Pay Up or Die.

Issues of Health Insurance

by Ryan Huang

Some time during the early morning in the big city: a young man walks through a moonlit alleyway over oil-tinted puddles, past reeking dumpsters and sickly shards of green bottles.  The night air is damp, moist from light rains the evening before; a smell of overcooked grease wafts slowly from overhead vents on the alley walls.  A dull yellow cab drives swiftly past the entrance, splashing putrid street water over the walk, disturbing the forced calm of the night.

A hoarse, scratchy voice whispers across the alley.

“Hey.  You.  Yeah, you.  Over here.”  

The young man pauses momentarily, squinting to his left into the obscure darkness, noticing a glint, the burn of a cigarette.  Reflexively, he fingers his wallet in his jacket, bends his head as to avoid confrontation, and warily steps past the shadowy figure.

“Want to buy some stuff?”

The young man stops abruptly, looks up, and slowly turns around.  The dealer, now standing between him and the entranceway, spits out the butt, forcefully smothering the burning ashes with the tip of his foot before lighting up another smoke.

“Yes, the good stuff,” the coarse voice coons, “You can’t get this stuff anywhere else for a price like this.”  The dealer steps forward into the moonlit center and flashes a package; the young man instantly recognizes the contents.

“Good for two; includes everything.  You name it… it’s here.  Best options around.”  As if cued by the young man’s obvious interest, he holds up four fingers against the background of the lighted street.  Four thousand.  Four thousand a month for two.

Has this ever happened to you?  Have you ever been approached by someone in a dark alleyway?  No?  Well, perhaps something similar in a different setting?  Have you ever had to pay an excessive amount of money for something so vital, so essential to your well-being?  Come on, think a little bit.  True, true, maybe you are well off.  Maybe you have a secure job, a nice comfortable house in the suburbs or a loft in the city and maybe even a big fat retirement fund.  But what if you were one of the thousands of software engineers of hi-tech firms that got laid off this past year?  Or one of the hard-luck investors in the stock market?  How are you going to pay all your bills?  More importantly, what are you going to do about your health insurance?  Without an employee benefits plan, are you willing or even able to bear the costs yourself?  Are you even able to find an affordable HMO or PPO?  This, the national issue of rising health care costs, will perhaps blindside you on some future rainy day if you continue to believe in your apparent job security.  Do you take health care for granted?  Do you see it as an entitlement?

To understand the increasing problems this country has with health care costs, we must first consider general information on the subject.  The overall goal of health insurance is to pay the costs associated with health care.  Certain plans exist to pay for bills from physicians, hospitals, and other providers of medical care; such plans include indemnity, managed care, and government funded plans.  We Americans have many choices as to the types and ways we make payments for our health insurance: usually, for those of us lucky enough to be employed, either our employers pay the direct cost of health insurance or we authorize our employers to deduct a specified amount of money from our paychecks.  Other popular means, though more expensive, for those whose employers do not offer such plans or for those who are unemployed, include purchasing private health insurance policies by paying premiums directly to an insurance company.  In theory, health insurance should protect people from financial hardships caused by large medical bills.  But, really, that’s what it is: a theory.

          According to the October 9, 2002, issue of the Journal of the American Medical Association, health care costs are again rising dramatically.  Health insurance premiums have increased over 12% in the past year, the largest increase since 1990; especially contributing to this factor is the pharmaceuticals industry (involving prescription drugs) which has increased in expenditures almost 20% from 1999 to 2000.  What’s even more disturbing is the increasing number of people who cannot afford this rate hike!  In the October 14, 2002, special issue of U.S. News & World Report, the U.S. Census Bureau found that “a surprising number of young and affluent people are going without health insurance,” presenting alarming data on the percentages of people in different age groups without health insurance: for those 18 to 24, 28.1%; for those 25 to 34, 23.4%; overall 14.6%!  Imagine that.  Just walk into a university lecture hall and you’ll find that almost a third of the students there aren’t covered by health insurance (this is obviously not true at MIT which provides limited free health care to its students).  Sit in on a movie at the local Cineplex and you might be right next to one of every four persons in the US without coverage.  Who knows?  Someday it might even be you.

          Why do so many people not have health insurance?  I find that this question pertains to both personal preference and hard luck.  Some people may feel that they are invincible, that their immune systems can fight off any virus, any disease, any cold without the help of antibacterial agents or other expensive over-the-counter drugs, much less surgery or hospitalization or outpatient/ER hospital care.  Even if they do contract a debilitating virus, a cold, or a disease, they will most likely try to shrug it off by consuming enormous quantities of water and chicken soup, eating oranges, and sleeping for the better part of each day.  What they don’t realize is that if such an incapacitating disease is allowed to develop within their system, as Steinwachs states in the 288^th volume of JAMA they are more likely to end up in the emergency room, leading to “greater use of health care services and higher health care costs.”

Though I do realize that these actions are of course dangerous to my health, I follow this school of thought: usually, when I start feeling that tinge in my stomach, the onset of a slight headache or any other kind of body ache, I pop in those vitamin horse pills that give you 2000% of the daily requirements of every single nutrient, stock up on oranges, and drink water like mad until I have to piss every hour or so.  No way am I going to end up in the emergency room!  No way am I going to have to sit there for hours waiting to be treated and just be told to “drink a lot of fluids.  Get a lot of sleep.  Now pay me five grand.”  Are you kidding me?  Do you think I would want to sit, much less PAY to be in an emergency room where I’ll constantly be assaulted by four dozen different strains of the flu from some bleary-eyed kid sitting next to me who keeps sneezing, coughing into the air, and wiping his snot and other jelly-like excretions on the chair and wall around us?  Or even to be within five meters of some kind of nasty cold or bodily odor emanating from that homeless guy?  I’ll stick to my oranges and horse pills, thank you very much.

