is an epidemic, that obesity is an epidemic, that metabolic syndrome is an epidemic (all three are interrelated, of course), that drug addiction and deaths of despair have driven down average life expectancy two years running–all this and more data clearly indicates that the health of average Americans will continue to decline while the cost of providing care will increase. It’s the worst of all possible worlds.
I wish I could share Gilgamesh’s macabre optimism in the ER as a source of care. This is still the only country in the world where people declare bankruptcy and burn up their life’s savings on healthcare, where cancer can destroy your finances, where hospitals refuse to strike a deal with ANY insurance companies and then surprise bill functional patients to pay for the care of the dysfunctional–and where Congress does nothing about surprise billing because doctors and hospitals are afraid making it illegal will cut into their profits.
That Republicans would approve a return to the days of denying coverage based on a pre-existing condition is unconscionable. Is healthcare a right? Yes. I have a right to life, and nowhere in the Constitution does it say that my right to life is based on the vagaries of genetic roulette.
By just about any measure, the healthcare system is a catastrophe. The only way it is not a catastrophe is in terms of profits for hospitals/healthcare systems, insurance companies, pharmaceutical companies and some healthcare IT companies. Almost all in that group are making obscene profits.
Many of the previous comments touch on the problems with actual service delivery and insurance coverage. Consider, also, that healthcare threatens to bankrupt the nation. Healthcare spending in total is approaching 20 percent of GDP and our failure to bend the cost/spending curve seems to indicate that it will exceed that threshold. Also consider that diabetes is an epidemic, that obesity is an epidemic, that metabolic syndrome is an epidemic (all three are interrelated, of course), that drug addiction and deaths of despair have driven down average life expectancy two years running–all this and more data clearly indicates that the health of average Americans will continue to decline while the cost of providing care will increase. It’s the worst of all possible worlds.
I wish I could share Gilgamesh’s macabre optimism in the ER as a source of care. This is still the only country in the world where people declare bankruptcy and burn up their life’s savings on healthcare, where cancer can destroy your finances, where hospitals refuse to strike a deal with ANY insurance companies and then surprise bill functional patients to pay for the care of the dysfunctional–and where Congress does nothing about surprise billing because doctors and hospitals are afraid making it illegal will cut into their profits.
That Republicans would approve a return to the days of denying coverage based on a pre-existing condition is unconscionable. Is healthcare a right? Yes. I have a right to life, and nowhere in the Constitution does it say that my right to life is based on the vagaries of genetic roulette.
There is so much more to universal healthcare than emergency care without a bill. Though there is incredible peace of mind in that.
First universal healthcare in Australia, Canada, and all the countries with universal healthcare cost half what the American system costs. $4700 v $9900. Though you may pay it to an insurance company and we in higher tax. We have a 2% levey added to our tax so it is progressive. So it will not bankrupt America it will save everyone money except insurance companies.
Second prescription medicine is cheaper. If a company wants to supply a new medicine, they have to show it is better than present, and cost effective. The same medicine costs a lot less.
Third because birth control is affordable, the rate of abortion reduces. America 19.6 abortions/10000 women of childbearing age, reduces to 10 for many countries down to 6 for Germany. It is a lie that making abortion illegal = 0 abortions. It usually increases the rate because of reduction in other womens health services, like affordable birth control. http://worldpopulationreview.com/countries/abortion-rates-by-country/
Fourth if you have one sysyem they keep statistics to see patterns. For example bowell cancer is a major killer of older people. So we get sent, in the mail, a po test for our birthday at 50, 60 etc. Mine came back as positive when I was 70, had a colinoscopy within a month, and a follow up 6 months later. No cost, good till 75.
Fifth as a result of 4 life expectancy is increased. Australia has similar lifestyle to America, but life expectancy is 5 years longer. https://www.worldometers.info/demographics/life-expectancy/
I’m sure there are more. I am not in the healthcare system.
You can buy private health insurance here, but I believe there should only be one system so the wealthy get treated the same as the poor, and associate with them.
I can’t think of a reason why you would not have universal healthcare, perhaps ideology?
You will not find a right wing politician advocating repeal of universal healthcare, though they might be less generous in funding it.
I would like to add to my earlier post that I have a strong dislike of for profit hospital systems and hospices. If anything, I think Medicare should not go to any for profit medical institutions.
If health care is a right, then we need to put physicians on salary (or draft them into the Public Health Service), end malpractice lawsuits, and nationalize all of the private hospitals, right? To this point, we have treated health care like a business opportunity.
