My mom, my brother, and me, a few weeks before her death.
I don’t get political on this blog generally. But something has been eating at me recently, and I have a story I need to tell.
For most of the last 17 years of her life, my mother didn’t have health insurance.
You see, my father died in 1997. He was the sole breadwinner of the family; my mom hadn’t been in the workforce since before I was born. Funny: he worked as an actuary for a health insurance company. He’d devoted his professional life to the industry. They still kicked my mom, my brother, and me off the rolls before his body was even cold. My brother and I got health insurance coverage through CHIP, a government-subsidized program that provides health insurance to low-income children.
But my mom was a different story.
My mom had rheumatic heart disease, a lifelong side effect of a bout of rheumatic fever as a child. The disease caused damage to her mitral heart valve. She’d had two open-heart surgeries, the first around 1979 to remove scar tissue from around the valve, and the second in 1992 to replace the valve altogether with an artificial one. After the second surgery, she would spend the rest of her life on blood thinners. She had to get blood tests to ensure her blood was the right consistency. (Too thick could cause the artificial valve not to function properly; too thin could cause her to bleed out from a minor wound.)
So my mom was pretty much the walking, talking personification of a preexisting condition. Although she was only in her late 40s when my dad died, she could not qualify for most health insurance plans. The ones she did qualify for were just too expensive–over $1,000 a month, she told me.
When it’s a choice between having health insurance and feeding your kids, or having health insurance and keeping a roof over their heads…I guess you can figure out what choice she made.
As a 50ish woman without a college education, my mom had a difficult time finding jobs. When she did find them, they were mostly either part-time or temporary–and, naturally, didn’t offer insurance.
So she did what she had to do. She paid for her health care out of pocket. Doctor’s appointments, blood tests, medication–it all adds up. She put off unnecessary exams and testing.
The one time she did find a job that offered health benefits was 2003. She got a job at a bank. She was so excited! She finally started getting all the check-ups she’d been putting off. But a few months into the job, she ended up in the hospital. The new medication her cardiologist prescribed to her was too expensive–over $90 a month, even with insurance–and she’d stopped taking it. When she was admitted to the hospital, her resting heart rate was over 200 beats per minute.
Several months later, she slipped and broke her wrist quite badly. She had to have surgery to get it fixed. Having surgery was complicated for my mom. They had to take her off the blood thinners beforehand to make sure she didn’t bleed too much, necessitating around-the-clock monitoring. Then afterwards, they had to keep her in the hospital as they restarted her blood thinners until her levels got back to normal. In total, she was in the hospital about nine days.
While she was in the hospital, she got a letter from her employer. She had exceeded her allotted amount of sick leave–two weeks. Since she had not been at the company for a year, she was not eligible for unpaid leave under the Family Medical Leave Act.
They fired her. Her final termination date was, ironically, the date her surgeon cleared her to go back to work.
My mom in New Orleans, the year before she died.
Thankfully, her insurance from the bank did cover her surgery and hospitalization, since the injury happened while she was still insured, as well as physical therapy afterwards. But when her mobility didn’t return to normal and her surgeon recommended a second surgery, that was not covered. My mom didn’t get the second surgery, and she never did recover full mobility in that wrist.
Even with insurance, she amassed a lot of bills from her surgery and hospitalization. I think I remember her telling me that it totaled around $6,000. It took her years to pay off the debt.
My mom was excited when they passed the Obamacare law that prevented insurers from denying coverage just because of a preexisting condition. But she would be eligible for Medicare coverage before Obamacare came into effect. In October 2013, she celebrated her 65th birthday. For years before that, her doctors had been urging her to get an EKG. She’d been putting it off, waiting until it was covered by Medicare.
She never made it that far. She died just two weeks after her birthday. The cause of death was “acute cardiac failure.” I’m still not exactly sure what that means, except that it was her heart and she had heart disease that wasn’t being monitored as much as her doctors recommended.
For the rest of my life, I’ll wonder whether having health insurance could have prevented her death.
So when I hear a comment saying that poor people just need to choose between getting a new [insert luxury item here] and having health care, it pisses me off. Because basically what you’re saying to me is that my mom didn’t deserve to live.
We were what I’d call “borderline poor.” We never had to water down ketchup and call it tomato soup (although I know people who did). But we were financially insecure. My mom budgeted well enough that our needs were always taken care of, but an unexpected expense–like a $350 car repair or a $175 plumber visit to fix a leaky toilet–could set her back months.
Even with insurance, health care is ridiculously expensive. A visit to a specialist may be a $50 deductible. Blood work might cost $75-$150 above and beyond what insurance will pay. X-rays will probably be about $150. An ultrasound might be something like $200; an EKG could be closer to $400. I know, because I’ve had all of these tests done–all with employer-provided insurance coverage.
I’m in better financial shape now, so I was able to pay all these costs. (I don’t know what I would have done if I’d been in an accident or gotten sick, and I had incurred all these costs and more at the same time.) But not everyone is so lucky.
As long as health care is a for-profit business, our health outcomes will never be as good as other countries. And don’t lie to yourself: our health care outcomes are not good. Take a look at this article from Forbes, published in 2014. Specifically:
Equity: The U.S. ranks clear last on measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling prescriptions or skipping doses when needed because of costs. On each of these indicators, one-third or more lower-income adults in the U.S. said they went without needed care because of costs in the last year.
One-third. More than 33% of adults are skipping health care because they can’t afford it.
We spend much, much more money than other countries on health care, and we’re still sicker.
One of the main arguments I’ve always heard against a government-subsidized single-payer health care system is that the quality of our health care system would deteriorate. But look at the facts. Among other first-world countries, we’ve got nowhere to go but up.
Every time a discussion about health care or welfare or government aid comes up, I hear someone talk about the people who “abuse the system”–those people they met who were living in the projects, getting food stamps, but still managed to have the nicest clothes and cars and electronics. Hell, it’s even people who have been poor who do it, so quick to point out that they weren’t like other poor people.
Let me add my anecdotal evidence to others’ anecdotal evidence: that has never been my experience. My family was just doing the best it could to get by. And when my mom had the audacity to spend money on “little luxuries”–Christmas presents for my brother and me, a new television to replace the broken one in our family room–those were never the thing preventing her from obtaining health care.
Also, let’s just ignore the fact that many consumer goods–electronics in particular, but also food and clothing–have come down in inflation-adjusted dollars over the last several decades, while the costs of health care have continued to go way, way up.
But I’m going to conclude with this: yes, I realize there are people who abuse the system, who take freebies and handouts wherever and however they can get them. But even if someone is abusing the system, taking advantage, whatever, do they deserve to die?
Because that’s what this comes down to. The widowed mother who can’t afford to buy her medication. The recent college graduate who can’t afford health insurance and then gets into an accident. The minimum wage worker who has two jobs and still can’t afford to go to the doctor to get his stage four cancer treated. The real death panels are when you have to play Russian Roulette with your own health because you can’t afford not to.
That’s the cost of being healthy in America.