Surviving healthcare costs

This Sunday, Tropical Depression Claudia is passing over North Carolina, a loosely-organised weather front. The rainy weather is keeping me indoors, affording me the time to do some office work and write. One thing I've got to do is shredding paper from seven years earlier, like old bank statements and letters from debt collectors. Every so often, while shredding, I'll see letters from our credit union of 'insufficient funds'.

I use shredded paper for mulch - but that's something I cover in posts about gardening. Today, I'm writing about the extortionate cost of medical care in the US. On the couch in the living room, Stacey is recovering from a medical operation. The medical insurance she is required to use from her employer - or lose her job - has a deductible of $2,000. The insurance year runs from June to July. And since she's not been employed there for an entire year yet, she is not guaranteed any paid medical leave.

So in the space of two months, she has to come up with $4,000 to meet the deductible - and this doesn't include the copay to the surgeons, oncologists, anaesthestists, hospital stay, as well as for the many tests that must be done during diagnosis and development of a treatment plan.

She will be expected to work during her treatment, or lose her job. Without income, even with the Affordable Care Act, you may not qualify for a personal plan. And unless you are completely without resources and have been for an extended period of time during the course of the previous 12 months, you don't qualify for government programs like Medicaid.

When my late wife Cynthia's cancer returned in 2010 - while recovering from the Great Recession - the GOP was trying to drive a racist stake into what it called Obamacare. The Affordable Care Act passed and was signed into law. It included a personal mandate, so you could obtain health insurance when your employer didn't offer it, or if you were self-employed. It also prevented health insurance companies from declining to cover what they called pre-existing conditions. The law only began being implemented at the end of 2013.

When Cynthia's cancer returned, she was denied coverage for her cancer by the health insurance companies because she'd survived. Over the course of her treatment, we racked up well in excess of $250,000 in health care bills, and that doesn't count or include what we paid for out of pocket for her drugs, and at the end, the pain medication she needed as she was dying. It also did not account for debt incurred as a result of diverting money to pay for medical care. We raided our 401K. It took me four years after she died to finish paying off the debt incurred during her illness and I will never recover the loss of the savings to my pension.

But even today, with the ACA, premiums are creeping up. Useful insurance is unaffordable. Most people can't afford the Gold plans. The rest carry high deductibles that must be met before cover kicks in, or expensive copays. For the same benefits, my Blue Cross Blue Shield plan increased by $80 a month from 2020 to 2021, making consideration of it a question of rolling the dice in the midst of the COVID pandemic.

Since Reagan, the middle class in the US has been hollowed out with trickle-up economics. Most of the middle class cannot afford more than a few months without income and even with the Affordable Care Act in place, more than 30 million Americans are without health care coverage. Of those who are insured, millions are underinsured and face financial ruin in the event of a serious medical issue.

What they face is what Cynthia and I faced should they become ill - massive debt, possible bankruptcy, calls from debt collectors, letters from the bank of notifications of insufficient funds, choices between food and medical treatment, negotiation after negotiation with hospitals, doctors, and other creditors, and making treatment choices based on money rather than medicine.

Even with the ACA, as Stacey's treatment journey is demonstrating, she will have to find thousands of dollars. Every week, I see in social media feeds a Go Fund Me plea for some family who has a medical need not being met by the system we have in place. Medical treatment is a given for everyone. Us, too, in the US. It's not a question of if, but of when it will be needed. The young may be healthier, but they are also not immune to the the accidents of their genomic makeup or random misadventure.

Congress needs to add Universal Healthcare to its list of urgent to-dos. Along with that, there must be a mechanism to eliminate the crushing costs of medication, including for those who suffer from chronic conditions like diabetes, dementia, transplant patients, mental health drugs, pain meds, and others . We should not be facing ruin from illness, something that affects millions of households every year. Complex policy it may be, but it's been done successfully in many other countries, so we have the language to borrow for our country.

The sooner this is implemented, the fewer the number of people who will face the impossible choices brought on by a diagosis. We should not need to have to choose between losing cars or homes, or financial ruin in our retirement, or going short of food to keep a loved one alive.

 Header Image - By Alice Pasqual, downloaded from Unsplash.