Having health insurance does not mean you can afford medical care in the US


When it comes to health care in the US much of the attention has rightly focused on the plight of those who lack any insurance at all. But this gives the impression that those who have employer-based insurance have few problems and would even suffer with the increasingly popular Medicare For All proposal that has now been embraced by pretty much every Democratic presidential candidate and would replace the current system. But that impression is erroneous. This is because in order to lower insurance premiums, employers are pressuring employees to move to high-deductible plans. But a new study finds that a quarter of people with employer-based health insurance in the US cannot longer afford to pay those deductibles

One quarter of Americans say either they or someone in their family has skipped necessary medical care because of the cost, a Bankrate Money Pulse survey finds. And more than half worry about not being able to afford health insurance.

“My deductible is so high, it’s not worth it to go to the doctor for most things,” says Mandy Pullen, a 44-year-old single mom in Waltham, Massachusetts, who has health insurance through her job as a food service manager.

Having health insurance but still not being able to afford to get medical treatment, that is the American way.

Here are some of the stories .

Some of this, of course, is because many Americans (11.3%) simply don’t have insurance. But that’s just a small part of this: Even for families with insurance, costs are steep. In 2015, workers paid an average of $1,318 out of pocket before meeting their deductibles, and those in high-deductible plans (24% of workers) often pay even more. Even after surpassing their deductibles, workers paid an average copay of $24 for primary care office visits, $37 for specialty care office visits, and $308 for hospital admission.

Earlier this year, 20-year-old Eric, a senior at The College of New Jersey, tripped and fell down a flight of stairs on his way to meet friends. At first, he thought nothing of it, but when he woke up, his arm “felt like it was on fire” and he called his college’s medical services. “They asked ‘Do you want us to call you an ambulance?” he recalls. “And I was thinking ‘My health insurance doesn’t cover an ambulance.’” The ride was $450, a cost he couldn’t afford. “I was sitting here like, my arm might be broken, but I don’t have $450.”

Eric took painkillers and waited until the morning for his roommate to wake up and drive him to the hospital. The problems didn’t stop there: After his arm was set, E.R. doctors recommended Eric see a specialist to check for long-lasting muscle damage. The appointment carried a price tag of over $1000; his insurance didn’t cover it. Eric had to refuse, even as he worried that his arm would never be the same.

Americans keep being told how the insane system we have here is the greatest in the world and that people living in countries with socialized health systems suffer from extensive delays. Mary Robinette Kowal, an American writer living in Iceland sent out a series of tweets recounting her experience when she discovered a lump that she felt required seeing a doctor.

So what if so many have no insurance at all and so many others have insurance but cannot afford to get treatment? We must have the best health care system in the world because the US is the greatest country in the world, right?

Comments

  1. says

    I think many Americans cannot see the argument “USA is the greatest, therefore whatever USA has is the greatest” for what it is -- a circular echo, a logical fallacy glorified.

  2. cartomancer says

    As a British person, all I can say is, what are “deductibles” and “copays”?

  3. kremer says

    Beside the ‘delays’ in question, I’ve heard another counterargument against better healthcare access, from both much poorer and much wealthier family members, that goes something like this: “That sounds nice and all, but people in those countries pay much higher taxes”.

  4. mastmaker says

    Yeah. Plans have high deductible and there are simply not enough doctors. I live in the middle of San Francisco Bay Area, and my annual physical needs to be scheduled 2 months in advance. If I need to see my primary care physician for ANY reason, I have to wait a month or walk into an urgent care and see whoever is available -- thereby negating the very concept of PRIMARY CARE PHYSICIAN.
    The ‘waiting period’ situation is equally bad for all major hospitals and clinics except for Kaiser. However, my employer wants to charge twice as much for Kaiser plans as for similar non-Kaiser plans.

  5. says

    Being a diabetic, I look at the out of pocket limits. I hit that in the first half of the year. Anything approved is no cost to me past that.

  6. Holms says

    Having health insurance but still not being able to afford to get medical treatment, that is the American way.

    Worse: having health insurance AND A JOB and still being unable to afford it. Amazing.

