04 Jan

2015 America: Woman chooses wheelchair over medicine she can’t afford


The O’Leary: What a mess!  Thanks Obama for insuring (you will excuse the pun) the pharmaceutical companies.

2015 America: Woman chooses wheelchair over medicine she can’t afford.

Read this article.


Probably known more for its presence in the lobby of the Econolodge or Holiday Inn than exhaustive, in-depth reporting, USA Today has hit it out of the park with its recent article on the crushing burden — for an increasingly-strapped middle class — of health care in America.

Americans — working full-time jobs in the formal economy — are simply being abused by this country’s bloated medical-industrial complex. Let’s start with a heartbreaking anecdote and then dig deeper.

Jennifer Ross, an arthritis sufferer in Florida insured through her husband’s job, says she recently made the wrenching decision not to take a medication that might allow her to get around without her wheelchair. The $2,400-a-month medicine would cost her $600 a month out-of-pocket even with insurance, and she simply can’t swing it. To make matters worse, Ross’ 12-year-old daughter was recently diagnosed with arthritis, too.

Reread the aforementioned and join me below the fold.

At the toxic nexus of stagnant wages and persistent for-profit insurer, hospital, and pharma greed, Americans are suffering like never before in our dysfunctional, non-system “marketplace” — well, more like market failure — for health care.

Praveen’s father, Mohana Arla, says being forced to pay so much out-of-pocket “is as good as not having insurance” in an era of ever-rising health care costs. Inpatient care last year averaged $17,553, and insurance plans require people to pay a portion of that even after meeting their deductibles, up to an out-of-pocket maximum that can easily exceed $10,000 a year for families. Median household income in the U.S. is around $53,000, and the average American has less than $6,000 in savings, according to a 2012 report by Pitney-Bowes Software. A quarter have no emergency savings at all, reported in June.

In other words, the poor lucky enough to have access to Medicaid with zero cost-sharing (and, of course, many states have refused to expand Medicaid) seem to be able to access health care in 2015, the rich can certainly pay their way to the front of the line, but American workers are being screwed.

Physician Praveen Arla is witnessing a reversal of health care fortunes: Poor, long-uninsured patients are getting Medicaid through Obamacare and finally coming to his office for care. But middle-class workers are increasingly staying away.

Here are some more numbers worth considering.

A recent Commonwealth Fund survey found that four in 10 working-age adults skipped some kind of care because of the cost, and other surveys have found much the same. The portion of workers with annual deductibles — what consumers must pay before insurance kicks in — rose from 55% eight years ago to 80% today, according to research by the Kaiser Family Foundation. And a Mercer study showed that 2014 saw the largest one-year increase in enrollment in “high-deductible plans” — from 18% to 23% of all covered employees.

Meanwhile the size of the average deductible more than doubled in eight years, from $584 to $1,217 for individual coverage. Add to this co-pays, co-insurance and the price of drugs or procedures not covered by plans — and it’s all too much for many Americans.

And the consequences of those numbers are pain, suffering — dare I say, torture — structural violence committed against the American people by oligarchs earning eight-figure salaries at Aetna, Cigna and Anthem.

Holly Wilson of Denver, a communications company fraud investigator who has congestive heart failure and high blood pressure, recently went without her blood pressure pills for three months because she couldn’t afford them, given her $2,500 deductible. Her blood pressure shot so high, her doctor told her she risked a stroke.

And LaRita Jacobs of Seminole, Fla., who gets insurance through her husband’s job and has an annual family income of $70,000, says $7,500 a year in out-of-pocket costs kept her from dealing with an arthritis-related neck problem until it got so bad she couldn’t lift a fork. She’s now putting off shoulder surgery.

“How did we get to this crazy life?” asks Jacobs, 54. “We’re struggling to pay our bills like we were struggling when we first got started.”

But, what about the Affordable Care Act, right? Well, the ACA has certainly gotten a few million more people insured, but because it places no (significant) burden on providers to control costs, patients are left to do the heavy lifting, and, in America’s insurance-based non-system of health care, that means more costs for workers rather than lower profits for corporate insurers and hospital chains.

Since the ACA took effect, “there’s been an accelerated movement” to these  types of [high-deductible] health plans, says Brian Marcotte, president and chief executive officer of the Washington, D.C.-based Business Group on Health.

Marcotte, whose group represents 400 large employers, says that the looming Cadillac tax is one factor but acknowledged that managing health care costs is another.

In other countries, like Germany, Japan, Italy and the United Kingdom, governments set prices for health care procedures and drugs — patients are not left to put “more skin in the game” to control costs by “shopping around.” (Has anyone — discuss in the comments — ever been able to successfully “shop around” for health care in the United States?) But, in a country where over 1/4 of adults have no savings, “skin in the game” often just means the fast train to bankruptcy.

When patients do get needed care, some find themselves in massive debt. Kim Brown, an administrative assistant in Louisville who was earning about $40,000 a year, owes many thousands — the bills are still coming, so she doesn’t know exactly how much — after battling thyroid cancer. She says her annual out-of-pocket costs are $7,500, and she also has to pay 15% for things like hospital stays. No longer able to work because of her illness, she reluctantly signed up for Medicaid and will likely declare bankruptcy.

This is just how big corporate insurers like Anthem — formerly known as WellPoint — like it.

“By having deductibles, it puts skin in the game,” says Divya Cantor, senior clinical director for the insurer Anthem in Kentucky.

You see, in America, health care is game — and high-paid insurance executives can demand to extract a pound of flesh before you are allowed to pass go and visit the doctor.

Insurance in this country is not even about financial protection for most middle-class workers — it’s about debt reduction.

He cites the case of a young woman who couldn’t afford insurance on her own who stopped having periods and went to the emergency room with severe headaches. Diamond discussed doing testing for possible ovarian and endocrine problems. When blood work showed abnormal levels of the hormone prolactin, he recommended an MRI to rule out a pituitary tumor. Her bill for just a few hours in the emergency room was $15,000, something that will take her years to pay off.

If she had had a high-deductible plan, he says, it would have paid for a large chunk of the cost, and her debt could have been a third to half as much.

Single-payer advocates — like me — realize that there is a better path forward. We must put everyone in a single pool, because we truly are all in this together.

Originally posted to james321 on Fri Jan 02, 2015 at 11:07 AM PST.

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