Ignorance Goes On...

Today I attended a lunch for society ladies. Interesting stories always emerge when I tell society people about wanting to work in health policy, and this meal was no exception.

The current display of ignorance was on the reality of being uninsured. The woman I talked with didn't truly understand what it meant to be uninsured until her housekeeper had a health problem and couldn't get seen by a doctor.

She turned to me, "Did you know that if you're uninsured the hospital and doctors won't see you? Isn't that unbelievable? I had no idea! I just thought they'd see you!"

I responded, yes I knew that. Hospitals and doctors are only required to see you if you are in immediate danger of dying or giving birth. And even then they're allowed to bill you for the services you used. There are 46 million people in this country without health insurance, and that's how hard it is for them to get care.

"But we cover kids, right? Kids have insurance."

"Yes, we cover kids. Not that it does a lot of good if their parent is so sick they can't work or if they die. A healthy kid doesn't mean much without a family. So what happened to your housekeeper?"

"Oh, we got her into see [insert well known wealthy KC doc here]. He saw her no problem."

That was the real kicker -- this woman was unlucky enough to be uninsured, but lucky enough to work for some of the wealthiest people in the city, and therefore go in to see a family friend for treatment. If the housekeeper needed surgery or expensive treatment, this family wouldn't help her. Not that they should -- $70,000 is a lot to spend on your housekeeper. But the simple fact that she's employed by them is one major reason she doesn't have health care. I didn't get the impression that the housekeeper was an immigrant. Maybe she wouldn't have been able to find a job that provided insurance -- but she certainly has no chance staying where she is.

It's unbelievable that people in this country still don't realize how serious it is to be uninsured. A member of the upper echelons of Kansas City wealth was shocked, shocked that her housekeeper might not be able to go to the doctor at all. I hope she lost sleep over it.

Comments

[Jim S]

My employers are your basic conservative Republicans. In a discussion on this issue the CFO says that if someone can get into the ER then they have health care and it's OK. It really amazes me that they don't understand what that really means, that the ER will do nothing for anyone unless it's as dire as Kate posts.

[nancyirving]

By the way, if I find a lump in my breast, or blood in my stool, that is not an "emergency," by the definition of emergency that applies here.

It's not clear at what point cancer becomes an "emergency." I guess not until you're screaming with pain, can't breathe, have fallen into a coma, etc. What is clear is that you wouldn't be entitled to treatment until long after the point where treatment would have a chance of curing you. So effectively, you are sentenced to death.

[ArchTeryx]

Yep. That's what people don't seem to really understand about being uninsured. Yes, if you get hit by a bus, the ER will give you lifesaving care no matter what your insurance situation. They'll save your life at the cost of your financial future -- or bankruptcy at the least.

But if you get ANY sort of chronic disease, be it cancer or ulcerative colitis (as I have) it's a sentence to death by slow agony, unless you're lucky and persistent enough to find and get into a free care clinic. They do exist, but are extremely spotty, overwhelmed with patients, and going downhill fast in our laissez-faire society.

[C Smith]

My mom doesnt have health insurance. She had some kind of kidney stone, went to the hospital, and then got a 7,000 dollar bill in the mail. As an added bonus, she got a staph infection that they initially refused to treat, but relented when she threatened legal action.

The weight of the uninsured is hanging over our country like a building about to collapse. Eventually the pols will have to notice. Hopefully. If not, then this country isnt worth saving.

[stillonmt]

I also think that part of the problem is that many people do not understand how expensive it is to get health insurance. My dad who is in his mid 80's just cannot absorb that for two adults and two children I pay over $1000 a month. That is with a a BCBS group and since I am self employed I pay all of it.

[Scorpio]

Heck, even with insurance sometimes our vaunted "system" is a real pit. One person I know found a breast lump, and the doctors in her city told her it would be a month before they could fit her in. Fortunately she had family in the medical profession in KC which was an hour down the road, and they got her in to see a doctor the same afternoon. She was out of surgery a month before the "normal" system would have given her a first look.

Another guy I know waited to see a doctor until he had health insurance, despite vomiting blood and losing 100 lbs. He had his insurance two whole weeks before he was dead of cancer.

There's a lot wrong in this country. Insurance only helps some of it.

