What it's like to be uninsured

When I was in second grade, I got health insurance for the first time. I remember my parents—with looks on their faces somewhere between proud and relieved—telling me that it was now totally okay to fall out of a tree and break my arm. Frankly, that didn't sound like much fun, so I never took my parents up on the offer.

It's only years later, as an adult, that I really understand the significance of that event. I honestly have no idea how my parents paid for the regular preventative check-up appointments I remember going to. I have no idea how they paid for the time I smashed my finger between the hinges of a door and ended up in the hospital. The fact that those things happened, at a time when we had very, very little money and no insurance, gives me a little bit of a retroactive sense of budget vertigo. Did my parents lose sleep over this stuff? In all likelihood, yes. It's a wonder I was allowed to climb trees at all.

Since I was a kid, the costs of healthcare—and the cost of insurance—have increased dramatically. And that's widened the gap that people fall into, when they make too much for Medicaid, but can't afford insurance. When I was uninsured, my mother was a home daycare provider and my father was a bartender. Today, it's perfectly possible to have a Ph.D., have a decently paying professional job, and still have to make some terrifying budgetary decisions that leave you and your children without health insurance.

Kevin Zelnio is one of those people. He's a marine biologist who left academia after a string of contract teaching jobs—positions that come with no security, no hope of tenure, and usually no insurance benefits. Today, he's a science journalist, blogger, and science communications consultant. But that means he's self-employed. And since his wife doesn't have insurance, either, that means his family has no medical safety net.

This is not a good position to be in. (And I'd be in the exact same position if it weren't for my husband's job.) The only health insurance Zelnio's family could afford is high deductible—leaving them to pay thousands to an insurance company every year, in exchange for only the promise that, if the Zelnios spend more than $5000 or $10000 in a year, the insurance company will cover some percentage of anything above that. And, of course, that comes with a lot of caveats, because we all know that paying for large expenses is not something insurance companies like to do.

That's a situation that feels pretty hopeless. And it leads to people taking risks with their health that they shouldn't have to take. Kevin Zelnio has a post up on Scientific American that puts a sharp spotlight on this devil's arithmetic that every uninsured or underinsured family has to do. It starts with this question, based on Zelnio's real-life experience: If you didn't have insurance, how long would you wait to take your child to the hospital if they were extremely sick?

How do you balance your family's future financial well-being against the immediate health needs of a 5-year-old? That's a decision that nobody should ever have to make. If you don't remember a time when you didn't have health insurance, if you've gotten complacent in the security your current insurance provides, or if you just want further proof that our healthcare system is based around the wrong incentives and the wrong priorities ... you MUST read Zelnio's story.


  1. Thank Ceiling Cat for socialized medicine!!!!! Because of that, Canadians have the luxury of pointing at you guys and saying WTF, how can you live like that?

    1. For some reason, the US sees socialization as some evil commie practice. Maybe it’s because the right-wing god (also known as Ronald Reagan) was so firmly against it. 

      We already have socialized education, law enforcement, fire protection, road maintenance, retirement, and numerous other programs. The only reason our healthcare isn’t socialized is there are too many big players profiting from the current system. 

      1. and, a socialized interstate highway system built by that commie Eisenhower. The biggest public works project in history.  The irony is that Vancouver and Seattle are the same distance as Moscow and St. Petersburgh but you can get from Vancouver to Seattle in a couple hours – but not Moscow to St. Petersburgh because Soviet Russia did not invest in a highway system

        1. But not a socialized public transport system… Two trains a day and taking four hours for such what should be a short journey .

        2. Same distances? Seriously? It’s 3.5 times longer distance from Moscow to St. P. Although you won’t be able to make it in 6-7 hours due to the terrible traffic and stricter speed limitations.

          Yes, the roads in Russia are quite bad indeed, but it does not make your statement true.

      2. Education?  The US education system is one of the worst in the world and getting worse every year.  Law enforcement?  BoingBoing runs a few articles a week on just how fucked up our law enforcement agencies are, from local to federal.  Retirement?  The Federal (not counting states) government has some 60+ trillion dollars in unfunded liabilities in this area.  The way they “pay” for this retirement is by writing IOUs and printing money, causing the price for everything else to go up for everyone. 

        The government fucks up pretty much everything they touch.  That you insist on giving them more control of your own life is fine by me.  But don’t try to force others to share in your delusions that the same corrupt assholes who got us into this situation are anywhere near qualified to get us out of it.

        And I don’t have to wonder what it would be like to be in Zelnio’s position, I am in his position.  

        1. “And I don’t have to wonder what it would be like to be in Zelnio’s position, I am in his position.”

          And yet, I somehow get the feeling that you would oppose any effort to change that by instituting a single-payer system. If you would like to know what private industry is capable of, please do look back in history to the early part of this century and get back to us.

          1. And in so doing massively subsidized the trucking industry, the automotive industry, the oil industry, and singlehandedly created the urban blights known as ‘suburbs.’

        2. Your house is on fire, and they won’t turn on the hose until you pay them? It used to happen. Some areas of society should not be subject to unfettered capitalism. I believe health care is one of them. By demonizing government, you are arguing that profit is king. If you want government out of your life, you’d best get ready for MORE corrupt assholes, not less.

          1. During the heyday of Rome, sometimes for-pay firefighters would light buildings on fire, then demand payment to put the fire out, if business was slow.

            Although such departments already exist in the U.S., they’re a bad idea IMHO.

          2. that’s how the private fire brigades operated in 19th Century New York.  One of the richest Romans (Scipio?) did it as a business as well.

        3.  Compare to countries where education, law enforcement, and retirement are handled better than in the U.S.  Have those countries opted for privatization of those public sectors?  No, of course not.  They are all more socialistic than in the U.S.

          Many of the worst problems with U.S. education and law enforcement are the result of private corporations effecting a sort of regulatory capture of these industries, for example companies that manufacture riot gear and weapons lobby for the militarization of police forces, the for-profit prison industry lobbies for harsher sentences and laws that favor prosecutors, and text book publishers and education consultants shape much education policy.

          One of the biggest problems with education in the U.S. is that it is locally funded and administered.  The countries that outperform us educationally pretty consistently have national curricula and teacher development policies.  A little more socialism with respect to schooling would do us a world of good.

        4. And yet, somehow, other countries manage to have functioning government-run healthcare and education systems. Possibly because those countries take their commitments to their citizens seriously, and don’t allow for-profit rivals to sabotage their healthcare and education. 

        5. In what bizarro world is the US education system one of the worst in the world? Granted, we do worse on some measures than some of our main economic competitors in Europe and a few east Asian countries. We have our problems with getting good education to the poor. However, there is still all of central Asia, China, India, south America, and Africa. That’s a large chunk of the world. For example:
          US literacy rate: 99%
          Chinese literacy rate: 95.9%
          India’s literacy rate: 74%

          1. 99% is the literacy rate UNESCO assumes for rich countries without statistics. The United States is peculiar among these, and other estimates have been lower. Of course, it’s peculiar in precisely the opposite way from the nonsense ialreadyexist made up.

          2. The US literacy rate is 99%, and yet more than HALF of all Americans never read a book in their adult lives.

            They are literate enough to read a menu at McDonalds. ie, functionally illiterate.

            The US educational system is a disgrace, and has just gotten worse since the Dept. of Education centralized decision making.

          3. The problem is not simply what percentage of the population are literate but what percentage of those who receive a full education end up illiterate. China and India, I believe, would end up with a much lower percentage according to the second criterion. There used to be a respect for education which has been lost as working class organisation has been smashed by the right wing and many have lost a sense of identity. Politicians can then claim that it is not simply a question of money and withdraw funding, exacerbating the problem. Both commitment and funding are necessary.

        6.  Unfunded liabilities for retirement? I’m calling shenanigans. And medicare does a much better job of providing health coverage than the private insurance industry.

          Really. What are you talking about?

