Tikkabik

Last week I wrote about my experience with state-mandated health insurance – how it probably saved my life and without question saved my family from bankruptcy. Making health insurance affordable solves one problem faced by many Americans today – it keeps them from suffering catastrophic financial ruin in the event of a major medical crisis. But it doesn’t do a thing to actually reduce the cost of that care, which has spiraled out of control over the past few decades.

A recent article in The Boston Globe certainly drives this home.

“Of more than 3,000 Massachusetts adults surveyed in fall 2010 — the most recent survey data available — 17.5 percent reported having problems paying medical bills in the previous year. Twenty percent said they were carrying medical debt and paying it over time. Those figures changed slightly from 2006, but researchers said the difference was not statistically significant.”

Contributing factors include medical insurance plans with high deductibles and lapses in coverage.

Certainly having insurance coverage helps reduce the financial strain on families who undergo unexpected and catastrophic medical expenses, but if your budget is already stretched to the limit just trying to meet your family’s basic needs, it doesn’t take many high deductibles or hidden expenses to push you over the edge.

A 2010 survey from Blue Cross Blue Shield cited in the article cited a significant drop in the number of patients with unpaid bills totalling between $500 and $1,000. “But there was no statistically significant change in people reporting smaller or larger amounts.” It’s trivial to run up a much larger bill than that for seemingly minor procedures, or for the associated cost of emergent medical care like ambulance transportation.

But a bigger problem – and one that Massachusetts has yet to solve in any substantive way – is what happens to a lot of lower-income families like ours:

“Low-income people commonly lose insurance for brief periods when they move from one state assistance program to another. Others can get lost in a maze of eligibility requirements.

“The state is developing a website meant to streamline the enrollment process. Meanwhile, bills can add up during those gaps in coverage.”

There’s a huge problem with a lack of transparency when it comes to the cost of coverage. Patients can run up huge bills without realizing it, even if they’re insured. That’s precisely what happened to us last December when my daughter was hospitalized. She had insurance, but the insurance wasn’t good enough to cover non-emergency ambulance transportation from one hospital to another – required because the hospital she was brought to didn’t have the inpatient services needed to treat her effectively. We ended up getting a bill for the ambulance that drove her, to the tune of almost $2,700.

We’re still fighting that one. But it’s not like we were given the choice between taking her to the other hospital ourselves or footing the bill for the ambulance. It wasn’t until months after the incident that the issue of the bill even came up.

The bottom line is that insurance improvements in Massachusetts and the Affordable Care Act both help to make sure that catastrophic illness won’t be a death sentence for the financial stability of families living at the edge or below the poverty line. But both services stop dramatically short of actually correcting many of the cost problems that make health care in the United States such a big problem for so many people. For that, we’re going to need much more dramatic changes to the way that hospitals, pharma companies and others do business.

Greg Knauss’ recent blog posting “Bugged” describes his experience in the hospital when his son’s bug bite turned into something much worse. As it turns out, without insurance, he would have been expected to fork over almost $24,000 in medical expenses. Knauss’ comments have encouraged me to write more about my recent hospitalization, because I was in a different place all together: If it weren’t for government-mandated affordable care, I would be dead or bankrupt.

Knauss makes the point that the Affordable Care Act – “ObamaCare” as it’s known in political vernacular – will provide a safety net to many Americans who don’t have health insurance. If you’re insured, or if you can afford a lengthy hospital stay, it’s easy to poo-poo this as yet another government “entitlement.” But until you’re staring this situation in the face, you cannot possibly understand how terrifying the prospect of going without insurance really is.

As some of you know, I spent the last part of June and the first week of July in the hospital because of a foot infection. I had stepped on a sharp piece of plastic that punctured the bottom of my foot. I went to the doctor shortly after noticing swelling in my foot, but an infection had already set in. Bonnie brought me to the ER at the local hospital two days later; I was admitted and surgery was performed immediately. I ended up spending a week and a half in the hospital recovering from that.

Unlike Knauss, I didn’t have COBRA coverage. Anymore.

For the uninitiated, COBRA enables workers in the United States who lose health benefits to continue them temporarily. It isn’t an “entitlement” – you pay the entire premium for the insurance, up to 102 percent, actually.

