It is no secret that most states in the US face a financial crisis, and that state universities everywhere are being asked to tighten their belts. One of the recent belt-tightening news we received at my big state R1 was an impending increase in health insurance premiums. I love our health insurance plan (HMO): the network of doctors is large and excellent, and the premium payments were tiny. Even after the increase, the premiums are not very high, but looking at some of the announcements and delineated percentages of how much we pay versus how much the university pays, I realized that the annual cost of health insurance for my whole family (paid largely by my university) is over $20,000. Holy cow!
This reminded me of my first (and very sobering) encounter with how broken the health care system in the US actually is. I had my first child in grad school, when I was still new to the US (this was in 2000). I had the standard student health insurance plan at the time. I had a normal, uncomplicated vaginal delivery (there was epidural involved though), and was discharged after 2 days. Within a week of coming back home, I called my insurance and added the baby to my plan. Shortly thereafter, I stared receiving monstrous medical bills from the hospital, doctor, anesthesiologist, everyone separately, in the total amount exceeding $10,000. I was completely terrified and spent several months on the phone with doctors' offices, my student health liaison, and the insurance company, trying to straigthen it all out.
What happened was the following: when I called the insurance company to add the baby to the plan, the incompetent moron with whom I spoke did not know how to do it, so he terminated my plan the day prior to baby's birth and opened a new one for me plus baby starting on the day of the baby's birth. Since I started laboring a 8 am one day, was admitted at the hospital at 3 pm the same day, and delivered the next day around 5 am, my old plan was terminated by the idiot's mistake on the day of my labor and the new started on the day the baby was born, so I was treated as uncovered for the day of the labor. It took me months to sort it all out, and I was terrified the entire time: these letters requesting payment get progressively more threatening as time goes by, and my husband and I were really broke and had little idea of how the system worked.
What still baffles me to this day, is that, if you are uninsured, a simple delivery would cost over $10,000 (in 2000). How is that possible? It's not even an illness, it's the most basic of human functions -- shouldn't a woman, any woman, be able to deliver a child safely, in a hospital, without having to sell a kidney afterwards to pay for it all?
Now, when I see that my university and I combined pay over $20,000 per year for my family's health insurance, I still cannot wrap my head around the number. Yes, of course, I know how insurance is supposed to work -- everyone pays, whether they need health care or not, which spreads the risk around so that payments can be made on behalf of those who need care when they do. But still, the sheer amounts of money just astound me. For instance, just the the faculty in my 40-ish people department cost over $800,000 every year to insure! Doesn't that blow your mind?
After more than 10 years in the US, I still cannot understand some things, such as why were insurance companies ever allowed to be for-profits? I wonder how much less the costs would be if they were all non-profits. How much does it cost in places like Canada or most of Europe to pay for the equivalent of one worker's health insurance? Among the aspects I don't understand, or rather -- I understand but don't want to accept that the people can be so uneducated and misguided -- is this voluntary submission of people to the exploitation by companies and stubborn refusal to allow the government to do anything for fear of becoming a socialist country. There are plenty of developed countries in Europe and yes, our northern neighbor, Canada, where it has been shown that health and education, which should be everyone's unalienable rights, are best kept out of the hands of corporations. It is clear where the republicans are coming from (PlS nicely put it yesterday), but what I do not understand the resistance of a number of people to public healthcare -- I don't understand the blue collar workers who think that any corporation would ever look out for the workers' interest better than the federal government. Is it the education system that prevents an average worker from learning about the systems in other countries beyond the politically fueled fear-mongering? Is it the brainwashing via Fox and other red media? Is it the failure of the democrats to connect with the middle and lower class, deliver something tangible, and actually take credit for when they do?
This is such a great country, yet dysfunctional on such surprising levels... It's such a shame.
10 comments:
The US has the most expensive system of health insurance in the world on a per capita basis, and that although many are uninsured. The UK for example has a public system that costs about half that amount and covers everyone; of course there are other issues there, such as waiting times. You can get some very interesting data and analysis in a World Health Organization report here: http://www.who.int/whr/2000/en/index.html.
As someone who works in Canada and has also worked in the US for a good while, I will say that US health care for insured people is heads and tails above what you get in Canada. In the US, if you live in a relatively large city and are treated at an university hospital, for example, you get simply the best health care available anywhere in the world.
Neither system is perfect. It is very expensive in the US. In Canada, people wait for months and months for an MRI, or breast cancer treatment, or other "elective" things like gall bladder removal. Now I'm not sure that expensive MRI's ever save anybody's life, really, but to wait for your surgery for a whole year in acute gall bladder attack is pretty bad.
