“A nation’s greatness is measured by how it treats its weakest members.” ~ Mahatma Gandhi
“Let your conscience be your guide” is a conviction we have not learned as a society when it comes to health care.
As a country we have cast a blind eye on the moral consequences of our health care system. As I told my son: “Actions have consequences.” So many people worry that someone will get something for nothing that we have built barricades of rules to control costs by defining who can get care, where they can get it, what is covered, and who is going to pay for it. It is the very weight of those rules—private and public—that is collapsing the system with its costs and many all too human consequences.
Over the years a system of separate employer and insurance silos emerged that is based on the odds of someone getting sick. Until the Affordable Care Act there were virtually no national standards for health care even though there are national standards for transportation and banks. Before the Affordable Care Act, people were denied insurance if they had a pre-existing condition. Insurance companies could place a lifetime limit on the amount they would pay for someone’s health expenses. There were no limits on insurance administrative costs and profits. There were no national standards to hold hospitals, doctors and others accountable for quality care.
I have excellent insurance with Medicare and a good supplement, but I could have been easily bankrupted by my health care costs were it not for anonymous friends who unbeknownst to me created a fund to cover costs I could not have afforded. Hospital co-payments are high. Doctor and therapist co-pays add up. Assisted living is not covered by Medicare. My co-payment for one medication alone was $278 per month—for a life threatening condition. I am incredibly lucky! I lived and I was not bankrupted in the process. I know others who don’t have such gifts. I have now walked in their shoes. They are no longer a data point on a ledger sheet or a brief news story.
I cannot remain silent. I know too many people harmed through no fault of their own. They are solid middle class people with professional careers and homes. They had insurance but faced too many co-pays and deductibles and coverage rules. Others ran out of money when they had breast cancer or a stroke or had parents with Alzheimer’s.
In one horrific case, a six month old child was diagnosed with a rare illness. She would live six years at most. Her parent’s insurance company would not cover her care because she would live so few years. They said hers was not a ‘medical issue,’ it was long-term care which was not covered by her parents’ policy.
Many families nearly lost their homes. Others I know took out loans or second mortgages for a child’s mental health costs. Mental health is not a ‘medical’ condition and until the Affordable Care Act was not covered by insurance. Coverage still remains marginal.
These people are not strangers. They are all our neighbors, fellow workers, Rotarians, community leaders and friends. They are people who were laid off because their industry is vanishing, or their jobs were shipped overseas or their jobs changed to part time with no insurance. Many are contract workers. Even Medicaid’s expanded coverage for the poor is not an option for those living in one of the 25 states that refuses Medicaid expansion. Medicaid eligibility depends on poverty. Poverty level for an individual is $11,880. Some states may allow more but it is up to the state.
In one soul shivering case Mississippi considered balancing its budget in 2003 by eliminating 13,000 Medicaid nursing home beds. The fight raged back and forth three times between the Governor and the legislature with vetoes and overrides before the state failed to do so. How could a state even consider stripping already destitute frail elderly of their only hope for care in their final months or years of life?
Political debate after debate and personal conversations are about costs and how to pay for them as a country, family or individual. Someone I know had open-heart surgery. The bill was $357,000. If Health Savings Accounts are the answer, how many people could save enough for a $357,000 unanticipated life-saving surgery? Who can save or budget for such unpredictable events that slam into life like a tsunami?
Different insurance plans dictate the cost, services and where people get them even when a person is healthy. Even people with the best private insurance still face questions about what and how much is covered, their co-payments and deductibles and even medications. Our system is deeply flawed, inequitable, costly and too often unaccountable.
Even flawed as it is, the Affordable Care Act offers concrete steps toward a more fair, accountable, safe and more affordable system which is all most people really want. The Act is not perfect. Large changes can’t happen overnight whether it’s this Act, Health Savings Accounts or Medicare for All. If we abandon this Act then we as a society will have turned a blind eye on our out of control costly system and its far too human consequences. Don’t we have a conscience?
Kathleen O’Connor © March 2016
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Coming Next: Tools for Accountability–Hospitals