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Poverty Series IV: In the Land of Plenty, A Sicker, Poorer Population

Few would argue that there is not a health care crisis in America.  We now rank 29th in infant mortality, behind countries such as Cuba, Slovakia, and Hungary.   Since 2000, according to a study by the non-partisan Kaiser Foundation, the average worker contribution for a family health insurance policy has increased 107%.   Over 45 million people are uninsured, and eight out of ten of them are from working class families in the low-to-moderate income range who have no access to employer-sponsored health care plans.   Between 2005 and 2007, the number of working-age Americans who had problems paying their medical bills rose from 34 to 41%.

Minnesotan Lisa C. is one of them. In 2005, after suffering a series of debilitating migraines that sent her to emergency rooms, and to specialists for tests and treatment several times, she racked up over $15,000 in medical bills.  Uninsured and working for a temporary employment agency then, Lisa struggled to send in minimum payments to multiple providers, a process she says was confusing.

“I ended up receiving something like six bills from my first visit to the ER, and I couldn’t figure them all out.  There was one from the hospital, another from the doctor who treated me, another from radiology — I don’t remember the rest. But then I had to go in again, and again, and there were more bills, and when I couldn’t pay them all the collection agencies started sending me their bills on top of that, and everything had different account numbers. . . .and I just got lost even trying to keep track.”  Presently threatened with wage garnishments against her $9 per hour salary, Lisa is trying to save up the money to file bankruptcy.

“There are judgments against me now, and with legal fees and everything, I owe more like $21,000.  It’s just impossible.”  Bankruptcy may also be impossible for Lisa, whose salary leaves little disposable income to pay the costs of an attorney, or the credit counseling mandated by state law.

Joe Squillace, an adjunct professor of health care policy at the St. Louis University School of Social Work and a doctoral candidate in Public Policy, has studied the issue of health care extensively.  He points out that the dim statistics on the uninsured don’t tell the whole story.  “Because there is such variation in health insurance policies, including benefits covered, it is difficult to determine the actual numbers of the under-insured.  According to Kaiser’s studies, 10% of insured non-elderly adults reported that they lacked drug coverage in 2001.  29% had no dental coverage, and 37% had no vision coverage.”  Rising premiums, deductibles, and co-payments among the insured may mean that even those who have health coverage forego necessary treatment or medication.

Squillace says it is not clear whether either of the health plans proposed by Obama or McCain will contain outrageously high health care costs, but “Obama’s plan will help those working families that earn too much to qualify for Medicaid, and provide an affordable option if the employer does not.  McCain’s plan does not really provide an option for many reasons. “There are many problems with McCain’s proposal for the working poor and lower income households.”  Squillace compares the “play or pay” element of Obama’s plan to the recent Massachusetts plan to cover all of its citizens.

The Massachusetts plan places a $295 per year/per employee assessment on employers who do not provide health insurance.  Since its inception, 439,000 of the 650,000 uninsured in Massachusetts have gained coverage.  Still in its experimental stage the plan is not without its flaws, including a shortage of doctors to handle the influx of the newly insured, and increased waiting times — sometimes up to 100 days.  Massachusetts is seeking to attract new doctors with school loan payoffs, investing more in its medical schools, and waiving tuition and fees for medical students who agree to work as primary care doctors in the state for four years after their training. The results of these efforts won’t be seen immediately, but the plan is being carefully watched by other states and policy makers, both for short and long-term effect.

Jeff Crim, a chaplain at a public hospital in Tennessee that treats many of its area’s poorer residents, sees the need for universal health coverage as urgent.  “Oftentimes, when poor people are discharged, their primary care is carried out in undermanned, overburdened public clinics or not at all. In fact, for some of them, the ER is their primary care doctor. They can get the best care possible in the hospital, but it can be undone by poor follow-up or by late diagnosis.”

“People claim that universal health care is somehow un-American.  Yet, I grew up as a military brat. I had all the free health care I wanted from the medical facilities on the base. If I didn’t like that care, I had an insurance policy I could use to get health care from private physicians. If that mixed system is good enough for the military how is it too un-American for civilians?”  Crim, who meets face to face with the sick and dying everyday, argues against the bootstrap philosophies that inform those who are against universal coverage.

“Bootstrap and meritocracy philosophies are pure garbage that only serve to anaesthesize people not in poverty from the reality of poverty. Poverty is cyclical, there is no doubt about that. Economic resources are finite, there is no doubt about that. As long as the majority of those resources are hoarded by a small number of people at the top of the economic ladder, the number of people at the bottom will be huge” states Crim.

Although insured now, Lisa C. rarely goes to a doctor.  “I owe everybody money, and I feel so stupid about why.  $21,000 for headaches?  I’m glad I didn’t have anything more serious, but I didn’t know that at the time — I just knew I was in a lot of pain. Now, if something like that happens again, I probably won’t go in (for treatment).  My plan has a $1000 deductible anyway.  Who can afford that?”  Not Lisa, or millions of other Americans who are uninsured or under-insured.

One of the greatest nations on Earth, heralded for its progressiveness and ingenuity, has so far failed to find a solution to its health care crisis.  Without one, America can only grow sicker, poorer, and more divided.

Next:  Pt V, Conclusion

8 comments to Poverty Series IV: In the Land of Plenty, A Sicker, Poorer Population

  • Pirate Queen

    Health care? What health care? We need to go back to roots, bark, leaves and what nature provides until the medical system implodes upon itself just like our government is in the process of doing!

    I had been treated in England once after getting tonsillitis. This was back in the 70’s and they already had universal health care in place. It was called ’socialized medicine’ then. The ’socialized’ part of the phrase is what the US uses to equate universal medical programs to Socialism, that’s why it’s perceived as un-American.

