The Dilemma of Health Coverage in the US
Have you ever wondered what it would be
like if you couldn’t count on healthcare to be available to you whenever you
needed it? To not be able to afford a visit to the doctor for a small issue,
knowing full well that the issue isn’t going anywhere and is just going to get
worse? Up until very recently in the US this was reality for many people. I
grew up in England and France where we had access to free and universal
healthcare (even though the system in France sometimes seemed a little
convoluted). Everyone was on an equal level; you had your GP, your dentist,
your optician if necessary. You had to wait for some tests, sometimes you
couldn’t get a same day appointment, but at least you knew that you would be
seen without being faced with thousands of dollars of medical bills that there
was no way you could pay.
When I first moved to the US over a decade
ago I worked for a company that provided health insurance. This really meant
that every year or so they would negotiate with a new insurance and we would
have to change our plans and premiums accordingly. I can’t even begin to
explain how confusing the system was, you had to choose a network and a doctor,
and depending on your choice, your bi-weekly premiums would be higher or lower.
As a single woman blessed with very good health I always chose the lowest
premium without really looking into the details. Things like co-pays,
deductibles, covered and non-covered services went right over my head, and I
just kept my fingers crossed that I wouldn’t have to actually go to the doctor.
Every practice accepts a certain amount of insurances, and anyway, how do you
choose one practice out of so many without even knowing anything about them?
Why could I just not walk into a doctor’s office, make an appointment and be
seen?
When I left that job I also lost my health
insurance. This meant that if I ever fell ill, was in an accident, needed
surgery or any other health-related service I would have to pay out of pocket.
If you have a quick look at how much simple healthcare services cost you would
be astonished… A simple trip to the ER for a broken bone or a rash can run into
thousands of dollars. So what did people do? What do people still do? They wait
until they are in so much pain and go to the ER, knowing full well that they
cannot pay but cannot be turned away either. People end up with terrible credit
due to unpaid medical bills. You know that whole thing about Americans having
wonderful teeth? That’s just a TV myth, emphasised by the brilliant pearly
white smiles you see on sitcoms. Most people can’t afford to go to the dentist
until it’s too late, and then just get their teeth pulled because it’s cheaper
that way.
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| Credit to https://phsj.org/ |
In 2010 President Obama passed the
Affordable Care Act (ACA, often dubbed “Obamacare”), which was a first step
towards ensuring everyone in the US would have access to affordable healthcare.
Instead of insurances being able to pick and choose who they covered based on
all types of criteria (have a pre-existing condition? Your premium would be
much higher than someone without one), you could shop around for an affordable
premium based on your earnings. In addition to being available to everyone,
nowadays if you refuse to sign up for an insurance plan you will be fined, and
this fine is taken when you file your taxes. While the ACA has many flaws it
was a first step towards allowing everyone to be covered without worrying about
having to pay extortionate medical bills. The ACA has been implemented in steps
over the past few years, and while it has hit some stumbling blocks, all-in-all
it has been pretty successful.
Cancer doesn’t discriminate, neither do
congenital heart defects nor diabetes. However, before the ACA was implemented those
with more money were more apt to be seen by a doctor earlier. The ACA was a
start to make healthcare available for everyone. Some people found that they
were paying a lot more than they had been before, but most people I know were
able to say that they had health coverage for the first time in their adult
lives. Pretty incredible seeing as this country is supposedly the leader of the
world in so many areas! The ACA is NOT universal healthcare, far from it, but
it is a step in the right direction. I honestly have no idea if there will ever
be some form of universal healthcare in this country, there are too many people
who “don’t want to pay for other people”. If they actually thought about it
they would pay the same towards universal healthcare in their taxes as they
already do in private insurance premiums.
In 2013 I was a bartender and restaurant
manager, and not eligible for employee-based health insurance (while the ACA is
now pushing all employers to provide health insurance to their employees, it
doesn’t affect smaller businesses or those employees who work less than 40
hours a week). As I was rarely ill I hadn’t yet signed up for affordable
healthcare, and was just waiting to see if the kinks would be ironed out… But
then I found out I was pregnant. Honestly, the first thoughts I had weren’t
about how I was going to raise a child and could I be a mother, but about how
on earth was I going to afford to have a baby! Luckily, the ACA also expanded
the coverage of Medicaid, state-run healthcare that is available only to those
who earn under a certain amount. I was lucky to be in a state that expanded
their coverage and had a great plan for pregnant women, and I fell within their
income requirements. I was covered from my first visit to my 6 week post-natal
check up, received great care, and my kids were automatically covered too. I
don’t know what I would have done without it, because I saw a couple of
hospital bills, and if checking into the ER before being led up to Labour &
Delivery cost $1,000 I can’t even imagine what my very simple, no meds, 20
minute birth cost. I can’t even begin to imagine what an emergency c-section
after 40 hours of labour would look like!!
My eldest has a congenital heart defect
that requires yearly specialist check-ups and possible surgery in the future.
Without insurance we wouldn’t be able to pay for the very expensive work-ups
they have to do every year. You see, while we are covered this year, there are
no guarantees that we will be next year. One of Trump’s main deals before he
was elected was to remove the ACA and replace it with his own vision of
healthcare, one that basically sent this country back into the dark ages again.
Well if you weren’t well off. Luckily he didn’t get enough votes to push it
through this time, but who knows what will happen next time? Obama fought tooth
and nail to get only a small part of his vision approved, and nothing says that
it will stay forever. As I said before, the ACA is far from perfect, but it is
better than whatever was there before.
I basically just scratched over the surface
of healthcare in the US, it’s very complicated and confusing and I still have
no idea what I am doing half the time. For those of you who sometimes throw
your arms up in the air because your public health system isn’t always perfect
and you have to wait a while for certain appointments, please do everything you
can to help save it. Don’t abuse the system and use it as you need it, but
please, appreciate how important universal healthcare actually is. Because when
you live in a country where it doesn’t exist it really, really sucks.
Next
time I will touch on the current political climate now that Trump has been in
office for a few months, and our personal journey into getting our kids all of
their citizenship's sorted. If you are interested in reading more about the ACA,
you can check out the website here http://obamacarefacts.com/health-care-reform-timeline/.
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