The State of Medical Care in America


The following is from a letter that I just wrote to a British friend.

It is my understanding that many in your country want to replace your public healthcare system with a private one. I will preface my comments by saying that few Americans can even afford medical care unless they have insurance, yet they can't afford insurance unless they are able to get it through their employer because the cost of anything beyond "catastrophic coverage" can easily exceed $20,000 a year. It doesn't help matters that insurance companies do everything possible to discriminate against those who are deemed likely to actually need medical care. 

Under Obama, such discrimination was banned, but Trump has returned to doing everything possible to allow companies to price "poor risks" out of the market or even to refuse coverage altogether. Those who support such discrimination tend to be healthy young Republicans who argue that they shouldn't have to pay more because other people enjoy less than optimal health (the unstated motto of the Republican Party is, "Me first and screw you"). Peggy and I had employer-sponsored insurance until we turned 65 and could go on the government plan called Medicare. It is the best insurance we've had had, but even so, we have to supplement it with private insurance, and insurance companies do their best to fool people into thinking they're getting more than they actually are.

Here are three examples that people in your country might bear in mind in regard to the imagined success of privatized healthcare. All three of these examples were in the news here last week.

(1) Nearly all insurance plans have "in network providers," i.e. medical providers who have agreed to accept a lower level of reimbursement in return for insurers throwing business their way. If, for whatever reason, a person elects to see an "out of network" provider, his or her insurance company will pay a much smaller percentage of the bill.

Because the Republicans are doing their utmost to deregulate and privatize anything and everything, more and more of America's ambulance services are going from being owned and run by municipalities and county governments to being owned and run by private companies. This means that if you have an emergency and have the bad luck to be taken to the hospital in an out of network ambulance, you can, and almost surely will, end up many thousands of dollars in debt because ambulances are damned expensive, and god help you if you need to be taken on a second ambulance ride from, for example, a small community hospital to a remote big city hospital; and double god help you if your condition is so dire that you need to be transported in an air ambulance.

(2) Insurance companies are moving in the direction of refusing to pay any of your ambulance and emergency room expenses if they (the insurance company) decide that you didn't really need to go the emergency room. One problem with this is that it relies upon the honesty of dishonest insurers. Another is that patients are often in no position to know whether or not that they can get by with either waiting to see a doctor during regular office hours, or, in the case of the larger urban areas, going to an "urgent care center," which is a clinic that provides speedy medical care to people who, although their condition doesn't appear to be life threatening, are in too much distress to wait until regular office hours. Obviously, there will be people who die because of this policy, but as every American with an IQ above 60 knows, the priority of insurance companies isn't with getting people the care they need but with maximizing profit. I suspect that the same is true of private anything.

(3) America's drug manufacturers have shown themselves especially eager to buy up the exclusive rights to manufacture drugs that are the only approved treatments for life threatening illnesses, and then jacking up the prices of those drugs by hundreds or thousands of percent, a practice that is entirely legal in the U.S., and that insurance companies refuse to pay for. The most infamous of these drug company profiteers was a man named Martin Shkreli who, literally overnight, raised the price of the only approved treatment for toxoplasmosis from $13.50 a pill to $750 a pill (a 5,000% increase). Even so, Shkreli doesn't stand out for what he did, but for not bothering to offer the usual bullshit lie for why he did it, even claiming from behind his perpetual smirk that he deserved appreciation for not raising the price of Daraprim even more. After all, he said, it would have been legal. Shkreli was sentenced to seven years in prison last week, but it wasn't for the deaths he caused, but for fraud in a non-related case. He cried in self-pity in the courtroom, self-pity being the only pity of which he is capable.

America has the highest cost of medical care of anyplace on earth with 25% of the money going to insurance companies. The cost of healthcare in America increases yearly at a rate that is far beyond what almost anyone can afford, yet there is no end in sight because well-funded lobbies--like Big Oil, Big Pharma, the National Rifle Association, and the insurance lobby--owns Congress. Despite what it spends, America doesn't even have a high standard of medical care compared to other first world nations. 

I'll throw in a final example that didn't hit the national news but very much hit the news in our household.