Thanks for sharing your experience and it is good to hear you are doing well now.
In the U.S., we have two general health care systems, one for the sufficiently employed and one for everyone else. For the employed, the plan is tax advantaged employer provided group health insurance plans.
For everyone else it is a two prong system. The first prong is called “Don’t get sick”. This covers everything except catostrophic coverage. The catostrophic coverage, as OP so clearly demonstrates, is bankruptcy courts, and the cost is born by those who are employed enough to have health insurance.
This is a plan that was carefully designed and crafted by no one ever. Rather it is the accidentally created by encouraging everyone to use employer sponsored health insurance.
Obamacare tried to fix some of the most egregious problems, like coverage for preexisting conditions, but did little to control costs. The “individual mandate” was unpopular, but provided an incentive to people to get insurance without waiting until they got sick. Republicans claim credit for eliminating the individual mandate but surely won’t take responsibility for rising insurance premiums if people wait until they are really sick to opt in.
This is the problem: everyone is going to use the health care system, and in the end, someone is going to pay the piper. We can either choose an organized structure to manage it, or let the chaos continue.
Gilgamesh: Drilling down a bit more into the VA case, there are two factors there that don’t exist in universal healthcare: 1) vets don’t have the same voting bloc power as those affected by a universal system, and 2) vets need much higher rates of care and don’t have healthy payers covering those costs–the money is coming from the generosity (or lack thereof) of the government., and there aren’t many political penalties for screwing over the vets. The VA isn’t given enough money, everyone needs help, and so they start cutting how much help each person can get. I’d be satisfied if we all had the same health care our lawmakers have.
However, I hasten to add that the rollout of ACA also had problems, and legislators weren’t great at avoiding some obvious gaps. We created a marketplace, but didn’t compel providers to service all states. This is why in AZ I only had one “not real” healthcare option initially. There also is no cap on what they can charge for those buying insurance directly (rather than via a corporation). Friends of mine who own their own business had a huge increase in their premiums and were paying over $25K per year the first year after the ACA. They were generally healthy people, but getting older. In other words, the insurance companies still held all the cards. They could decline to participate in a state with an older population or just jack up the rates to cover their risks. A national system would help level this out.
It’s really the parable of the Good Samaritan, isn’t it?
Do we walk on by those who can’t afford premium insurance policies and access to good medical care because we have ours? Or are we the ones who stop and ensure that our brothers are taken care of too?
J: Where your statement falls apart IMO is that my health need for a craniotomy is (for me anyway–not for everyone), a once in a lifetime event, yet I have paid health care premiums every year since I was 26, and my parents paid them every year before that. I have contributed to this system for decades with barely a trip to the doctor. That’s why individual providers want to exclude for pre-existing conditions. They want to keep all the “healthy” money I poured in, while denying as many benefits as they can. Obviously they would want to do that! But allowing them to deny coverage for pre-existing conditions means that once you’ve ever been diagnosed with anything, you can never change providers, even if you get laid off or change companies. My opinion is that the public good demands that any company engaging in health care needs to act as if they were a universal provider. Otherwise, get out of the way so we can create a system that does act for the public good. We don’t allow doctors to refuse to provide services because it’s not profitable to them. They take an oath to do no harm. Insurance companies absolutely do not.
My step father-in-law (now deceased) always got good medical treatment at the VA—including brain surgery—and lived to be 96 yrs old.
Hawkgrrrl’s and Angela C’s experiences highlight perfectly what is wrong with America’s medical care. At least before Trump warped the definition of conservatism, I used to define myself as a free-market conservative who hated banks (because they make so many mistakes) and insurance companies. I include medical insurance companies in the hate.
While we lived overseas in 1988 I had a conversation with an Australian doctor practicing outside his country, who told me that he had to pay a medical malpractice insurance premium of 1,000 USD, to treat people from every country in the world except the US. If he also wanted to treat Americans in his practice, his insurance company added $50,000 USD to his premium. The legal costs of treating Americans were prohibitive.
I am lucky that in my retirement, I have Rolls Royce medical insurance for me and my wife, but I pay a lot for it: Medicare Part B, back-up BC/BS, and dental supplemental cost me just about exactly 1,000 USD per month. I am lucky that I can afford it. So many of my retired friends, in poor health, need to go to the ER, and have to debate whether they can afford the co-pay. This is just plain wrong. I have a friend trying to quit smoking who was told that a prescription anti-smoking suppressant prescribed by his doctor would have cost him a $600 USD copay. He could not afford it. The State of Utah is moving to limit the cost of insulin to patients, because the price has skyrocketed.
