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