(4) Peggy spent hours last week fighting over the costs of her drugs while in the hospital for back surgery. Her hospital bill alone--the surgeon and anesthesiologist will bill separately--for the twenty hour stay was $17,000). When it comes to their charges and business practices, hospitals appear to say, "If you can't trust us, the people who work to keep you alive, who can you trust?" but the fact is that "the people who work to keep you alive" are the last people you can trust because they: (a)
refuse to give estimates, although charges for the same services differ dramatically from hospital to hospital; (b) are notorious for charges that are excessive and downright fanciful; (c) after their services are rendered, they refuse to send out itemized statements. In Peggy's case, her phone call was transferred from one office to another before she finally learned that she was being charged for at least one drug and one medical device that was neither ordered nor received. As is typical, she is unable to get the mistake corrected simply because it is not in the hospital's financial interest to correct it, this at a Catholic hospital that boasts of its "Christian values." 

The older I get, the more I become convinced that unregulated capitalism (which is what America's Republican Party assures us is the remedy for all of our ills) brings out the worst in people, and nowhere is this more obvious than when it comes to medical care. It speaks to the immorality of our system when a mugger with a gun receives a death sentence for murdering someone for $20, while a white collar thug like Martin Shkreli openly laughs about raising the cost of an essential drug to the point that only the rich can afford life.

It seems to me that people who voted for Trump fell into three main categories: the super rich who believed he would make them richer, which he has; fascists who believed he would inspire hatred and division, which he has; and the naive poor who believed that he was "the friend of the little man," which he most certainly is not. The people in the first two categories knew what they were getting; the people in the final category had no idea, and it is they who are being increasingly left to suffer and die as the government-funded medical care and economic assistance that they disproportionately rely upon is being slashed. Sadly, the Republican Party enjoys its greatest popularity among the very people whom its policies hurt the most, but how it does this will have to wait until another post.

15 comments:

Marion said...

Snow, mainly what I got out of your post is that you hate Republicans. I am in none of the 3 categories you so neatly put hundreds of thousands of people into at the end. I have Medicare and have virtually no problems getting the healthcare and medication I need, both at reasonable prices. I took an ambulance ride in June and was not charged one red cent over and above what Medicare paid.

I highly disagree with your opinions here. After 8 long years of Obama, I'd have elected the Road Runner for president. But for the most part, instead of whining ALL THE DAMN TIME, Republicans bided our time and elected Trump. He may not be the best there was to choose from, but Lord have mercy, my half dead, crippled mother would have been better than Hillary Clinton. Seriously. xo

Elephant's Child said...

We have 'socialized medecine' here. It isn't perfect, but does mean that if something life threatening happens anyone can get treatment. The grey area is in 'optional services'. If your condition is not life threatening you can get treatment under the public medical system but will have to wait. Sometimes for a long time.
And dental treatment is NOT covered. A mistake. I am so grateful to have the public medical system. My partner's life was certainly saved, and we paid nothing (other than the component of our taxes which goes towards supporting the system).
We also have some private insurance. Expensive, and with rather a lot of loopholes to keep the insurers happy. But I use it for dental treatment, and sometimes physio.

PhilipH said...

That's a truly nightmarish account of the American health business. I am so glad that we in the UK have medical treatment free of charge at the point of delivery.

OK, it's not entirely "free" as we pay for the NHS during our working life, a sort of tax, like pay as you earn tax on income. But it works, reasonably well for the vast majority of Brits. Even foreigners come to England simply to get various treatments that are not available in their home country, or are too expensive there.

My granddaughter spent her 16th birthday just after Xmas fighting for her life in a hospital in Sheffield, suffering from EBV, HLH and an immune system that had shrunk to nothing because of another illness, ulcerative colitis. She stayed in isolation, together with her Mum, my youngest daughter, for many weeks. Thanks to the skill, knowledge and collaboration of various consultants and other hospitals my lovely young granddaughter was able to return to school earlier this week. Thank goodness she was not in the USA on 26th December 2017!

I still find it hard to believe that any sane and intelligent person could have put this monstrosity Trump bloke into the most powerful office in the world. It's simply unbelievable, but it happened.

I wish you well, dear Snowy, and hope you manage to keep as well as possible and don't get mugged by the "health system and its insurance scams" for as long as you and Peggy survive.

Snowbrush said...

"Snow, mainly what I got out of your post is that you hate Republicans."

