Saturday, September 04, 2010

Not about busses this time…

I may as well admit it—we are using government-funded insurance. Not for us, but for the girls. Andrew doesn’t qualify for state-funded insurance because he has a student health plan available to use so is required to do that, which is fine because that’s only about $97 per month. To add the girls and me onto the plan would bring our premium to $315.50 per month.

Without being too frank about our finances, I can tell you that the maximum gross income a family our size can have while maintaining eligibility for government-funded health insurance is $3,675. We don’t make anywhere near that amount per month, even when Andrew was working full-time (without benefits, of course) this summer we were shy of that amount by at least a grand. Now that the semester has begun Andrew has had to drastically cut back his working hours. He went to the MPA orientation two weeks ago and this past week was the first week of real classes. He’s gone before the girls and I get up in the morning and comes home in time for dinner before sequestering himself in the office to do homework. Rachel has already asked why Daddy lives at school instead of at home so if that’s any indication of how the semester is going to be…well, yeah. It will be tough.

I’m working, too, though not very much. Before we had children I worked approximately 40 hours per week—not all at the same job, of course, because no one ever seems to be hiring for full-time positions—but now that we have children I’m lucky if I work 40 hours in a month. Being a work-from-home/stay-at-home mom is a tough job but we figure it is worth my staying home to avoid child care costs, which can be quite astronomical. Also, so that I can raise our children. That’s good, too.

We already took out a student loan to help buffer the cost of Andrew’s last degree and we have to cover tuition for the MPA program. So in a nutshell? We’re basically broke.

But that’s what young family life is about, right? And eventually we will be contributing members of society so I don’t feel too badly about being a leech for a while. After all, I was raised a socialist.

Live together, die alone. You scratch my back, I scratch yours.

Isn’t that why we live in societies?

Anyway, our girls qualified for government-funded health insurance, so thank you to all tax payers. One day we’ll be able to help someone else out and I think that’s great, but for now we’re willing to accept assistance.

Once we had gone to the orientation meeting and selected a provider I called a clinic by my house—you know, since I don’t drive—to make appointments for our girls since Rachel is due for her yearly check-up and Miriam will be due for her yearly check-up soon and both girls are behind on their vaccination schedules.

“Will you be able to bring in a copy of their vaccination records?”

“Yes, I will.”

“And what kind of insurance do you have?”

I told her.

“Oh. Well, in that case Dr. X won’t be taking new patients until March.”

“You mean…like Tuesday?’

I dunno. Perhaps she spoke French or Spanish. Mardi…Martes…March. It could happen.

“No, I mean March.”

Ummmmmm…Excuse me, March!? That’s next year.

“So, are there any other doctors at this clinic taking new patients?”

“Yes, Drs. Y and Z but they won’t be taking your kind until 2012.”

Seriously. 2012?!

And what the “my kind?” Who do you think you are?

Luckily the clinic we were going to before we moved doesn’t mind that we’re now on government-funded health insurance because we are “established patients.” I made appointments for my girls there, so now I’ll actually be able to take Rachel to the doctor before she starts kindergarten (which won’t be for another two years, mind you).

Now, I realize that some might consider me a burden to society but did society ever stop to wonder how it might be a burden to me?

America’s medical system is broken and this is a burden for me and my family.

Medical costs in America are extortionate. My deductible for having a baby in Egypt was $50. If we were to have a baby here in the States the current deductable is $7500. That’s up $2500 from when we had Rachel three years ago. That is insanely expensive! With a typical co-pay amount in America ($25) you can easily pay 100% of a visit to a doctor in a swanky private clinic with a doctor educated in “The West.” I don’t know anyone who wouldn’t agree that medical prices in America are out of control.

I know that for some reason it is more costly to doctors to treat patients with government health insurance, though I do not understand why that is when in other countries with universal health care doctors treat patients with government insurance all day long and still seem to make money.

Schooling for doctors is too expensive—changing that would be helpful. The liability insurance that doctors must pay is also expensive—they wouldn’t need such hefty insurance if patients weren’t so sue-happy. That is another thing we could change. Equipment is expensive, medicine is expensive. I still do not understand how it is that these things are so expensive in America and not expensive other places. Sure, there are subsidies other places, but come on! I’m no economist but something seems fishy to me. The wool is being pulled over our eyes somewhere along the line and someone is getting filthy rich, and I suppose that is their prerogative in this progressive, free market—they lie a little, take advantage of others, dig a pit for their neighbour, and there’s no harm in this because at least they’ll be stinking rich. Right?

On the contrary, I think that the well-being of the poor is a reflection on society as a whole. Not everyone can be the Steve Jobs, Bill Gates, and Carlos Slims of the world. There is always going to be a bottom rung of the ladder—the better off the people on that rung, the better the society, I think. I think it is our duty, as citizens of society, to take care of the bottom rung (our family isn’t quite on the bottom rung, but we’re in close second).