      3. I seriously don’t get the post-Reagan right wing.  I don’t get it.  I mean, I understand the part about acknowledging that government in the U.S. tends to be corrupt, and tends to squander money.  I also get the bit about being unhappy about having no choice in whether or not we’ll fund that corrupt system.  And finally, I understand how a person could be upset that the money that’s collected from them every year might end up, in theory, going into the pocket of someone who is poor because they don’t want to work and have no intention of working, and I understand that if they choose to be charitable, they’d like to be more selective in their giving. I understand all of it.  I think some of it tends to be based on misconception, and therefore I don’t agree 100%, but when framed that way, I understand.

        What I don’t understand is how a person can be against the social spending, be adamant that we shrink the government (I have no problem with this), and against Keynesianism, but then be perfectly peachykeen with spiraling military spending, and fine and dandy with a 40+ year war on drugs.  Both have ended up being a source of Keynesian stimulus, and both have ended up being government work programs.  If you want to set off a shitstorm of panic in my home region, suggest that we’ll be closing military bases around the world, and that the War on Drugs is being dismantled.  It’s unbelievable how many people here work for the military, the prison system, or some private company that services one of those two…and then, of course, there’s the ex coal miners who panic if they find out General Dynamics might not be getting the fat defense contracts anymore, because their pensions are dependent upon GD’s fortunes.

        Oh, and the top priority, right after defeating Obama, is on enforcing decency laws.  Because we’ve solved all problems, and now we can get on to fining FOX affiliates every time a woman on a TV show utters a fake moan of pleasure.

        Now, I know not everyone in the right wing feels that way, but when I look at the spread of right-wing Presidential candidates, and Federal-level politicians, and I see that many of them espouse these (to me) conflicting ideas, I can’t help but feel that the modern right wing is totally confused.

    2. Chuckleheads here in America actually seem to like it this way. 

      Back when Obama was trying to push his healthcare plan through, a group of family friends were filling up their dinner conversation ranting against socialism and all that commie bullcrap. 

      Flu season hits, and one of these guys gets sick. No insurance, it gets serious, and he eventually dies from it due to complications with diabetes. One would think that this would serve as a wakeup call to his surviving friends that maybe social health care is a good idea but, but nope. They maintain that the government has no right to spend taxes on healing people.

      The message I take is that, in general, Americans prefer to watch friends die over adopting socialism. It’s amazing how backwards this country has turned itself.

      1. Obamacare passed in crippled form.  You will be hearing a lot about it between now and November.  It’s certainly possible to disagree with a lot of the specifics of the program, but unfortunately the Republican position is just “repeal Obamacare” rather than “replace Obamacare”.  

        Does anyone know the specifics of “Romneycare” and how it differs, and how it has performed?

      2. In some ways, it’s not their fault.  They’ve been brainwashed by a well-oiled machine and I can prove it:

    3. I’m not joking when I say that, sometimes, you’ll see people running fundraisers.  I’ve even seen people putting cans in gas stations with an appeal to donate.

      My parents are 100% against socialized healthcare, at least in its present form.  Come to that, the way they act these days, I think they’ve forgotten that they were unable to pay for surgery to correct my lazy eye, and had to rely on a charity group to pay for it.

  2. I’m the treasurer of the local childhood cancer support group.  When our kid was diagnosed with cancer, we were some of the lucky ones with two employer-sponsored health insurance plans. We still have one plan, even after our lives were turned upside down by the disease and its treatment.

     However, many of the families impacted by childhood cancer have no insurance. Our tiny non-profit ends up paying some of these families’ utility bills and rent on occasion so they can survive through the ordeal without becoming homeless too.

    This is why I get so mad when people tell me that government-sponsored health care is a bad idea.

  3. I remember begging my parents to let me go to the doctor as a teenager. I had been sick for weeks with a terrible cough that just kept getting worse. Finally, with me in tears, they allowed me to go. It was expensive. I’m sure it went on a credit card. I’m sure it was heartbreaking to see me like that. My dad forged forms required from a doctor so I could play high school sports. I didn’t see a dentist from age 4-17. We were a normal middle class family and no one would have suspected we were one major medical accident away from financial ruin.

    When I was 17 my mom got a job with the school district, which she still has. With that came insurance and doctor visits, surgeries and dentists. Within the next couple years I had moles removed that were pre-cancerous, a much needed breast reduction to relieve a lot of other medical problems, actually going to the doctor when I had a kidney stone, and cavities filled. It was glorious. 

    1.  You say that “no one would have suspected we were one major medical accident away from financial ruin”.

      I think it would be just as accurate to say that most families don’t realize they’re one major medical accident–or illness–away from financial ruin. The only thing that might have made your family the exception is that you were aware of how close you were to ruin.

      There are a lot more families who are in the same situation you were in than most of us realize or would care to admit.

      1. I think it would be just as accurate to say that most families don’t realize they’re one major medical accident–or illness–away from financial ruin.

        And, they ironically vote Republicans and/or DINO’s into office that continually push them towards disaster.  It’s crazy.

  4. I can not understand why a democratic country like the USA does not enforce Health Insurance for anyone. I am selfemployed in Germany, I make 600 € a month, and I can pay my Health insurance, what is wrong in America ? A state has to care for its citizens, provide things like postal service and health insurance, how is it possible that someone fights, as far as I understood it, Obama tried to set up a State Health Insurance and was stopped. What sane argument can some have against a “Everybody has to have Health Insurance” ?

    1. Well, the laws known as “Obamacare” will force everyone to buy health insurance, even if they can’t afford it. (Unless they’re below a certain income cutline, at which point the government will pay for part or all of it.)

      It’s basically the absolute worst case, because right now, insurance companies have to limit their prices somewhat – otherwise, they’ll lose customers left and right. But, with forced purchasing of insurance, the insurance companies can charge whatever they want, and everyone has to pay.

      This is why capitalism and medicine don’t go hand in hand.

      Another argument against any form of socialized medicine, that a lot of people in the US make, is that could give the government too much control over personal actions (the idea being, if an accident that could cause broken bones would increase healthcare costs, any actions that could potentially cause broken bones would be either taxed very highly, or outright banned), as well as have a government-run “death panel” of people who decide whether you live or die if you have a severe disease that’s expensive to treat. (Never mind that death panels ALREADY EXIST in the existing capitalist health care system…) Also, I’ve heard claims that taxing 100% of all income in the US, and diverting it to healthcare would not pay for all the healthcare costs here. Almost certainly bullshit, but that’s the argument that people make.

      1. is it the worst case? one would have thought that the pre-existing conditions bullshit is worse, for those that have insurance and have been paying it for years only to find out that – ‘oh you had acne- sorry that disqualifies you. My dad had a faulty heart valve which he was born with and because of that would have been denied insurance in the US. Here in Canada he had open heart surgery to fix the valve, later a defibrillator put in, then he went on peritoneal dialysis for a couple of years.  I don’t know what it would have cost in the US but here in Canada it cost nothing.  Well maybe not nothing, we do have obligatory health insurance we need to buy, its $54 per month (and was only $35 per month up to about 5 years ago)  and I can tell you there are still people who don’t get it and get treated.   We also don’t get those skyhigh medical prices you are concerned about.  The reality is that Americans pay more than anyone else in the world and but have lower life expectancy  (than Canada) and other countries.   The real problem is that the insurance companies have no competition – a single payer system would make them all irrelevant and they know it.

        1. At least the insurance companies have to compete against each other.  A single payer would be an absolute monopoly.  And as higher education has proven, when the provider of a service knows that the federal government is going to keep paying no matter what, prices skyrocket.

          There’s a bit of chicken-and-egg situation regarding health care costs.  Does everyone need insurance because the prices are so high; or are the prices so high because everyone has insurance that someone else is paying for?

          1. Since Americans pay much, much more than about anyone else – even the socialists with their mandatory insurance – I don’t think that it’s the latter.