How I do or don't feel about Republicans is irrelevant to the points I raised because, with the exception of Peggy's recent experience, my points were based upon verifiable news items rather than feelings.

"instead of whining ALL THE DAMN TIME, Republicans bided our time and elected Trump"

Either you never listen to Rush, Sean, Lars, Laura, and (until last year) Bill--to name a few--or you don't call Fox's 24/7 vituperation whining.

"I have Medicare and have virtually no problems getting the healthcare and medication I need, both at reasonable prices. I took an ambulance ride in June and was not charged one red cent over and above what Medicare paid."

I agree that Medicare is a good program--a good GOVERNMENT program, I might add--but unless you have insurance that picks up where Medicare leaves off, and that covers charges which Medicare does not approve, you can still end up bankrupt. Perhaps, you have heard that the leaders of your preferred party are pushing to "reform Medicare" (that is, privatize it), so that in theory, it can operate more efficiently (as they're fond of saying, "whatever the government can do, the private sector can do better and cheaper") our nation can spend more money on the military despite the fact that we already spend more than the next ten highest spending countries put together.

"And dental treatment is NOT covered."

(Elephant's Child is an Aussie). Dental insurance here is also separate from medical insurance, and unless a person has it through his or her workplace, it's of doubtful benefit (I have it, but Peggy doesn't). Optometry is the same way. Public insurance here is for the elderly, the destitute, and the disabled. A justifiable criticism of public insurance of the destitute is that it doesn't cover the ALMOST destitute, who have to either hope they stay healthy or pay more than they can afford for insurance. It's not unusual for people here to ask for help on Go Fund Me when they're ill, and sometimes a pizza restaurant will sponsor a fund raiser for them, and this is as true for children and it is for adults.

"Even foreigners come to England simply to get various treatments that are not available in their home country, or are too expensive there."

I had wondered if this was possible. It surely must arouse a lot of resentment.

"I still find it hard to believe that any sane and intelligent person could have put this monstrosity Trump bloke into the most powerful office in the world."

I also wonder how much people in Britain hear about Trump's latest asininities because they really do happen so thick and fast that there tends to be one or more per day. Some highlights... Last week, he recently announced on Twitter that he had fired his Secretary of State, this BEFORE he let the man know that he had been fired. This week, there has been more scandal over his affair with a sleaze named Stormy Daniels who he paid to keep silent, but who decided that she could make more money blabbing, so now he's threatening to sue her for talking about an affair that he says they never had. The two of them deserve one another in that they're as narcissistic as they are devoid of honor. Another recent outrage is that Trump, through his personal lawye,r is calling for an end to the "Russia investigation" the excuse being that the FBI is untrustworthy, something that Trump has said all along, but that was fueled of late by the firing (two days before he was to retire--meaning that he will receive no retirement benefit), of an FBI bigwig who supposedly told a lie to investigators.

Strayer said...

My brother's daughter is in a dilemma right now. In July, she is aged off her mother's health insurance and she has an extreme lifelong medical condition. She may lose her job now too as she is experiencing another outbreak of illness. Where does that leave her? My brother is trying to find out how in the world she can find insurance after the first of July, that won't mean her living in a tent to afford it, and that's if she still has a job. Medical care is a huge financial drain on people. My brother had an event with his heart a couple months, collapsed and no one could rouse him, so the ambulance was called and he was in the hospital overnight. Well, they can only afford a policy with a $10k deductible, and an ambulance ride and overnight in the hospital means they'll be working many more years because they have to shell out for the deductible and their bill will exceed $10k for the 24 hour issue he had.

Emma Springfield said...

I have a couple of horror stories to add to yours. They are only a small sampling of what I could offer.
Recently my doctor ordered a few blood tests for me to take. I dutifully gave my precious blood. The kindly technician came to me and informed me that one of the tests was covered by neither Medicare nor my supplemental insurance. Did I still want to have the test done? When I asked how much the test cost I was told $220.00. I did not take the test.
When I was a cashier at a superstore in the area in which I lived I would often cringe at the prices of some of the prescriptions for retirees. These were things they needed to keep them alive. These were people living on Social Security. One woman had one medication that cost her Almot $1000.00 for 30 days. It was medication to regulate her heartbeat so she would not have a heart attack.
Before my niece died at the age of 8 her little body could not take nutrients from her food. Most vitamins did not absorb into her system either. A specialist found some special vitamins that helped her to live. Insurance would not cover it because it was "only vitamins". My brother was working 3 jobs and his wife had a job besides trying to take care of 2 small children, one of them terminally ill. Just to pay for medicine.
I could go on but it is just too depressing.

