By MEG JORDAN, PhD, RN, CWP, program chair and core faculty, Integrative Health Studies program. Meg is also a clinical medical anthropologist and editor in chief of American Fitness Magazine
If you don’t have health insurance, you are 40 percent more likely to die than those with private insurance. But what’s the risk if you’re among the growing numbers of underinsured? Although the statistics aren't available, the everyday reality is that insurance policies with inadequate coverage can be just as bad.
As a university professor in the health sciences, I give many talks, nationally and internationally, on the state of health care in the U.S. Just this week I was scheduled to present at the National Wellness Institute on the status of health coaching in the U.S. An emerging profession dedicated to helping people turnaround unhealthy habits, health and wellness coaches are part of the solution to our nation's rising medical costs. So far, they're outside the reimbursement system of health insurance, but I'm on a national team of leaders and educators hoping to reverse that.
I've also argued long and hard that true reform of an ailing sick care system requires both individual commitment to change (since almost half of all health care costs relate to personal behavior) and supportive policy change and overhaul within public and private sectors.
Today that argument came home with a forceful reality. My firstborn, a college graduate who works two jobs, seven days per week, in order to pay off massive student loans and afford her rent in Denver, pays a large co-pay premium every month (over $350) at her meager $10-an-hour job as a pastry chef at a major four-star hotel. The health insurance offered by the hotel is so inadequate, she and her co-workers wind up foregoing reasonable medical care in order to avoid paying inordinate out-of-pocket expenses. Studies confirm that people will ration their own needed health care when faced with high deductibles.
But her policy is among the more ridiculous, and for some reason rejects all gynecological expenses. As a result, a 28-year-old young woman with a troublesome IUD decides she can't afford the routine check with at an OB/Gyne office, after hearing that she will be charged about $500 cash upfront in order to have it removed. ("Sorry, we checked with your policy and they don't cover gyne.")
So what is the end result of systems like this? People don't get the care they need, and they are shoved along a continuum from prevention to crisis. My daughter had sudden pelvic pain two weeks ago, and wound up in an emergency department, where they made a decision to not do an ultrasound since "her insurance probably wouldn't cover it."
She limps back to work, holding her gut together, only to have the problem exacerbate. Today the pain was excruciating and again, she left work, barely making it to an ER. Internal hemorrhage was noted and she was rushed into exploratory surgery.
She had a ruptured ectopic pregnancy, one of the risks of certain IUDs, that required removal of the fallopian tube, and major clean-up of a pelvis filled with blood. Heavy doses of pain medication given in the ER complicated the amount of anesthesia needed for surgery; more problems ensued with overdose and nausea, creating a challenge for intubation.
In short, she joins the ranks of Americans who face crisis upon crisis, undergo tremendous pain and suffering, and incur huge costs—all because they don't receive preventive health care.
Who's to blame for this?
As a mother, I can practice tough love, and tell her she alone is accountable for choosing to work at this hotel, for selecting a lower-cost insurance that allowed her to take home slightly more in her paycheck, and for not taking out a loan in order to see a doctor earlier. Or, I could beat myself up for not making sure she had the cash she needed. However, she was fed up with asking her parents for help—a common situation for many late 20-somethings who struggle to be independent in this economy.
Being responsible for her choices aligns with the argument posed by conservative voices in Washington, D.C.: Our systems of entitlement require analysis and radical reduction. Absolutely.
Then another lesson at home kicks in. My brother, the insurance expert, taught me that all insurance works via the leveled waters of pooled risk. We each pay a little something so that both reasonable care of the near-healthy and crisis care of those in need can be managed. When non-participation by large numbers of people or unmitigated profit and payments to Wall Street throw that trusted model of pooled risk out of balance, insurance systems will fail to cover people adequately.
Another example—bear with me—this time with a former husband, a die-hard Republican, who railed against how "government can't do anything right." He suffered with a slipped disc for a year in the U.S. but couldn't work through a maze of barriers to see a specialist, and then was laid off and without any health coverage.
We moved to Vancouver, British Columbia, for a work opportunity for me, and within four weeks of arriving, two medical care cards arrived in the mail, along with a bill for $50 per month each. He complained about the bill, of course—here we were in "socialist Canada"—now without a choice, being forced to contribute.
I made a call to a clinic that day, expecting to have to wait six months for a Pap smear, like I did in Northern California, only to be told—"No, you can get one today. Just walk in any provincial medical clinic. You'll see one every few kilometers in Vancouver. No appointment necessary. Just bring your medical care card." I did. When I went to the desk to hand over the co-pay, the clerk didn't even understand what I was offering. No payment required.
When I told my husband what happened, he decided to test the system, and called for an appointment with a neurologist. He saw him in a week, and had an MRI the next week. He came home saying he was "rather floored—nobody at the hospital asked for any money." The end result? He continued to boast about America's greatness, but watched FOX news a little less. He also got help to change his diet and exercise more, and saw their physiotherapist once a week, alleviating the back pain.
Now we've all heard endless stories about the long waits and inferior care of these so-called "socialized medicine" systems in countries such as the United Kingdom and Canada. But any actuarial will tell you the basic requirements of large systems. Research shows how a universal system of coverage for a basic level of care is the right financial (and moral) decision for a progressive society.
I also know that a natural migration toward a hierarchy of care (tiers of wealth and privilege) will inevitably manifest. But I can live with that, as long as we offer a basic care for everyone. When everybody is in the pool, the cost comes down to $50 per month. When fewer participate, individual cost burden is higher. I feel like we need Ross Perot with his white board right now to explain this to Americans who have been dumbed down by ignorant political sound bytes.
Universal coverage addresses sick care. Preventive care is another matter. Arguments have been made that there are not enough dollars within pooled systems to cover the screening and preventive health services, but those arguments need to be nailed within the coffin of outdated, unproven old fears.
Spend a little time at prevent.org.
The Partnership for Prevention is a coalition of business, nonprofit and government leaders working together to make sound and reasonable evidence-based models of health promotion the national norm. The number of publications and resources available today on how and why prevention is our only solution is astounding.
I'm probably an unusual voice in their pack, since I want to see both this modicum level of care (universal coverage) for everyone, and a robust system of disease prevention, health promotion and wellness initiatives in place. But after spending time with my colleagues at the National Wellness Institute, I know we're capable of both quality sick care and extraordinary wellness incentives for individuals, businesses and communities to go the extra measure.
Our nation's health depends upon it. My daughter's life does as well.