Recently, my husband’s company sent us an email letting us know the cost of our health insurance premiums for next year if we keep the same plan. They were kind enough to include a little note that said āHey, weāve also raised the prices a little bit,ā because, you know, the billionaires running insurance companies want to buy a twelfth jet. They didnāt say that last part. But they did let us know about a price increase. A boy was it a doozy: $26,000.
I donāt know about you, but I canāt afford that.
And it isnāt just me. There are so many people who canāt afford health insurance and health care or canāt afford to use the insurance they have. And that is so not okay.
So letās talk about it! Because this is conversation that needs to happen and it needs to happen everywhere and with everyone, regardless of age, social standing, financial status, or political opinion. Because this isnāt about politics. This is about people and a broken system that canāt continue the way it is.
Check out my video on the topic here or read on, whichever is your preferred medium. The information is all the same!
Soā¦when did the system start to not work. And why isnāt this a problem in other countries. For this we must travel back in history a wee bit. Letās go.
In ye olden times when people got sick, doctors came to their house. And then the people paid the doctors. There were a few hospitals, most of them run by churches, but they really were mostly just good at killing you almost faster than if you stayed at home because the scientific process wasnāt sorted out. So best you just stay home and try the remedy your local doctor gave you. This obviously benefitted people with money to pay a doctor, and if you couldnāt afford it, well, you probably should just try not being poor.
Clearly, it was because poor people were lazy, and lazy people donāt deserve to be given the privilege of accessing care that helps them stay alive. As you can see, some things never change. But more on that later.
In the 1910-1920s, some companies and labor unions started to offer assistance for paying for medical care, but it was not commonplace until after World War II. In 1943, President Roosevelt put in place a sort of freeze on wages, because there wasnāt much money with a war going on. So jobs needed a way to incentivize people to work there, but without money, and they decided to leverage something else: the ability for employees and their families to have access to something they may not otherwise have access toāmedical care.
Insurance companies then needed to be born to become the middle man between the people and the health care, and they became widespread because somebody needed to actually handle the transaction of exchanging moneys for healthcare availability. And it worked. People took jobs they otherwise wouldnāt have due to low pay or just not liking it, because they wanted medical care. And it slowly became more common for more exclusive jobs to start offering health insurance to lure in quality candidates when there werenāt many available.
And you might be sitting there saying, but Liz, that makes sense. We had no money and needed an incentive. The intent seems good. And to this I say, yes, at that time it was a decent solution to a problem. But that wage freeze eventually stopped. And guess what didnāt? This insurance system.
Did some people have objections, saying that this was largely unfair and could be used to manipulate people into staying in low-wage jobs or jobs that treated them poorly just for health insurance, of course! So, how did private insurance companies, who profited the most from this system, convince the general public that this was okay?
Great question.
The lobbyists told voters that this was in THEIR best interest. You see, they didnāt want socialized healthcare like GERMANY had. Those evil Nazis. Slogans like āpolitical medicine is bad medicineā were started. And if I may be so bold, this continues to be a fear-mongering tactic we still see used to this day. We don’t want any kind of socialized medicine. The word “communism” is thrown around a lot. “It’s perfect the way it is.” There is a lot of fear around if we changed it, it would be so much worse. I think you’ve probably heard that before.
Back to history! Noticing that this system was leaving quite a few people still without healthcare, President Truman began talking about the idea of having a government-funded health plan in the late 1940s, like the rest of the developed world was doing at the time, because they realized that humans are inherently valuable and worthy of things like access to healthcare. But he was met with opposition from the unions, doctors, and hospitals, because they very much liked things how they were. As were the insurance companies. The insurance companies were also quite thrilled. There was nothing dictating how much a doctor could charge for visits, same for hospitals. They certainly didnāt want to switch to a medical model that would be reimbursed by a set fee by the government and could be controlled that way. And how would unions get people to work crappy jobs if they didnāt have the perk of āif you get sick you can at least get medical careā to dangle over peoples heads like bait.
All attempts, and there were many, to create a single-payer, government-funded healthcare system failed, because over and over again, medical providers, healthcare systems, unions, and, later, insurance companies would lobby in favor of making themselves more money at the cost of human lives. And as the lobbyists became more wealthy, they were better able to push the narrative based on fear, NOT facts. They just kept pushing the same line, to the people that we did NOT want to be like the socialist countries out there.