[Bob Burkhart]

I developed a quarter-sized tumor on my right cheek in March of this year. I am unemployed and uninsured. I went to Lahey Clinic here in Massachusetts, where surgery for skin cancer was performed within two weeks. I was asked about my insurance status before I was diagnosed.

I'm now free of cancer, without any sign of facial surgery, thanks to a skilful surgeon and her assistants.

As I wrote, I'm unemployed, hardly well connected.

For those who read blogs as I do and still are surprised at the confident passage of misinformation.

Bob Burkhart

[Kate]

Bob, no offense, but how did you pay for that surgery? Because it must have been extremely expensive.

[Lis Carey]

Lahey Clinic prides itself on not turning away patients in need of treatment. Not everyone lives in close proximity to a first-class medical facility with similar policies and similar fundraising abilities.

[Onetrue]

With all due respect Bob, just because you were seen, doesn't mean everyone is as lucky as you.

FYI, even having insurance doesn't guarantee being able to afford health care. This past March I had a bicyle accident that in addition to care for a rib injury caused me to have to root canals. I'm on the hook to the tune of $1600 even though the dental work was a direct result of my accident. At $50/month, I'll be paying on this for quite a while.

[Kevin]

You should've asked her if she provided any kind of health coverage/insurance assistance as an employer... mildly fatuous question, but it would've been nice to see her squirm

[Kent]

If you have insurance, you MAY not be able to see a doctor. But you may. It all depends ... on a lot of things.

I didn't have insurance when I got an ingrown toenail (twice), but I got in to see a doctor. It cost some money each time, but way less than even a month's worth of health insurance!

I know, I know -- this isn't a serious case. But Bob Burkhart is correct. Saying "no insurance = no see doctor" is false.

[Dick (no, not that one)]

There's no doubt one can see a Dr. without insurance if one can pay for it up front. Most primary care physicians where I live have a pay up front policy. The problems arise when there are conditions more serious than in grown toe nails. For example, if a person has a herniated disc in their back, he can pay a family practice physician $100 to examine him and be told he needs an MRI, and a referral to a nuerosurgeon.

The hospital will not perform the MRI without insurance or $3000 up front. The nuerosurgeon will not see the patient at all without insurance. The hospital, the Surgeon and the anasthesiologist will all refuse the surgery without insurance because although the condition causes extreme, unrelenting pain, it's not life threatening. The patient by this time is not working and unable to provide for basic needs, much less $50,000 in medical care.

Most people can handle the routine matters without insurance. It's the conditions which require diagnostic testing, specialists or surgery that no one can handle without insurance and can't be seen for.

[Mara]

Bob was lucky. We shouldn't have to depend on luck in a country as wealthy as ours. We need single payer health insurance where everyone is covered. It's not as if what we have now is anything to boast about: we spend 14.2% of our GDP on healthcare, have higher mortality at birth than most other European countries, shorter life span, and still have 46 million people who don't have access to the systm. That's just nuts.

[Cal Gal]

If Congress won't go for single-payer, why don't they just let all of us into the federal employees health system (the one they're in) if we're willing to pay for it?

[Mara]

Cal Gal,
Good idea. Is it gonna happen anytime soon? Don't think so. We've got the best guvmint money can buy.

[J Bean]

My aunt is crazy. She is also a Republican and feels that Medicare is "socialized medicine". So even though she is over 70 she pays cash for all of her care including a partial colectomy for Duke's B colon CA. Fortunately she is also a trophy widow (she was a trophy wife, but the old guy died) and can do stuff like that. She'd be surprised to find out that she can't get medical care because she doesn't have insurance.

I used to pay cash for my Pap smears because I didn't want the guys that I worked with putting their fingers down there. Gross, but my employer only provided HMO insurance so I would walk across the street to another OB and pay cash. They never refused to schedule me; when they asked for my insurance I just told them I was paying cash. Perhaps things are different in California? I used to pay for my non-plan dentist when I was an engineer too. It was cheaper than getting the dental insurance that would cover my dentist. Again, no problem paying cash.

[Kate]

J Bean,

I'm glad you and your aunt can pay cash for your health care. Most people are uninsured because they can't afford insurance, let alone colectomies.

This woman couldn't get seen because she didn't have enough cash upfront to pay for the vist. The problem with being uninsured is much different if you have money. Although if you get in a bad accident, few people have the cash lying around to cover that kind of treatment.

