Yes, American healthcare still sucks

Michael Moore has been right on the matter of health care for ages, and we should listen now. I think we can have a very candid conversation about the state of healthcare in the US without glorifying the dude who assassinated that United Healthcare insurance CEO last week (both of whom are villains in this story and both shall be unnamed here on this blog). We can acknowledge that assassinations are rarely "good" or "heroic" actions. It's murder. But then again, if we think about the role that insurance corporations play in denying care to average working folks like myself, we can ask how much blood on their hands these insurance companies as well as any of the other corporations that run our healthcare system, including hospital corporations and pharmaceutical corporations. There is such a thing as organizational violence, and that is violence where some bureaucratic action is systematically responsible for the harm to people who would not have been harmed otherwise. 

The reality is that too many claims get denied or delayed, which delays or prevents treatments that would have saved lives or at minimum improved the quality of life of those affected. Then we have to look at deductibles (often costing more money than any of us have squirreled away), copays, coninsurance, etc. for procedures, as well as medications and medical equipment. If you find yourself facing a medical emergency, if you did have any savings, it will all be wiped out pretty quickly. And if you are like most of us who find the notion of savings accounts to be little more than a pipe dream, you're going into a lot of debt fast. There is a reason I've seen Gofundme referred to as the health insurer of last resort. It's easy to rack up some scary bills and go bankrupt. I've been there. Trust me. I don't recommend it.

I will acknowledge that the situation is better now that the Affordable Care Act (ACA or Obamacare) has been law for over a decade than what it was like prior to the ACA going into effect. Still, there is a ton of room for improvement, especially when one looks at how much we pay for medical care and how little benefit we get relative to what people experience in other advanced economies. If you see a lot of anger directed at insurance companies, it's anger well-deserved. 

Since I've been through this enough times over the last few decades, I'll go into a little of my own history. A bit over 20 years ago, my wife broke a knee in a skating accident. Aside from pain and recovery it should have been no big deal. Well, here was the problem: there was no nearby full-service hospital that accepted the health insurance plan that my employer at the time had me on. That bit was never disclosed to us. We ended up at a hospital that could do the knee surgery (or what later turned into surgeries), but we ended up on the hook for the whole bill. By the time all was said and done, we owed more on her knee than I could ever hope to earn over a couple years, and after struggling to pay that massive set of bills, I gave up and declared bankruptcy. That obviously had some repercussions. One was that with a very sorry credit rating immediately preceding the bankruptcy and in the early years post-bankruptcy, seeking out a better job was out of the question. I simply could not afford the moving expenses or get any semi-decent housing at the time. I was stuck where I was at, which set my career back and probably set my own kids' lives back. Eventually I recovered financially. It was a slog. Finally having enough years behind me to actively go on a job search and relocate helped a ton. But the psychological impact of going bankrupt is something else. I was raised to be a provider and when I found myself in an impossible situation, I ended up blaming myself for failing to provide and was severely depressed for several years. There's still some lingering trauma from that awful chapter in my life, and I do react to unexpected bills with something of a near panic level response even a good couple decades removed. That can't be healthy.

I could go into some other experiences with our healthcare system, but that is probably TMI. I will note that there are plenty of other ways that health insurance can suck the life out of you. Obviously the literally not covering costs at all is one way, and I've been there as described in the previous paragraph. But I have also dealt with delays. My wife had a severe injury in early 2023 and not only required a hospital stay but also really needed to go to a rehab unit or rehab hospital so that she could get the physical therapy she needed. Instead, the hospital discharged her to my care with no backup plan in place other than to put in a call to a home health company. The next couple days were rough as neither I nor my now adult kids had the training needed to provide the care my wife needed. So I spent a lot of time pestering any agent I could get in order to impress upon them the importance of her getting the care she needed ASAP. I was about to cancel a professional engagement that would have had some unwanted career repercussions, which I really could not afford. Our one saving grace was a home health professional visited and did an assessment and was horrified at what she saw. Our house was not equipped to handle what my wife needed, and none of us was up to the task (and I was by that point less than 36 hours away from my flight out). That professional contacted the appropriate people in the hospital system we use as well as the insurance company, and her assessment is what got my wife into a bed at a nearby rehab hospital. The impression I got was that usually United Healthcare likes to wait a while before approving admittance to a rehab hospital, so we lucked out, I suppose. But it took way too much effort on my part and just by dumb luck getting the right home health professional to visit in order for the insurance company to expedite approval. 

There are other things I could always mention that are crazy-making about our healthcare system. Over the years I have become aware of the fact that my insurance plan may cover some services for a specific hospital but not all services. So one thing I have had to stay on top of is which hospital system or systems are nearby and what services are covered. The hospital system I rely on at home is fully covered by my insurance, thankfully. Also, thankfully it is in that tier of coverage that minimizes some of the financial pain. In an emergency, I may still end up owing several thousand dollars, but at least it is not tens of thousands or maybe hundreds of thousands of dollars. I also have to remember to research which hospitals and urgent care clinics are located at any destination I travel so as to not find myself incurring any more unwanted costs in the event of an emergency. I have had a couple out of town ER visits in the course of my lifetime. Each time, I was thankfully cognizant enough to get online and find out which hospitals honored my insurance plan. But one day I will not be cognizant. Then what?

Look, our healthcare system is definitely a mess. Could it be fixed? Yes. There are plenty of templates for how to make healthcare affordable and effective, with minimal hassles. We can look to our friends in capitalist countries in Europe and east Asia and use what they do as potential templates. Those systems are not perfect either, but there are so many places where people spend less on their healthcare and live longer than we do, and we're supposed to be the wealthiest nation on the planet. I recall reading that the healthcare sector counts for about 1/6 of the US economy, so obviously great care needs to be taken whenever we set out to reform healthcare. However healthcare is reformed, the mindset needs to be one of healthcare as a human right, rather than as a luxury only for the elite. We need to take the profit motive out and focus on the well-being of those who need any healthcare service from a checkup to an ER visit. We would be so much better off, and maybe we wouldn't have hotheads celebrating the assassination of a CEO and treating the assassin as a great hero or martyr. I know...dare to dream. Change is hard, but not impossible. We may have the wrong politicians in power to effectively address our own national healthcare mess - as last week's assassination laid bare - but we can advocate for change and challenge those in power to do better or get out of the damned way. We could end so much organizational violence, if only the will to do so exists.