Letās fast forward a little bit to the 60ās. What happened in between then and now? Well, things just kept getting worse because people are greedy. Shocker.
In 1965, tensions in healthcare were reaching a boiling point in the whole country in general. Those without health insurance were dying, because they couldnāt afford health insurance, similar to how it really always has been, and even though they had jobs, they didnāt have āin demandā jobs, so the jobs didnāt need to incentivize people to come work there with things like benefits.
It was also still a thing in the 60s that if you were Black, or really any minority, you couldnāt go to the White hospital. Hospitals were segregated, which just blows my mind. When my parents were alive, hospitals were still segregated. That still is difficult for me to wrap my head around. And even if it wasnāt an entirely separate hospital, it was a separate wing or a basement where your medical care was immensely sub-par. Shockingly, thatās also something thatās still happening, and we need to address it. If you were not lucky enough to be very wealthy, White, or to have a job that provided health insurance you, you had no other option at this point. Kind of like now.
And thus, in 1965, to try to address this, Medicaid and Medicare were formed. And one of the requirements for creating Medicaid and Medicare was they hospitals would be forced to desegregate in or for them to get federal funding. If they didn’t, they weren’t going to get any money, which was a really big motivator, since healthcare always really likes money.
This was an immense breakthrough for older patients, who could now get Medicare, individuals living on very little income, who could get Medicaid, and this would hopefully start to desegregate medicine just a tiny bit. At least, it was the first, tiny step in the right direction. Not ideal, but the right direction. Unfortunately, it still left out a massive middle ground of Americans who didnāt qualify for Medicaid, but also couldnāt pay for health insurance or they weren’t at one of those jobs that incentivized people to come there with health insurance. Sound familiar? That was when our first “sort of” state-funded healthcare came onto the scene.
Next, how did we get to the place that insurance companies now not only can charge us insane amounts of money to have access to healthcare, but they also dictate our care? That arrived with the implementation of HMOs, Health Maintenance Organizations, in the 1970s. At that point, it became legal at this time for HMOs to offer insurance and operate in a system where there are set guidelines in place of how to manage every condition and the providers within that system are given parameters of how to practice medicine.
It wonāt shock you to know that these guidelines were put in place to save as much money for the company as possible, even if it wasnāt the best treatment for the patient. It also wonāt come as a surprise that humans are not all the same, so they probably shouldn’t receive the exact same medical care and that doing so doesn’t always have the best outcomes. We don’t even have the best of both worlds. You can’t say, oh, well, we don’t have nationalized healthcare, but that means we’re not working within those parameters. No, we DON’T have nationalized healthcare, AND we don’t have the freedom of choice as healthcare providers to make our own decisions.
This is how we not only have the most expensive healthcare system in the world, because itās driven by profit, but also how we manage to have the poorest health outcomes. Because insurance companies donāt allow for individual provider discretion, leading to mismanagement of patients if they donāt fit the model. Oh, and then thereās all those people who fall into the āno insuranceā hole or the āmy deductible is too highā hole. Those donāt help us with outcomes either. Should we look at those real quick?
I cannot tell you how many people I have talked to in my decade in healthcare who were hardworking, excellent humans who made too much money to qualify for Medicaid, but who couldnāt afford insurance. How is this possible, you may ask. Thatās no MY reality. Well, letās use me as an example.
My job does not offer insurance. So we get insurance for our family from my husbandās job. My husbandās job offers two types of insurance. First, a very cheap insurance that covers annual physicals, (Awesome!) but, unfortunately, that is literally all it covers. If you need anything else, if you need to go to urgent care, if you need to go to the hospital, if literally anything but a physical happens, you pay out-of-pocket. As we all have some medical conditions, and I canāt tell the future yet to see if we will be requiring hospitalization, this option was out.
Next we have the second option, the more expensive option, which is, like so many out there, a high-deductible plan. If you aren’t familiar, with a high deductible plan, you pay a monthly premium to the insurance company to have the privilege of having insurance with them. Our monthly premium for this privilege is $1,333 a month. $16,000 a year. One might think, WOW. You are going to have amazing insurance with that cost. I bet they even cover massage therapy, chiropractors, all of that. And, oh friend. Oh, friend. You could not be more wrong.