Emma Springfield said...

By the way I want to mention that I began paying taxes at the age of 11. That's right eleven. I worked for 51 years and paid into the Medicare fund all those years. Now they are telling me that Medicare is an "entitlement" meaning that I am receiving monthly payments and medical coverage out of the goodness of the hearts of our gevernment. I paid for it for 51 years do I would not have to worry about it when I became old. Jerks!

angela said...

Our health system isn’t perfect. But when compared to what my American friends go through I feel very grateful for the one we have
We all pay a small percentage of our wages into our national medicare fund, and in return
We get free health care in public hospitals, private hospitals have to take a certain number of public patients, many doctors bulk bill the government their consultation fees, thus allowing us to see the doctors without paying and subsidised medications.
There are waiting periods for operations. But I have never had to wait very long.
It’s the one that go to the hospitals for every cough and sneez that make the waiting times in emergency so long
Even my friend, who died of cancer, had free chemotherapy and free consultations with the head of oncology for women’s cancers in Victoria.
She only had to pay for her meds, which are heavily subsidised. And if you spend more than the threshold, they are then all free
Unfortunately our government is trying to mess with this, but every time they try, we all start to yell and scream.
So far we have been able to keep them honest.
But I wonder for how long

Sue in Italia/In the Land Of Cancer said...

Dear Snow
You are so so right about the evils that the current administration is bringing to us. My hope is with the young people won't accept the BS that is being spewed out.

Snowbrush said...

Me: "Either you never listen to Rush, Sean, Lars, Laura, and (until last year) Bill--to name a few--or you don't call Fox's 24/7 vituperation whining."

How oh how could I forget Glenn Beck along with the two most evil ones of all (among those whom I have often listened to), Ann Coulter and Michael Savage. Marion, when you congratulate conservatives for not whining, I don't know if you're joking, fibbing, or simply misinformed because, aside from its actual news reporting, whining is, in my experience (which is based upon having listened to Fox for hundreds of hours), 100% of what Fox does, and Fox is all but synonymous with American conservatism. For those in other countries, Fox is an ultraconservative TV and radio network that millions of American conservatives listen to as often as they can. Perhaps Sean Hannity is its most currently popular radio and TV personality. Back when I listened to him, he would say the following words repeatedly during his three hour radio program: "Three hours a day is all we ask," meaning that if he could get people to listen to him for three hours a day, he could win him over to his way of thinking, that is to brainwash them because, I never could tell that anything Fox did was based upon evidence or logic, and their motto of "Fair and Balanced" is the most Orwellian lie that is in common usage in America. I found that what cured me from listening to Fox was to try to verify the things that I heard on Fox. What I found was that they would take a story that had a tiny bit of truth to it, and blow it up so as to defame anyone who wasn't a conservative, and often people who WERE conservatives if Fox felt that it could exploit the person for something he said or did. Another thing that turned me off about Fox was that they would invite non-conservatives onto their various programs, and then the host would insult them, and cut them off every time they tried to make a point. They might ask a liberal Christian if he was still an atheist; demand that a war protestor confess that he hated his country; offer to buy a vegan a steak dinner, etc.

"The kindly technician came to me and informed me that one of the tests was covered by neither Medicare nor my supplemental insurance"

I have this experience regularly.

"My brother was working 3 jobs and his wife had a job besides trying to take care of 2 small children, one of them terminally ill. Just to pay for medicine."

I am so sorry, and I get so angry when people who are young and healthy object to having to pay for coverage they're unlikely to need so that others might have coverage at all. To me, such thinking typifies Republicanism, which has been strongly influenced by libertarianism and by the writings of Ayn Rand, both of which deny that the individual has any positive obligation (as opposed to the negative obligation of not murdering people in their beds so you can rob them) to the public good. Rand even wrote a book entitled "The Virtue of Selfishness," and that's it, that's Repubicanism. Back in the day when there was even a such a thing as a moderate Republicanism (which hasn't been more than ten years ago), I occasionally voted for Republican candidates, but now that the moderates have been forced out, I've lost ALL respect for the Republican Party. The only good I can say for Repubicanism that it does not yet have the ability to do all the evil it would like to do because if it had that ability, people would be dying in the streets, their medical and economic safety nets having been taken from them.

