On this extremely hot summer day, the ear-splitting siren screaming through New York’s streets is coming from the ambulance I’m in -- on a gurney on my way to the ER. That only makes the siren, loud as it is, all the more alarming.
I fell. The pain, its location and intensity, suggests I’ve probably broken my hip.
The kind face of the emergency medical technician hovering above me asks questions softly and I confess that I’m in terrible pain. Other gentle hands are busy taking blood pressure and doing oxygen counts. These EMT workers, employees of the Fire Department, are good at what they do.
At the ER entrance, the gurney’s lifted out of the vehicle, wheels are dropped, and it’s rolled inside. Under a ceiling of bright white lights, it passes -- and so I pass -- one cubicle after another. I catch bits of voices, speaking in several languages.
My friend, who’s come with me to the ER, roots around in my purse for my insurance and then heads for the admissions office. Alone, I close my eyes to shut out the glare of the ceiling lights. I want one thing: relief from the pain. Oblivion would even be more appreciated.
My friend returns to my cubicle and asks, “Is this the only insurance you have?” I panic. Will they not accept me? But they have to! It’s the ER! That’s the reassurance I offer myself and then I tell her, “Yes, it’s all I have.”
“What?” I ask desperately. “What?”
“Don’t you have some kind of supplemental?” And she begins to try to explain, but I can’t deal with this right now. All I want is relief from the pain. Any other moment, I’d worry about the money, but not now. I can’t! Instead, simply to remain half-calm, I remind myself that I have insurance, that I have a Health Maintenance Organization, or HMO, a plan that offers a wide range of healthcare services through a network of providers who agree to work with members.
After vital signs are taken, I’m moved to a hospital room and given pain meds that don’t offer oblivion, but do help. There, I learn what the X-rays show: a hip fracture. Surgery necessary. Operating rooms all taken. It may be two days before they can operate, the orthopedic surgeon tells me. My friend whispers that every extra day in the hospital will cost a mint. She then appeals to the staff to expedite the surgery. They can’t.
At that moment, I don’t care if the hospital costs a million dollars a day, I just want to get better. However, I, too, want the surgery to happen, within the hour if possible, since my leg is now frozen in a distinctly awkward position, thanks to the way I fell, and I realize that it won’t be straight until the operation’s over.
Two days later, after successful surgery, I develop an infection, pneumonia, and the days in the hospital begin multiplying into weeks. My doctors are so busy they can only visit once a day, if that, but the nurses, well... they’re the healers, the angels, though they themselves are desperately overworked.
Everyone’s so busy here. Hospitals have grown larger than ever in recent years as they’ve swallowed smaller hospitals and medical treatment centers. Given the overworked nature of the staff, I hire a healthcare aide to be with me several hours a day. My friend tells me that insurance won’t pick up this expense either, but I can’t worry about that now. I simply need to heal.
Finally, I’m discharged to months of physical therapy, three times a week. Fortunately, the therapy practice takes my insurance (not always a given). But on that first visit (as on every visit thereafter), they run my Visa card through their machine and I get charged a $40 co-pay. There’s nothing I can do about it. After all, my goal is to get back on my feet, literally as well as metaphorically. Still, that’s $120 a week for 16 weeks and so my out-of-pocket patient expenses begin to add up.
Back at home to recuperate, I find a stack of unopened mail, including notices from my insurance company alerting me to the bills that are to follow. Soon enough, they begin to arrive. They include out-of-pocket patient costs for the ambulance, the hospital, doctors, tests of all sorts, drugs of all sorts, and sundry other services. Those bills list both what insurance has paid for each service and the amount of money that I still owe.
And here I experience what must be common to so many Americans. I’m surprised and distressed to learn how much of the cost my insurance doesn’t pick up. The surgery, for instance, was $72,000, but my insurance only covers $67,000 of it. The other $5,000 is my co-pay. Add in the co-pays for everything from that ambulance to other medical services and my costs come to almost $13,000.
An Insurance System of Out-of-Pocket Disasters
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I’m sharing my recent journey as a cautionary tale. And, yet, what am I warning against? That we are all somewhat powerless when sickness strikes, but that those of us who aren’t wealthy suffer so much more. The thought of being without insurance is frightening indeed, yet in our present system we pay in so many ways for the existence of those insurance companies. We pay in co-pay; we pay in not getting treatment we need if insurance deems it unnecessary (no matter what your doctor says); we pay yearly out-of-pocket fees whether we’re 20 or 80 years old. (For Medicare patients, a monthly payment comes out of Social Security.) For most American families with insurance, whether workplace-based or individually purchased, premiums go up regularly, if not annually. At present, we have no alternative to the existing health insurance system, yet it is actually failing us all in so many ways.