For a family like us, COBRA was absolutely vital: my daughter’s been hospitalized several times, some of us take expensive prescription medications, and I suffer from chronic health problems that require drugs and regular monitoring from doctors. I’m an insurance risk, just the sort of risk that companies love to reject, similar to how Greg describes himself. But going without insurance would quite literally be a death sentence for me, and possibly for other family members too.

I paid out of pocket for COBRA every month I could after I lost my job. I was happy to. It was the continuation of services that kept us healthy and alive during my ten-year tenure at my previous employer.

It was only when the eligibility period ran out that I was finally forced to go without.

Fortunately, I live in a place where there is a safety net. I live in Massachusetts. In 2006, our governor signed a health care insurance revision bill into law. The law mandates that Mass residents can obtain a minimum level of healthcare insurance coverage, and makes sure that you can get free health care insurance if you earn less than 150 percent of the federal poverty level.

That governor was Mitt Romney, and the law I’m referring to is colloquially known as “RomneyCare.” It’s also been widely described as inspiring large parts of the Affordable Care Act.

The bottom line is that the vast majority of the residents of Massachusetts – an estimated 98 percent – have some sort of health care coverage, even if it’s the bare minimum needed to cover catastrophic events like hospitalization. Thanks to RomneyCare.

It was this insurance that I was able to get. I’m sorry to admit that those Federal poverty guidelines pertain to me, so I got the free coverage. Quite frankly, the economy and the publishing industry have not been kind to me since losing my last full-time job.

Without RomneyCare, I probably would have put off getting to the doctor or the hospital until I’d been much worse. And I’d be footing the bill for that ten day hospital stay. For the surgery, and the anesthesia. For each and every pill I took, every bandage I used, every linen that needed to be washed. For the bags of antibiotic administered intravenously. For the nurses, doctors and technicians who treated me every day. For the months of followup treatment I’ve required – a month and a half of IV antibiotics, more pills, daily visits to a wound care treatment facility for hyperbaric oxygen treatment, a visiting nurse who comes once a week to check on my progress, the specialized bandages and medicines I must use to keep infections at bay.

Two months later, it’s still not over. All this, because a piece of twisted, sharp black plastic less than two centimeters long got stuck in my foot.

I have little doubt that without RomneyCare I’d be declaring bankruptcy at this point, because I have barely the money to keep the lights on right now, let alone pay for a ten-day hospital stay to treat septicemia. Let alone the months of specialized post-surgical treatment I’ve needed to recuperate.

It was a totally unexpected event that I couldn’t have reasonably planned for. And even if I had, it would have required me to be able to afford to pay the expensive insurance premiums which are totally beyond my reach right now. I take no pride in admitting that. And to reiterate: I paid for private insurance as long as I could. I didn’t want to burden the system if I didn’t have to.

The system isn’t perfect. Premiums and service costs continue to rise into the stratosphere. There’s still a serious need for health care reform in Massachusetts and throughout the United States, and the Affordable Care Act doesn’t change that.

Knauss writes:

We can make this work. We have to make this work. A bug bite cannot be the thing that draws the line between a middle-class life and poverty, between opportunity and the stagnant dead-end of could-have-been. Our friends, our neighbors, our children, the future of this country as a cohesive society — as an endeavor where we see each other as more than opponents, as more than comptetitors [sic] — depends on it.

There are millions of Americans who can’t afford routine medical treatment, much less catastrophic care. Many seniors and others on fixed incomes have to decide from month to month whether they pay their utility bills or get the medication that keeps them healthy. Expecting friends, relatives, churches and charities to help them all is ridiculous. Expecting them to barter chickens for doctor visits is insultingly stupid.

And current “entitlement programs” – many of which inadequately cover the needs of these people to begin with – are being eviscerated by legislators who use the guise of reducing government spending to conceal their craven pandering to corporate interests and lobbyists.

I find it inconceivable that we’re still having a national discussion about health care as a privilege only for the wealthy or those lucky enough to work for an employer who offers affordable insurance. We need to recognize it as a fundamental human right if we’re to ever evolve as a compassionate society that actually wants to uplift its population to prosperity. We’ve heard a tremendous amount of lip service from the political right in this country about that, but their actions to dismantle the ACA and Medicare are completely counter to effort.

RomneyCare saved my life. And it kept our family out of bankruptcy.

The system worked.