Snowbrush said...

"Now they are telling me that Medicare is an "entitlement" meaning that I am receiving monthly payments and medical coverage out of the goodness of the hearts of our gevernment."

How did a word that means "earned and deserved" come to mean something that only freeloaders demand? Again, this is Republicanism.

"My brother is trying to find out how in the world she can find insurance after the first of July, that won't mean her living in a tent to afford it."

I can't understand why Obamacare was structured in such a way that if you don't need to buy into it within a small window, you can't buy into it for nearly a year.

"Unfortunately our government is trying to mess with this, but every time they try, we all start to yell and scream."

Same way in Britain, but, perhaps, with less success on the part of the people. The fact is that greed never sleeps, and if the privatizers and deregulators can't destroy the public good in one fell swoop, they can always chisel away at it little by little. In America, we are seeing what a fascist administration looks like, and only hope is that the laws that have been set in place to safeguard democracy will prove tougher than Trump's attempts to destroy democracy, and that enough people will have enough courage to see that those laws are enforced. He is currently doing his utmost to replace every person in federal law enforcement with people who will make loyalty to him their first priority. When he appointed his attorney general (the head of America's Department of Justice), he said as much outright when he stated that he wanted a man who would protect him, yet the job of the attorney general has nothing to do with protecting the president and everything to do with seeing that justice is done. (Many think that Trump's statement constituted obstruction of justice.) A major obstacle in getting rid of Trump is that a president can be Satan incarnate (which, come to think of it, Trump is), but if the economy is doing well, people tend to be complacent, their real distaste only becoming evident when the economy tanks. Even so--and despite a soaring economy--Trump has the lowest average approval rating of any president ever: http://www.businessinsider.com/trump-approval-rating-first-year-worst-ever-gallup-2018-1, and it seems that not a day passes but what he does or says something else to put himself closer and closer to destroying his own presidency.

"My hope is with the young people won't accept the BS that is being spewed out."

Demographically speaking, if you approve of Trump, you're likely to be: poorly educated, white, male, evangelical, Republican, over 65, and live in the rural South or the rural Mid West.

Snowbrush said...

PEW Research always puts out good stuff, and here's an interesting survey it did regarding who does and doesn't like Trump, and how they feel about those who are the opposite side of the fence. Interestingly, those who can't stand Trump are less likely to think that people on the other side nonetheless share many of the same values and goals. I very much identify with this because I can't place any positive interpretation upon how anyone can support such a man. http://www.pewresearch.org/fact-tank/2018/03/15/disagreements-about-trump-widely-seen-as-reflecting-divides-over-other-values-and-goals/ft_18-03-15_trumpvalues_demographic/

Charles Gramlich said...

The greed of people seldom fails to astonish me

PhilipH said...

"I had wondered if this was possible. It surely must arouse a lot of resentment."

It's certainly possible, and it raises the hackles of many Brits. How to obtain payment from those who get free medical and surgical services via the NHS when they are not entitled is a sore point.

Snowbrush said...

"It's certainly possible, and it raises the hackles of many Brits. How to obtain payment from those who get free medical and surgical services via the NHS when they are not entitled is a sore point."

Why not simply deny anything beyond emergency medical care to non-resident foreigners? I know that there would be many Brits who would oppose doing this--just as there are many Americans who would oppose doing it here, that is if we even had medical coverage for the public--but I--and possibly you--would hold that a nation's primary responsibility is to caring for its own citizens. Now, I don't mean by this what Trump means when he says "America First," which is code for, "And screw the rest of you," but rather a rational allocation of national resources in the same way that every individual must make a rational allocation of personal resources lest he find himself in the position of having spent so much on other people's children that his own children go hungry.

Philip (and other Brits), America's dumbass president called the murdering, election stealing, Putin this week to congratulate him upon winning yet another Russian election. When you think of America, please try to remember that no more than 40% of us support Trump, with millions upon millions of us being so embarrassed by him that we count ourselves lucky if we don't have to travel oveseas and have it known that we're from America.