I don’t have the answer. Obama Care was unpopular when it was introduced, and then when the Republicans tried to repeal it, THEY became unpopular, and now opinion surveys show Obama Care is more popular. People just tend to automatically default to opposing anything new. And I am leery of people who confidently tell me that they DO have the answer, and that they can find ways to pay for it, because social planners (and changing America’s medical care system of payment WILL involve social planning) never seem to take into account the inevitable Law of Unintended Consequences. The answer of most people seems to be that they want more services at less cost, and leg the other guy pay for all this.
We have got to move as a society toward a system of more equitable and affordable health care, but I don’t think we want to pay the price that it will entail; I am NOT referring here entirely to financial costs.
In the meantime, the story of the Australian doctor I spoke with is key, I think. I think America’s litigious culture has terribly warped medical costs. I don’t think doctors in Denmark or Singapore pay very much in malpractice premiums. I have an MD friend who specializes in pain management and his malpractice premiums are in the low hundreds of thousands of USD each year.
A lot of people praise Canadian and British health systems, and they are popular and I am sure do a lot of good. There are also many stories from those countries of very long waits to see specialists and to have elective medical care.
There is a basic fact of life. It has nothing to do with right or wrong, and in fact Is all too often unjust. When demand exceeds supply, costs will go up. Medical care is no exception. We have much greater need for medical care than before: people living longer, aging population, etc.
I feel very depressed after writing all this; I am just glad that Angela C says she is doing better, and I hope Hawkgrrrl is, too.
I had an internal medicine/general practitioner Dr. I really liked. Very good Dr. Three years ago he decided he wanted to change his practice. If we wanted to remain his pt., we would now have to pay $1800/yr out of pocket. If we needed to see him, our out-of-pocket (after insurance paid) would be applied against that $1800. If we were healthy and only saw him 1/ yr, then he would end up pocketing much/all of that $1800. Because I really have no health issues, I decided, sadly, to find another Dr. If I had a health condition that required frequent Dr. visits, I would’ve paid the $1800 and stayed his pt.
Obamacare isn’t perfect, but it gave health insurance to 20 million people and slowed growth in premiums. You take it away, you take away health insurance for millions of people, many of whom are Trump supporters. This idea that all the problems in the healthcare system are attributable to the ACA and government intervention into the system and that things will just magically fall into place with increasing privatization and a market-based system is fairy-thinking. What I’ve found is that if I scratch a little harder at these folks who believe in the fairy-like magical powers of the market is that more often than not they really just don’t like poor people.
JI, in Aus there is a price the doctor is paid for a proceedure, or visit. The doctor can charge more and the client can agree to pay more or find a doctor who provides the service for the government fee. In hospitals there are doctors on wages, and specialists also operate in certain hospitals.
Yes Alice it is. In countries with universal healthcare (socialised medicine) we are proud that we agree to support each other especially in time of need.
Unfettered capitalism is rarely the best path, it will be abused. Funny, above people are concerned that universal healthcare will be abused. Capitalist healthcare is already being abused. Another benifit of universal healthcare is that statisticians can compare doctors, proceedures etc and abuse will stand out.
Hawk I hope you plan on doing this for a number of hot button issues. Abortion, socialism, electral reform etc. There are so many lies that republican have a testimony of.
“Does anybody not see the atrocious way the Democrats are behaving?
Democrats are running on open borders, gun confiscation, medicare for all, the green new deal, abolishing ICE, eliminating the Electoral College, elevating foreign nationals above Americans and Infanticide.
They have no policies to run on. They have nothing to offer”
These need to be answered. Half are lies and the other good policies made to sound bad.
They were said in response to those praising Mitt Romney on BCC, Apearently you can’t praise Mitt for saying a republican president deserves impeachment, without also listing democrat faults. A new concept to me. Worth discussing too?
Medical care isn’t a right. People were being treated by doctors long before health insurance companies even existed. Doctors and medical personnel made a good living but they weren’t millionaires. (My great grandfather was a country doctor with 10 kids). Access to health care ( in terms of freedom from discrimination) might be a right. Freedom of association is a right but the government doesn’t provide all citizens a free car. Right to bear arms is a right but the government doesn’t provide everyone guns. However, we are to the point where a national health care system is warranted. Just as we no longer have the stomach for public executions we no longer have the stomach to see suffering if it can be prevented. The market approach has failed for any number of reasons, the least of which being there really is no free market. Medical schools strictly control the number of doctors available. Federal and State boards control how health care is administered. The only issue to me is how to fairly fund and administer the program. I would impose a national sales tax (no exceptions and no exemptions) of say, one cent. Haven’t done the math but it should be plenty of money to cover national health care.