What do you do when sickness occurs, if you aren’t rich? Suffer the illness, for sure, and then suffer the out-of-pocket costs afterward. And keep in mind that tens of millions of Americans under age 65 don’t have any health insurance at all. (In the age of Trump, in fact, those numbers are on the rise.) Moreover, the persistent growth of income inequality to Gilded Age levels has had a decided effect on the health of many Americans. For low-paid wageworkers, the unemployed, and/or undocumented immigrants, getting sick or having any kind of medical mishap is a disaster of the first order. For them, paying out-of-pocket costs of any sort may simply be impossible, which means that they will often do without medical treatment or even medicine. To put this in perspective, 40% of Americans can’t afford an extra $400 even in a medical emergency. Imagine what $5,000 or $10,000 in expenses means!
After an illness, accident, or chronic disease hits, a startling number of those of us with health insurance find that we have to choose between paying for daily needs and paying our medical bills. Such expenses leave people even more impoverished and often in debt, which is tantamount to remaining unhealthy.
For the poor, Medicaid, the government program that helps those with limited or no incomes, can make a major difference, but many people don’t have Medicaid because their states don’t readily offer it. Even where it’s more easily available, many with incomes not much above the poverty line don’t qualify for it. And as Elizabeth Yuko pointed out in the New York Times recently, “Even if you are fortunate enough to have health insurance, that doesn’t mean that all of the members of your medical team -- which may include out-of-network specialists -- are covered by your plan.”
As I learned with my fractured hip, someone who is in great pain or out of it for any number of physical reasons can’t be expected to focus on that future bill. And even if you could, who would want to cancel any of the services needed to heal?
Though Barack Obama’s Affordable Care Act, aka Obamacare, helped significantly, there are still far too many people who will have to agonize over how to manage both an illness and the co-pays that go with it. Meanwhile, of course, the Trump administration and congressional Republicans are working overtime to undermine Obamacare and deprive ever more Americans of any sense of a medical safety net.
What Medicare for All Would Mean
All the talk about making insurance affordable, under the present medical circumstances in this country, adds up to just so many wasted words. Unless something changes big time, insurance companies will continue to sell us their services at ever-higher prices because we can’t do without them. Since we lack alternatives, they remain indispensable. The result: out-of-pocket costs will continue to rise, no matter what any politician promises. And if the Republicans in Congress were ever to succeed in doing away even with Obamacare, the services that insurance companies now provide would no longer be guaranteed. What then?
With a single payer system, whether called Medicare for All or universal health care, everyone would be able to access health care; health would, that is, become a right. Most likely, such programs would be covered by a tax increase, yet they would cost each person so much less than what is now being paid out to insurance companies. With single payer or Medicare for All, there would be no more co-pays, no more premiums, no more refusals of non-doctors to pay for services recommended by medical specialists, no more bills arriving at a patient’s house.
Understandably, some might be reluctant to part with a familiar healthcare system, however flawed, in exchange for a new but untested universal program. Yet once implemented, any version of Medicare for All would be likely to cost less, be so much simpler to access, and ultimately save lives.
The present Medicare system is a good indicator of not only what’s possible, but of the ways in which health care can serve people’s needs. However, Medicare is offered only to those who are over 65. Nevertheless, Medicare and Medicaid prove the positive. Those programs work well for the elderly and the poor. Even with Medicare, however, insurance companies continue to handle many aspects of your services, should you opt for a Medicare Advantage plan (an all-in-one alternative to original Medicare), in which co-pays and other costs are still the patient’s responsibility.
According to Open Secrets, insurance companies, Big Pharma, and hospitals spent a staggering $143 million in 2018 alone in their lobbying efforts against any future Medicare for All plan. Nonetheless, as the National Nurses United Association has pointed out: “There has never been this much public support and momentum for Medicare for All. Eighty-five percent of democratic voters and 70% of all voters support it.” With significant administrative setups already in place, thanks to Medicare and Medicaid, the expansion of those health systems to include everyone seems doable; nor is it hard to imagine that many of the workers now employed by insurance companies would be able to shift to working for an expanding single-payer or Medicare for All program.
Truly decent health care is a necessity for a society in which people do more than just survive. Health is not a negotiable matter. You can decide not to buy a new coat and so shiver through another winter, but you really can’t decide to ignore sickness, disease, broken bones, or chronic illness, all of which can put lives on the line. How can any society function properly without health care available to all? How can any society survive in a reasonably decent way when so many millions of people are left with the choice of either being impoverished by illness or living with an otherwise treatable one?
Health care should be as much of a right as public education -- the right to educate all children, that is -- which was only won after its own set of lengthy struggles. After all, who can now imagine making all Americans pay for the first 12 years of schooling? Yes, we know that there are people wealthy enough to pay for whatever kind of education and health care they want, but they are hardly the majority of Americans.
Good health care must not only be affordable, but also provide easy access to medical services -- to better nutrition, a healthier environment, and greater longevity. In this context, Medicare For All would be a literal lifesaver.
Finally, good health care is peace of mind, which, at present, our system does not deliver. In my case, the cost of recovery was far too high.