[Eclectic]

Always nice to see people prove the poster's point. Here comes the relatively affluent claiming that since they can pay cash for health care they are let in the doctor and somehow this disproves the poster's point. How sad. So many people, including a couple commenters here, have no idea what it is to be part of the rest of the country, without cash on hand for surgery (!) or medical insurance. Sometimes I hope these folks end up in a world of hurt just so they can wake up and feel empathy for once in their lives, even if it is only empathy for themselves.

[Mara]

And yet, it's these folks with money who don't want universal coverage for those who can't afford to pay for treatment. That's compassionate conservatism for ya'!

The sign of a civilized country is not how they care for the healthy and wealthy. It's how they care for the sick and the poor. We rank with the likes of Burundi and Tasmania (actually, Tasmania probably has better health coverage than we do as it is probably on the same plan as Australia).

[nancyirving]

J Bean, you didn't answer my question: would you let them run a tab?

[hmmmm]

here's to your universal health care, via wsj (i know, satan):

London's Daily Telegraph reminds us why the idea of government-controlled health care is a terrifying one:

People who are grossly overweight, who smoke heavily or drink excessively could be denied surgery or drugs following a decision by a Government agency yesterday.

The National Institute for Health and Clinical Excellence (Nice) which advises on the clinical and cost effectiveness of treatments for the NHS, said that in some cases the "self-inflicted" nature of an illness should be taken into account.

If you aren't scared by the idea of Hillary Clinton or Mike Bloomberg deeming you unworthy of medical care because of your bad habits, imagine how the "religious right" would treat AIDS patients if they gained power under such a regime.

[nancyirving]

Bob, you are lucky to live in Massachusetts which, as the Publicans keep telling us, is a socialist state. Not to mention one of our wealthiest states, and bursting at the seams with medical facilities funded by rich philanthropists. Most of them Deocrats, by the way. My advice to you is, don't move until you get insurance coverage. Boston is the medical capital of the world; you don't want to know what it's like out in the hinterlands.

[Nancy Irving]

The point being, Americans shouldn't have to be lucky to get medical care.

[Can't Get Insurance]

It's astonishing to read posts by people with some money who say that not having insurance is no problem. What the hell is wrong with you people? You think having the money to pay for a freakin' hang nail is the same as having the money for heart surgery? I don't know if these people are stupid or deliberately ignoring reality. Or perhaps they have a psychosis arising from a significant disconnect from reality.

I don't have insurance and can't get it. I have the money to pay for it, but no one will sell it to me. I seem to have a mild, benign neurological condition -- it's not been diagnosed, a doctor just suggested that I have it -- and can't get insurance as a result. Carriers refuse to cover my daughter because we took her to the doctor when she complained of painful periods. She had some tests done and they all came back negative. The OB-Gyn said that she was fine, just having painful periods. Too bad . . . no coverage for her. My wife was injured at work almost two years ago, so she's on workers' comp -- we can't get her any other health insurance. Our son (19 years old) is the only person in our immediate family who can get coverage. Just as he got coverage at work -- he got laid off.

Since I make a pretty good living, we've been able to pay for some fairly expensive experiences -- such as our daughter's tests -- ourselves. But, that's just because we're lucky. I feel like I'm walking a financial tight rope. The first significant gust of wind will blow us into the abyss. We'll loose everything.

And for you dumbnuts who think it's just grand to pay for hospitalization yourself, instead of having an insurance company pay -- here's a fact I haven't seen in these comments yet: Hospitals routinely charge uninsured people 5-10 times as much as insurance companies. I'm not kidding, it's true. So that woman who paid for serious surgery herself -- she probably got royally screwed.

Oh, and you guy who thinks you got off so well with getting surgery without paying for it up front. If the hospital, and doctors, who performed those services for you are anything like the vast, vast majority of medical providers in the country, they will hound you for the rest of your life for the money. They'll charge you ten times more than they would have charged an insurance company, they'll charge you interest and collection costs. They'll sue you, get a judgment and take your wages when you're working again. And don't think about going bankrupt, that safety valve is largely gone. Man, I hope for your sake, that medical provider is the one in the country that will actually just give you such services.

The health care system in our country is broken. People are dying and suffering so that others can earn obscene profits. Enough already. We need universal health care.