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.