health care, North Carolina

The sad state of access to health care in America

Periodically, whether in a Facebook status update or a blog post or just a random conversation with whomever will listen to me, I feel the need to express my utter frustration with the difficulty folks face when trying to access the U.S. health care system.  Until I decided to pursue yoga teaching full-time, I spent four years working for UNC Health Care.  One of my roles there involved obtaining authorizations from insurance companies for chemotherapies and medications associated with cancer treatment (e.g., anti-nausea medications like Emend and colony stimulating factors like Neulasta which boost a patient’s immune system and keep them from getting infections).  If the patient did not have insurance, I would try to obtain assistance for them from the drug manufacturer, a nonprofit organization like the wonderful Leukemia and Lymphoma Society, or get them enrolled in NC Medicaid or UNC’s Pharmacy Assistance Program.  All of this work happened after they were already in the door.  That is, they had already been seen by a physician (usually several at that point).

But what happens before that?  If the patient is unemployed or makes very little money and has a dependent or two, they might qualify for NC Medicaid after a ridiculous amount of paperwork.  This is the best-case scenario.  If they don’t qualify for Medicaid, they might qualify for UNC’s in-house “Charity Care” (way to make people feel good about themselves, by the way, UNC) if they meet certain income guidelines and other criteria.

But what about those of us who make too much money to receive these benefits and not enough to afford to purchase private insurance?  (Yes, I know the Affordable Care Act begins to address this, but the key word is “begins”.  And it hasn’t begun yet.  And it’s not enough, although it is a step in the right direction.)

I, along with many, many others, am currently in this somewhat-gainfully-employed-but-uninsured situation that many Americans find themselves in–especially low-wage-earners like food service workers, retail sales associates, and other service providers like, um, YOGA TEACHERS.  The cost of buying one’s own health insurance on one of these salaries is prohibitive, and if you’re like me and formerly had a full-time position with relatively decent insurance, COBRA benefits are very costly, too.  For instance, I’m in my mid-30’s, healthy, and my COBRA premium is $426 per month.  That’s more than half my rent and nearly twice my car payment.

This is on my mind, of course, because I just had a nasty case of strep throat.  At first I thought, this is very likely a viral upper respiratory infection, and if I just rest, take ibuprofen, and drink lots of fluids, I’m going to be fine.  I don’t need a doctor.  Then several days went by.  My lymph nodes became more swollen, my throat became more sore, my tonsils were inflamed with exudate (an awesome medical word for pus).  I had the good sense at this point to know I needed to see a doctor.  I called the office of my primary care physician at UNC Family Medicine.  They would see me for a minimum of $80 and bill me the rest (“the rest” equals at least $150 with “facility fees”).  UNC Urgent Care at Carolina Pointe: minimum of $175.  The Family Doctor urgent care: minimum of $110.  Duke Urgent Care: minimum of $75 and a one and a half hour wait.  None of these health care providers were willing or able to tell me a final cost for my visit, and I understand why, having worked in health care–they don’t know at the time of your call or visit which tests you will need, how complicated your illness will be to treat, or any number of other variables.  But that is very frustrating to a patient with limited access to funds.  Then–what about the pharmacy bill?  My specific situation worked out okay because I had a credit card on which to charge all of these minimum amounts.  But what if I hadn’t?  What happens to those people who have a more serious infection than I did, but don’t go to the doctor for financial reasons?  Emergency room, you’re thinking.  In some cases, that is true.  And that level of care costs all of us who pay taxes a lot of money (it’s called “uncompensated care” in the world of health care policy).  In other cases, the patient, scared of the hospital bill, forgoes care altogether and suffers and potentially spreads their infection to others, causing further illness, cost, and suffering.  It would be way cheaper and more humane to insure that all Americans have at least a basic level of primary care like practically every other so-called civilized nation.  Forget the public option considered by Congress during the controversial health care reform debates.  We need universal health care (e.g., Medicare) for all.  Now.  This should be a no-brainer in a country such as ours.

Wondering how much my strep throat cost me?  So far, $361 (including a few herbal remedies and over-the-counter drugs I purchased).  That doesn’t include my lost wages from the past three days.  I’ll keep you posted on the total bill once the mysterious thing arrives.

If you’re really interested in this subject, I suggest reading Deadly Spin, a book by former health insurance executive Wendell Potter, whose conscience made him quit his job with a major health insurance company and go to work trying to educate Congress and the rest of us about the evil doings of many major insurers.

(Stepping off of soapbox now.)

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