Two days later, after successful surgery, I develop an infection, pneumonia, and the days in the hospital begin multiplying into weeks. My doctors are so busy they can only visit once a day, if that, but the nurses, well... they're the healers, the angels, though they themselves are desperately overworked.
Everyone's so busy here. Hospitals have grown larger than ever in recent years as they've swallowed smaller hospitals and medical treatment centers. Given the overworked nature of the staff, I hire a healthcare aide to be with me several hours a day. My friend tells me that insurance won't pick up this expense either, but I can't worry about that now. I simply need to heal.
Finally, I'm discharged to months of physical therapy, three times a week. Fortunately, the therapy practice takes my insurance (not always a given). But on that first visit (as on every visit thereafter), they run my Visa card through their machine and I get charged a $40 co-pay. There's nothing I can do about it. After all, my goal is to get back on my feet, literally as well as metaphorically. Still, that's $120 a week for 16 weeks and so my out-of-pocket patient expenses begin to add up.
Back at home to recuperate, I find a stack of unopened mail, including notices from my insurance company alerting me to the bills that are to follow. Soon enough, they begin to arrive. They include out-of-pocket patient costs for the ambulance, the hospital, doctors, tests of all sorts, drugs of all sorts, and sundry other services. Those bills list both what insurance has paid for each service and the amount of money that I still owe.
And here I experience what must be common to so many Americans. I'm surprised and distressed to learn how much of the cost my insurance doesn't pick up. The surgery, for instance, was $72,000, but my insurance only covers $67,000 of it. The other $5,000 is my co-pay. Add in the co-pays for everything from that ambulance to other medical services and my costs come to almost $13,000.
An Insurance System of Out-of-Pocket Disasters
I'm sharing my recent journey as a cautionary tale. And, yet, what am I warning against? That we are all somewhat powerless when sickness strikes, but that those of us who aren't wealthy suffer so much more. The thought of being without insurance is frightening indeed, yet in our present system we pay in so many ways for the existence of those insurance companies. We pay in co-pay; we pay in not getting treatment we need if insurance deems it unnecessary (no matter what your doctor says); we pay yearly out-of-pocket fees whether we're 20 or 80 years old. (For Medicare patients, a monthly payment comes out of Social Security.) For most American families with insurance, whether workplace-based or individually purchased, premiums go up regularly, if not annually. At present, we have no alternative to the existing health insurance system, yet it is actually failing us all in so many ways.
What do you do when sickness occurs, if you aren't rich? Suffer the illness, for sure, and then suffer the out-of-pocket costs afterward. And keep in mind that tens of millions of Americans under age 65 don't have any health insurance at all. (In the age of Trump, in fact, those numbers are on the rise.) Moreover, the persistent growth of income inequality to Gilded Age levels has had a decided effect on the health of many Americans. For low-paid wageworkers, the unemployed, and/or undocumented immigrants, getting sick or having any kind of medical mishap is a disaster of the first order. For them, paying out-of-pocket costs of any sort may simply be impossible, which means that they will often do without medical treatment or even medicine. To put this in perspective, 40% of Americans can't afford an extra $400 even in a medical emergency. Imagine what $5,000 or $10,000 in expenses means!
After an illness, accident, or chronic disease hits, a startling number of those of us with health insurance find that we have to choose between paying for daily needs and paying our medical bills. Such expenses leave people even more impoverished and often in debt, which is tantamount to remaining unhealthy.
For the poor, Medicaid, the government program that helps those with limited or no incomes, can make a major difference, but many people don't have Medicaid because their states don't readily offer it. Even where it's more easily available, many with incomes not much above the poverty line don't qualify for it. And as Elizabeth Yuko pointed out in the New York Times recently, "Even if you are fortunate enough to have health insurance, that doesn't mean that all of the members of your medical team -- which may include out-of-network specialists -- are covered by your plan."
As I learned with my fractured hip, someone who is in great pain or out of it for any number of physical reasons can't be expected to focus on that future bill. And even if you could, who would want to cancel any of the services needed to heal?
Though Barack Obama's Affordable Care Act, aka Obamacare, helped significantly, there are still far too many people who will have to agonize over how to manage both an illness and the co-pays that go with it. Meanwhile, of course, the Trump administration and congressional Republicans are working overtime to undermine Obamacare and deprive ever more Americans of any sense of a medical safety net.
What Medicare for All Would Mean
All the talk about making insurance affordable, under the present medical circumstances in this country, adds up to just so many wasted words. Unless something changes big time, insurance companies will continue to sell us their services at ever-higher prices because we can't do without them. Since we lack alternatives, they remain indispensable. The result: out-of-pocket costs will continue to rise, no matter what any politician promises. And if the Republicans in Congress were ever to succeed in doing away even with Obamacare, the services that insurance companies now provide would no longer be guaranteed. What then?
With a single payer system, whether called Medicare for All or universal health care, everyone would be able to access health care; health would, that is, become a right. Most likely, such programs would be covered by a tax increase, yet they would cost each person so much less than what is now being paid out to insurance companies. With single payer or Medicare for All, there would be no more co-pays, no more premiums, no more refusals of non-doctors to pay for services recommended by medical specialists, no more bills arriving at a patient's house.
Understandably, some might be reluctant to part with a familiar healthcare system, however flawed, in exchange for a new but untested universal program. Yet once implemented, any version of Medicare for All would be likely to cost less, be so much simpler to access, and ultimately save lives.