The High Cost of Doing without Universal Health Care

Here’s the news that rocked my little world this week: We got a call that a family friend, let’s call her Lorraine, was in an ICU, barely able to breathe on her own. In the last few weeks, there’d been some mumblings about “not feeling a hundred percent,” but no hint of anything seriously wrong. The diagnosis came back in a couple of days: fourth stage breast cancer which has spread to a number of other organs including her lungs. If you know anything at all about breast cancer “staging,” you know there is no fifth stage.

Lorraine, it turns out, has no health insurance. We didn’t know that, in fact, we’d been content to believe that her consulting business was going as well as she said it was. In her late forties now, she’s a former accountant who never could find another decent job—also a news junky, an avid reader, and an energetic volunteer in a number of worthy causes. She’s usually balancing a half dozen projects at a time, all of which she’s ebullient about.

But it turns out she’s been struggling with the cell phone bill and the rent. A few weeks ago, unbeknownst to us, she’d moved out of her apartment and into a free room offered by one of the nonprofits she volunteers for. The cost of a mammogram – well over $100 – must have been out of reach.

The current discussion about President Bush’s health saving accounts proposal needs to include Lorraine. The idea, laid out in his State of the Union address, is that we should each have a “catastrophic” health insurance policy for the big ticket items like breast cancer, plus a tax-deductible savings account for the little things, like mammograms. If we have to take “personal responsibility” for our doctor visits and routine care we’ll be thrifty about it – or so the thinking goes – and the nation’s medical expenditures will stop spiking like an Ebola fever.

It’s an old idea, going back at least to the Clintons, that the problem with the American health system is that we, the consumers, just consume too much. Make us mindful of the costs by raising co-payments and other out-of-pocket costs, and we’ll stop indulging in blood work-ups, MRI’s, prostate exams, and all those other fun things.

President Bush, meet Lorraine. Her problem wasn’t that she feasted on unnecessary care, but that like so many of 45 million uninsured Americans, she wasn’t getting any care at all. Maybe, when she first noticed the lump, she should have staged a sit-in at the nearest clinic until they sprang for a free mammogram. But her idea of “personal responsibility” was not to be a bother to anyone.

And how much does the “personal responsibility” theory even apply to the insured population? I have insurance – at enormous cost, because I’m not part of a group plan and I’m an ex-breast cancer patient myself – but that doesn’t mean I choose what care I get. It’s not my idea to have annual mammogram and pap smear. The doctor had to threaten tears before I’d submit to a bone scan, and they’ll have to drag me in for a colonoscopy. No one aside from the rare victim of Munchausen’s disease goes looking for recreational medical care.

The fact is there’s a big difference between the economics of health care and that of, say, costume jewelry. We the consumers control the demand for costume jewelry; we can splurge on it or leave it alone. But we have precious little control over our demand for health care. Sure, we can exercise and refrain from smoking and sky-diving and swimming with sharks. We can eat right too (whatever that may mean, with the dietary advice fluctuating from month to month.) But it’s the medical profession that determines how often we need our blood drawn, our breasts squished, our cervices scraped or any of the other nasty interventions they have to offer.

If the medical care we consume was under our own control, I’d say, sure, save up for it and use it wisely. But it’s no more in our control than the wind and floods we insure our homes against. When something is not in our control, we share the risk with some form of insurance. We don’t say: Save up because you’re on your own.

You think it’s too expensive to have universal health insurance? Let’s be hard-headed about Lorraine’s case. If she’d been diagnosed earlier, she might have gotten by with a mastectomy and a bout of chemotherapy instead of burning up Medicaid dollars in an ICU. She might be out volunteering for the needy right now, instead of lying in terror in a hospital bed.

