"I Can't Afford to Get Sick"

[RedEarth]

Think your insurance has you covered? Just wait till you need it most.

By Kerry Howley

April 2006

System of Dilemmas

Heart surgeon Mehmet Oz was set to go. On the operating table lay a 50-year-old man, dying from heart failure. He was anesthetized, out cold, and his chest was painted with sterile Betadine. In minutes, Dr. Oz and his team would implant a mechanical pump to keep him alive until a donor heart could be found.

All that remained was for Dr. Oz to scrub his hands. As he soaped up just outside the OR, he thought about the brief chat he'd had with the patient earlier that morning. The man, a mid-level executive with an agricultural company, was clearly terrified, knowing that he could die.

Just then someone called out. There was an urgent phone call for the surgeon. With suds dripping from his hands, Dr. Oz walked back into the OR and a nurse held the phone to his ear. It was someone from the patient's health insurance company. His policy covered heart transplants, but not the cost of the mechanical pump. At the end of the operation, someone was going to owe a small fortune -- and the insurers were insisting that it would not be them.

........

Millions of other insured middle-class Americans aren't nearly so lucky. Between 2000 and 2003, seven in ten adults who were driven into debt by medical expenses had insurance at the time. In 2001, 42.5 million people in insured households paid 10% or more of the family's net income in medical expenses. They are America's underinsured, caught in a Catch-22: too well-off to qualify for government programs that support the poor, while not nearly affluent enough to pay their health bills without wrecking the family finances. And there's no rescue in sight, for the system is broken at every link along the chain -- from insurers who protect profits by raising premiums and restricting coverage; to doctors who can't keep up with the skyrocketing costs of malpractice insurance as well as the burdensome paperwork that some carriers require; to companies whose soaring medical costs force them to push more and more of the expense onto their employees.

At the end of this chain is the hard-hit consumer. Premiums for family coverage in employer-sponsored health insurance plans have increased by 73 percent since 2000. Currently, they're rising three times faster than the average paycheck and more than twice the rate of inflation. The bills keep adding up.



http://www.rd.com/content/openContent.do?contentId=26204

[Deja Q]

1. He's an executive. He can afford it.

The price of life in the culture of life.

Except the culture is bacteria. Such a low form of life that they'll eat their own.

No loyalty.

Except themselves.

Forgive me if my SympathyMeter(tm) doesn't respond.

[JackintheGreen]

3. That's a terrible response

First of all, we don't know if he's a mid-level exec at ADM making $500,000+/yr, or a mid-level exec at a much smaller company making much less. "Mid-level exec" often just means "office bitch/the buck stops HERE."

Secondly, if he works at an even moderately responsible company - and yes, there are a few out there - his employees have exactly the same insurance as he does. That means that is the same thing happened to his secretary, who probably makes $40,000 at most, you'd be using the same story to argue for single-payer/universal healthcare.

Chances are, if he's a mid-level exec, he worked his ass off to get there. They don't move from corporate board to corporate board in the same way as too many CEOs/CFOs seem to these days. And he's STILL getting screwed.

The point is not that "he can pay for it himself." Maybe he can. So what? The point is that in civilized nations he shouldn't have to pay everything he earns for the next 100 years to pay off medical expenses, whether he makes $30,000 or $30,000,000.

[RedEarth]

6. I certainly agree.... not all people who are called executives make

enough money to cover medical expenses not covered by health insurance. I know of a number of them and I'm sure you do as well.

[DFW]

2. I think the point

Is not that we are to sympathize with a mid-level executive who will pay a high
price to live, but that there are 40 plus million Americans who may die because
they will never be able to afford the price of life.

This same economy is brought to you by the same folks who dare to call themselves "pro-life."

[Nobody]

4. Perhaps the insurance co would be willing to pay instead

for the costs associated with this guy dying. His funeral, the wages he will no longer be able to earn, the cost of training a replacement at his job, the costs involved with his co-workers having to do his job as well as their own.

We need single payer health insurance NOW.

[Vinca]

5. Most bankruptcy filings are because of medical bills and most

of these are people WITH insurance. The average policy covers about 80% of the tab AFTER any deductible is met. Throw a serious illness or injury into the mix and 20% of hundreds of thousands of dollars is what you owe. I haven't read the Massachusetts "no fault" insurance law and I'm wondering if that is taken into account. "Mandatory" insurance means Jack Squat if it only covers a portion of an illness. Quite frankly, any "universal coverage" that keeps the insurance companies involved smacks of more corporate pandering.

