http://www.alternet.org/healthwellness/79226/?page=entire
I get so angry when I read articles such as the one below. It needn't be like that. Seriously, my American friends, the single payer health system works in other countries, so there is no reason why it can't work in the richest country in the world. I'm told that half the bankruptcies in America are because of medical bills. This is no way to live. Access to adequate health care is a basic necessity to which every member of a society is entitled. Otherwise, you haven't really got a society at all, have you. There is only one way for health care reform to take place, and that is for you to make it happen. Make it the issue in the election. It isn't too late. It's never too late. And to all the naysayers who say it can't work, point them to here.
Health care has become the top domestic issue for most Americans this electoral season -- and for good reason. By nearly any measure, the system simply does not work. Heart-wrenching stories of its shortcomings can be read ad infinitum. And while they rightly evoke feelings of empathy and anger, experiencing the system's brokenness first-hand -- as I recently did -- gave me a new understanding of its horror.
I have cystic fibrosis (CF), a serious genetic disease that primarily affects the digestive and respiratory systems. My lungs create excess mucus that is thicker than it should be. This means I am more susceptible to everyday lung infections -- such as the flu or pneumonia -- which can, in turn, be life-threatening.
Despite amazing advances in medical research over the last couple decades, the average person with the disease still does not live to see his or her 40th birthday. The best we can do is stick to long, arduous treatment regimens -- and trust, often in vain, that the U.S. medical system will help us do that.
Cystic fibrosis is a rare ailment; there are only about 30,000 cases in the United States. In business terms, this means that medicines used to treat CF are developed for a very limited market. And since insurance and pharmaceutical companies need to make their billions, the costs of the various drugs that I must take on a daily basis are insanely expensive. (Last spring, I calculated that my prescriptions cost more than $60,000 annually.)
That makes me a life-long cash cow for the drug companies and, paradoxically, an enormous liability for any insurance company -- one that ideally should be expunged as quickly as possible. Indeed, I'm the worst kind of member to have on the rolls: someone with a chronic illness whose medical expenses, as long as a cure remains elusive, will always be exorbitant. I show no profit potential.
Not surprisingly, then, navigating the health care system has never been easy for me. Even when the system is working as smoothly as it can, I have had to jump through countless hoops. Those are an unavoidable and exhausting part of this tortuous circus. But my experience in insurance company hell reached a new low last year. Last November, I spent weeks politely jostling my inept doctor's office and insurance provider to get one of my prescriptions filled. Nobody seemed to take me seriously or put any priority on my case, even as I stressed that I was quickly running out of my medicine. To my disbelief, I began to realize that I did not have intrinsic value in their eyes, but had effectively been reduced to a "member number" and data on their seemingly endless medical forms. And when your needs become too expensive -- since the price of life apparently can now be calculated -- the companies find every possible way to dodge their obligation, playing the role of absentee landlord or deadbeat dad to perfection.
The system's labyrinthine bureaucracy serves to diffuse responsibility for those who must do the dirty work and to demoralize those forced to navigate it. People who are caring and decent in their personal lives dispassionately read the scripted reasons why they are denying medicines -- which, for you, may literally mean the difference between life and death -- over the phone.
"That drug is not on our list," she says.
"We need more clinical proof that you need this medicine."
"The review can take up to 72 hours."
"I'm sorry, but that is our policy."
Armed with excuses, the barricades are erected. The refrain sung. Never mind that you have a valid prescription from a doctor on their plan. Never mind that he called to authorize it and filled out the requisite "medical necessity form." Never mind that you've been on that particular medicine your entire life. That is our policy.
At one point I was on the phone from the moment I woke up until the company's office closed for four days straight. I paid close attention to their complicated explanations for the hold up and tried my hardest to follow their instructions. Once one obstacle was cleared, new ones faithfully arose. Even making the financial argument that if I didn't get the treatment I would have to go to the hospital, which would be vastly more expensive for the insurance company, seemed to have no effect.
"I guess you should go to the emergency room then," I was callously advised more than once. Did they realize that they were talking to a real person about his health and not some trivial matter? Did they get what an utter waste of taxpayer dollars that would be?
Completely desperate, I spoke with a friend who is a lawyer. He was eager to take action. "I'm always ready for a good fight," he reassured. "We can send them a nastygram," he explained, which would put pressure on the company to resolve this before it gets ugly. His confidence and support put me at ease.