Comments

[Concerned]

State governments are among the worst offenders of maintaing uninsured workforces. They have caught on to the practice of keeping essential personnel at "part-time status" so as to avoid paying into health plans. Most of the professors at community colleges, for example, are considered part-time state employees. Before state governments grandstand to compel private companies to give their workers access to affordable healthcare, states should practice what they preach. Several bills in Massachusetts to provide health insurance for college teachers have been defeated. This is the grossest hypocracy immaginable.

[Hattie]

Barbara: you state the case so well. My husband would quit his job tomorrow if we could get decent medical coverage any other way but through his group plan.
I don't agree with you, however, about colonoscopies.Anyone who has a first degree relative or, as I have, two second degree relatives who had bowel cancer: make that appointment for the exam. My husband's father died of cancer of the rectum at age 62. At age 60 my husband had a colonoscopy and had a pre-malignant polyp removed. I quote his doctor: "Congratulations on saving your own life."
Look at it this way: Do you want to drink a disagreeable compound that cleans out your intestines and have them examined under light anesthesia every few years, or do you want surgery, perhaps a colostomy, chemo, and/or radiation with the possibility of not surviving anyway?

[theresa]

Here's a good article on being unemployed and uninsured by a recently ousted pharmacuticals executive:

http://www.counterpunch.org/rost02092006.html

[Carlysle]

Just finished "Bait and Switch." I am stuck in a postdoc... I know what it is like to not have adequate health insurance. The story is: if people were able to get care when they needed it, we could actually cut the cost of health care. Simply put, the earlier path to diagnosis would mean less invasive treatments, which could lead to fewer secondary cancers. If cost effectiveness is such a big issue, one would think that this logic would pervade. But apparently, we need to wait. Think about the prevention and how much money could be otherwise going to balance the budget-- instead of going to support people who are well beyond the stages of early intervention. I am waiting for some kind of change in thinking...

[A3K]

So the high deductible plans would be more affordable for folks like your friend making it more likely she would have bought it in the first place.

If you know anything about these plans, you'd know that they typically include annual physicals outside of the deductible. So far from preventing her from seeing the doctor, she might have been able to go and have the visit paid for by the insurance company.

If they found the cancer, her total exposure would have been about $2,000 if she had an individual policy.

So Barb, Bush is thinking about folks like this. He's trying to find a way for them to be able to afford the responsible choice of getting insurance for themselves.

And by the way, had she possessed one of these things all along, she could have built up the savings account in the years when she was healthy and working for an employer that provided coverage. When she went out on her own, she could have used the built-up savings to pay for premiums and deductibles.

And further, Bush is proposing that people like your friend be able to get the same tax benefit as an individual that a corporation gets. Right now, a corporation buys health-care coverage for employees and pays no corporate tax on those dollars and their employees pay no income tax or FICA/Medicare tax on that income either.

If you buy it for yourself, you don't get nearly as generous tax treatment.

So what do you dislike about balancing the table?

Oh, that's right. Coming up with ideas that fix gaps in the existing policy might negate the perceived need to have a government takeover of the entire enterprise. How kind and caring of you to hold so many people hostage to your ideology.

Oh, and BTW, the benefit of the high deductible is that for the large number of visits by hypochondriacs would be borne financially by the hypochondriac him/herself.

Also, for doctor visits for the sniffles and whatnot, a cheaper alternative will be found, out of necessity. CNPs or Physician assistants could just as easily see people for minor issues that don't really require a visit to an MD.

While touting the Europeans, how about touting the fact they visit the doctor less than we do?

Oh, and that pesky liability reform stuff. If you doubt that doctors recommend unnecessary tests and treatments because of their fear of lawsuits, you're not paying attention.

[A3K]

BTW, if your friend's income was so low she couldn't afford an apartment, why didn't she apply for medicaid?

[A3K]

"No one aside from the rare victim of Munchausen’s disease goes looking for recreational medical care."

Actually, the cost of hypochondria to the system is quite large. I don't recall the precise figures but a study I recall reading about a few years back put the number of doctor office visits attributable to hypochondria at greater than 10%.