          2. I pay $596 per month for health insurance. Plus $25 for an office visit, $10 per prescription, $25 per x-ray, etc., $100 for a procedure like a colonoscopy, $100 per ER visit, $200 per day if I’m hospitalized.

          3. When a cost is mandatory it ceases to become insurance but in reality becomes a tax.  In the case of the U.S., this “tax” is paid to insurance companies.  I would love to have a business where every single person in the country is “required” to buy my product.

            The sensible thing would be to have a single payer basic medical system (with a nominal deductable) and let insurance companies have the non-life threatening parts (dental, vision, experimental, etc.)

          4. Which maybe means that things need to be socialized from top to bottom – even communized, as far as medicine goes.

            As in, the US government buying a drug company, developing, and manufacturing all drugs used in the US, and then the government owning all hospitals and doctors offices in the US (and doctors and nurses being employees of the government)?

            But, that gets into its own nasty slippery slope.

            FWIW, the preexisting conditions thing could’ve been fixed separate from the rest of Obamacare.

          5. A single payer would be an absolute monopoly.

            No, it wouldn’t.  The rich can still get privatized insurance.  The real “travesty” would be that average Americans would get health care and it would help stop 45,000 agonizing deaths per year.  Not to mention, all the productivity that’s lost.  Maybe one of those people (or the millions more who aren’t dying but are terribly sick) was the next great inventor?  We’ll never know.

            provider of a service knows that the federal government is going to keep paying no matter what, prices skyrocket.

            LIES. Other countries that have a single payer system for healthcare have far less costs.  Please educate yourself.

          6. Um no.  The prices are so high (simplistically), because of the ridiculous amount of administrative costs that providers incur just to have the privilege of doing business with the myriad of insurers, each with their own set of coverage, medical coding and billing rules on top of deductibles, co-pays, out-of-network rates, etc.  Pretty much every state in the country has a handful of viable commercial insurance options (outside of the federal programs) due to the cutthroat competition between the major players that ultimately screws patients (yes, docs and employers take some collateral damage).  The minimum of real competition allows for constant cutting of reimbursement rates relative to costs and lead the insurers to come up with their recent strategies of recissions and lifetime maximum benefits.  Like the bankers, the insurers gamed the system so there was little to no risk and then incrementally took more and more from employers and insureds.

            Regardless of your opinion regarding Obamacare, the major health insurers in this country deserve as much of our disdain as the financial industry.  Backdating stock options, taking advantage of loose regulation while flouting the actual laws and then settling without admitting guilt, outright fraud (see  http://www.ama-assn.org/ama1/pub/upload/mm/368/uhc-ingenix-qa.pdf ), ridiculous executive compensation, etc. – it’s all there.  A single payer system (while certain to have flaws) will alleviate the administrative burden on providers significantly and this will remedy the country’s pathetic costs vs. health outcomes than any other “solution.”

            Employer-sponsored health plans masked this issue for the past decade since managed care and capitation failed the first time.  After years of taking the brunt, employers have banded together to cut workers’ “benefits” (without recompense, of course), thereby passing the ridiculous year-over-year premium increases onto us unwashed masses.  So now, we finally are paying attention.

            The fact is, the healthcare reform can has been kicked down the road since Clinton stubbed his toe when he tried – the financial writing on the wall has been there for decades (the Baby Boomers were born a long time ago now, life expectancy has increased significantly since they were born [though, amazingly, it’s now going backward here in the States despite all of our scientific breakthroughs!!], and Americans are having less children to pay Medicare taxes – pretty cut and dried to foresee a funding shortfall considering).  Now the narrative has been changed from parasitic corporate abuse to socialist federal policy and/or our responsibility to our fellow countrymen to “if you’re not rich, that’s your own fault.”  

            It’s sick.  We’re sick!  This should make us all sick.  Maybe Obama bit off more than he could chew by trying to tackle it all at once, but considering the number of major corporations who held a stake (insurers, big Pharma, etc.), I don’t know that it can be tackled any other way.  Sorry for the dearth of citations, but I work in the industry so you should just believe me ;)

          7.  LOL, sure they will. They’re competing against each other right now and we spend almost double for health care what other countries do. Learn something for a change.

          8.  The increase in postsecondary education costs is more of a function of our collective decisions to defund our state schools, in order to put more money into the pockets of the rich.

            30 years ago you could pretty much go to a state school for a song. but reagan et al decided it was more important for rich people to have more money, so we decided to place that burden on students and their families. in some cases we did this in part by creating lotteries “for education” that served primarily to reduce the amount of general fund monies that went towards education. and of course, you replaced them with a capricious revenue stream built on what is essentially a tax on people who don’t understand probability, very often the least educated among us already.

        2. @yahoo-Z2PCUJLFNNZNVRIBXBER67IBTI:disqus , thank goodness your Dad got to a better country!  The corporatist-controlled USA would have killed him.  But, I’m sure you know that already!

      2. “with forced purchasing of insurance, the insurance companies can charge whatever they want, and everyone has to pay.”

        incorrect. rules on the medical loss ratio (mandating that, iirc, 85 cents of every dollar in premiums needs to go to actual care) have already gone into effect. this substantially limits what insurance companies can charge.

        frankly, from my vantage point it looks like the ACA (or “Obamacare” as it has been somewhat derisively referred to here and elsewhere) has a goodly number of disincentives to insurance companies to keep squeezing the little guys and putting that profit into their shareholders’ pockets.

        it’s not Germany or even Canada, but speaking as someone who’s spent half their life without insurance, it’s a damn sight better than what we had before. and with a little luck, those insurance companies will decide that the health insurance market is simply not lucrative enough, and look for other ways to fleece us, paving the way for direct state-sponsored insurance.

        you know, like sane countries have.

  5. I freelance and my wife does not get any insurance through her small employer. We have two kids. We’ve been scaping-together the payment for the private plan we purchased on the open market. Every year, the premiums go up. We recently received notice that the premiums will go up to a whopping $1,500/month. That’s roughly twice as much as our next largest cost…our mortgage payment.

    I’m really not sure how we can afford this. On the other hand, I had to have emergency back surgery two years ago and there is no possible way we could ever have afforded it without insurance (the total pre-insurance billing on the operation and hospital stay for that was north of $40,000)

    I’d really love to see our elected official stripped of their taxpayer-provided healthcare plans, and forced to find coverage on the open market. No doubt, though, that many insurers would happily give them sweetheart plans.

    1.  $1500/month is not far from my total monthly tax liabilities, for which I get healthcare and a state pension. OK, so now the UK goverment claims it can’t afford either (don’t start wars then!!!), but for 250,000,000 people, a centralised healthcare system has to make sense. The economies of scale alone would be massive.

      1. I totally agree. Unfortunately, the US is in the throes of a decentralization/privatization fetish that shows no end in-sight. At least not until the ones in power start getting their butts bitten by healthcare costs.

  6. I haven’t read the article yet, Maggie, but I can answer the first question you asked, as someone who has been in their position:

    Yes, your parents lost sleep over this.

  7. It horrifies me that families in a rich Western Nation live like that, then a large portion of that society (presumably those with Employer insurance plans or enoug money so it doesn’t matter) resist socialisaton of healthcare. You guys (America) should really sort that out. Having said that I’m a British Canadian so maybe I just don’t get it but it seems insane to me

    1.  You would think it’s the financially secure people and those with employer-provided health plans that oppose socialized medicine, but that’s not quite right. Many of those people do oppose it, but by and large the well-educated professionals in this country lean left. The republican base is working class white people who would actually benefit quite a lot from socialized medicine (and who in fact already live in states that get more aid from Washington than they pay in federal taxes, vice versa for the more democratic and urban areas).

      It really is baffling, but a large fraction of this country has consistently voted against their own best interests for generations.

      1. I guess it exposes the fallacy that in a democratic society that people will vote for the good of society or failing that they might at least manage to vote in their own interests

        1. It’s even more insidious than that: by and large, Americans will vote not for the good of society, nor even for their own interests, but against the interests of those lower in the hierarchy than they are, lest those lower down manage to claw their way above. 