With a high-deductible plant, after paying $16,000 for the honor of having insurance, if we DARE use the insurance for ANYTHING other than physical exams, we must then pay out-of-pocket until we reach our deductible. This is for things like my daughters getting sick, or my needing to go to the doctor to get a refill on my Zoloft. Appointments are usually $250 a pop for a non-specialist provider. If you have to go to a specialist, like a psychiatrist, or gastroenterology, it’s about $350-plus. But donāt worry, we only have to pay that out of pocket until we hit our deductible. What is our deductible? $13,000. Because we are a family of four. if we were just one person it would only be $7,000. So really, we are getting quite a deal. FOUR deductibles for the price of two? Wow. Thanks, Aetna.
And that, my friends, is how I cannot afford healthcare. Because if we combine the annual cost of health insurance with our deductible, which we almost always hit because weāve got a family full of people who utilize healthcare, we have a cost of $26,000. Which is more than a quarter of our income. And that doesn’t include taxes or any of that stuff. For one year of medical care for my family of four.
And this is not just me. It’s not just me complaining and saying, “Oh, woe is me.” This is millions of people. This is countless patients being unable to go to the cardiologist for their heart murmur, because they havenāt reached their deductible and they canāt afford it.
This is cancer patients DENYING TREATMENT or denying palliative care, and asking me to not tell their wife, because their credit cards are already maxed out and they canāt get a loan, so they canāt pay their deductible and theyād need to declare bankruptcy to proceed with treatment. And if they don’t live, they donāt want to leave their wife a widow AND in bankruptcy. So they decide to die from treatable cancer so their spouse can live without that burden. I have seen that more than once. I have seen people die in pain because they don’t want to hit their deductible to pay for palliative care. And if you tell me that that is a lie, you are wrong. I have seen it. And you are wrong. It DOES happen, and it happens often.
This looks like sitting in your OBGYNās office after your first ultrasound, this happened to me, with your new, tiny, poppy-seed-sized baby in your belly, a time that should be joyful, but instead you are in tears in the financial office, because that’s where they direct you after your pregnancy is confirmed, realizing you will need to come up with $13,000 to have this sweet baby. They want $7,000 by next week. But, donāt worry, they offer payment plans. For your BABY. It takes most people years to pay off the birth of their children. Most of my friends, we’re STILL trying to pay off the births of our children. Thatās not OK.
This is people paying their t$13,000 deductible for their D&C after a miscarriage. They didnāt even get a baby. They just got a bill.
This is patients not treating small problems because the cost is too high for a visit, only to come into the ER months later with a now incredibly serious and life-threatening complication of a disease that would have been easily treatable, preventing this whole situation, if only they had access to care a few months before and could have dealt with it then.
This is coming off medication for crippling depression because you canāt pay for the office visit that you need in order to get your refill and you havenāt met your deductible. I’ve done that. It was not fun. it did not go well.
This is stretching your insulin, because yep, meds apply to this too. Gotta pay out of pocket until that deductible kicks in. And since you obviously chose to be born with Type 1 Diabetes, you get to pay the $13,000 deductible every single year to cover your medicine before anyone else will pay if you work somewhere that has a high-deductible plan.
This is not working.
This is not working for 90% of the patients I see. I don’t have hard statistics on any of this, because it is just my experience. We have data on how many people have insurance, but we have no data on who is able to utilize their insurance.
I spent 75% of my appointments in primary care trying to figure out how the heck to get treatment for people or fighting with insurance companies who didnāt want to provide the treatments people needed when they finally did meet their deductible.
We’re like, we got here, and then the insurance company was like, “No, try X, Y, and Z first.” And then the year timed-out, and it was time to start over again. Or, I was researching treatments I was never trained to prescribe, didn’t feel comfortable prescribing, because the patient could not afford to go to the specialist who was trained in this. And without it, they may die. So I guess I’m going to be looking into this with my collaborating physician, and we’re going to be figuring this out.
I am not being dramatic. I know some people will say I am. I KNOW people will say that I am.
But I promise you, this was every day. Almost every appointment. And itās heartbreaking. And I am angry. I tried for a long time to film this without being angry, but I think it’s okay to be angry, because this is not okay.
Are I know some of you are going to point out that this isnāt every type of insurance. And you are right.
Some jobs offer awesome healthcare insurance. My old nursing job had incredible insurance. I paid very little for it. I paid $88 to have my first child in comparison to the $13,000 I paid for my second child. People drive an hour-and-a-half to that hospital to work there just for the insurance. They drove by dozens of other hospitals to get to ours just for the insurance.
