The cancer recurred three or four months later and more surgery was required, followed by chemotherapy. The 15-year-old who loved to dance, and who wasn’t sure whether she wanted to be a model or a pediatric nurse, was now having to battle for her life like a warrior in combat.
The next round of bad news came in a double dose. One night, after coming home from school, Brittney suddenly found that she couldn’t walk. The cancer had attacked her spinal cord. As the doctors geared up to treat this new disaster, Ms. Hightower received word that her insurance policy had maxed out. The company would not pay for any further treatment.
Ms. Hightower was aghast: “I said, ”˜What do you mean? It was supposed to be a $3 million policy.’ ”
She hadn’t understood that there was an annual limit of $75,000 on benefits. “It was just devastating when they told me that,” she said.
Most of the debate about access to health care has centered on people without insurance. But there are cases like this one all over the country in which individuals are working and paying for coverage that, perversely, kicks out when a devastating illness kicks in.
Americans with inadequate health coverage ”” the underinsured ”” are a major component of the national health care crisis. Like the uninsured, they can be denied desperately needed treatment for financial reasons; they often suffer financial ruin; and in many cases they die unnecessarily.
“This is a very significant problem,” said Daniel Smith, president of the American Cancer Society’s Cancer Action Network. “We want to help educate Americans more broadly about the idea that while they think they might be insured, when they’re diagnosed with something as devastating as cancer their policies may not give them the coverage they need.”
What a heart-breaking account, sigh. I’ve probably preached on this subject too much here, but one can’t emphasize enough that, with our health-care system, EVERYONE except the uber-rich is one serious illness away from disaster.
It continues to boggle my mind that as an uinsured person, I must pay $200 in cash for specialist appointments while the same office accepts less than $100 per appointment from the insurance companies and waits a month or two for payment! It’s like they penalize you for not having insurance or being underinsured while making it impossible for someone with a serious disease to get or expand coverage.
I must eat a little bit of crow, though, regarding faith-based initiatives. I found a small Presbyterian church in town that has stepped up to the plate. They have a Medical Mission clinic in town that they quietly run to provide medical care for those without insurance. My doctor referred me to them. It is literally the ministry of just one little parish — they fund-raise like crazy, pay two doctors and two physicians’ assistants, and rely on volunteers for clerical work and maintenance. While TEC waves signs and makes speeches about the MDGs, this one little parish has been hard at work making a difference.
I just don’t know how anyone (particularly one who professes to be Christian) works for a company that cuts people’s health benefits off when they most need them. It’s just beyond cruelty….
Teatime: Try negotiating a bit. Once the office realizes you are not one of those patients who pays [i] nothing, [/i] they are likely to accept as payment whatever they would get from an insurance company. Especially if you can give them a check right away, with no waiting for billing.
A big drawback of any third-party payer system, whether Government or private insurance, is that the covered patients don’t squawk much about their medical bills, reasoning it is largely somebody else’s problem. So doctors & hospitals blithely charge more & more. When someone with clout & sophistication like the insurance company balks, they lower their rates for these patients. Then they raise them for everybody else, to make up for both this & for patients who pay nothing.
I don’t know what the solution is. Sometimes I think going without insurance, while risky, is not altogether irrational for some people.
The solution is socialized health care. Nobody in Canada has to go without cancer treatment because they can’t afford it. Yes, there are sometimes wait lists – they are triaged, and the most seriously ill get seen first. We spend about 10% less per capita on health care than in the States, and [b]everyone[/b] is covered. Canadians don’t wait until they are so sick they can hardly move before they go to the doctor, because they don’t have to. Our percentage of GDP (in 1997) spent on health care was 31%. In the United States, according to the same OECD study, it was 30%.
All, as someone who has been involved in the healthcare system intimately for the last 24 years (as cancer survivor, spouse of a nurse, and now analyst at a major health insurance carrier) I would give anything to allow the entire public to see what I see, and have seen, over these years. I will tell you this much, and welcome to reality:
1. Nationalized Health Care: If by that, you mean extending the equivalent of Medicare to everyone in America, you will create two huge problems in the process of solving the coverage problems. First, you will add $2T (that’s TRILLION) dollars to the U.S. budget annually. We already spend almost $500B a year just to cover those 65+. It’s true that younger folks need less care, but there are a WHOLE lot more of them. The tax to fund that will make $3 gas look like a lark. Second, the quality of care in the U.S. will plummet. The reason is that what Medicare pays to hospitals today is below their cost on almost every category. Privately insured or cash paying patients are the ONLY patients hospitals make money on. They lose on Medicare, Lose BIG on Medicaid, and of course, absorb a certain percentage of the unisured. Take out the private insurance payments, and they close down. Period. The privately insured, even those with bad insurance, are subsidizing (heavily) the whole system.