          1. I’m not sure if it’s even that – I’ll go for, our schooling system (not education, schooling – as in, “you got schooled”) designed to beat the desire for critical thinking and disrespect of authority out of people (because critical thinking and a healthy disrespect of authority would cause the lower classes to organize against the upper classes in an effective way, and not be good obedient consumerist slaves), combined with the authority being media that tells people that this is what they want.

  8. “And that’s widened the gap that people fall into, when they make too much for Medicare,”
    You mean Medicaid, Medicare is only for old people, Medicaid is for poor as well as disabled and elderly (although some people want you to only remember the poor part, not the middle-class parts like long term care.)

  9. How old are you, Maggie? Paying for a doctor’s services was not all that bad when I was a kid, forty years ago, because that’s what we did, too. Now the health insurance industry has made sure the average person cannot afford to access a health provider directly. the game has totally changed in just a couple of generations.

    1. Strange, how those doctors of 40 years ago couldn’t keep people alive as long as they do today, even though we insist on stuffing us with fat and sugar, hindering their efforts. 

      1. It’s also strange that my grandfather of 93 keeps getting pumped full of antibiotics and medication to keep him alive when he lives in an assisted living home, has dementia, and rarely remembers who anyone is.  Those same doctors of old probably would have let him throw a clot when he was 85 or so, pass away in his sleep, and save my parents and relatives the heartache (and financial burden) of watching their dad turn into a child.

        I’ve seen the same thing with my wife’s grandparents as well.  If I make it past 80, let me die.

      2. (1) We spend several times more than other countries on health care, and receive many more tests and surgeries, but aren’t any healthier and do’t live any longer.
        (2) The lion’s share of life extension has been from preventing early death, not extending later life.

        1. I don’t get (2).   Sorry, I don’t get it.   “Preventing early death”  means not letting early-born die because their is no money for incubation and proper hygiene.   It’s also not letting babies die because you couldn’t do open heart surgery on an infants life back then. 

          Yes, the American health care system wastes a lot of money (waste being defined as how many people get better per dollar), but of course medicine has improved and gotten better.   And more expensive. l

          1.  I think AnthonyC is pointing out that most of the apparent increase in “life expectancy” statistics in the 20th century is the result of fewer instances of infant and childhood mortality rather than consistently longer lifespans.  This is actually true.

  10. Come move to Massachusetts!  Not only is it the academic mecca of the USA, but we actually have enforced healthcare standards, and the state supports the collective buying of insurance by folks who can’t get it through their jobs.  And the state will subsidize your healthcare if you make under a cap, but you still get to choose the coverage you get.

    It’s not communism, it’s a transparent marketplace, created to benefit the consumer.  Having lived through high-deductible insurance hell, I would have to think very hard before going elsewhere.

    You can check out the insurance marketplace here:

    1. Yes indeed. I went without health insurance for about a decade, until I moved to Massachusetts and Romneycare forced me to get it. I was resistant at first, but it turned out to be high-quality insurance for a mere pittance, and life was suddenly better. Now I’m married, and on my wife’s plan, but I still roll my eyes a bit when people complain, sight-unseen, about the coming horrors of Obamacare.

      1.  The amazing thing to me is that the Obama health care law was based on Romney’s, which was in turn based on the one the republican’s proposed when Gingrich was speaker as the conservative alternative to the plan the Clintons proposed.

        And yet, Obama is an evil Communist.

        1. This isn’t the first time a policy idea invented by conservatives in order to salvage something from the supposedly inevitable triumph of socialism turned out to be unnecessary. The proposed “negative income tax” was another example of the same phenomenon.

      2. I understand the state of Hawaii has excellent public hearth care plan – for ages.  One of Romneys weaknesses (and you know it will be Romney -lets face it) is Romney care. He’s going to have a hard time criticizing Obama for his healthcare plan which was essentially based on his own. 

        1. Oh, but obviously they’re completely different, because one of them was just for the state.  So the argument is really about, um, states rights and the, ah, ability to make choices at a smaller-governmental level instead of the national one?

          Seriously, that’s what his line is going to be.  And some people are actually going to buy into it.  That’s how messed up it is.

  11. God, I know what this is like. As a child, my family was working class, poor. I was born with multiple health issues, and as a result we had something of a safety net, though strictly for me. But I remember, clearly, the hand wringing my poor mother went through every time I got sick. The state programs I was on could cover some, but not everything. 
    Those health problems followed me into adulthood, and try as I may, they shape the decisions I must make where work is concerned. Doing the things I truly love results in being un- or under-insured; doing things I am good at (but are really trying on my psyche) pays the bills but exact a toll on my soul. That is the situation I believe that many of us are forced into in this country. The economy has evolved into something that forces us to put these choices first, ahead of what true skills we have. Out of sheer necessity, we do what we have to do. Putting children into the equation tips it more so. This is the true heartbreak. 
    America, freedom of choice is an illusion when the choice results in this.

    1. Those health problems followed me into adulthood, and try as I may, they shape the decisions I must make where work is concerned. Doing the things I truly love results in being un- or under-insured; doing things I am good at (but are really trying on my psyche) pays the bills but exact a toll on my soul. That is the situation I believe that many of us are forced into in this country.

      I wish someone would perform a study on the lost productivity this situation causes.  It’s an enormous amount of wasted money.  Ironically, the savings would be more than enough to kickstart a single payer system for health care and even give us a surplus when you also consider the money saved in administration costs, etc. and lost productivity of people that don’t get preventative care and rely on vastly more expensive emergent care. Also, dead people aren’t very productive either.

      What a sick, wasteful, ironic country the USA is…  all in the name of profits for the very few at the expense of the rest of us.

      1. they should start by taking the health care plan away from the politicians. I’m sure that people saw the video clip in the early debates when Ron Paul was asked if someone chose not to get health care but got sick – should he be covered or let him die (and the audience famously yelled let him die). The irony is that it happened to one of Ron Pauls campaign staff, he had no insurance, got sick & died.

    2. And I thank my lucky stars that I was fortunate to be born and grow up in the UK, where despite a similar background and parents who struggled to put food on the table, repeated trips to the doctors and the odd broken bone couldn’t bankrupt us.

      1. It really is a blessing and I’m glad you’re thankful for it.  You should be!

        aeon, imagine getting a serious disease in the USA that could be treated with proper healthcare.  First it bankrupts you and your loved ones and then you die.  Or, many distance themselves from others so they don’t “drag them down” financially and die alone in agony in a darkened room somewhere.

        What a wonderful way to leave this earth within the “greatest country on earth”, huh?

        In the meantime, corporatists cash in on this corrupt system and use the money to propel lies into the public’s consciousness.

        Somewhere in the USA right now, there’s a country song playing on a rightwing radio station proclaiming how much greater the USA is compared to anywhere else on the planet just before Hannity and other corporatist parrots come online to spew their half-truths and lies to the brainwashed.

        Yep, it’s war…  with very real suffering and deaths.  An ugly, cruel and embarrassing time for the United States.  Meanwhile, look at all the hatred and mockery reserved for the Occupy Wall Street movement instead of these fucking murderers who profit off the needless suffering and deaths of their own citizens.


  12. To those who think USians are “insane” for being against socialized access to health care, the majority of us are not actually against it.  During Health Care Reform, polling consistently showed that around 80% of Americans were in favor of a Public Option.  This was in spite of the fact that “Obamacare,” and “socialized medicine” were being demonized in the media at every turn.  The reason real strong health care reform was not possible is because health insurance companies have more influence over policy than the people do because they can influence politicians with their dollars and lobbyists.  Without Campaign Finance Reform, there is no real fix to the big problems that America faces, including affordable health care.