And here’s a fun fact. If you are an executive at a company, this is also likely not a problem for you. Because companies usually have āexecutive insurance policiesā where you donāt have to pay for insurance and you donāt really have a deductible either, and if you do, itās super low and they usually throw a health savings account at you with enough to cover a good chunk of the deductible. I did not know that until my spouse worked in insurance, and he was like, “Did you know this was a thing?” And I was like, “Excuse me?” So these are people that are making a lot of the decisions because the executives have a lot of money. Interesting. Follow the money.
There are also non-high-deductible plans, like PPOs. We donāt have that option available to us, but they exist if your employer pays more on your behalf to have that option provided, as a job incentive, like when this all started. Some companies offer better insurance than others. They’ll offer PPOs, they’ll pay more for it so you pay less out of pocket. So again, just work at a job that has those. Easy, right?
And there are cost-sharing insurance plans that act as a sort of insurance where they decide what they will cover, usually based on religious influences, and the cost is shared amongst people, like MediShare. This is fine if you align with those principles are are OK with their limitations. It can usually kind of get pretty expensive if you need certain other things, but for a lot of people, those do work.
We have the healthcare marketplace now, as well, where people can go on and shop for their own insurance if it’s not provided by their employer. But itās usually in the same ballpark of price as my plan I described earlier. We looked and searched all over for one, but couldnāt find a plan for cheaper than our $26,000 plan so, bummer, dude. Good try though. They had it, but it was catastrophic, so, great, as if this whole situation isn’t catastrophic. It’s fine.
And then there are the people who just canāt afford it and they just don’t have insurance. And they show up at the ER when they are epically sick. Unable to pay the $300,000 dollar bill they get after emergency surgery and a hospital stay, they declare bankruptcy to not die, and the hospital writes it off as a loss. Donāt think that happens? The number one cause of bankruptcy in the U.S. is medical debt. People are desperately trying to stay alive and are destroying their financial world to do it. What a cute and fun American tradition.
So, what do we do?
Letās change it. Please, letās change it.
Please listen to this and donāt blow it off as a āliberal schemeā, because this is not political. This is people. Remember how this started. Lobbyists trying to make money, using what they KNEW would scare people. āSocialist like Germanyā. How many times do we hear single-payer healthcare described like that today? As socialist. As communist. As something that would ānever work as well as our American systemā that is not working. People were using that fear tactic back in the 1920s. And it’s 100 years later. We can do better.
We can open our eyes and see that EVERY single other industrialized country has figured out single-payer healthcare. And we can too. We can figure out how to implement a healthcare system that acknowledges everyoneās right to receive healthcare because they are alive and living here and they don’t need to go bankrupt to do it. What if the most stressful thing about getting diagnosed with cancer wasnāt how you are going to pay for it, but how you are going to survive. As if it’s not already stressful enough. Can you just imagine that, and put yourself in the shoes of other people, and say, “Oh, people deserve this.” Even if the current system is okay for you, it is not okay for most people.
If YOU have experienced a lack of healthcare due to either lack of insurance or lack of an ability to hit your deductible, I am sorry. I have been there, I AM there, and it sucks. If youāre comfortable, I would appreciate you leaving your experience in the comments. It doesn’t have to be details, just the general gist. Iāve tried so many times to have this conversation with people and every time it ends the same way:
āWell our system is better.ā
āPeople donāt have insurance because they are lazy.ā
āSingle-payer is socialist or communist.”
āThe wait times would be too long.ā
As if our wait times arenāt too long. I have to wait nine months to get to primary care. And, have we ever thought that our wait times would also be even longer if EVERYONE had access to healthcare versus only those who could afford it? Other countries might have slightly longer wait times because EVERYONE has access. And it seems like everyone having access is an important thing to make things equal. But we’re not always very good at making things equal. I digress.
So what would I love to see? I would love to see if we could stop with the āwell I got mineā attitude. And what do I mean by that? I mean, let’s just stop thinking that if this isn’t an issue for you, wonderful, but I have taken care of a lot of people, and I can tell you that this is an issue for A LOT of people. They don’t have access to healthcare. And I would love if you could help me spread that message. If we all talk about this, we can change it. I really think that. Please share this. please share your experiences. Thanks you so much, and thank you for reading this. Remember, this is a PEOPLE issue, and I so hope we can see it as that and come together to fix it.
