When medical disaster strikes, there's no time to think about money. The helicopter zooms you to the trauma center and before you know it, you've had two surgeries and seven days in the hospital. But in the back of your mind is this niggling question: how much will this cost?
For years we had no health insurance. The kids (until they turned 19) had Medicaid, but Adam and I just trusted to God's mercy and protection and counted ourselves fortunate to be generally healthy and uninjured.
On January 1, we got insurance again, and for my readers who live in other countries, here's an American truth: if you don't have health insurance, you don't have health care. You can't get dental work, and doctors won't see you. The first thing the hospitals ask is to see your insurance card. You can pay all that stuff out of your own pocket, but ... (another unpleasant American truth) because most health insurance is attached to people's employment as a benefit, people who don't have jobs generally don't have insurance either. Thus, they don't have the cash to pay for the care. It's a mess.
The insurance we got in January is affectionately called Obamacare, or ACA. The government pays for most of our premiums, but the insurance itself comes from Blue Cross/Blue Shield, a huge insurance company. We had to enroll, by law, and we were happy to do so. I'm fully aware of several facts: 1) Some of my friends think it's criminal for the government to pay for our insurance and consider us thieves because it's taxpayers' money, 2) Many other nations have similar systems, or (horrors!) a single-payer system, and 3) The Obamacare model is the model the Republicans promoted back when the Democrats wanted a single-payer model. My take is this: I loathe the fact that people's lives and health have become balls that politicians, in their venomous competition, love to bat around. It's sad to me that people who are each others' neighbors are angry that their tax money might go to pay to preserve their neighbor's life. Obamacare provides insurance to millions of America's "working poor" -- people who work at businesses that won't or can't provide their insurance. And who are the customers of those businesses? Who are the customers who benefit from the fact that tens of thousands of businesses don't charge their customers higher prices to pay for those employees' insurance? It all boils down to the same fact: people pay for other people's insurance. You can pay in taxes, or you can pay in wares, or you can pay in high healthcare costs. But you pay.
I digress. American healthcare is complicated.
I took Adam's blood pressure medicine to the hospital and handed it to the nurse. "He needs to take one of these every day." I could have given them to Adam, but I figured the nurses needed to know what meds he was taking. She said, "I have to get this bottle verified by our hospital's pharmacy." Later she brought the meds back. "The hospital pharmacy would prefer for him to use their blood pressure meds," she said. "Is it the same as this medicine?" I asked. "Yes." "Well," I replied, "I'm sure they'd prefer him to use theirs. How much do they charge for their blood pressure medication?" And when she checked on the price ...
Their tablets were $3.00 each.
And Adam's meds cost us 30¢ each.
So I fussed and insisted, and she wrangled with the pharmacy, and at last I got my way. And I saved the American taxpayer $15 by stubbornly not allowing the medical establishment to criminally overcharge us on one item. One item. How could one possibly insist on reasonable charges for every item in a week-long hospital stay?
After Adam's discharge we drove to our local pharmacy to fill the prescriptions his surgeon had given us. Adam declined to get the percocet (pain meds), but he had to have the blood thinner. And then the pharmacist told me that Blue Cross would not pay for a penny of the blood thinner; it's a "non-formulary" drug (one they refuse to pay for) because it's fancy, non-generic, new, and $150.00 for only 14 of them. (Sigh!!)
So I'm standing in the pharmacy with my exhausted husband in the car after a 2 hour drive, wondering if I should go home without his blood thinner and risk a blood clot, or pay out $150 ourselves. If I told you how much we live on, we'd both be embarrassed, so I won't. (The church provides housing, but not a large salary, which is common for small-church pastors.) I save money any way I can. So I called the doctor's office and talked to the nurse. She said she'd get back to me.And I drove home without the meds.
When she called back, she said the doctor agreed Adam could just take a baby aspirin instead of the blood thinner. Adam is a young, healthy man, and a baby aspirin is adequate. So I drove to Dollar General and spent $2 on baby aspirin. But only because I insisted and refused to be overcharged by a pharmaceutical company for their new drug, and refused to accept the prescription of a doctor who didn't think it through.
What's wrong with our medical system? We all have our opinions, but I think perhaps the biggest problem is that healthcare is exorbitantly expensive -- ridiculously expensive, even criminally expensive. When each item a hospital provides is ten times more expensive than it is elsewhere, what mischief is produced? Is every med, every sheet, every bed pan, every procedure, every piece of equipment, every single charge, ten times overpriced? If Adam's final charge ends up being (I have no clue ...) $50,000, does that mean that it could have cost $5000, if the prices weren't inflated?
What are we paying for, when healthcare is that expensive? Is there wastage? (Of course there is.) What mechanism should regulate those prices, to keep them low? Is there a competitive mechanism in place? A government regulation? A watch-dog group? Certainly the patients and their families are in no condition to complain. Most will not fight against the overpriced medicine and insist on using their own. What if we all dragged our own sheets, wheelchairs, gowns, and ace bandages there? Can you imagine the chaos?
All I'm saying is this: if the care weren't so expensive, the insurance wouldn't be so expensive, and many people would be able to pay for their own insurance or care. Perhaps if it weren't so expensive, people wouldn't even need insurance! Perhaps they could feasibly pay for the care out-of-pocket, without help from anyone. The insurance companies would be out of business, and that would crimp their style. I do believe that both the healthcare industry and the insurance industry have great incentive in keeping costs as high as possible. As long as they do, they get lots of $$$, and the American population pays, one way or the other -- because the payment mechanism is rerouted so many times.
Meanwhile, the working poor, families with children, living on under $25K/year, unable to find a job that would provide healthcare no matter what they did, are viewed as the "bad guys." Everybody hates the moochers, the ones who live on the taxpayers' hand-out, who accept the government's help. They get help, but it's very grudging. People actually tell them, "You should pay for your own insurance!" As if a family that doesn't even make $2K a month can afford premiums that cost $2K a month. They couldn't afford $500/month. They couldn't afford anything. And no, Medicaid does not cover parents in that situation.
And so a system that overcharges at every turn and impoverishes the nation, then produces a large group of people who can't afford the services and are vilified for their poverty.
I don't have a solution, but I know there are politicians paid hefty salaries to come up with one, and they haven't. Obamacare is far from an ideal model, but the Republicans didn't care to improve such a broken system when they had the chance; they had other items on their agenda more important to them. This post is no defense of either party. But my eyes were opened a bit more in the past week to some of the weaknesses and abuses of our healthcare system, and it was not pretty to see.
(If you care to leave a comment, please do not leave a political rant. If you have something useful to say about healthcare, that's fine.)