Here it is, from an article in the New Yorker from 2003: "In the United States, it is estimated, twenty billion dollars a year is spent on patients whose psychological distress requires repeated tests and procedures."

That's just under $70 per man woman and child in the US.

Hypochondriacs tend not to be diagnosed until they've been at it for nearly a decade. Making them bear the cost might bring this issue to a head sooner.

[Hattie]

A31000: Where do you get the idea that Europeans visit doctors less than Americans do? Is this an actual statistic, or did you pull it out of thin air?

[A3K]

Hattie,

Do your research. It is an actual statistic and it'll do you good to locate it yourself.

BTW, enjoy this piece. Off topic, but only a little...

http://www.msnbc.msn.com/id/11298986/site/newsweek/

[Laurie]

A3K:

What about the infamous Medicare prescription drug benefit law? The Bush administration is seeing to it that Medicare has no power whatsoever to bargain for lower drug prices for a demographic which likely pays the most out-of-pocket for necessary medication it often cannot afford.

Why isn't Bush "thinking about folks like this"? Because big pharma puts too much money in his pockets to do so. You can only defend a greedy government for so long before you have to admit that money is the ultimate incentive.

[Hattie]

Yes, I could do some therapeutic research. But I don't need to. I did not bring up the subject, and I know it's a load of crock to state that Europeans visit doctors less than Americans do. Which Americans and which Europeans?

[Laurie]

Working in an ER, I can attest to the fact that many of our hypochondriacs are Medicaid patients. So much for making them foot the bill.

[theresa]

"many of our hypochondriacs are Medicaid patients"

and I'll bet many of these people are lonely. We don't leave much room for our old folks to get the attention they need...

Yet another symptom joining unemployment to show the systematic failure of our current social structure...

[Laurie]

No, not Medicare--Medicaid patients. Although there are certainly elderly hypochondriacs, many of ours are simply those willing to make frequent trips to their local ER because they don't have to pay a dime for the visit.

[A3K]

Laurie,

"What about the infamous Medicare prescription drug benefit law?"

Yeah, that should never have passed. With Medicare projected to drown in red ink, there was no reason to increase the scope of society's wealth shift from the working age to the aged.

Especially when we're still struggling with chronically underperforming schools which are preparing many of our kids to do little more than push pictograms on cash registers.

But what the Democrats were proposing (wait, did they ever actually submit a proposal?) would have cost a ton more. And while it may have "controlled" costs, it would be a cosmetic savings. Unlike the Canadians and Europeans, who pay less because their societies can afford less, the US has no wealthier country to shift drug development costs to.

[Laurie]

A3K:

Big pharma is notorious for its LACK of development regarding new and innovative drugs. In fact, most of the budget for all major drug companies in both America and Europe go to "marketing and administration," with only a very small percent accounting for research and development. These companies rely on outside sources, such as medical schools and biotech laboratories, to churn out the truly progressive, life-saving medicines, the formulas and patents for which are handed over to big pharma for a generous sum. (Also, since R&D costs are tax-deductible, the relatively little testing big pharma does is essentially covered financially by the federal government.) The end product is an industry which fights free market practices and rewards its own excessively. Hardly a model for Canada or any other country to aspire to.

And the day society's wealth is concentrated primarily in the elderly will be the day that liberals and conservatives call a truce.

[Heidi]

I've heard similar stories but will only speak to my own experience.

My oldest child was diaganosed with 2 brain tumors in 2003. She was cancelled by our insurance 2 months prior to college graduation (age requirements) with 2 months until her new found employer would pick her up. The "episode" and diagnosis occurred less than 2 weeks before her new insurance would kick in. She'd not suffered any problems prior. It was bad timing.

The docs think it is MS. Now, she is uninsurable, can't get a decent job, is finishing her CPA this year but, as it sits, she'll always be 'self-pay' though she is still in her twenties.

She'd like a family and kids. But it is unaffordable, not knowing what happened that year and not being able to obtain health care insurance.