  13. I lived without insurance for years. The most important rule of thumb was to avoid the hospital unless it was a life or death situation. As soon as a person walks into an emergency department, the charges start adding up and you can expect to be at least $700 in the hole at a minimum. I know a lady who used to take her kids to the hospital whenever they get a sore throat or an infection, then she would freak out when she got the bill. Going to a 24 hour clinic or a walk-in med center is a much better and cheaper idea. It could mean the difference between a $120 charge and a $1,200 charge.

    1. Going to a 24 hour clinic or a walk-in med center is a much better and cheaper idea.
      Sure. As long as those exist in your area. There are lots of places in America, outside the large cities and especially in rural areas, who don’t have either of these and have to solely rely on a regional hospital.

      1. In a situation like that, I’d still choose to see a local country doctor before driving to a regional hospital XX miles away to have my sore throat looked at.

    2.  The family in the story did just that — when it was clear their son was gravely ill, they took him to an urgent care clinic rather than going to the hospital. The urgent care clinic looked at him and sent them immediately to the ER, because it was a life or death situation.

      1. My post wasn’t meant as an indictment of the story’s author; clearly his was a situation that warranted a hospital visit. I was just speaking about my own debt avoidance technique when I was uninsured.

        1.  Fair enough, and true that it’s better to avoid the ER if you can. I guess my point was that your technique does help minimize medical debt while uninsured, but only as long as you don’t find yourself in a life-or-death situation!

          (And sometimes $120 is just as out of reach as $1200, depending on how much money you make and how much your non-negotiable bills are. A $120 debt is easier to resolve than a $1200 debt — but you can still get sent to collections.)

    3. Seen from here (Norway) even  USD 120 seems like a large amount of money to pay to visit a walk-in clinic.  I normally pay about USD 25 for a consultation at my local surgery plus maybe USD 20 for a course of drugs (rarely as my doctor won’t prescribe them unless he is sure they will do some good, no antibiotics for simple viral infections).  If I pay more than about USD 170 per year the extra will be refunded through the tax system.  The fees discourage casual hypochondriacs while not being enough to discourage anyone in need.  Of course I pay for all this through my taxes but nothing changes if I become unemployed.
      The socialization of medicine is just one of the facets of a sensible social security system that promotes social mobility, you aren’t trapped in a dead end job because you can’t afford the risk of falling sick between jobs.  You can afford to move not only from job to job but place to place in order to better yourself.   In my case I moved from one country (UK) to another (Norway) secure in the knowledge that if it didn’t work out I would not be bankrupted while trying to either move back or find another job.

      1. “no antibiotics for simple viral infections”

        I certainly hope that doctors in sane countries (i.e. not the US) don’t prescribe antibiotics to combat viruses, as antibiotics apply to bacterial infections not viral infections.

        The fact that people in the US demand – and get – antibiotics for afflictions that antibiotics have nothing to do with is insane. Though of course that’s far from the most insane aspect of the US system.

    4. my impression, having been to quite a few of these (and simply waiting out the 7 years of debts i incurred since it’s then no longer on your credit record) quality of care in these places is generally poor, and significantly lower than what you get in even a county hospital.

      but that’s just my impression. you might find some data to back it up, but i get the sense from medical folks that those places are profit driven and, while filling a need, they are filling a need that’s only there because we do not fund medical care in a sane way.

  14. Ugh! So sad. And before any more Canadians get feeling good about our health care system – remember that we’re importing America’s system to our country, not the other way around.  I won’t be at all surprised if we have to make the same decisions in a decade or so.

    1. It’s disingenuous at best to imply it’s a dichotomy. The NHS has serious problems of it’s own that really do need a solution. I’ve no idea whether the Tories plan will work, but one thing I’m fairly sure about is that nobody else has a clue either. I wish policies could be tested honestly and openly and discussion held on that (like whether the cost benefit is worth it), rather than on idealistic fundamentalism.

      The real problem with health and privatisation is that an individual will spend *all* their money to stay alive.

      1. The NHS’ problem is that it doesn’t have a real lobbying budget. The UK already has the most efficient system adjusted for demographics in the industrialized world. If they wanted to improve on the medical outcomes, then fine-tuning, not a complete re-organization is needed.

        1. I suspect the NHS had —past tense— the most efficient system in the industrialised world. 

          The ‘Healthcare Reforms’ of the early 90’s and repeated reorganisations since that under “New Labour” have added competitive internal markets that have merely reduced the amount of central planning of services and vastly increased the proportion of managers compared to frontline clinical staff with consequent reductions in overall efficiency. It’s now so inefficient that the next step will be to sell it off piecemeal to healthcare conglomerates in order to “save” it,  so the UK will end up in the same boat as the US…

  15. This is my life. The only insurance policy I qualify for was an $800 / month, $10,000 deductible policy. For myself. I am overweight, but in good health other than that, but I literally cannot get insurance from any of the big providers.

    The mandate in 2014 scares the hell out of me – given the rise in policy costs, I’m afraid that I’ll end up having to spend over $1000 per month for useless “insurance”, because my employer is too small to be able to get a group policy, and the inhuman assholes in these companies only see me as a profit center.

    The hell of it is, it was cheaper to pay for major surgery out of pocket than to go through the only insurance I can get for any money. I would LOVE to have health insurance that didn’t consume a quarter of my income for no clear benefit unless I have to be hospitalized for a week or more. Thanks, but I’ll take my chances, and live my life with some risk, instead of being chained to the rent-seeking assholes who will own a third of my paycheck in three years.

    And I make too much money to be considered “low income”. So, I get to be broke, and dump my money into the pockets of disgustingly wealthy medical company coffers, to save myself from bankruptcy. The ogre’s choice, personified.

    Some fucking “compromise”. Thanks, Congress.

    1. But, in 2014 any pre-existing conditions won’t be calculated into the formula, so they won’t know you are overweight when getting the prices. Additionally, you will be put in a very large pool of people, instead of just buying for yourself, so the costs will go down due to that too. And, depending on your income, the “low income” group will be much higher than it is now and you may qualify for a subsidy.

      In other words, you don’t really know what you are talking about and should do some research.

      1. We’ll see.  Romneycare did cause expanded coverage in MA but it also (predictably) increased costs, though marginally.  More importantly it’s set up some pretty heinous incentives; I know at least one local coffee shop offers an insurance plan that’s too expensive for most of the employees, but since it is offered they cannot get the MassHealth option subsidized so employees there are still forced to pay more than they can afford for health insurance.  And if they don’t buy this thing they can’t afford then they get a fine they also can’t afford.

        There’s research to be done all around, I think.

  16.  Thanks for the post.  My parents had a few years without health coverage, and few more without dental when I was a kid.  I never much liked going to the doctor but they must have been stressed.  They were both college grads.   It seems to me that HC was cheaper and coverage was lower back then.  how quickly people forget.

  17. The start of health insurance coverage as we know it in the US was WWII.  The government put a wage freeze in effect, so larger companies came up with a work-around to attract the best candidates out of a much smaller employee pool: offer health insurance as an added benefit.

    Most of the new jobs created in the US are created by small entrepreneurial companies.  These are the same the companies which are least able to afford offering health benefits in addition to salary.  (They’re also the companies least likely to outsource jobs to other countries.  Apparently we don’t think that’s important enough to support.)

    There’s no official wage freeze in effect any longer, but the government is still responsible for the end result: millions of hard-working citizens without adequate medical support.  And that costs this country a great deal, on many levels.

    On a personal note: my favorite example of health insurance insanity was when I was turned down for catastrophic-only insurance because, and I quote, there was the “possibility of future infertility”….a condition that would not have been covered by the policy in any case.  I was a single 36 year old woman, 4 months pregnant .  *snort*

  18. I recall when I started my career about 10 years ago… For the first time in my life, I had insurance and could go to the doctor without worrying which meals I’d need to skip, how much gas I’d need to save by driving less, etc. It was an overwhelming thought.
    I played soccer as a child. The guilt I felt the 2 times injuries forced my parents to take me to a clinic was substantial.
    I was lucky enough never to have broken a bone or developed a severe illness (and haven’t been sick at all for more than 20 years), but I can’t imagine the stress this causes on families in that same situation with normal kids, who get sick and get hurt and don’t have good teeth.
    I remember how long I waited to save enough money to have my wisdom teeth extracted. I remember having the chance to go to the dentist once every few years. And to a physician only when it was absolutely necessary.
    What do most families do?
    When I started my career out of college, I made just over $30k. And I had insurance. And that felt like opulence to me.