“we no longer have the stomach to see suffering if it can be prevented.”
While I hope this is true there’s another more self-interested perspective on this issue. It’s the public health issue and we are woefully behind in that respect because of our spotty I-get-mine-perhaps-you-do-to0-and-perhaps-you-don’t approach to health care.
I said I wouldn’t go story by story through my national health experiences but I’ve gotta tell this one. Back around 2002 (I think it was) I was exposed to hepatitis via cold food from a restaurant in Vancouver. At approximately the same time in the US a food service worker in PA was spreading his similar infection. In Vancouver, when Case #1 showed up at the hospital, notices went out on every media channel, a team of public health workers was assembled, their schedule of appearances at public venues around the lower province were advertised, anyone who had reason to suspect exposure was administered a gamma globulin shot and the “epidemic” was stopped at a single full blown case. Meanwhile, in PA the contagion spread. Cases of hepatitis popped up around the Eastern and Southern US. If I recall correctly, 11 people died. Who knows how long it took people to realize hepatitis was why they were feeling so lousy? Who knows how many went on to spread their infection? Who knows how many remained vectors because they didn’t have access to decent health care?
I was only hearing news stories from my vantage point in BC but my interest was acute because I’d just been through the same thing.. It seemed to me it was a great mystery for months before anyone got a handle on it.
Also worth knowing is that when I showed up for my gamma globulin shot, I offered to pay for it since I wasn’t eligible for provincial health. They declined payment. They told me that the expense wasn’t the point. The point was containing the disease and they’d much prefer that I didn’t spread it than that they recovered a cost. That’s why people not only live far longer in BC. They are vigorous and have a quality of life well into their 80s and beyond that we can only envy.
In the US, there is a growing number of age 65+ people opting for Medicare Advantage which is an optional form of Medicare that uses private Insurance companies, with most of the premium, if any, picked up by the Government. My plan is like a Gold plan with low maximum out of pocket, has more Doctors and all hospitals available, includes dental, vision, hearing, athletic club memberships, and a zero added premium to me. I still pay the low Medicare Part B which all must.
I do not see any politicians spouting Medicare Advantage for all, probably because it marries the Govt and insurance companies. I personally would like to see some safety netof medical coverage for all, and am just not certain how best the US should align the responsibility between Govt and Industry and Insurance.
I’m confident we in the US have plenty of $$$ allocated to the health industry today to cover EVERYONE with sufficient healthcare coverage to make all more happy and secure.
Largely a US problem. The bigger problem is the logical pretzels required for justify the lack of public healthcare, but still swell with pride at how amazing Murica is (or how you’re Making It Great Again). Add to that the lobbying system that maintains this awful status quo, gun control, systematic prejudice of non-white CIS people, government corruption and crumbling infrastructure. Viewing from afar, healthcare’s *almost* the least of your worries.
I am a resident of Canada and very glad of it. These past few years we have had the best GP we’ve ever had. He once told my husband that for a number of years he practiced in California but finally came back to Canada when he could no longer tolerate dealing with HMOs who basically controlled how he could practice, and what tests he could or could not order. Sometimes there can definitely be long wait times on elective surgery or getting in to see a specialist and I think support staff in hospitals and care centres are overworked. However, I have never experienced wait times that affected outcomes. When something is of a critical or time sensitive nature you do get into the system quickly. There never has to be a fear of not being able to afford appropriate care.
Amen, Di!
I was living in Vancouver when some friends came to spend a week of their vacation with us. Why not?! We lived in a rental at Horseshoe Bay overlooking Whytecliff Park. It was heaven!
Anyway, my friend’s husband began complaining of a pain in his arm. It took us 2 days to talk him into getting it checked out. Thank god he would at least mollify us by chewing the occasional aspirin.
So, eventually, Madeline-style, we rushed off in the middle of the night to the ER. They prioritized him immediately. He spent the rest of his “vacation” in the hospital but he went home healthier than he went in and equally impressed with his experience of Canadian healthcare. … as opposed to the horror stories of “socialized medicine” he’d been fed in the US for decades.
You’re exactly right, Di. I have Canadian friends who’ve waited months for elective surgeries — elective being the operative word — and friends like my husband and my SFO visitors who are treated immediately and effectively when the need is pressing.