Three(ish) Year Blog Anniversary
In the Matter of Kathy Sierra

Healthcare - One American's Story

category_bug_journal2.gif 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.


But their "non-choices" are a direct result of the choice they made to drop health coverage. The trouble with universal coverage is that, in the interests of being "fair", it satisfies few.

Think about it - how will the premiums be set? Will high-cost areas like NY drive up the cost for the rest of us, in lower-cost areas? Will it be mandatory? Will people be able to make their own arrangements, or will that be illegal (don't laugh, that was the case in England for quite some time)? Will the currently uninsured have to pay - or it this a way for those of us currently paying to pick up their costs, which will raise our coverage costs?

It's not universal coverage that makes the difference, it's the fact that some choose NOT to be covered - then complain when the inevitable happens, and they have no coverage. A landscaper with skin cancer who drops his coverage is not a good gambler - it's a fair bet that more problems will arise.

By my reckoning, there are 4 people at that house who could help pay - and a few others not living there. This is not a tragedy - it's a choice that has consequences. And the consequences are very painful.

For now, either pay the increased premiums, negotiate with the doctors and hospitals (many are reasonable once they realize you are not insured), or take out a loan.

And, pass the word - don't drop any coverage, however expensive it seems at the time.

There are a great many facts that make me think that universal coverage would be a good path; however, I cringe at the thought of one more way for corruption to eat into our dollars. Think of Cheney's influence in every other area and what makes us think he (or someone, like him, in a position of influence) wouldn't get his thumb into this one.

BTW: Have I missed a big push by the health-care industry to ameliorate the greed and waste that have pushed the price of health care beyond reason?

John's employer does not offer health coverage as is the case with many, many, working people. And, sometimes it is a choice between a large premium and adequate food, shelter, materials for children in school,car,etc. Premiums rise, wages remain low and stagnant. Have mercy!

I'm British. I totally deplore the waste, inefficiencies, absurdities, unnecessarily lengthy and painful waiting times and occasional tragedies of our National Health Service and if I could afford it (which I definitely couldn't) I'd opt for private payment in a flash for anything serious. But it only takes one story like yours to make me remember to be hugely appreciative of not having to fear this scenario. My income is similar to that of the couple you describe (half as much, since I am single). Setting aside 600 dollars (c 300 pounds) a month for health cover would mean giving up everything but absolute necessities. Yes, I'd be able to eat, but I'd have no outings for pleasure, never mind holidays, no new clothes, no professional haircuts, no computer, no mobile phone. And pretty soon would come the first unexpected household repair - broken toilet cistern, leaking pipe, failed heating: can't exactly call attending to those a luxury! For people on this sort of income, that 600 dollars a month is the difference between a halfway decent life and a wretched one. So, yes, maybe if I'd already had cancer I'd not have made the same choice as these people. But it's not a choice anyone in an affluent country should have to make. And whilst the corrupt and wasteful use of our hard-earned money is really shocking and awful, that anyone should have to live in fear of the situation you describe is surely so much worse?

Health care is turning me into an American isolationist.

Everytime I see a picture and an article about a poor foreigner (usually a doe-eyed child) being brought into the United States for some usually-expensive surgery I wonder about all the Mary and Johns already here.

I look at the VA hospital mess and then I see foreign nationals brought here from the same war for gratis state-of-the art treatments.

I read about the doctors who go to other countries to perform cleft-palate surgery and then I look at my cousin with cleft palate (financially in the lower middle-class) and wonder why no one is donating his surgery?

We lost our dental insurance with a corporate buy-out and I just hope our teeth hold out because I haven't found another country sending its dentists here to treat me for free.

Sometimes it feels selfish, but then I remember some old saying about "if you aren't for yourself who will be?"

As with many choices we are faced with in life, we can look for all of the reasons not to change the status quo, or we can commit to the change and look for ways to make it happen. If memory serves, even the U.S. Constitution was adopted with it's imperfections and inadequacies leaving the Bill of Rights to be added after.
The question, as I understand it, is whether or not people ought to be entitled to reasonable access to necessary care, and I believe that the answer to that is "yes."

Any society that treats access to health care as a commodity that a few may hoard to enrich themselves at the expense of the many is morally bankrupt.

Yes, I see far too many reasons to think this society is morally bankrupt.

