Health Care System Cost in the United States Leaves Many Uninsured

By HAYLEY SKENE
EL NUEVO SOL

Part of what sets this country apart are our constitutional freedoms. The U.S. was founded on the principles that people have the right to make their own choices, pursue their own dreams, and the federal government should not impose on these freedoms. This is a beautiful idea, but it has aided in the slow development of major problems in the health care system that we have today. Our privatization of the health care industry has driven up the cost of medical care and services, and so many people cannot afford coverage, or choose to do without it until they have a major health issue and it is too late.

Created by Hayley Skene. Data from the Commonwealth Fund shows how much different countries spend in each category of health insurance or payment

On July 2, 2012, Congress upheld the Patient Protection and Affordable Care Act, which will have major implications for the future of health care in the United States. But before we consider the benefits or flaws with the PPACA, it is important to understand the history of health care in the U.S., and how our system has differed from the rest of the industrialized world.

According to the Yale Journal of Medicine and Law, when the U.S. was founded, Life Insurance was a prevalent industry. More specific health insurance plans did not actually emerge until the 1930s. Prior to this, health care quality was so low that hospitals were often a last and unreliable resort. Scientific advances in medicine such as vaccines and x-rays built public faith and reliance on the medical field. Medical licenses were established by the American Medical Association in 1904. Higher standards for medical practitioners led to fewer doctors, which resulted in higher costs. The propensity for dissatisfied patients and their loved ones to sue doctors and hospitals when treatment fails has also contributed to higher costs of medical care.

The U.S. health care system has been continually evolving. To better understand our current system, it is important to consider the development of our health care throughout U.S. history.

As of 2012, there is no universal healthcare system for U.S. Citizens. From all aspects of medicine and treatment, health care in the U.S. is the most expensive in the world. Today, many U.S. residents are without health care. According to a recent Gallup poll, 25 percent of the population in Texas is uninsured. The state with the most people covered is Massachusetts, and despite a state mandate that all residents obtain health insurance, at least 4 percent are without coverage. According to the U.S. Census Bureau, about 19 percent of non-elderly adult residents of the U.S. are uninsured.

International Comparison:

The Commonwealth Fund is a private research organization with a mission to provide a cross comparison of international healthcare in hopes of informing better healthcare policy in the U.S.. Since 1998 researchers for the CWF have surveyed healthcare systems in the U.S., Canada, the U.K., Australia and New Zealand.

Data based on research composed by David Squires of the Commonwelath Fund

Commonwealth Fund researcher, David Squires, lead author of The U.S. Healthcare System in Perspective: A Comparison of Twelve Industrialized Nations, said that the higher costs apply to medicine, doctor’s fees and use of technology such as CAT scans and MRI’s. However, despite the higher price the people pay for care, “the U.S. doesn’t seem to be performing better than the other countries.”

According to Squires, “there’s a lot we can learn from a lot of other countries… Japan spends about a third as much money on health care as we do and they have the longest life expectancy in the world.”

Squires explained that in some areas the U.S excels, such as life expectancy rates after the five year mark with breast cancer patients, but cervical cancer survival rates are lower here than in other countries.

Australian native, Ian Cameron is a realtor for Prudential in Thousand Oaks, Calif. Cameron came to the U.S. when he was 38 years old, but he lived in Australia when the country made the switch to universal healthcare in the 1970s. Cameron described the Australian healthcare system as comparable to Medicare for all residents. Cameron said the doctors and medical providers would put the charges on the card, and the government would essentially pay off the balance, using the pool of taxes which all working residents contribute to.

According to Cameron, “there wasn’t any perceptive difference in terms of the quality of medicine under Medicare versus the alternative. Now you could get…’gap insurance’; Medicare would get you a bed in the public ward, and there would be four beds to a public ward. With gap insurance you’d either get a private room or an intermediate. So you could pay more to get a little more. But it was just to be at the top end. Not a lot of people did it… it wasn’t that extensive.”

When Cameron and his wife Caroline moved to the the U.S., they were able to have health coverage for several years through his employer. Now, he and Caroline have only “catastrophic health insurance,” and even that has a $5,000 deductible and provides very minimal benefits.

Thousand Oaks residents Julie and Alan Derber grew up and married in England. Julie says that when she was a child, her older sister went through three years of cancer treatment under the national healthcare system. According to Julie, her sister received excellent and comprehensive care. Coverage under the national insurance paid for a cancer treatment drug, Ceftin, which Julie said would cost about $50,000 out-of-pocket.

Alan Derber said that his father was diagnosed with brain cancer, and England’s universal healthcare saved his life at no extra charge.

“The obstetrician found that he had brain tumor. He was taken to a special hospital in London and they called a surgeon over from America. And he lasted until he was 82, and was fine after the operation… he was cured from that tumor… it was completely national health services, it was free.”