The following afternoon, an insurance representative called to say that the medical director had finally approved my treatment. There was no explanation. The extensive documentation that they had been demanding was, in the end, unnecessary, as I suspected. I rushed to the pharmacy. But by the time I was able to fill the prescription, I had already gone three days without it.
My fragile health was put at risk because some faceless suit wanted to save a buck and was testing to see how much of a fight I would put up. (I was told more than once by people who had their own horror stories with health insurance that companies hope you'll just give up. Whether it's true or not, that is definitely how it feels.) It was an emotionally exhausting process that I hoped I would never have to endure again.
Unfortunately the fight wasn't over. A couple weeks later, the insurance company rejected another medicine. It was déjà vu, except this time I was weary. I did not know if I had the stamina for another protracted fight. But when it comes to your health, you have little choice. I was forced to pick up the phone and make the exasperating calls all over again. After nearly two weeks of pleading -- with little to show for it -- I was at my wit's end.
In talking with a friend who is an expert on New York's different public health insurance programs, he said that he believed the company was technically in violation of the law. This was the final straw. With the confidence of someone who has nothing left to lose, I called the company and demanded an answer by the end of the day.
"I have spoken with a lawyer," I told them, "and I am ready to take action." Those magic words worked wonders. They snapped to attention and immediately began to work on my case. I even started receiving periodic updates by phone about their progress. It was as if I were talking to an entirely different company, one that actually cared about its customers. The about-face was striking. By the end of the day, I received a call from the representative I had been dealing with. "Go pick up your medicine," he said. "It has been approved."
My crisis was resolved, but what about the people who don't have my advantages? What about the immigrant, whose first language is not English? What about the mother who works two jobs while raising children? As a writer, I can generally make my own work hours. As an activist, I am accustomed to long battles and challenging the powers that be. I have important resources, including legal help, at my fingertips. But because the majority of people in need of government-assisted health care are poor, they rarely have such backgrounds or support networks. That leaves insurers in positions of complete power, able to ignore the cries of the poor with little fear of repercussions.
It could be different. Several years ago, while living and studying in Spain, I experienced one alternative. To get my medicines, I filled out paperwork for twenty minutes at a hospital in Valencia. Without further hassle, I was able to pick up the same name brand prescriptions that I take in the United States, at one-tenth of their cost. Even though I was not a citizen and did not pay taxes, the Spanish government graciously footed the rest of the bill. They simply have different priorities, one being taking care of whoever happens to live there.
With our great ingenuity, a better, more humane system is not out of reach. Health care should not be subject to the whims of profit-hungry corporations. It must be recognized as a universal human right. To put people through such tumultuous trials for a basic necessity is criminal. Life is difficult enough.
See more stories tagged with: health care, health care system, health insurance, cystic fibrosis, eric stoner
Eric Stoner is a writer based in New York, whose articles have appeared in The Nation, Huffington Post and a variety of newspapers. He can be reached at: ericstoner1@gmail.com.
Comments
I am the first to support some form of National Health Service, being both an Aussie (sort of) and a Brit, but equally note that it is not a universal panacea given the current post-code lottery that leaves people in a similar situation to the unfortunate above. Take this recent article from the BBC on breast reconstruction after mastectomy: 1/10 get the appropriate care. I picked this as it is the most recent. Equally there is a video article on the BBC website talking about how, in some places, you have to go blind in 1 eye before some Primary Care Trusts (money managers for the NHS area) will agree to fund treatment to stop the other deteriorating. Sigh.
Different people to fight. In the NHS there is only so much £££ in the pot. How do you decide who is to get it? But there should be more reasonableness, compassion, somewhere.
Back to the US, I found the below article interesting:
Red Family, Blue Family ~ Making sense of the values issue
It was written in Feb '05 and does go some way to explain the divide between liberal vs conservative positions. I found it very intersting as it does manage to pinpoint fairly logically some of the thought processes and history in how people believe things and why.
I wanted to thank the cat for posting that article on red/blue family thinking. Interesting read. I'm just p-o'd that I didn't write it first.
we also never hear anything on the arab-israeli conflict, nor darfur.