[winston61]

7. here's the deal

Although insurers make money on group health plans, in these days of shareholder pressure for more and political pressure from the government, group plans are going away. Monkey boy is still out pushing health saving accounts. These expensive plans will be out of reach for many. But that is the goal. Insurers want to collect premiums but not pay benefits. A prosperous middle class professional buys one these plans with a high premium and say, a $5,000.00 deductible. What this means is that he is essentially self insured for doctor visits and prescriptions. But on the plus side he can dump buckets of income into the account and avoid taxes. If he ever does get a major illness he will pay for it with his own money. Insurers love that part. Because these plans are marketed to young healthy customers the insurers make out like bandits. So what about the working poor? Fuck 'em. As Scrooge said about the surplus population, let 'em die. The federal and corporate state see poor people as an economic drain, a cash flow problem that can be corrected by neglect, as I said, fuck 'em, let 'em die. But here is the rub, plain old fashioned greed. As you know greed is blind and stupid. Greed never sees the consequences of itself. When the poor are dead or decimated who be the servants to the wealthy? When a culture fails to maintain it's middle and working classes, it becomes dog eating it's own guts. The dog realizes too late what it has done, it dies and the society dies. Ain't I a little ray of sunshine?

[boobooday]

9. Good thing the sun is out here in earnest today

Because you are absolutely right. And it sucks.

[boobooday]

8. I sympathize

With him and especially the millions of people who aren't mid-level executives and have to go without far less expensive, but often critical, procedures.

Maybe this guy could afford to pay for his own routine medical care, but his story points out that very few people could afford to pay for catastrophic care.

[China_cat]

10. We're paying $400/mo just for my husband's

insurance...through his work's group plan. We've read through it and it might as well be marked 'good only until needed'. But if you don't have insurance of some kind and have to go the hospital here, you'll have to pay a very large deposit before they'll even admit you.

[Tandalayo_Scheisskopf]

11. The solutions suck.

All they will do is increase the bottom line for the providers, drug companies and insurers. The consumers will not benefit in any substantive manner. Doubt that? Well, look at present profits in the industry. Somewhere, there are efficiencies that are not being passed onto consumers.

[Blue_Tires]

12. i can't afford to get sick either

uninsured(!)

[alarimer]

13. Why is universal health care not even being brought up?

Most mainstream Democrats propose incremental changes at best. Why aren't people screaming at their representatives to give us universal health care? And I mean truly universal care. One not involving insurance companies, who can all go to hell for all I care.

I think before we get universal health care, we first need public financing of elections because, insurance companies, like every other industry, has too many Congressmen and Senators in their pockets. Too many of our elected representatives (of both parties) are beholden to them for caomapign contributions and that is why they are all too timid to make major changes.

So we also need to control Congress and probably the Presidency before we get universal health care. Either that or the economy collapses first and they are forced to do something.

I am not optimistic and stories like this just make we want to move to France or something.

[winston61]

15. we already have univeral healthcare-

Take a look at your pay stub. You see the entry for Medicare deduction? The system is already in place. But only if you are 65 or older.

[alarimer]

16. well then it isn't universal really

they should just extend it to everyone, over time. It will cost money but probably not more than the Iraq war.

[winston61]

17. Have you ever read Eisenhower's Cross of Iron speech?

Just google 'cross of iron speech', read it and you can began to know just what mindless militarism really costs our society. Schools, health care, infrastructure all suffer to feed the military machine. We don't need to completely dismantle the defense industry, but can't we realign? My question has always been, if they can build planes, why can't they build trains? Can we use the skill and billions in the MIC to rebuild this country? I think we can.

[Puglover]

14. Bleh

Readers Digest is a RW tool. If you take the time to read the entire article one of their solutions to the problem is The Idiots savings accounts. The solution is national health care. Period.

[fencesitter]

18. Yes read the solutions(?) section..

They give Bush's HSA's and Newt Gingrich's plans as solutions. Newt a campaigner for health care?? I lost my insurance this year and looked into HSA's as a solution for myself. It was no solution. Ask me anything.

[Porcupine]

19. When did we all decide we were never going to die?

Ok, here's the health insurance I want. I want health insurance that covers me for infections, diabetes, broken bones, stitches and anything that I can recover from and return to work.

What I DON'T want is health insurance that will not cover me until it's time to crack me open, gut me like a fish, and leave me on meds for five years until I die of what was killing me in the first place.

Can I get health insurance that specifically DOES NOT cover heart disease, kidney transplants and cancers with a prognosis of less than 50% in five years?

When did we decide we could beat death? That's what's costing us a fortune.