America’s bottom rung is actually pretty well off compared to places like, ummm…Swaziland, Sierra Leone, and Afghanistan. But compared to developed countries like Japan, Canada, or the UK we actually aren’t looking so hot. Our life expectancy is ranked #38 in the world. Our standard of living is in the top 20% but even Alan Greenspan, a prominent American economist who calls the American economy “the most extraordinarily successful economy in history,” says that “the income gap between the rich and the rest of the US population has become so wide, and is growing so fast, that it might eventually threaten the stability of democratic capitalism itself.”

The median household income in the United States (for 2008) was approximately 52,000 USD. In Canada it was 63,900 CAD, after taxes. Today 63,900 CAD is equal to 61,471 USD. So it seems to me that people are making more in Canada…after having taken out their taxes, which pay a large portion of their medical insurance. But, as I said, I’m no economist.

Anyway, I suppose what I’m saying by all this is that we should be taking care of our poor. It may not be the “right” of the poor to receive health care but denying it to them only reflects poorly on society. We can close the rich-poor gap, but not by perpetuating our flawed, broken systems. We need to change things.

For example, I don’t have to pay a penny for my girls to see the doctor and while that’s nice, that’s not exactly what we were looking for when we sought assistance. We were looking to not go broke, not to not have to pay anything. Everything is covered 100% and I think that is a little extreme. I wouldn’t mind paying a $10 copay or $50 for an appointment. I simply can’t afford to pay $315 each month and then pay $25+ for each doctor visit I go to.

Isn’t there some happy medium out there? Can’t we make a system that allows affordable health coverage for everyone—the rich and the poor? It seems to me that if we had a better health plan our entire population would be healthier and wouldn’t need to go to the doctor as often, freeing up room in the ER, and increasing our ability to work hard and improve our country, which would increase our rankings for standard of living and life expectancy.

I know I’m a lone voice in this area of the country, crying out for liberty and justice for all. I forget that health care isn’t considered a right by all—and that I am so often considered crazy for wanting to care for those who can’t care for themselves.

And I think I will end now before I say anything too inflammatory. But first I will think all the tax-payers again for helping me take my baby to the doctor when she was sick. Otherwise her illness may have progressed to pneumonia and then she would have risked death. But I suppose if she had died it would have been “my fault” because I “didn’t work hard enough” to provide for her. So thank you, one and all, for keeping my baby alive.

14 comments:

  1. For a non-economist this was one very good analysis. My Profs would be very proud of you :).

    I totally agree with you that health care should be a right for all and it's a shame the American system isn't taking care of it. But the picture isn't as rosy as it seems in Europe. The public health insurance companies in Germany are running huge deficits and the costs of the health care system are one of the biggest challenges facing the country. And it also comes at a price. If you earn around 40.000€ gross a year, seriously this isn't much, you only get 40% or less of what you cost your employer! In the UK health care is kinda rationed, which also isn't perfect. I think one sustainable model, albeit with huge deductibles, is the Swiss one. It gives ppl the incentives not to go to doctor unless necessary and forces them to pay as much as they can afford for their own medical expenses.
    Hope the girls are all healthy!

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  2. All you're gonna get is a BIG FAT AMEN! From me. :)

    As a side note, when/if you find yourself out of insurance, most Dr.'s offices offer an ENORMOUS "cash pay" discount. (Which just goes to show how broken the system is....) All you have to do is ask for that discount in most places. Totally worth it.

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  3. You see, you are not a lone voice here--you have Amy, Tamsin and me to back you up. And Ahmed isn't here, but he is backing you up as well! Good summary, Nan!

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  4. You said that equipment and medicine are expensive in the US, but cheaper overseas. The reason you can get medicine so cheap overseas is because they are 'knock-offs' of medicines developed in the US. You can get the same thing at Wal-Mart. The reason the non-generic medicines in the states are expensive is because they are developed in the US - and that takes a lot of money. A lot of countries are riding on the medical coat-tails of the US, and we're paying for it.
    Here in Egypt, where healthcare is universal, whenever they can, people scrape the money together to get to the US whenever they have a problem that can't be fixed here. Brandon saw that every day in the consular section. They may make fun of our privatized system, but when something goes terribly wrong, everyone comes to the US to get it fixed.

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  5. Thanks everyone who didn't dissent. It's nice to know I'm not alone. And to my sole dissenter so far, you're perfectly welcome to do so.

    However, I would like to comment on the issues you raised.

    First off, I don't believe everyone rushes to the US if something goes terribly wrong. In fact, Medical tourismMedical Tourism is a well-established habit in at least 50 different countries worldwide. In 2008 an estimated 85,000 people came TO the US seeking medical attention, according to a report by McKinsey & Co., whereas approximately 750,000 Americans went elsewhere abroad seeking the same thing.

    Granted, there are subsidizes abroad that cheapen medical costs, but I wonder where these subsidizes come from. I don't believe the United States is the sole champion-of-the-world. In fact, I sometimes wonder if instead of other countries being subsidized we're not just being ripped off.