As I have said before, the US has some much more serious problems at the heart of government that need to be solved before we tack on yet another program like this. These problems include the following:
So as might be readily apparent from what i have said above, if we don't solve these problems Publicized Healthcare will be just another BS program that doesn't really work for the public good while handing public money to the usual suspects lining up at the public trough. In case people haven't paid attention, these are typically moneyed interests. In the case of health care in the US it will most likely be insurance companies or if that doesn't happen it could be some new monster - like a corporation that sets up and manages "public" hospitals. Or just throw a stone - you name it, someone will figure out how to transform this into their profit at the expense of public good.
Furthermore, despite the way this is discussed by pundits, it is not an emergency that needs to be solved immediately. It needs to be solved, but it needs a solution that works well, and that will take time - a LOT of time. The crisis approach that so many proponents seem to be advocating will not allow that time for a solution. Usually a politician sees the fabricated crisis as an opportunity to further their career rather than as an opportunity to solve a problem. They make promises that they'll solve it, but real world projects do not fit within the timescale of the election cycle, and so rather than a real solution the public will receive rushed and flawed policy spun as a success by politicians hoping only for higher ratings at the polls.
And that more than anything, Snowy, is why I respond to these health care posts of yours with my nay saying. You are fueling emotional politics and urging on American voters for Universal Healthcare. First of all the kind of system you have in Australia isn't even feasible for us right now. And this isn't because it would fail. It is because no politician will offer it. Instead, they take this uproar about healthcare and respond with different policy that they think will make it through Congress.
The way to hell is paved with good intentions, Snowy. I'd rather this problem be solved, than just some more of the same old crap that typically comes out of Washington. Until at least the lobbyist problem is taken care of I don't believe public healthcare will improve our lot.
Access to health care for all is not some utopian dream, as other countries have shown. For this reason, it should be the catalyst to address all the obstacles you mention, not shunted aside as a lower priority. As I said before, the threat of being bankrupted by medical bills is no way to live. This threat should unite conservatives and liberals alike to find a more humane system. We are, after all, just people trying to survive, despite all the labels that are hung on us.
And why is it so necessary that I should be converted to your way of thinking? Is it just possible that you may be wrong?
I am not opposed to the process starting now either. I just don't need one of the presidential candidates enacting their disastrous healthcare plans. THAT is the problem, Snowy. And it is not a matter of converting you to anything. You just need to see what the results are. Simply look at the plans put forth by Obama and Clinton.
That is what these emotional politics lead to now. So, no, I'm not wrong. I'm aware of what is happening right now. Since you aren't in the US, I thought it might be helpful for you to understand the political landscape.
The thing is... I am not against the idea. I'm not saying to wait. You should know that when you go off on the "good health" sermon, that I am well aware of what you are talking about. You're singing to the choir. I have told you this before. So spare me, or I'll start preaching to you clean living, and exercise. (For a taste: A surprisingly large portion of the health issues in the US stem from a lack of these two, and this problem is increasingly significant with childhood obesity as an example.) So no I am not saying to wait. I'm saying to cool off the emotional jets, and look at this rationally so that something good can come out of the desire for a public health initiative.
Because it is not true that anything is better than what we currently have. It can be worse. And what Obama and Clinton offer is undeniably worse - unless you work for an insurance company.
The months leading up to an election are the time to float new ideas, as politicians are at least prone to paying lip service to them at this time. The more activists can get Universal Health Care out there as an issue, the more chance a politician seeking votes will listen. I seem to recall that Ralph Nader's platform includes single payer universal health care. The more chance that Dem candidates see a leakage of votes to Nader on this issue, the more chance that they may commit to going further with their Claytons UHC than they intended.
Yes, I suppose that my anger at reading articles such as the above does tend to lead to a sense of frustration at the lack of progress towards to UHC. I suppose that venting here on Vox is more about making me feel better than anything else. At least I can say I tried, as futile as I know that must be.
And guess what kind of Health Plan he was proposing.....
I understand your frustration, Snowy. Truly because I live in this country.
But the two leading parties know they are on top of a broken system and so they don't even have to play real politics. Its all about image, emotion, and other BS. I find it hilarious when the repugs claim to be the rational party. What a laugh. But thats the kind of laughter that will lose me a lung. I've got somewhat decent healthcare, but I'd rather not push it THAT much. And with that, I gotta go.