Maybe I’ve been lucky for the past seven years, or maybe it’s just that I’ve been taking really good care of myself, but I have yet to set foot in an emergency or outpatient room as a ward of the hospital (I have been a volunteer at hospitals for the past five years).  But there are those who have not been so lucky.

There are people demanding health care at affordable prices, but cannot even obtain an insurance plan worth their time or money.  In the October JAMA issue, it was found that “[a]s co-payments increased… the average number of prescriptions filled declined substantially by more than 30%… rates of serious adverse events and emergency department visits associated with reductions in the use of essential drugs also increased significantly.”  Similarly, it was found in US News & World Report that “people manage when they lack insurance” by borrowing drugs, taking lighter doses than prescribed, and using over-the-counter or more natural herbal medication.  “They forgo preventive care like mammograms, Pap tests, and colorectal screenings.  Their illnesses get diagnosed later, at more advanced stages.  Uninsured women… have a 30 percent to 50 percent higher risk of dying than insured women.”  Yes, I agree that it is obviously foolish to not take in full the physician-prescribed medicine – I have been guilty of saving drugs for a rainy day on many occasions and as a result, have had prolonged illnesses.

What is even more disturbing is the seeming death sentences handed out by insurance companies when they refuse to pay the costs for vital operations.  An example of such a case was brought up in the September 23, 2002, issue of The New American: John and Alicia Bennett, parents of three children suffering from Sanfilippo syndrome, a fatal genetic disorder in which sugar molecules are allowed to accumulate, causing damage to vital organs, were unable to obtain experimental therapy used on other Sanfilippo patients at Duke University.  Why?  Their insurer, Kaiser Permanente, denied coverage.  The insurance company’s decision, upheld by the California Department of Managed Care, was that the therapy was just too much of a risk for the $600,000 per child.  Wait.  Say that again?  You’re going to refuse to pay for the life of my three children, all because your rich insurance company is not willing to shell out six hundred grand each?  So where does that money go then?  Bonuses to the employees who manage to “reasonably” deny the most health care?  A new fleet of cars for the executive board?  A private company jet?  How can we put a price on a life?  Do you want to hear something even more disturbing?  Ryan Nguyen, born in Spokane in 1994 in dire need of a kidney transplant: his family’s health maintenance organization decides that this little kid was not a good candidate – a good risk – for such an operation and told the parents, as reported in The New American: “The time has come for your baby to die.”  Imagine the trauma inflicted on the father and mother!  “Sorry, your kid is too much of a liability for our filthy rich insurance company to care for!  Get well soon!”  It seems as though our society has valued saving the company millions over saving the life of one.

How could we have sunk so low as to allow such outrageous injustices?  Why are we, the United States of America, the only industrialized country in the world that does not have a national health insurance plan?  Oh, do I hear an echo?  Did you say money?  You mean, the reason we do not have a national coverage plan for all Americans, employed and unemployed, poor and rich, is because of money?  In 1993, President Clinton presented to Congress a health care reform plan guaranteeing insurance for all Americans; the administration claimed that the proposal would “stem the rapidly rising cost of health care” (Nielson).  However, Republican leaders denounced and opposed the plan for being too expensive!  Sure they may have stated other reasons such as “excessive government regulations on health care” or the restrictive nature of the plan, but really, which holds more power?  Many large insurance companies hold influential lobbies in Washington and contribute vast amounts of money to senators and other politicians.  If the national plan were to be passed, many of these companies would be out of business.  As stated by a surgical resident played by Don Cheadle in a recent ER episode, patients don’t decide when their life is going to end – politics does.

The threat of huge tax increases usually silences debate over national health insurance.  Insurance companies contribute generously to campaign funds.  Politicians pass on the chance of obtaining such nationwide coverage for the American people that they represent.  Who suffers?  Ryan Nguyen is denied a chance at life.  His parents fight to keep the hospital and their HMO from cutting off all life-support to the baby.  He dies four years later in 1998, still in need of a transplant.  Health insurance – why has it become such a problem in our nation?  Why do all other industrialized countries have national plans while we do not?  Perhaps the reason lies within the American psyche – that we care more for saving a few thousand here and there than for saving the life of a dying baby.  Each one of us will walk down that moonlit alleyway and be accosted by some strange dealer offering goods and services for unbelievable prices.  Are you willing to pay the outrageous price?

Sources cited: Brink, Susan.  “Living on the Edge.” U.S. News 7 World Report133 (October 14, 2002): 58-64; Grigg, William Norman.  “The HMO Culture of Death.” The New American 18 (2002): 44-45; Nielson, Norma L.  “Health Insurance.”  Microsoft Encarta Encyclopedia 2001.  1993-2000, Microsoft Corporation; Steinwachs, Donald M.  “Editorial: Pharmacy Benefit Plans and Prescription Drug Spending.” JAMA: The Journal of the American Medical Association 288 (2002): 1773-1774.