My friend Mary and her husband, John, [not their real names] are in their mid-50s, married for the second or third time each. Two of their combined total of seven children from previous marriages live at home - one is working, having dropped out of college for the indefinite future; the other will start college in the fall on a partial scholarship.
Both John and Mary work full time - Mary as the office manager of a small investment firm, John as a landscaping foreman. They have a low-interest mortgage on their home in the suburb of a large city in the middle of the U.S. They are newlyweds so they haven’t built up much equity yet – maybe $20,000 in a housing market that is declining in their area.
They own two cars with a total monthly payment of about $500, three cell phones on a family plan and credit card debt of about $3,000, half of which paid for some emergency dental work and car repair.
Their combined income is in the high five figures. Four percent of Mary’s salary goes into a 401(k) and her employer provides health coverage for Mary, but not John or the two live-at-home children. John’s employer provides no retirement benefits, no bonus or profit-sharing and John has not had a salary increase in more than four years. Nor is there any health coverage through his employer at any price.
These are not extravagant people. They eat at home six nights out of seven and rarely go even to the movies. Vacation is a four-day weekend once a year to a favorite, nearby wilderness area. They have no expensive hobbies, no skiing, no boat, no motorcycle. Their biggest extracurricular activity is their garden.
Like millions of middle-class Americans, John and Mary live paycheck to paycheck and are one serious illness or accident away from bankruptcy.
A year ago, John was diagnosed with a serious skin cancer that required extensive surgery and skin grafts. Before the treatment, Mary was able to add John to her employer-provided health coverage for $600 per month, but it stretched their budget to the limit so – living on a wing and prayer - they dropped the coverage when John’s treatment ended.
Now, a week ago, John was diagnosed with additional skin cancers and the treatment must be undertaken soon. It is possible to add John to Mary’s coverage again – at a higher premium than last time - but it would not go into effect until June and is useless for now anyway since the cancer is considered a pre-existing condition and would be disallowed for from 12 to 18 months.
The same conditions attach to other coverage Mary has so far researched.
Most insurance is a gamble for both parties. When we purchase, for example, homeowner’s insurance, we are betting something untoward will happen and if it does, we will be reimbursed for the repair or replacement cost. The insurer is betting that of the many homes they insure only a few will require payout and they will make a profit. It is unpleasant, in paying insurance premiums, to be always betting against oneself, but it is a sensible purchase to maintain family fiscal well-being.
This was once true as well for health insurance - back when a simple x-ray did not cost $500 and when the price of an average hospital stay was not in tens of thousands of dollars.
Treatment for a serious condition is now commonly discussed in percentages of millions of dollars. Even though an approximation of the 80/20 business rule applies to healthcare (20 percent of the people use 80 percent of healthcare), modern treatment and equipment are so expensive that private insurance is out of reach of most Americans and, increasingly, corporate healthcare programs as well. (There are other, more unsavory, reasons, but not for today.)
John and Mary’s options are few:
- Sell a few assets they have that might or might not cover the cost of the treatment
- Go deeply into debt, if it is even possible to get a loan
- bankrupty, which the last Congress assured with new legislation, is difficult to qualify for
Ignoring John’s cancer is not an option; untreated, it is life-threatening.
Mary and John are just one example of thousands of such crises a day in a healthcare system that is irredeemably broken. That statistic of 47 million with no healthcare coverage cited so often in the press doesn’t include the millions of underinsured, those with mental, not physical health problems or dental care (pretty much every one of us) which, when untreated, can lead to health problems elsewhere in the body and even death.
The United States is the only developed country in the world without a universal healthcare system. It is still widely believed that we have the best healthcare in the world, which is far from the truth by every standard benchmark.
Every time I write about the need for a single payer (universal) healthcare system, there are one or two comments relating a personal healthcare horror story in Canada or England or France. That is no reason not to insist that our government ditch private insurance to see that everyone has access to a doctor when they need one.
No system is perfect. Mistakes are made. Delays happen. But in no way can those problems in other countries be compared to the more than one-sixth of the U.S. population who have no affordable access to basic healthcare. The time is long past to change that.
It will not be easy. Our elected representatives in Washington are provided top-of-the-line health coverage for life. So what do they know about real-life healthcare. And the top-tier insurance companies and corporate health providers donate big-time bucks to their campaigns.
Keep that in mind as you follow the presidential election campaign. Tell the candidates the time is now for universal coverage, a single-payer system. Write about it on your blogs. Make a video about it for YouTube. Get your friends and neighbors involved. Only large numbers of loud people can overcome a government that now exists by and for the wealthy elite.
And remember, you too are only an accident or a rogue cell away from the non-choices Mary and John have.