Julie and Alan moved to the U.S. when she was 23 years old. “We probably didn’t have health insurance for the first few years that we got here,” Julie explained. The couple eventually did give in and paid the high premiums for a healthcare plan in 1991 when their son, Lee, was born. Julie believes it was more affordable at the time because she and Alan were younger.

“We don’t have health insurance right now… anytime we had anything, we still had to pay the first $3,000 per person out of our own pocket….we just couldn’t do it. If I’m paying $12,000 a year, I don’t have any money left to go and get what I really need beyond that. So we just said ‘forget it for now, we’ll wait for Alan to be on Medicare, and I’ll have to figure something out for myself,’” Julie explained.

For Julie and Alan now, even catastrophic insurance is not affordable. Julie thinks the political structure of the U.S. is to blame for the flawed system of optional private healthcare.

“We’re the only country in the civilized nations that doesn’t have free health insurance for all. That’s got to tell you something about this country. It’s all to do with special interest rights. It’s all about money. How’s anything going to be ‘for the people’ when that’s how things are run in Washington?”

Dan Douggan has lived in the province of Ontario, Canada his entire life. He says that Canada also has a universal healthcare program which provides care for all residents. Each province organizes and regulates healthcare for their residents; the provinces function similar to how states work within the U.S.. In Canada, the federal government requires each province to provide for a universal healthcare plan, but each province has its own system. The government collects funding through workers’ wages. Douggan said that the healthcare system has always provided excellent care, but he has noticed a few areas where the system seems to be failing.

“We’re covered for prescriptions by the government, so we pay absolutely nothing,” Douggan said. He explained that it has never been a problem to get an appointment with a primary care physician immediately, but he has noticed that actual treatment is difficult to obtain with urgency.

“I had problems with my knee, and I had to have surgery this summer, and I had to wait four weeks to see a specialist, and another seven after that. But all of the surgery was done at no cost to us whatsoever,” Douggan said.

Douggan explained that Canada also has less advanced equipment available, such as MRI’s and CAT scanners. Often times, Douggan and his family have had to travel to Buffalo, New York for more comprehensive diagnosis using such equipment. Of course, these treatments and services had to be paid for out-of-pocket.

Reliance on Private Insurance: Is it practical?

Carolyn Bereny is a health insurance broker for Van Go Insurance in Ventura County. Bereny helps individuals, who do not get insurance coverage through work, to find affordable plans. Bereny also helps small businesses find insurance plans for their employees.

“I think there are affordable options,” says Bereny. “Pre-existing (conditions) can be an issue.”

Bereny says, thanks to the PPACA, people 19 years old or younger are protected by “guaranteed issue,” meaning they cannot be turned down for insurance because of a pre-existing condition, but because of the segmented issuance of the PPACA, those over 19 have no such protection yet.

“So if you’re 20 and have had bronchitis, and use a machine at night, and take an antidepressant…it’s very possible that they could decline you coverage, which makes it really tough,” Bereny explains.

Bereny says California residents now have the option of PCIP, a pre-existing condition insurance plan offered by the federal government. There are a few guidelines for PCIP. People have to have been uninsured for six months, be a U.S. Citizen, and have been declined by a traditional carrier in order to qualify for the PCIP.

“It’s a good place to guide people to because I always feel terrible when I can’t get people coverage,” Bereny says.

Bereny can relate to those who choose to not purchase health insurance.

“When I was in my 20s and I was scraping to get by, if the bills came and it was between $60 for my health insurance or pay for a car payment…the health insurance would go. So, I personally think that when you’re young and healthy you think you don’t need it. Why should I spend the money for something that I don’t have?…But the problem is there’s a risk pool. And if we’re all putting into the risk pool, then the money is there for when things go wrong. You can’t expect to get diagnosed with something and just start paying $50 a month and get a surgery. At least here, that’s not how our system works.”

Bereny says that because of the PPACA, our system is in the process of changing.

“In 2014…there will be what’s called health exchanges and those are going to be run by the government, and individuals are going to be able to go there, businesses are going to be able to go there, and they say they’re going to have competitive prices to insurance companies. The interesting thing is that the insurance companies are going to be the ones participating in this government program.”

But despite all of the aid that the state of California has provided for those with part-time jobs or lower income, many still cannot afford care. According to a 2012 Gallup Poll, California has more residents without health care coverage than almost any other state.

Created by Hayley Skene. Data from a 2012 Gallup poll

Many people rely on free health care clinics for their health care needs. Therapist Louie Rosado recognized the need for medical care, especially in Los Angeles County. He started a non-profit organization, Medical Mission Adventures, which serves medical, dental and prescription treatment to those in need throughout Los Angeles County.

Some of the sections of the PPACA are already in effect. Adults up to age 26 can stay on their paternal family health plan. The Medicare “doughnut hole” gap has been reduced. In 2012, we may actually see major changes in the number of people uninsured, as the federal government will take an active role in providing affordable options through health exchanges. How this will change our nation is yet to be seen.