“I would love to see us reevaluate the whole purpose of
copays and deductibles… It makes no sense to put a barrier in front of care
patients need to get.”
Dr. Barbara McAneny,
President, American Medical Assn.
“There needs to be a way to relieve the pressure… Otherwise,
people will feel like they have no insurance at all.” Republican Utah Gov. Mike Leavitt
The American economy works for the richest segments of our
society… and virtually for no one else. The shudders of economic insecurity
course through most everyone here, from the youngest entrants to the job market
to retirees with vastly insufficient resources. From student loan debt (based
on tuition increases, corrected for inflation, that are 5 or more times higher
than in the 1970s), staggering housing prices, rising cost of food and other
basics to the elephant in the room: healthcare.
I have a dear friend, an American lawyer who has moved to
Germany to carry out an international patent practice. He travels back to the
United States on the bits and piece of business that require his presence here.
Recently, a slightly ruptured appendix led to sepsis and a dangerous blood
infection. He was in a first-rate Los Angeles hospital for a week after his
surgery; he remained in near-critical condition with the most powerful
antibiotics and blood thinners. The medical bill was rapidly approaching
$250,000. But he was on Germany’s state-supported universal healthcare system.
A phone call to his provider with a very medically sophisticated administrator
on duty 24/7, just a couple of minutes, and aside from his 500-euro annual
deductible, every part of his medical treatment far from Germany was covered.
Hospitalization. Drugs. Surgery. Out-of-hospital care. No fight. No questions
asked. 100% coverage.
He told me that other than cosmetic options, his insurance
covered dental (including implants), vision (including progressive glasses) and
hearing aids if he needed them. Our Medicare doesn’t cover those elements and
can be downright stingy with that donut hole in pharmaceutical coverage. Prescription
drugs have never been more expensive or covered less. And still the GOP is
trying to abolish the Affordable Care Act, a second-rate governmental option
that seems like an aging band aid on a festering wound. Twenty state attorneys
general, backed by Trump’s Department of Justice, are fighting in the federal
appellate courts to declare the ACA unconstitutional. And there is no back-up
plan. They may well get what they want. Nothing.
Meanwhile, even those Americans with some form of healthcare
coverage are struggling. “Soaring deductibles and medical bills are pushing
millions of American families to the breaking point, fueling an affordability
crisis that is pulling in middle-class households with health insurance as well
as the poor and uninsured.
“In the last 12 years, annual deductibles in job-based health
plans have nearly quadrupled and now average more than $1,300… Yet Americans’
savings are not keeping pace, data show. And more than 4 in 10 workers enrolled
in high-deductible plans report they don’t have enough savings to cover the
deductible.
“One in 6 Americans who get insurance through their jobs say
they’ve had to make ‘difficult sacrifices’ to pay for healthcare in the last
year, including cutting back on food, moving in with friends or family, or
taking extra jobs. And 1 in 5 say healthcare costs have eaten up all or most of
their savings…
“In the poll of working-age adults with job-based insurance,
a quarter said they had put off vacations or major purchases to pay for
healthcare. A quarter have curtailed spending on clothing and basic household
goods.
“Half said costs had forced them or a close family member to
delay a doctor’s appointment, not fill a prescription or postpone other medical
care in the previous year. That is higher than some other national surveys, but
a study published Thursday [5/3] by American Cancer Society researchers found
that in the last year, 56% of U.S. adults had problems paying medical bills,
delayed care or worried about affording care.
“Hardest hit in the cost shift are lower-income workers and
those with serious medical conditions such as diabetes, heart disease and
cancer — who are more than twice as likely as healthier workers, according to
the Times/Kaiser foundation poll, to report problems paying medical bills and
to say they’ve cut back on spending for food, clothing and household items.
“‘There has been a quiet revolution in what health insurance
means in this country,’ said Drew Altman, the longtime head of the Kaiser
Family Foundation. ‘This happened under the radar while everyone was focused on
the Affordable Care Act.’…The 2010 healthcare law, often called Obamacare,
provided landmark protections to Americans once shut out of health coverage.
But as Democrats and Republicans fought over the law, Altman said, neither
focused on the rapid run-up in costs for people covered through work… ‘We
forgot that most people get their insurance through an employer, and for them,
the issue is medical bills that they increasingly cannot afford,’ Altman said…
“Many other industrialized nations rely on private insurance,
but few of their citizens face the kind of medical bills Americans routinely
do. Fewer than 1 in 10 patients in Germany or the Netherlands, for example,
reported problems getting care because of cost, the New York-based Commonwealth
Fund found in a 2016 survey… By contrast, 4 in 10 U.S. workers had difficulty
paying a medical bill or insurance premium in the previous 12 months, according
to the Times-Kaiser foundation poll conducted last fall.
“The challenges are most severe for people with the highest
deductibles, according to the poll: Nearly half of those in a plan with at
least a $3,000 individual deductible or a $5,000 family deductible reported
problems affording healthcare… Even Americans with chronic conditions like
diabetes use less medical care if they have a high-deductible plan, according
to an analysis conducted for The Times by the Health Care Cost Institute, which
examined three years of insurance data for 10 million workers
“Other academic studies show patients with cancer , epilepsy
, arthritis , multiple sclerosis and other serious diseases also delay care or
skimp on vital medications when they have to pay more out of pocket. Doctors
typically recommend patients with such conditions get regular care to control
the disease and prevent complications… This wasn’t how the high-deductible
revolution was supposed to play out…
“Americans with chronic illnesses are more likely than
healthy workers to say their insurance has gotten worse in recent years and
less likely to say the system works well for people like them, the poll found… Across
the board, large numbers of U.S. workers are looking for relief… In a major
reversal from 15 years ago, 6 in 10 Americans with job-based coverage now call
affordability the most important feature of a health plan, outranking previous
top concerns such as a broad choice of doctors and hospitals and a wide range
of benefits.” Los Angeles Times, May 5th.
Three major economic segments of society that dramatically
impact our daily lives are utter failures: paying for education, providing
healthcare and supporting functional infrastructure. In each of these
categories, we sit at the bottom of the rest of the developed world. And still
we give tax cuts to the rich, defund or underfund public education, ignore
infrastructure repair and enhancement and find ways to pull the rug out of most
Americans ability to access and afford healthcare. We should be ashamed, but
those most severely impacted, working men and women, disproportionately support
the very politicians who are doing them in.
I’m Peter Dekom, and it is time for a major
regime change in the United States, because we have run out of excuses for why
government no longer serves most of us.
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