Thank you for reading.

[tom]

Nice piece -- but aren't we already swimming with sharks?

[AnneF]

Here is a site on research the indicates, contrary to right wing thought, that Europeans make fewer visits to Drs. Probably one reason why socialized medicine is so much cheaper.
http://www2.eur.n./ecuity.
Perhaps European life expectacy is higher than U.S. life expectancy as they are more fit and there is much less morbid obesity in Europe.
We recently had two experiences of Drs. visits, one in France and one to our hotel in Italy. Appointment within 2 hours of call and very good medical advice. According to a Belgium friend house calls are typical, at least in Belgium.

[Bruce Fealk]

I just have one thought for you all. Give me the name of one American that doesn't deserve health care.

[striebs]

It would not be acceptable here in the U.K. or indeed most of Europe to deny anyone access to proper healthcare , irrespective of ability to pay .

There is a trend throughout the developed World of squeezing the little guy but nowhere does it happen so shamelessly as in the US.

[John Beck]

Easy to follow step-by-step guide to financial freedom by buying real estate

[Jvarg]

look barb, government providing health care is just bad buisness.

First, you fail to leave out the bad about government provided health care, such as rationing and rediculously long waiting lines. Some of you supporters of UHC bring up Europeans. But do you realize that at any given moment, a million Europeans are waiting to receive health care? Or that in places such as Canada, a dog can get a hip replacement in a week while a human has to wait for years?

I'll agree that we should do something about the system, but I feel that your system is full of errors. Quit making it something it isn't.

PS Tell your friend about SimpleCare, Taking it to the Streets, or any other multitudes of places that provide free care to the poor. And if anyone wants to know where I got my stats as well as my alternative, just reply

[Devorah Tarrow]

Right on, Ms. Ehrenreich! "What does a person deserve by being a person?" is the question asked by philosopher Eli Siegel many years ago. I thought you'd want to see the Aesthetic Realism Foundation's website with many articles about this: every person deserves free and universal health care--that's what a government is for. Devorah Tarrow, dtarrow@aestheticrealism.org

[Jane]

While I sympathize with your friends plight, let me give you the flip side. My sister-in-law weighs over 300 lbs. makes no effort to diet or exercise.

She wanted children, $20,000 in medical procedures to have them. All covered by insurance. Now she is to busy being ill to take care of them.

Why should insurance pay for that? There are plenty of things not covered by insurance much more life threatening than not being able to conceive.

She has in the last 2 years convinced herself that she has had a chest pains, checking in the hospital for 24 hours and having countless tests including a nuclear scan. Report: your heart is a healthy as can be but we do suggest you lose weight.

She has a sleep apnea machine, doesn't use it because she feels it would upset her children. Insurance covered that. If you aren't going to use it, you should have to reimburse the system.

She convinced most of her friends and some of the family two years ago that she had a terminal illness.

7 different doctors, 3 MRI's, 2 days in the hospital for additional tests she insisted on, a nuclear scan, blood work, a nerve conductivity test and various others to numerous to even remember. End result, we can find nothing wrong with you. You should diet and exercise though. She thinks they were wrong.

She contends also that she has rhumatoid arthritis, fibromialgia, and a few others she is taking many presciptions for.

The doctors continue to test, give out meds and urge her to take more control over her health.

All this and you would like to make health care even easier?

When doctors start giving out the hard facts and making people responsible for themselves, health care will become affordable for people like Lorraine, up until that time, we will continue to pay for a system broken by every body looking to run another test, take another co-pay and often by people who just don't want to make the effort to be healthy.

Sorry folks, I don't think that health care is a right, if you abuse the system, you only make it harder on others, start penalizing the abusers and making them pay, then the doctors will have some time for those that are truly ill. The hospitals will have room for those that are truly ill.

I agree the system is broken, but be realistic, paying for everything, everytime won't make it better.