  19. Probably the only emergency I faced was when I was 10 and had a garden stake impaled in my shoulder in Australia. 

    I got rushed to hospital in an ambulance, and all I could remember long afterwards was my dad shouting expletives over the ambulance bill, never on anything done in hospital or in GP checkups. Each Australian state is radically different (Queensland has some weird levy that’s tacked onto your electricity bill). 

    So, like most Australians, I just have ancillary cover (lack of national dental care is something we may of picked up from the British).

  20. You fear losing your healthcare if you lose your job.
    So you work like a slave and don’t take all the vacation time you’re owed.
    You are chained to your job because you are chained to your healthcare. . .
    You can’t take a risk and start your own business or travel, or take a break.

    Land of the Free?

    Yeh – Er, Good luck with that. . .

  21. There but for the grace of the federal government go I.

    I happened to be in the military (at a service academy) when I was diagnosed with Crohn’s disease at age 19. At that point, my parents had stopped covering me with their insurance, as I was covered by the military. Thankfully, a change had just occured that classified midshipmen and cadets as active duty. If I had been diagnosed just a year prior, I would have been discharged with no coverage, and a proud owner of a pre-existing condition. As it is, I’m covered for Crohn’s by the VA. However, it’s still a concern – I’m limited to jobs with group healthcare plans, as there’s no way I could afford (or even be offered) insurance otherwise (I’m on ~$1000 a month of medication – guaranteed money loss). I know about the applicable provisions of the Patient Protection and Affordable Care Act, but I don’t have confidence in that not being gutted or otherwise sidestepped.

  22. Yikes. Gone were the $4.000 saved “…to visit [my wive’s] family in Sweden.” 

    Ouch. That one must hurt, one more than one level.

  23. I have proudly paid the quite high taxes in my country of birth, and have no problems paying taxes in my adopted country.
    Sure, I pay higher taxes than I would in the USA, but I also have access to a kickass education and healthcare system (one of those hippie/commie socialist systems). I do NOT have to make any kind of choice between my children’s health and future financial stability. (my daughter needs a dentist trip because of a fall. Completely transparent and free to me. Also lowers the possible long term costs to society if there is real damage…Same goes for emergency room visits. A bone that doesn’t mend correctly is a HUGE future cost for society. One more person who has problems working due to a preventable problem. THAT is why hippie healthcare is economically more sensible.)

    It is just so awful to hear about the daily problems faced by people in a supposedly first world country. It isn’t perfect here in Sweden (far from it) but…
    Zelnio just shows black on white that this is ridiculous!

  24. Man, I love the comments on that board. 

    How is it that it’s always health care that socialistic, yet almost never the military?   

    Hey, you want an army? Then rent one yourself!

  25. As an uninsured planetary science graduate student in Tucson, I fell in a cave and broke my jaw.  It was a 4 hour trip to the public hospital, who turfed me to an oral surgeon.  Turned out, he loved astronomy.  Barely able to talk, we negotiated the following deal:  Patch me up, and I’ll give you, your staff, children, and friends a night on our department’s 61 inch telescope. 
    Worked out wonderfully – he pinned & wired my jaw; a month later, he (and a dozen friends&kids) got a terrific tour of the solar system and beyond: Stunning views of Saturn’s rings, and a chance for me to do a show-and-tell of what’s happening in the skies.
    Obviously, health care isn’t for barter.  But every time I write a heavy check for insurance, I think of showing the skies to that terrific doctor.  On a few rare occasions, things work out.

    1. I don’t want to be a spoilsport here, but did you get your department’s permission to do this? 

      Because “bartering” usually consists of bartering with your own money and resources. 

      (Unless you are a bank, of course.)

      1.  In fact, my department was amazingly supportive.  They allowed me an evening of bright time, if none of the IR groups needed it.  Also, they arranged for the visit of a gaggle of students from nearby high schools, who joined in the festivities.  A part of of our grad school training was community outreach, so this worked out well. (and teaching in an echo-y dark observatory is good training in public speaking).  One of the students knew of my plight (I couldn’t eat much) and brought a jello casserole with planets on the top.

        Oh – bright time (around the full moon) is less desirable time at the observatory, because you can’t do deep-sky work.  It’s usually claimed by the infrared folks, with their liquid nitrogen dewars and bolometers. 

        1. Thanks for clearing that up.  It *was* nice of your department.  :-) 

          But, as you said, it’s not an feasible option for most people.

      2. I can’t imagine any astronomy department not going for such a deal made by one of their own grad students, particularly for a doctor who just wired up a jaw for free. Most astronomy departments have at least a scope or two that isn’t being used on any given night — the only thing stopping there from being more frequent tours is that someone actually has to lead them.

    2. This is perfect.  Try this the next time you go to the doc for something more extensive than an office visit:  offer to pay the doc cash on the barrelhead for that day’s services.  You’d be amazed how much cheaper they will be willing to go to avoid dealing with insurance, possibly dealing with claims denials/resubmissions, trying to collect deductible and uncovered charges, etc. etc.  Most docs over 45 did not expect that they would need an MBA just to get reimbursed for their services, and the climate of the past 15 years has made them understandably averse to all the obstruction and markups put in place by the middlemen.

    3.  Another barter story. Try doing that when you’re having a heart attack, or when your kid’s been hit by an automobile.

  26. The problem is that health insurance only works for the middle to upper class for some hospital systems.  I know of someone that had to have emergency gallbladder removal, because it was about to rupture, only to be denied financial aid by the hospital because she has insurance. 

    Now she has to declare bankruptcy because she can’t afford the $30,000  that is not covered by her insurance.  In her case she was better off not having insurance apparently since she will get financial aid from the hospital. 

    1.  That’s how it happened for my surgery – being uninsured cost me $4000 less than the copay for their insured price – they had reduced fees for uninsured patients…

  27. What a great read! Zelnio is spot-on, and provides a harrowing look at the state of health insurance. 

  28. Here in BC we have universal insurance, though we have to pay about $120/month for a family plan (in my case my employer pays half).  I believe two other provinces require some sort of monthly payment, the rest do not.

    Honestly I cannot imagine why anyone would want to have a private system (though there are morons in Canada who do, including our current government).  With two kids we have been to the ER at least 8 times over the past 6 years, events that would break us in the homicidal US system.  And we are fairly healthy.

    Next week I have some minor surgery which I would almost certainly have put off indefinitely if I had to pay for it – at least until it became critical or killed me.  When I was in university I had to have 8 rounds of surgery on my throat that would most certainly have meant leaving school and/or bankrupting my family.

    I realize the US political system is more or less wholly owned by large interests, and the so-called ‘debates’ are mostly just circuses (bread being too socialist), but seriously people.  It is actually breaking your economy, among other suicidal policies.

    Of course, our current government is keen to duplicate the suicidal policies of our Southern neighbours.  But even the most radical among them knows they’d be fleeing from a pitchfork and torch brigade if they tried to privatize our health care.

  29. I recently had a chance to look at a Pennsylvanian addendum-retroactive-health-insurance-form (the kind used to *partially* subsidize low- income individuals who required care) and not only was the legal language head-spinning but buried within the fine print was a statement proclaiming that they (ICE maybe?) have the right to fingerprint anyone who fills out the form.   I was infuriated that the poor would be forced into signing away their 4th amendment right in order to gain financial assistance so I asked a case worker; their response indicated to me that no one has ever asked that particular question before (which just angered me more).