Besides, in countries where medical treatment is publicly covered, it costs in and around half of the budget. With aging populations in the Western world, people "entitled" to everything and anything "for free", and doctors allowed to run amok with taxpayers' money, these medical systems are simply unsustainable. Not to mention that many of these governments with "great" social programs are finding that the money is drying out at present, so stay tuned...
People need to have a vested interest in shopping around for best value for their medical money, otherwise they end up all like cattle at the public trough. I am not sure why US universities don't set up high deductible plans where they cover as big a chunk of that deductible as the do with the HMO plans.
I feel Americans value the element of choice (even to their own detriment) rather than putting all their eggs in the Federal basket. Especially in the middle of the country, which is more old-fashioned in its mindset, imo.
My parental units unfortunately had to be in the position of deciding for several months whether I might actually kick the bucket and taking me to the ER and being bankrupt and homeless for the rest of our lives. Thankfully I pulled around so we scraped by.
Stories like Hermitage's are what I find so ridiculous about the US health care system. In what society is it a good idea to allow people to bankrupt themselves for their health or choose ill-health so they can pay the bills? On a philosophical level, how is that good for a society?
I'm going to have to guess most people who want the "choice" have only had stellar healthcare. At my workplace we have a great HMO and a terrible PPO that costs the employee three times as much. And yet many employees will choose the PPO so they can choose their own doctor and other such nonsense. Of course, I choose my own doctor with the HMO but don't tell them that. The HMO had a reputation for long wait periods for appointments that's now gone, but the reputation sticks. Most people who are anti-government healthcare have never been unemployed and without health coverage (or not with a whole family not covered and not when they weren't young and healthy) and many of them fail to realize medicare is a government program that doesn't entirely pay for itself. They think it is something they "paid into" and so deserve, and don't connect it to how one pays into public education or the military or the post office.
I suspect most uninsured people stuck with that $10,000 bill couldn't pay it. They'd go bankrupt and the cost would be absorbed by the hospital and passed on to those with insurance in the form of higher fees.
This is not to say that $10,000 is a reasonable amount to pay for the service.
During my MS, I developed a pretty rare tumor and had numerous procedures before finally having it removed. When it was all over, I was lucky to take out student loans to cover my cost (20% plus anestesia at 75%). When I inquired about not going trough insurance, they said I'd get and 80% discount, which means I'm still paying 20%. So that little incident taught me that just going through insurance companies means 5 times more work for the hospital, which is not supposed to be the case.
Also, when you go to the hospital, why do you get bills from 1000 different entities? Doctor, hospital, hospital unit, nurse, specialist... That's where a lot of waste incurs. I went to 1 place for a procedure. I want 1 bill from 1 entity. Everything else they should figure out internally.
The state of healthcare in the US is embarrassing. Even disregarding the large number of uninsured, the insured people who put off care due to large copays, and the fact that over 50% of bankruptcies are due to medical expenses, I know quite a few people who can never, ever leave their jobs (even though they hate them). They are uninsurable (or have uninsurable children), and are only "safe" with their current (large corporation or government) employee insurance. They live in terror of being laid off.
When I had a short term high deductible policy, I got sick and had to see a doctor (I had symptoms consistent with meningitis, which is nothing to fool around with). My doctor visit cost me $250 (plus half a day off to go) and the lab tests cost another $350. Not having access to the insurer negotiated rates is a double killer for people without insurance. Meanwhile, a friend of mine in Canada needed to go to the hospital by ambulance (not covered by public insurance). In the US, this would cost many thousands of dollars, but in Canada, it was $100 (which is much more reasonable).
Thank you for writing this post. I moved from the UK to the US four years ago, and am still baffled and occasionally terrified by the US healthcare system. I know that state-run healthcare is far from perfect (as Anonymous points out above), but I just don't understand why access to healthcare should be so tied to employment in the way that it is here (and not just for those with major health problems: http://www.nytimes.com/2011/02/20/opinion/20Dubinsky.html?partner=rssnyt&emc=rss) There are many great things about the US, and I enjoy living here on the whole, but some aspects just make me feel so very foreign, and sad. Your last sentence summed it up for me.
Why are people in the US content with employment-linked health insurance?
Imagine that one has to be employed to qualify for auto-insurance and how people would revolt against that.
And I think health insurance is more of a fundamental human right than auto insurance.
Post a Comment