If by Nationalized Health Care you mean putting in the British/National Health Service type care, then once the bleeding (I mean real, physical, battle bleeding) is over it would probably mean an acceleration on the detioration of the average life expectancy in the U.S.. Keep in mind, today in England, the #4 cause of death, after heart disease, cancer, and hypertension is…(drum roll please….) Admittance into a hospital. I’m not kidding about that.
2. Evil insurance companies: Yes, there are less than reputable people out there selling all types of insurance. And insurance policy is a CONTRACT and it had BETTER spell out for you exactly how much they will cover and for how much. If you can’t read the policy, then they have an OBLIGATION to explain it to you (we literally use 6th grade English in our policies, and 4th Grade in some of them) just to make sure everybody knows they have a $5M lifetime max, no matter when or where you use it. But trust me when I say, if you take the insurance companies out of the mix, the first thing that will happen is that the price of everything in the medical field will go up dramatically. Insurance companies, love ’em or hate ’em, are the only drags on medical inflation. The contracts they negotiate with hospitals and doctors are the reason insurance patients pay less.
Consider this: The U.S. is the only developed country in the world where physician’s are in the top 2% of revenue earners. Other countries spend less money than us, and have longer life expenctancies that we do, but they benefit from NOT having adopted the fast food model, and when their elderly get sick, they have the good grace to go ahead and die, not burn up millions of dollars on treatments that have zero chance of extending their lives like we do. You will spend 83% of all your lifetime medical expenses in the last 13 months of your life. Think about that.
None of the solutions you have been treated to in the National Media are going to fix healthcare. If your objective is to cover everyone, buy them insurance. In the healthcare business today, you either have good insurance, or you’d better quit smoking and eating all that fast food, cause when you get sick (not if, we all gotta die sometime) you want to make sure its not until you are 65, so Medicare can take care of you.
And #4, Mrs. Falstaff, the U.S. spends 17% of its GDP in 2007 on healthcare. Whatever stats you are looking at are incorrect, we’ve never spent more than 15% before. Canada only spends about 9% of their GDP on healthcare. Perhaps you’re looking at the % of their federal budget. We do spend a solid 1/3 or the federal budget already on Medicare and Medicaid.
Trust me, unless you are willing to give a politician the right to ration your healthcare (been a bad boy? You’re off the transplant list!) the last thing you want is the Canadian system.
Whew! Any questions? 🙂
KTF….mrb
#4- The solution in NOT socialized health care. My former boss, having lived in Canada many years, was diagnosed with cancer there. The doctors put him on a treatment waiting list so long, he would have been dead before they could have scheduled the operation. He came back to the U.S., got the surgery, and has been healthy the past 3 years.
Stick to making beer, Mrs Falstaff.
#3, I tried to negotiate, with no results. I have a not-so-common disease and there is only this one rheumatologist for 160 miles so he can do what he wants. GPs are very skittish about treating me because Lupus is complex and systemic.
The system is broken, despite the insurance analyst’s comments. Surely American ingenuity can come up with something between socialized medicine and our current “medicine as big business.” Meanwhile, I will get my $2,000 per month medications from Canada for $360. Hey, if they want to put me in jail over it, I’ll at least get health care there!
1. Unfortunately, one is not permitted to charge the uninsured less than the government because this is considered “Medicaid fraud”. Thus, even though it is obvious to the meanest intellect that a person has no possibility of paying, one has to go through the charade of billing the uninsured a sum greater than what the government pays, so that Medicare will then give the hospital and her physicians a percentage of that “usual and customary fee”. This is why the uninsured are charged more. Everybody else (from Blue Cross to Medicaid) gets discounts from the usual and customary fee, and if one tries to give the uninsured a break or waves the charge, then your “usual and customary fee” drops to whatever you charged that person.
2. It is true that most physicians in the united states are paid very well. However it is also true that it would be more lucrative for most nonspecialists to be physician assistants or nurse practitioners rather than physicians. Most family practice physicians (who have amassed an average of 100,000 debt) earn the same as nurse practitioners (who have an average debt of less than half that) per hours worked. Most work an average of 60-80 hours in order to earn more than nurses. Thus, if the US wished to lower prices, it will need to either pay physicians less than nurses (and we have a shortage of both) or find a way to lower costs, particularly regulation, billing/coding/record keeping, and malpractice insurance. Most other countries have vastly less mandated overhead for physician/hospital administrative expenses than does the US.
Finally, one gets what one pays for. Europe has a higher life expectancy than we do because it counts preemie deaths within the nine month gestation period as “still births” while we count them as deaths. (This is why their “third trimester” fetal losses are three times higher than ours) We count preemies as live births, and actually try to save premies, which for the most part they do not. We also try to save the elderly. To a large extent, that would be considered malpractice in any US city, Europe lets both die. However a premie who lives a few weeks and then dies, or who lives 60 years, but has a reduced life expectancy due to seizures or damaged lungs, lowers a countries life expectancy rate from the 75 year average. OTOH, a 70 year old who has his coronaries fixed and lives another 10 years increases a countries life expectancy by only 5 years. Thus, saving preemies negatively impacts a countries life expectancy statistics, rather than the reverse. If life expectancy were evaluated beginning at the beginning of the third trimester, the US would be way ahead of the rest of the world.
