250 million, Insured But Still in Trouble 

The health-care crisis for the rest of us

NEW YORK--Some people are just cheap. Others are playing the odds, reasoning that paying for doctors and prescription medications on an ad hoc basis will prove cheaper than the $500-plus per month they'd have to shell out for health insurance. But most of America's 47 million uninsured live and die without coverage because they can't afford it. Worse than a national scandal, our failing health-care system is an international disgrace. Hundreds of thousands of Americans are so desperate that they travel overseas in order to leech off socialized medical care systems, which are prevalent in other industrialized nations.

"We are overwhelmed by you (expletive deleted) Americans," an exasperated emergency-room physician at a Canadian hospital across the border from upstate New York told one of my friends, whose girlfriend had driven him the eight hours from Manhattan to Quebec after he'd fallen down some stairs and broken his arm.

We are Canada's Mexicans.

Fortunately we have our first chance to fix the sorry--more like non-existent--healthcare system since 1993, when the Clintons botched things up with a convoluted scheme designed to protect insurance industry profits. Democrats won control of Congress with two promises: getting us out of Iraq and fixing health care. A USA Today/ABC News poll conducted two weeks before the midterm elections found 80 percent dissatisfied (60 percent highly dissatisfied) with the staggering cost of health care.

Staggering it is. In 2006, insurance premiums for an employer-sponsored health plan for a family of four averaged $11,500, more than the net annual salary of a full-time employee who earns $8 per hour. Americans pay over $2 trillion per year--four times the federal defense budget--on a health-care system that sucks. And the cost keeps going up, two to three times faster than inflation.

Even the Republican Party, hard-wired to oppose anything that might end up helping someone who needs help, is starting to take notice. Arnold Schwarzenegger, the centrist Republican governor, got such a boost from his proposal to provide insurance to California's 750,000 uninsured children, including undocumented illegals, that he expanded it to cover adults as well. As The New York Times editorialized, "putting children first is a good start, because they are usually healthy and cheaper to cover."

It's obviously outrageous that tens of millions of citizens of the wealthiest country to have ever existed in human history are one cluster of metastasizing cells away from bankruptcy. Did you know that 25 percent of mortgage foreclosures result from high medical bills?

But there's a second, even bigger healthcare scandal that no one ever talks about. There are 250 million other Americans--those of us "lucky" enough to have health insurance--who aren't much better off than the uninsured.

Workers and employers pay an average of $465 per month each to insurance companies who use every shady trick in the book to avoid paying out claims. Pre-existing condition? Not covered. Don't want to drive hours to see a doctor who belongs to your plan? Pay out of pocket. Suffering from an unusual condition that requires the expertise of a high-priced specialist? Denied. You might think a chronic condition calls for long-term care, but to a claims analyst, it's merely another excuse to refuse to pay up.

Every now and then, you luck out. Odds are, however, that your deductible will eat up your payout.

When an insurance company hack can't invent a legitimate excuse to turn down a claim, they do it anyway. They play the odds, assuming that most petitioners, baffled by Byzantine voicemail trees, impenetrable Web sites and endless wait times, will be too discouraged to pursue appeals to rejections of their rightful claims. They want you to simply go away.

Let's not even talk about vision or dental plans, which have become rare benefits offered by fewer and fewer employers. Hey, it's not like eyes or teeth are important.

Even the military, which uses health-care coverage as a recruitment tool, is welching on its duty to treat illnesses--even those it causes. In December 2005, Private Bradley Brown went to an Army doctor at Fort Sill, Oklahoma, complaining of back pain. Brown told the South Bend (IN) Tribune that "the doctor gave him an anti-inflammatory nonsteroid prescription for Naproxen and shot dye into his veins for radiographic (X-ray) studies."

Two weeks later, he was in an Indiana emergency room, a victim of near-fatal IgA Nephropathy, also known as Berger's Disease, as well as acute tubular necrosis--which is caused by "a number of things, two of which are reactions to dye used for radiographic studies and nonsteroid anti-inflammatory medication." Bradley requires a kidney transplant, but the Army--which threw him out of the service and refused to pay him wages while he was fighting for his life--said no. "I don't know how this is allowed," says his mother, who is hoping the Army will help a vet whose own procedures left him with a stutter and memory loss. "I sent them a perfectly healthy child. Now we have a broken one."

My favorite personal tale of health-care perfidy involves a relatively trivial problem: a wart on my left hand. My dermatologist froze it off with liquid nitrogen and billed me $150. After I filed a claim, the insurance company issued a rejection, tersely noting: "non-essential procedure." It took an hour and a half on hold and three letters before I was granted the privilege of discussing the issue with a flesh-and-blood representative. "Is it your policy that people shouldn't treat warts?" I asked.

The insurance company woman, who gave her name as Becky, was polite but firm. After all, they paid her to be obtuse.

"This kind of procedure isn't essential," she (sort of) replied.

"I want to make sure that I understand this," I explained. "You're saying that, if your customers get a wart, they should just live with it?"

"I'm not saying that."

After a tortuous exchange, she conceded that any wart, no matter how large or unsightly, would be removed at a patient's expense or not at all.

"What if I told you that a wart nearly killed me?" It's true. When I was in college, a wart appeared on my chest. Twenty-four hours later, I landed in the emergency room, receiving a transfusion as curious physicians gathered to gawk at the Incredible Killer Wart. The wart's root had pierced an artery, spraying blood on the wall of my girlfriend's dorm room. Fortunately for me and less so for the Republican Party, I woke up and called for help.

Finally, it occurred to me to ask her where she was. "I am in Bangalore [India]."

"Whatever, 'Becky.' Try not to catch any warts."

The solution is obvious: nationalize the health-care system. Doctors and nurses should be federal employees. Hospitals should be healing centers, not for-profit corporations beholden to shareholders. If socialized medicine is too radical, however, there's always the single-payer system. The key, in that case, is to put the insurance companies--which are squeezing doctors and patients alike--out of business.

The unbridled greed of corporatized health-care is breathtaking. United HealthGroup, currently listed as No. 37 on the Fortune 500, earned $3.3 billion in net profits in 2006--up 28 percent from the year before. Wellpoint made a whopping $2.5 billion, a 157 percent increase. When is the last time you got a 28 percent raise? 157 percent? It's blood money, pure and simple. How much profit is generated by the death of an uninsured or undertreated American?

These rapacious entities are even worse than the oil companies. After all, you could move to a city with mass transit. You don't have to buy gasoline. But Private Brown needs his kidney transplant no matter what. This isn't Mali. We can afford it.

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