  7. DonDueed says

    Oh cartomancer, just you wait. After Brexit you’ll be learning all about copays and deductibles.

  8. file thirteen says

    This isn’t news though is it? From memory, Moore’s documentary film SiCKO was mainly about the deficiencies of health insurance in the US. It’s worth watching if you haven’t seen it; you can watch it here.

  9. lochaber says

    I’m really lucky I haven’t needed any serious medical attention in my life, because insurance or no, I certainly can’t afford treatment.

    I remember once talking to someone who dealt with a lot of chronic pain patients, a significant amount of which were homeless. On of the things they said was that a lot can be traced back to them getting hit by a car, or assaulted, and not being able to afford or get proper medical care to treat the injuries, so they never healed properly, and continued to cause them problems for the rest of their life.

    And then there is the thing where if you go to the emergency room (maybe other services as well?), most insurance doesn’t cover the doctor’s fees. So, they will pay the hospital fee or whatever, but then the doctor (or multiple doctors) will bill the patient separately.

  10. ridana says

    #4 @ mastmaker: My employer offers several plans and Kaiser has always been the cheapest. Even so, if I were dying and Kaiser was the only option, I’d tell them to just let me die.

    #7 @ DonDueed: Wasn’t one of Pumpkin’s agenda items for his rub-elbows-with-the-royals trip to try to strongarm the UK into selling off the NHS by tying it to any trade deal? Not only can *we* not have nice things, he doesn’t want anyone else to have them either.

  11. jrkrideau says

    Bloody hell. I live in Canada and health care is provided. I think the last time I saw my doctor the office apologized because it was Friday and they could not give me an appointment til Monday. So much for long delays.

    Oh, long delays do happen but only for non-rush issues. If you can live with a bad hip for six months then you may have to. If you have a life threatening problem then watch out as you are rushed into Emergency.

    Drugs are not covered so I did have to pay about 12 dollars for prescriptions after a cataract operation.

  12. fentex says

    I broke my leg playing football, was picked up by an ambulance (after a delay -- turns out I picked the wrong day to be injured as the local hospital was overwhelmed by a multi-vehicle mess on a motorway that day) -- had my leg put in a cast and had a freidn take me home.

    I went back to hospital a week later after waking with a start and wrenching my leg -- worried I’d unset the break. X-rays to test and nope, no problem.

    After another couple of weeks my break wasn’t knitting (I’ve had that happen with a break before -- it seems I don’t heal that well from complete breaks. So in on the weekend, two foot titanium rod inserted, but had to stay an extra day (again, just like the last time I was under general anesthetic I spiked a fever 8 hours later that forced staying for observation in case of infection).

    A few weeks later (my leg, after weeks in a cast was no thicker than my arms) and I started regular physio-therapy sessions with water resistance training to help build strength.

    At no point was any bill presented.

    I have long wondered if I pay much more tax than I would in the U.S and I once spent a good effort on working it out. I make several multiples of the mean income for NZ and, as far as I can tell, pay about 2.5 ~ 3.5% more of my income in direct taxes, but if I was paying for health insurance it’d easily surpass that.

    I can, by the way, also buy health insurance from any one of several nationwide providers for (depending on plan) 1.5% ~ 3% of NZs mean income. The reason why many do in NZ is because there are measurable benefits and there are delays in public care you can avoid (my father for instance used insurance to pay for prompt service replacing bad knees).

    And the reason health insurance is affordable is because it has to be to compete with public provision.

  13. Mano Singham says

    fentex,

    I think that unless you are in the US and a victim of this system, you do not realize that the out-of-pocket costs, while considerable, are just one part of the problem.

    What is a major factor is the worry that people have about just how high the bill will be (and you never get a simple itemized bill, you will get multiple bills from different places with no idea when you have got the last one) and the unbelievable amount of confusion and paperwork and running around between doctors, hospitals and insurance companies involved. Unless you have been through the process, you have no idea how complicated and stressful it is.

    Paying much higher taxes more than compensates for the relief of knowing that if you or your loved one needs care, you will be given it and that’s the end of the story.