However, I agree that the system is unsustainable. My feeling is that rationing will be necessary. Whether this will be like the United Kingdom with dialysis denied to people over the age of 50 or rationing by waiting times (allowing the sickest people to die while waiting for care as is the Canadian model) or whether it will be like the Netherlands where euthanasia is now one of the leading causes of death, with doctors frequently euthanizing the disabled without their consent or their families, I do not know. Personally, if there is to be rationing, I personally would favor explicit rationing: eg no elective surgery or intubation or mechanical ventilaton for people over the age of 80. This would bring our costs down dramatically, as a large part of the costs are generated in the last two years of life.
Ah, but we spend far, far less on administration than in the US. #6 – Sorry, I just don’t buy it. Cancer waiting lists are simply not that long, there must be more to the story than that.
Yes, my numbers were from memory. I shall have to be more careful next time (although I haven’t checked out your numbers either)
[i]None of the solutions you have been treated to in the National Media are going to fix healthcare. If your objective is to cover everyone, buy them insurance. [/i]
That’s exactly what socialized medicine is, except that instead of buying insurance, the government pays our medical expenses. Doctors run their practices like small businesses, and bill the government on a fee for service basis, and there aren’t thousands of insurance companies making a profit in the middle.
[i]In the healthcare business today, you either have good insurance, or you’d better quit smoking and eating all that fast food, cause when you get sick (not if, we all gotta die sometime) you want to make sure its not until you are 65, so Medicare can take care of you.[/i]
That’s got to be one of the most heartless things I’ve read in a very long time. Not everyone who gets sick is at fault. Would you consign the bartender who never smoked a day in his life, but gets lung cancer from second hand smoke to the same fate? I’ll take the Canadian system over the American one any day.
Ah, Mrs. Falstaff, thanks for Opening this post back up! I hope you had a Merry Christmas.
Please feel free to check out my numbers. A good source of that data is the non-Profit Kaiser foundation. They have a wealth of data on health spending at http://www.statehealthfacts.org. There you can see the truth, once separated from all the anecdotes, about where money travels within the US healthcare system. It’s actually a lot simpler than people make it out to be. To summarize, if you can imagine all the healthcare premiums spent in the US as a single dollar bill, this is how it gets spent:
$.35 goes to hospitals
$.30 goes to doctors
$.20 goes to buy drugs
(that means $.85 of each dollar pays medical bills directly, this is a stout industry average across the board)
$.10 of each dollar goes to administer health plans. We estimate that this $.10 invested in programs like disease management, wellness, and health advocacy programs takes about $.15 OUT of the system completely. IN other words, this invested dime generates about 15 cents of savings. That’s why insurance companies bother with it. Part of that money also supports all the consultants and brokers without whom none of the Fortune 500 would be able to manage their own healthcare plans as they do today (Companies like GM self-administer, carrying their own risk)
That last nickel either goes to shareholder equity (stockholder owned insurance companies) and capital investment, a nice way of saying profits, or in the case of POLICY holder owned companies (like the one I work for) we put that money in reserves for a rainy day. We typically keep enough money in reserves to pay everybody on the books healthcare for about two or three months. As a Louisiana-based company, I can tell you that we literally kept the healthcare business running because we had some savings in the bank for several months when everybody else (including the state) had lost the ability to pay.
We’ve looked into how much the government spends to administer healthcare here in the US, and how they manage those who are under that care, and what we found out was that even though their admin % is lower than insurance companies (about 6% vs 10%) they don’t actually work with doctors or hospitals to manage patient care, they just set out a table of how much they will pay for each event, and then they pay it.
They are, by that system, rationing healthcare by forcing Docs to take only what they will pay. Today, Medicaid programs and Medicare programs don’t pay enough to keep Docs and Hospitals open. Only we pay enough for them to keep the lights on. So force everyone to work for Medicare or (heaven help us!) Medicaid wages and the system shuts down, starting with the outrageously expensive US Medical Schools.
ANd in the US, it might interest you to know that about 10 Health Insurance companies own 75% of the business, more if you collapse all the Blues into a single association. So there really aren’t thousands of them.
ANd my statement about not smoking or eating fast food was not meant to offend, I apologize if it does. I am a malignant bone cancer survivor myself, and I’m pretty sure that what happened to me was not behavioral, but the smartest docs now estimate that by changing our behavior 70% of all disease can be prevented. So I’m talking about changing the odds that you will get sick, and be less likely to need healthcare or insurance.
Now, to be clear, I’d be the LAST person on earth to decry any other country’s health care system as better than ours. My point is that, starting from where we are now, installing a National Health Service would completely bring down the system, and I’m not even talking about insurance companies, I’m talking about docs and hospitals.
You take care! I hope you’re having a wonderful holiday season!
mrb