    1.  I worked in the welfare office for five years and no one ever asked me any question about the fine print.

      And it wouldn’t have been ICE, it would have been a state agency because our form doesn’t have that provision.

  30. If you got to the John Hopkns Pancreatic Cancer discussion board, you may find out why some people prefer private insurance. Every once in a while there is a desperate Canadian posting questions regarding how to get in to an American hospital because in Canada the Cat Scan wait was 6 weeks, the Chemo was single agent and not more-effective combo chemo, and the life-prolonging Whipple procedure was either refused, or the wait was so long, that it was a waste to even schedule it with such a fast moving cancer….every day means more spread.

    In the US my family member had a Cat Scan in the ER, a biopsy the next day, and chemo going 2 days later…and a successful Whipple surgery 6 weeks later..

    Granted there are a lot of people dying from lack of insurance in US and I feel a basic plan should be avail. cheaply, and pre-existing conditions should not be a factor, but lets not get too gushy about socialized medicine, because one of the ways costs are kept down is thru this subtle rationing thru waits. You wont find this out until push comes to shove, like those poor Canadians with PC.

    1. Let’s also remember the *explicit* rationing inherent in the US insurance model. You don’t even get a full ‘death panel’ – just a (probably underpaid) insurance company clerk that is paid to refuse as much as possible.

      1. But that isnt institutionalized like British and Canadian death panels are…where they assign a dollar amount to year of life. Yes a clerk can hassle you, but most oncologists have specialized people, or social workers in hospitals, who know the rules and the insur. cos. requirements, and dot all the “i”s.  Not perfect, but no system is..my point is the socialized medicine does depend on waits for rationing…and it is a problem worth considering. People in Canada who are extolling its virtues may not have dealt with such a critical situation yet, since most people never have to.

        1.  As an Australian I want to say this “rationing” bs of healthcare has to stop. They are not being denied the procedures. If it is a life threatening situation you get immediate access. For the majority of us a “wait” for GUARANTEED ACCESS is better then none at all in the US.

    2. We already ration, except that we don’t it not based on cost effectiveness of treatment or on the maximization of societal good.  Instead, it’s based on contracts negotiated between your employer’s health insurance company and your provider.  You could kinda say care is rationed based on your employer’s willingness to pay for you and your children to live.  Oh, and I sure do hope you’ve got an employer or you’re SOL.

      I’ll take the Canadian system, even as someone who A) has great health insurance and B) would be out of a job if healthcare were more effectively delivered.  I would choose the Canadian system EVEN IF IT MEANT POTENTIALLY SACRIFICING THE LIVES OF MY CHILDREN.  

    3.   I’m really sorry, I don’t know how to put this less harshly. But I’ve never known anyone survive pancreatic cancer. So what was the outcome of the prompt treatment?

  31. Poor analysis regarding high deductible….
    1. It is only in years that you have high health care costs that the full high deductible kicks in, not every years as she implies. In most years you save huge money due to cheaper monthly premiums, which add up quickly. She doesnt even consider savings due to cheaper premiums…as if that isnt real money.
    2. My high deductible is 2500, so not sure why she saying 5000 or 10000….2500 is usually an option and qualifies for a tax saving HSA.
    3. After deducible I do pay 20 percent but only up to 5000 and then Blue Cross pays 100% up to 5 million….called out-of-pocket max. Might even now be unlimited, not 5 mil, due to law change…not sure if that kicked in yet. So her claim that insur co. only pays “some percentage” is not correct…they pay 100 percent above 5k…skys the limit.
    4. The best part about having high deductible as opposed to the no insurance “option” is I get the negotiated rates, that Blue Cross itself pays doctors. I went to get a rash looked at and my Harvard educated dermatologist scraped it and analyzed it under a microsocope, and when I went to pay my visit was 30 bucks, including 6 bucks for the procedure. Doesnt the writer think this is worth mentioning?
    5. Her point that insur. cos. dont like to pay and use “caveats” applies to both high deductible and more typical, low deductible policies equally. To use that as a argument against high deductible plans, as she seems to do (its in same paragraph) is therefore silly.

    1. The insurance industry is rapidly pushing more and more services to be subject to deductible. When I first enrolled in my self-paid insurance plan (self-employed here) it had a medium-high deductible but lab work (ordered with a physical exam) was covered, and ER visits were a $100 co-pay. Since I am healthy, this was a decent option.

      My plan has changed a lot over the last three years. My premiums have more than doubled, and now ER and all lab work is subject to the deductible. When I was at the lab in October getting my blood drawn for $1000 worth of tests (lipid panel, vitamin D, other routine physical stuff) the nurses were shocked that I hadn’t used my deductible up for the year. One told me flatly that most patients pay at least the deductible out of pocket every year- it’s become the norm.

      And guess what? Just try to find a policy where these basic things are covered with a co-pay. It’s only the alarmingly expensive monthly policies that have a low deductible anyway. And, surprise, as of January first, my deductible went up by another $500.

      All this just for the privilege of getting a physical. It’s broken, and out of control.

      1. “the nurses were shocked that I hadn’t used my deductible up for the year. One told me flatly that most patients pay at least the deductible out of pocket every year- it’s become the norm.”
        This is rank nonsense. Health care spending is highly concentrated, almost unfathomably so, in the US as elsewhere. For most people, most years, outlays for health care amount to less than $350. You can look it up:

        “….individuals ranked in the bottom half of the health care expenditure distribution accounted for only 3.1 percent of medical expenditures (with a mean expenditure of $232 in 2008)”

        Nurses know more about the cost of care than most health professionals – but they know almost nothing, just like 99.7% of everyone in the US.

  32. Why can’t concerned doctors and citizens set-up an alternative system? If I knew and trusted the docs, I could even see signing some agreement that I wouldn’t sue if something went wrong. We have start-up techno fever in some aspects of our lives, but this seems to be the furthest thing from issues of health care. Why?

    1. The trick is, a doctor who would try that trick would need an absurdly expensive team of lawyers, one of whom would act as his receptionst, basically. The idea being, it would be too risky to even think about suing. (Either that, or simple thugs – sue, and you suffer from acute broken bones, or death, the next day.)

      Or, a group of doctors could set up a megacorp, possibly offshore, that would be too big to sue, and share the absurdly expensive lawyers.

  33.  I’ve been uninsured now for 26 years.

    I let my Blue Cross lapse and when I tried to sign up again I got turned down for TWO YEARS for a pre-existing condition.  I waited two years, re-applied and got stonewalled.  
    I have been unable to find any kind of health insurance for anything less than $1500 a month because of this.  I don’t make enough money to afford it.

    Since then I have found it is cheaper to simply pay as I go as I have been fortunate to not have anything major happen to me, I am in relatively good health, the “pre-existing condition” they refer to is rather benign.

    Now I am going back to college (Nursing School oddly enough…) and the school REQUIRES Health Insurance – why?   The school has an in-house insurance program they bill you for automatically unless you show proof of insurance.  
    FINALLY- I thought I might get health insurance.
    Unfortunately the in-house policy is only good for those UNDER 30 years of age.
    I am older.

    Since all they wanted was a card to photocopy for the files, I forged one.

  34. I’m a 31-year old employed graphic designer (company too small to have insurance) and I’ve never had health insurance. Not having any insurance feels like I’m playing a constant game of Russian roulette. It is highly stressful.

    Growing up, I always saw any kind of health/dental insurance as something rich people had.  I lead a particularly active lifestyle, as do most members of my family, and it is a wonder most of us haven’t needed hospitalization (those who have pretty much went bankrupt taking care of medical costs). Our grandfather was a veterinarian so for some things what basic medical knowledge all his descendants had gleaned from helping him patch up animals was good enough for us. Certainly cheaper, though not something one generally discusses in public. ;)

    For myself,  I have managed to be careful enough and take good enough care of myself that I’ve only needed a hospital visit once (for a double inner-ear infection that was about to go into my brain, so the docs said).  I had a bad skiing accident once and managed to break several ribs and mess up my back but since there’s nothing they can really do for cracked ribs I didn’t bother seeing a doctor (ribs healed fine). I did have to find a good chiropractor for my back – I was lucky on that count.  I can count on my two hands the amount of times I’ve seen a dentist – I have a few small cavities right now but I can’t afford to have them filled at the moment due to the following paragraph’s story.