    As for where medicines are developed, almost every medication I purchased in Egypt was developed in Europe and produced in the UAE or some other well-off ME country. There are plenty of pharmaceutical companies abroad that compete with American companies. In 2009 six of the top 12 pharmaceutical companies were based in the US, that's true, but they were ranked according to revenue and not according to what wonderful things they discovered. If generic brands are available at such a low cost it makes me wonder why brand-name formulas cost so much. If they are truly comprable in content it seems the brand-name company is saying, "I don't care what you charge for the medication. I'm going to charge THIS much!"

    $4 prescriptions at Wal-Mart are my favourite. Just sayin.'

    @Ahmed--In Alberta, before they started covering 100% (from oil revenue) they used to have people pay a percentage of their income. So everyone was paying the same percentage--the rich paid more, obviously, and the poor paid less--and then everyone still got medical coverage and, really, not a lot of debt was accrued. I think that is one idea for a sustainable model.

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  6. I'd just like to throw out there that my dad is undergoing cancer treatment in Norway, where my family lives, and the treatment he is getting is wonderful. Whereas if he had lived here, seeing as he works for a very small company who probably couldn't offer health insurance, he probably wouldn't be here, if you see what I mean.
    Some countries with universal health care are actually able to take good care of their citizens without everyone hopping on planes to the US to get proper care.

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  7. The high cost of prescription drugs drives me crazy, too, but one reason it is that way (that you didn't point out) is the cost of research. Until their patent expires, drug companies who formulated a certain drug charge so much to recoup their research and development costs.

    And not to read too much into what Ashley was saying but I think she also means that drug companies in Egypt, etc rip off the American brand-names. It's not legal, but it sure does make the drug cheaper. In Syria, we could buy the real American drug and it was super expensive. Or we could buy the Syrian knockoff whose formula was totally stolen from the real American drug, and pay tons, tons less. It's not happy shiny lucky cheaper. It's cheaper at the price of honesty.

    In the US, the drug won't be cheaper until the patent has expired and a generic can be created.

    (On the other side of the argument, I hate that name-brand drugs spend so much on advertising, or at least appear to. I'm fine with having R&D costs passed on to me - it's only fair - but NOT PR costs.)

    That said, I also believe the American healthcare system is broken. I just wanted to point that out about prescription drugs.

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  8. The USA needs insurance like their own military gets: $197/month for families; $3, $6, $12 prescriptions (usually just $3); choice of seeing your own provider and no referrals needed. You pay a little out of pocket when the bill comes, but you don't have a co-pay. I love it!

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  9. I'd definitely agree that things are broken and messed up. The grad staff plan for Gareth costs us $750/year just for him (and that's after a partial subsidy by the school) and they won't cover a thing until we hit a $350 deductible. So, basically, it's catastrophic insurance because no kid, unless they're really sick or hurt, is going to wrack up $350 in medical expenses in the year. We're not people that overuse the system, but it'd be nice to be able to take my kid to the doctor if he's truly sick and in need of medication.

    The problem is what the best solution is. Is some form of universal health care the answer? Or would it be better for people to start using their health insurance more like we use auto insurance. After all, we don't use our car insurance to buy gas. So, pay out of pocket for annual exam expected type stuff and have insurance only for the unexpected? (Basically like what the article "How Healthcare Killed My Father" presented). I don't know what the best solution is, but we've got to try something different, that's for sure.

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  10. Is this the article, Erin? http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/

    If so, thanks for the tip. Good article. Any of Nancy's commenters are also welcome to read my blog post (http://myrnalayton.blogspot.com/2010/09/tale-of-two-cancers-and-two-surgeries.html), which just basically tells stories, or my sister Marie's blog post (http://mammodouy.blogspot.com/2010/09/give-me-your-tired-your-poor.html), which gives more well researched information. Both of us wrote in response to Nancy's post.

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  11. In Canada, I just send a free printed and filled application form, and a week after, I get a "Health Card" in the mail... and that's where it ends.

    I can't compare between the two countries though. It's a much smaller population (although the NDP is also less so it's all relative), and Canada is more Centralized/Socialist than the US...

    In Egypt, I don't know about that "free insurance" thing, but I do know that every profession with a union had a huge discount, and even if you were paying cash, clinics and procedures were cheap. If you're working for a decent place, they give you free insurance for medical services (including drugs) at the best hospitals in the country.

    When I moved to the US, for only half of my time, I had private endurance which cost me $350 per 6 months, which was a rip off since I was required to pay almost 100% of all initial work, and a huge chunk of everything else...

    I'm telling you, Corporate America made a boo-boo a couple of decades back...

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  12. You're definitely not a lone voice. I love this post! Maybe especially since I was also raised socialist... I wish I could put my feelings into words as well as you do. (I love reading your blog, but I'm about 12 posts behind. I'm so impressed with how diligent you are at posting such long, detailed, entertaining, and worthwhile posts).

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  13. Yes, Myrna, that's the one. Thanks for the links to your post and your sister's - I'll have to go check them out!

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