Our For-Profit Health System Is Not Worth Defending

There's a talking point that often dominates the debate around health care reform: The majority of Americans like their health care plan. That's why when Barack Obama was running for president -- and when he rallied Congress to pass the Affordable Care Act -- he repeatedly assured people that there was nothing to worry about. If you liked your health care plan, he promised unconvincingly, you could keep it.

More Americans actually fear the cost of treating an illness than the illness itself.

Joe Biden followed the same logic when he campaigned against Medicare for All in the 2020 Democratic presidential primaries, insisting that "160 million people like their private insurance." But his opponent, Senator Elizabeth Warren, questioned that statistic. "I've actually never met anybody who likes their health insurance company," she said during one of the Democratic debates.

The reality is that polls of Americans' feelings about health care policy are all over the place. The majority of Americans do indeed say that they like their health care plans. But the majority of Americans also favor a single-payer system. And the same Kaiser Family Foundation poll that found that most people are "generally satisfied" with their health coverage also found that 40 percent of people with employer-sponsored insurance still said that they had trouble paying out-of-pocket medical expenses.

So what, exactly, is going on? I'm willing to bet that insured people are more likely to report that they are happy with their health care plan when they're not actually using it. And I say that because I'm one of the people for whom the American health care system is supposed to work at its best and most seamless -- I'm young, relatively healthy, and have decent employer-sponsored coverage -- and I still hate interacting with my insurer.

Let me explain why. Last summer, I had a seizure for the first (and hopefully last) time, and I dislocated and fractured my shoulder as a result. Despite having what is apparently considered good coverage, the months that followed were a bureaucratic nightmare.

There was a wait for essentially every part of the recovery process. Getting appointments to see doctors sometimes took weeks, and probably would have taken longer had I not been lucky enough to have a friend with a family of doctors who could help me find the right people. I had to start physical therapy several weeks late because the available therapists in my network were booked. I couldn't get an MRI until my insurer -- not my neurologist -- deemed it a necessary expense. (Some of these delays may have been exacerbated by the stress COVID imposed on the health care system, but they also aren't out of the ordinary.)

That is to say nothing of the out-of-pocket fees. The two-mile ambulance ride cost $1,000. The MRI was $600. Physical therapy had a $40 copay attached to each visit, with a recommended minimum of two sessions per week for several months. In the end, I got over a dozen bills, ranging from $14 to $1,050, making it hard to keep track of what I owed and to whom. (I still worry that I have missed a payment that will haunt my credit score sometime in the future.) When all is said and done, a single unfortunate and completely unpredictable incident ended up costing me over $3,000.

I'm not the only insured American who's had a terrible experience dealing with the health care system. People with insurance have so much trouble navigating and paying for medical services that a fifth of households that make over $120,000 have avoided seeking medical care because of the associated costs. More Americans actually fear the cost of treating an illness than the illness itself. Clearly, this system is not working as it should, and yet the idea that most Americans are satisfied with their health coverage continues to stunt many politicians' imagination of what health care in America could look like.

Unfortunately, a major health care overhaul is not on the Democrats' agenda for now, despite the fact that it occupied much of the debate in the 2020 elections. That's in part because of the party's extremely narrow majority, but also because more moderate Democrats are afraid of thinking bigger.

But there's no reason to be so timid. I can complain only so much about my health care, because I'm one of the lucky ones -- lucky for having insurance in the first place and for having enough savings and a family to lean on to help cover out-of-pocket expenses in the event of an emergency. But when a system relies on good fortune, then it's not a system worth defending, because it can fail almost anyone, especially the people who need it most.