    Just like medical treatments that I pay for (57% of my plan’s costs come from my paycheck) here, in the 21st Century, I waited in a British waiting room for several hours before I saw a doctor. He wrote a script for antibiotics and I would have to wait three days for the pharmacy to fill the order.

    My aunt, who still used the gifts from nature to cure most ailments, send my cousin to the off-license (corner liquor store) to get two bottles of Guinness Stout. She told me to ‘drink one now and another after tea. It will build your hemoglobin.’ I was concerned that if my mother found out I’d be yelled at for days; I was only 13 years old at the time. My auntie assured me that she’d never tell and gave me the Guinness’.

    Aside from finding everything funny due to my first state of inebriation, I woke up the next morning and the tonsillitis was gone!

    New Mexico has a huge need for medical staff as well. Seems we’re a forgotten corner of the UNITED States, just like MN. The new docs want to go where the money is, so major cities are glutted while the rest of us hope we don’t get sick. Ever.

    Heck, there’s a fight in my county about building a small hospital in the area since the closest one is over an hour away in Albuquerque. Let’s just say the politicians are in-fighting about which good-ol-boy friend will get the contract. The good-ol-boys in the medical community don’t see any profit to be made so they can’t be enticed by their politico friends to build a hospital in the poorest county in NM.

    The system SUCKS!

  • Gia

    I’m so confused about the health care system. I am insured by a state employees plan. I only have myself covered since my son is covered by his father, so I do not pay any premiums. However, the insurance company has raised the deductibles and co-pays that I rarely go to the doctor. Just to go in to be seen for a sinus infection will cost me no less than a hundred bucks when it’s all said and done.

    I had a hysterectomy last year, with insurance I’ve still had to pay out over 2,000 bucks! I’m still paying that off….the calls from creditors is so bad, I never answer the phone anymore.

    Something has to be done!!! I am thankful to have health insurance…but pissed off that I need new glasses, but can’t get them, I’ve been sick for weeks, but don’t go to the doctor for antibiotics because I don’t have an extra hundred dollars right now.

    As for my fellow Americans who are not covered, it shames me to hear leaders who have the authority to do something about it, chant it is un American to have even a hint of socialism within our economic structure!

  • Sandi K

    This series you are writing is so compelling. I wanted to congratulate you on the corporate tax post you did on Huffington. This election season has been a roller coaster of emotions everything from hope to disgust to despair. Great job!

  • Kira

    My heathcare through my parents was cut off at 23, and because of so many pre-existing conditions and disability, I have been repeatedly denied insurance despite the ability to pay monthly premiums. People look at me and say I should just get my own insurance (since I’m self-employed), but don’t understand that being able to pay is only half the problem.

    I’m now on my third appeal for SSDI; I don’t even care about a stipend…I just want some sort of insurance. Prescriptions cost over $400 a month, and since I can’t work much, I struggle to pay, and sometimes, don’t even have enough to do so. Since going off my meds for even a day is bad, I often deal with migraines and horrible withdrawal (several websites compare going off my medication to withdrawing from heroin or worse). Because of costs, I don’t take several medications.

    It’s a vicious cycle. I can’t work because I can’t get my medications or go to the doctor for cortisone, but if I did work, I could get those things, but my body would run down faster. I’m stuck somewhere where a serious accident could ruin my family, and no one will give me a chance to get help. Being disabled and uninsured has been such a burden for me…a stigma I can’t avoid, and a quality of life that has me unable to leave the house most days.

  • V-Grrrl

    Kira, I have a family member who is an attorney specializing in social security disability law in Florida. She had a case involving one of her clients go to the Supreme Court and I went to hear arguments in D.C. One of the things I will always remember is Ruth Bader Ginsburg saying, “Ordinary people should not need to hire an attorney to navigate the SS disability process!”

    While living in Belgium, I used their public health care program. It was amazing. Not only did I receive excellent care but I got it promptly and the system seemed very efficient. With universal health care, there isn’t a need for a huge office staff to process insurance claims or manage an enormous paper trail and documentation burden. Doctors pay does not depend on the number of patients they process in an hour. Most doctor’s offices (those who were not specialists) operated without nurses or receptionists. The doctors answered their own phones, handled their own schedules, never seemed rushed or frenzied, would take calls at home if you needed them. I loved Belgium’s health care system. The taxes there are very high, but people get something for their money!

  • Kate McLaughlin

    Each piece in this series highlights your journalistic talents. Well researched, perfectly parsed and compelling in topic and style, your writing illuminates the truth and satisfies the reader. Again, so very well done.
    Thank you!

  • Ann Parker

    When people apply for SSDI they either have to be brain dead or paralized to get approved the first time. The appeals take almost a year or more. Then, if the SSDI is approved, the reciepient gets payments back to six months after the last day of work. The lawyer gets a third of the back pay. The longer the process takes the more the lawyer gets. I don’t know why almost everyone gets turned down the first and second time they apply. When it gets to the judge most of the truly dissabled get approved. Why can’t the cases go to the judge first? Who are these people who reject the applications? What qualifications do they have? Not many or they would not constantly be overruled by a judge. They are getting paid while people unable to work use all their resources and lose everything they have. What branch of the government has the power to “reform” this process since almost every candidate promisses to “reform” everything.

  • Tanya Barham

    This issue of health and poverty is frightening to me. We do very little to ensure poor children and neighborhoods have access to fresh fruits and vegetables or the kind of simple preventative screenings that could save lives. Asking employers to finance health care for their workers means that minimum wage earners are less likely to receive any health care at all and what they might be offered would be a huge cost compared to their wage. The situations is scary and complex and not getting any less ugly anytime soon.