    I read most of the comments so far and didn’t see any mention of mental health care. This is one department I think is severely overlooked. I lived with my mother and sister, both of whom ended up losing their jobs. Then my mom, who is a type-1 diabetic (which comes with a slew of costs), developed breast cancer. I didn’t have enough money to live on my own much less take care of two other adults but that’s what I tried to do. I ended up having a very bad mental breakdown that required outside help. I spent days trying to find a clinician who would take on a case like mine with no insurance. I was going to die of starvation (I was unable to eat) if I didn’t find someone soon.

    I lucked out that there was a small state funded health center that takes in people in situations like mine  that only required a few bucks a visit.  They saved my life.  The experience really opened my eyes to a completely different facet of the health care system that is just as broke as the rest of it.

  35. My family’s daily life is proof of the many problems inherent in the dysfunction of American health care. While my husband and I do have jobs which provide care, what is NOT covered is an equally important issue. Hearing aids? $3,000 each, not covered by health insurance because most plans consider them to be cosmetic for anyone except the elderly. Every 6 years, roughly, my husband (he has a profound hearing loss) must find a way to pay for these. Paying that much out-of-pocket is beyond our means. Prescriptions? Oh, I’ve fought for years with health insurance over their ridiculous and limited formularies which permit one medication for a condition but will not permit the one which, after you’ve tried the one allowed, works even better. 

    But right now my mother faces an insurance Catch-22 that boggles my mind. In January she fell ill with Guillain-Barre Syndrome, a rare neurological disease which results in paralysis. Recovery happens for about 85% of patients, but recovery can take upwards of a year or two. She too has health insurance, but we live in constant fear that she will be denied coverage because her insurance company decides each week whether or not to continue paying for her to remain in a skilled nursing facility. This is the most perplexing thing: if she were hospitalized, insurance would cover everything. But she doesn’t need intensive medical care, and has been discharged to a skilled nursing facility. If she cannot live on her own again – and there is a good chance of this – insurance will refuse to cover her. In order for Medicaid to cover my mom, she will have to sell off the few assets she has in order to qualify. In other words, she must become impoverished to qualify for Medicaid.

    So, in a nutshell: health insurance will cover critical care, but not daily rehabilitative care. And for Medicaid to cover an elderly person, they must impoverish themselves first.  None of this is as horrible as not being insured, but it’s just as worrisome.

    1. That was a great summary right there. Similarly, while most industrialized countries with evil, evil socialized healthcare (all of them except the US) constantly try to get people to go to the doctor for check-ups, the American system seems to discourage preventative care, resulting in delayed treatment which is not only bad from a public health standpoint but also much more expensive in the end.

  36. I have been uninsured for about 3.5 years. Luckily, at the moment, I seem to be very healthy. However, I have a rare, genetic bone disorder. If I were to trip going down some steps, there’s a better than average chance I might break a femur. This would result in a trip to the ER, and major surgery that I couldn’t afford, but would have to be done anyway. I would then declare bankruptcy because there’s no way I would be able to pay the bill, which would likely be at least $50,000. 
    I am self employed, and am finally making enough money to be able to afford health insurance. Before “Obamacare”, I likely would have been turned down for private health insurance because of my bone disorder. It still will probably result in a higher premium, higher deductible, or both. Honestly, I’m not a very good risk. At some point, I will break a femur. It’s happened 15 times in my life, and it will happen again. Insuring someone like me does not make any sense, from a profitability standpoint, and never will.  I shouldn’t be fated to go broke about every 10 years just because I got shitty genes.

  37. I wish there was available insurance that covered only accidents and injuries.

    I simply don’t trust the western medicical system, haven’t been to the doctor in many years.

    Alternative treatments have worked quickly, cheaply, and without side effects. for all minor health problems I have had so far. Were I to get seriously ill, I  would exhaust all alternative treatments entirely before I would even consider going to see an MD.

    The times I have talked with MDs I have been appalled at their ignorance about fundamental health topic such as nutrition.

    They are, however, excellent and hard to replace when it comes to treating trauma and major injuries.

    Is it possible to get insurance that covers only that? If so, I would buy it.

    Other than that, I am completely unworried about being uninsured.

    1. Yes. You’re the guy who likes to link to videos talking about how AIDS can be cured with garlic and beets.

    2. Yeah, we had a highly publicized case of “exhaust[ing] all alternative treatments” here a while ago. A little girl had cancer, detected early, easy to cure. The parents insisted on alternative treatment, left the country and took the girl from one medicine man to the next all while being on the run from the authorities (kids have rights too, you can’t just deny them medical care because of your own superstition). When she had a tumor literally the size of a soccer ball they managed to get hold of them, the girl started chemotherapy and quickly recovered (a small miracle at that stage).

      (BTW: have you ever looked up health stats of countries that have great access to the “Western medical system” and compared them to countries that don’t?)

  38. I don’t understand how this isn’t the most dominant rights issue in the US. Where are the marches? The pro UHC superPACs? It is not only a moral issue but an economic one. Saddling small businesses and companies for paying for costly private health insurance is insane. There seems to be a lot of people in agreement with having universal healthcare but no movement to push it forwards.

  39. Aussie here. We have a version of socialised medical care but I believe Americans should look elsewhere for solutions. A broken arm should never break the bank, even when you pay the full cost of treatment up front. I suggest that Americans find out where the money is going. And beware: a government run system could be more expensive.

        1. Another layer? The current system in the US is already the most inefficient and expensive in the world. Of every dollar spent 33% goes to administration costs. Compared to Australia private insurance at 12% and Medicare at 3%. If the US went to a single payer system they would save around 300 billion dollars a year. This doesn’t include saving money from importing cheaper pharmaceutical drugs from other countries and capping the overtesting done by doctors and hospitals. They could pay for our system twice over. So what are you going on about?

          1. So what are you going on about

            That the inefficiencies in the US health care system are the real problem, not the source of the money to pay for care.

            Having said that, a universal safety net is important too.

          2.  Thanks for the clarification. Though I would say that a universal safety net trumps private insurance by any measure. Uninsured people are a liability. It is cheaper to insure people then to pay for their emergency costs or have them die from easily preventable sicknesses.

  40. I am Australian, I am 36 and I have chronic mental illness (to the point that I’m just getting back on my feet after the better part of a decade of illness).

    I am a pensioner, so not only do I get paid an allowance not to starve to death in the streets, I get a higher level of health coverage than that provided by default to all citizens. My ongoing psych meds (branded) cost me less than $10 (for about 2 months worth). Like all Australians, my hospitalisations are decided on medical need alone. Because I’m a pensioner, I pay nothing should I require an ambulance. My GP charges my visits to the government system (medicare) and I pay nothing out of pocket.

    Additionally, because I have the chronic condition I do, I decided to take up elective private healthcare. I pay about $98 a month as a single person (but I’m getting top of the line cover). Normally, my policy includes a once a calendar year excess of $500 for hospitalisation – however, this year I was admitted unexpectedly to hospital for cellulitis, and the hospital agreed to pay the excess on my behalf if I went in as a private patient. I was in hospital for 6 days and I paid nothing for it.

    My combination of pensioner benefits and private health benefits has allowed me to access treatments that have gone a long way to bringing me closer to a healthy state. The insurer hasn’t gone broke, the private providers haven’t gone broke, and the government hasn’t gone broke – the American argument that this isn’t doable or profitable is utter bunk.

    We pay our taxes (I certainly did when I was healthy and had a job) and seeing what we get in return for that makes it money well spent. We pay less than Americans and we get so much more.

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