This story was published in the Sunday Herald on July 26, 2009.
As his healthcare bill began to unravel in Congress, Barack Obama addressed the nation, to stress the importance of reform. It was a curiously bloodless performance. He used the well worn rhetorical device of a letter from a constituent, mentioning a “woman in Colorado who paid $700 a month to her insurance company only to find out that they wouldn’t pay a dime for her cancer treatment,” but it was only a passing reference in a speech that was too academic by half.
The next day, at a town hall meeting in Ohio, he seemed determined to make up for it. “The stories I hear are the first thing that I think about in the morning, they’re the last thing I think about at night,” he said, stretching credulity. But again, he inexplicably failed to tell them, wasting reform’s biggest selling point, which is that in America, everybody knows someone who has slipped through the safety net. Unless he can remind voters that the health system wrecks lives as it generates profits, his plan for universal coverage will be stillborn.
While Obama dealt in abstractions, his opponents went for the gut. On television, every other commercial is a scare story about government administered medicine. They are certain to be shown throughout August, now that Senate Majority Leader Harry Reid has conceded it will be impossible to pass a bill before the summer recess.
“President Obama and his gang cannot run the healthcare industry, and they will create chaos if they try,” crowed Bill O’Reilly on Fox News. “The folks know this, and that’s why the president is taking a beating. He does not understand that freedom trumps ideological legislation.”
The reality is more complex, of course. The non-partisan Kaiser Family Foundation’s tracking poll found that 56% of Americans think reform is more important because of the recession, but 54% are worried that Congress will pass a bill that’s bad for their families. Obama has lost control of the debate because he has failed to make the case that people are suffering.
It shouldn’t be so difficult. Private healthcare’s failings affect everyone but the most privileged, whether through rising premiums, diminishing coverage, depressed wages or the financial catastrophe that often follows a serious illness or injury. Employers have seen medical bills rise 119% in a decade, to the point where the average employee costs $13,000 to insure each year. Workers pay around 30% of these premiums themselves, if they’re lucky. In the last two years, 60 million people have been without insurance.
I sent out an email to friends in New York, asking for anecdotal evidence about the healthcare system. Their stories illustrate a few of the ways that the free market model fails people, whether they are insured or not.
Art critic Adam E. Mendelsohn stitched his own face after being bitten by a dog, because he couldn’t afford a trip to casualty. He sterilised the needle himself and bought drugs in a pet shop, because “you can get amoxicillin and tetracycline from fish antibiotics.” As a freelance writer, insurance is prohibitively expensive for him. “If there’s something wrong with you, the first place you go is the internet, not a doctor,” he says.
Gemma Hoffman, who asked us not to use her real name, had good insurance, but when she suffered chronic back pain following a road accident, her specialist demanded additional payment. “The day before my operation, when I was on all kinds of medication and didn’t know what was going on, he had me sign a form that waived my network benefits and agreed to pay him $6,000,” she remembers. When she found out the procedure was covered by her policy, she decided to fight. “The surgeon called me at home, on a Sunday, yelling that if he accepted the amount offered by my insurer it was going to put him out of business.”
Oliver Helden and his wife Susan were bitten by a rabid dog on holiday in Zimbabwe. They had the first vaccine injection for free, before leaving the country, but required a course of seven more each on their return to the USA. “We didn’t have a way to pay for it, but that wasn’t our primary concern, because without the full treatment, there’s a high chance rabies can be fatal,” he says. Each injection cost $350, plus hospital fees. The total bill came to $7,000.
After holding fundraising parties at their flat and putting the maximum on their credit cards, they still couldn’t pay, so they declared bankruptcy. This is less unusual than it sounds: according to a Harvard University study, two more Americans go bankrupt every minute as a result of medical expenses.
I heard from a couple who were told to drive a hundred miles to their primary care clinic when their baby caught pneumonia because it didn’t qualify as an emergency; a woman who discovered a cyst on her ovary but can’t afford the follow-up scan and must hope that it is benign; a lighting designer whose insurer pays for genetic breast cancer screening, but will double her premium if the test comes back positive; a taxi driver who ruptured his knee playing baseball, but cycled to hospital on one leg because it costs $1,000 to call an ambulance. These are mundane, every day occurrences.
Phyllis Zolotorow, from Maryland, has spent half her adult life battling the insurance industry, on behalf of her son, who was diagnosed with cancer as a child, and her husband, who had a heart attack while uninsured. Considering her struggle, she is remarkably good humoured, with an incredulous laugh, as if she can’t quite fathom what has happened to her. “None of us can believe it, but that seems to be the way it is,” she says. “In this country? In Somalia, maybe, but in the US? It’s absolutely disgraceful.”