The first comment got my dander up, I'm afraid.

"It's not universal coverage that makes the difference, it's the fact that some choose NOT to be covered - then complain when the inevitable happens, and they have no coverage. A landscaper with skin cancer who drops his coverage is not a good gambler - it's a fair bet that more problems will arise.

By my reckoning, there are 4 people at that house who could help pay - and a few others not living there. This is not a tragedy - it's a choice that has consequences. And the consequences are very painful.

For now, either pay the increased premiums, negotiate with the doctors and hospitals (many are reasonable once they realize you are not insured), or take out a loan."

Yes, let them eat cakel.

A society as rich as ours that refuses to provide health care for everyone -- at least basic and catastrophic coverage -- is a disgrace.

Iam *embarrassed* and *ashamed* that we are this selfish and stupid, that we can't pay our taxes, especially the wealthy, to provide coverage for everyone.

We ought to *demand* this.

Sometimes decisions come down to common 'horse sense'. The thing that might get the politicians (and doubting Thomas's) behind universal health care is "It's the money, stupid." The United States spends more per capita than any other nation on health care and we still have the most inefficient system in the world. For those like Linda F. in the first comment I would say, think about the billions raked in by the insurance industries making money on health care. The government is picking up the tab for Medicare and Medicaid and the insurance companies are getting rich on it. If the profit were taken out of health care the cost would lower dramatically. So we are already paying for the health care of others in our current system. The cost to doctors under our current system is enormous. Look at a one doctor office and see how many employees he has to have just to fill out the myriad insurance forms in the present system. Our health care system is broken. And we must not blame victims like John and Mary.

I agree that it is shameful that this country does not have some effective system that enables every person affordable access to health care and care for those without such means.

There are several issues deserving of being addressed I think:

l. I would like to see knowledgeable people with no vested interest examine our current system with the intent of drawing up a plan(s) which would make insurance for all a reality.

From the inside or outside of healthcare we all know there is tremendous waste. There are so many middle people now taking a share of what is charged for an actual service, that by the time the actual service provider is paid, they likely receive considerably less than half of the charge and donated a lot of free time completing paper work to get that.

2. Examine some of the better national health care systems around the world to determine their weaknesses and strengths.
Then draw up a plan for the U.S. reflecting those improvements.

Pay attention to some of the patient anecdotal accounts of flaws to find ways to eliminate them.

3. Have any proposed plan analyzed by knowledgeable people who have no vested interest. Don't we have any people left in this country who can't be bought off by insurance, pharmaceutical, other big healthcare companies?

4. Constituents demand their congresspersons read, understand and assess the plan, and then provide specific information to voters in their areas before voting to pass the legislation. Remember how they didn't bother to do that with the Patriot Act, and probably others? Surely that responsibility is in their job description.

5. Any plan adopted will also be the plan covering government employees, Congresspersons included, like the rest of us Americans. No special plan like they have now -- just one plan, the same for everyone, including our President.

Well, that's good enough for starters, for now.

Good points, joared!!!! My question is: What would Social Security and healthcare be like if our Congress critters had to use it. I don't have healthcare insurance and it isn't my choice. I wish I did. I've been denied services that were crucial with my medical history and so I walk around with a potential time bomb. I'm not going to explain why I can't have it here. However, there are a lot of people like me. We are alone; we aren't well and no one cares what happens to us. If I get angry enough I might just bare my soul at my blog one day but I have a modicum of pride left and am embarassed to have exposed this much. I saw some judgements made here that I'm not sure I like.

My husband and I are like John and Mary, Kay, and millions of others who have no health insurance. This is not a choice. It is a terrifying reality for many people that we can't afford the ultrasounds, biopsies and MRIs that would catch diseases in time for treatment because we are paying so much for doctor's visits, and prescriptions. I was recently scheduled for an ultrasound for post menopausal bleeding (before the doctor would even SEE me she wanted this test done) and nobody could even tell me how much it cost. Most people don't pay. Their insurance does. I had a strep throat last month and the lab would not do the "fast" culture because I don't have insurance. We pay over $600 in prescriptions a month, for diabetes, HRT, and high cholesterol. The insurance companies don't pay this much. Who's paying for the high cost of medical care? It's not the people who are insured.

The comments to this entry are closed.