Her son, Craig, has Hodgkin’s Lymphoma. He was covered under the insurance she received through her job, as a florist, but the policy’s lifetime maximum was only $250,000. This lasted a year, after which he became uninsurable. “Who wants him? In a good year, if absolutely nothing goes wrong, his healthcare bill is $35,000.” A friendly nurse handles his monthly gamma globulin injections at home, as a favour.
Now that his family’s savings have been exhausted and both his parents are unemployed, he qualifies for the government welfare programme, Medicaid. He will start university this autumn knowing that unless the rules change, it is almost impossible for him to get a job without losing his health insurance, because employers will be wary of the increased premiums and Medicaid only covers the very poorest people.
His father, Mike, lost his job after a workplace injury and couldn’t afford to maintain his health coverage. Two years later, while trying to get fit, he started feeling sick. Phyllis wanted him to go to hospital but “he said ‘no, I have no insurance, I’m nauseous, it’s probably just a stomach virus.’” A week later he suffered a massive heart attack and almost died. It took two painful, hideously expensive years before he qualified for Medicare, during which the Zolotorows incurred debt that they can never pay off.
To Susan Starr Sered, author of Uninsured In America, this is a familiar pattern. “If you don’t have a good job and you get sick, you can’t access care, so your health deteriorates. When that happens you become less employable. This spiral has created a caste of the ill, infirm and uninsured,” she says.
Her research was conducted in the demographically diverse states of Texas, Idaho, Illinois, Massachusetts and Mississippi. Everywhere she went, she found people self-medicating with painkillers, alcohol or street drugs, using casualty as a last resort, waiting too long for treatment while tumours metastasized or kidney infections became acute renal failure.
“We interviewed people who’d gone to the emergency room with sharp stomach pains,” she says. “The emergency room did what they’re required to do by federal law: they assessed, discovered that the person had stomach cancer and sent them home to die.”
Employer-based healthcare is falling apart at an alarming rate. Policy journal Health Affairs estimates that seven million Americans will become uninsured in the next two years. If unemployment rises to 10%, as seems likely, another six million will lose their coverage.
“My concern is that so many people have lost their jobs – and therefore their healthcare – that there are going to be millions of Americans whose health is going to be so harmed that even when the country comes out of recession, they’re not going to be employable any more,” Sered says. “Stocks bounce back. Human bodies don’t bounce back.”
Last month, Wendell Potter, a former executive at one of America’s leading insurers, CIGNA, testified in Congress that “to help meet Wall Street’s relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick.” This was no revelation, but the source, a high level whistleblower, forced legislators to take notice.
From 2000 to 2007, profits at the ten largest publicly traded health insurance companies increased by 428%. The average CEO salary was $11.9 million. One year, the President of United Health made so much money that $1 in every $700 spent on healthcare in the USA went to pay him. With all this at stake, it is hardly surprising that the campaign to prevent meaningful change is so relentless.
Supporters of reform are not without resources or influential friends either, but in the deafening racket made by both sides, the voices of ordinary people living on the brink of disaster have been drowned out.
Vicki White quit her job at Walt Disney World, in Florida, to become a freelance estate agent, just as the market started to crash. Soon afterwards, her husband had a coronary at work. When he was forced to retire, they were left without coverage.
Their retirement fund is long since spent, on medication and cardiologist appointments. Vicki has stopped taking drugs to keep her cholesterol down, no longer has injections to control her allergies and suffers constant sinus headaches. “I’m just hoping and praying every day that I don’t run into a major health problem,” she says. “We just worry all the time because it would wipe us out totally.”
She has Republican friends, who tell her that “socialized medicine” means higher taxes and less choice. “My feeling is that most of those people who are complaining about government-run care have good health insurance and no clue, no idea what it’s like for people like us,” she says. “We’ve worked hard all our lives. We didn’t plan to be in this predicament. They’re naive, because they’ve never had to suffer.”
As a Brit, living in the USA without insurance, it’s easy to get nostalgic about the National Health Service. Settling by debit card after a routine check-up, you forget that the alternative, back home, is a bloated bureaucracy run by overworked, underpaid doctors and nurses, which makes people wait in line, rations care according to need and sometimes withholds life-saving treatments, seemingly arbitrarily.
I have only been to hospital once in New York, after slicing open my finger. After a three hour wait and an interrogation about how we proposed to pay, they x-rayed my hand and put in four stitches. The bill came to $800. When I went to have the stitches taken out, the doctor demanded $100 up front, in cash. “This is my first experience of the American healthcare system and I’m shocked,” I told him. “Oh, trust me, it stinks,” he replied. We now have insurance, which costs around $700 per month and is far from comprehensive.
Like most people raised in Britain, I’ve sat through a trip to casualty that dragged on all night, waited months for knee surgery and heard disturbing tales of institutional dysfunction from friends in the medical profession. But after experiencing for profit healthcare, and hearing from its victims, I’m convinced that however imperfect the NHS may be, it is something to be cherished.