In 2009 my husband and I took a vacation to London. We stayed in an apartment just blocks from the Marylebone Underground Station, where the Beatles filmed the famous opening scene for Hard Day’s Night. We spent a week sipping beer in neighborhood pubs and eating lots of takeaway curry. We saw As You Like It at Shakespeare’s Globe Theatre. We saw Billy Elliot on the West End. We took a day trip to Bath where we walked in the footsteps of Jane Austen. As vacations go, it was damn near perfect. Then my husband got sick. He has a recurring infection in his eye and it flared up shortly after we arrived. If we’d been at home, he’d have called his doctor for a refill of the very expensive oral medication and the even more expensive eye drops he uses to treat the infection. But we weren’t at home, so we began to explore our options.
The nearest community health center was a few blocks away. We showed up at the clinic early in the morning and the doctor saw my husband within a half-hour of our arrival. She asked him a lot of questions and confirmed the specifics of his usual medication. She wrote out a prescription and told us to have it filled at a local pharmacy. She warned us that since we weren’t residents, we would have to pay full price for the medications and for the visit. We prepared to spend a large chunk of our vacation money on medical expenses. In America, where we had insurance, the medication would cost more than $200. We figured we’d probably pay twice that much in London. We were pleasantly surprised to pay only a small fee for the doctor’s visit. I can’t remember the exact amount, but it was less than our usual co-pay back home.
At the pharmacy, we got more apologies. They didn’t have one of the medications in stock and would have to bring it in from another location. We asked how long it would take, figuring we might be better off going to a different pharmacist. “An hour,” he said. “Maybe a bit more. I’m so sorry.” We laughed. Back home, we’d easily wait an hour for a prescription to be filled. It was nearly lunchtime and we told him we’d come back for the medication after we grabbed something to eat. We didn’t ask about the cost of the medicine, because we knew we would pay it no matter what. My husband needed it. When we returned to the pharmacy an hour later, the prescription was waiting for us. The pharmacist told us the price and my husband thought there was some mistake. The total for both medications was a fraction of what he paid in the U.S. with health insurance and prescription coverage.
This was not our first close encounter with health care inequity. A few years earlier, we’d gone to Prague and I had one of my epic allergy attacks. We went from drugstore to drugstore asking about allergy pills. At the time, Claritin was still a prescription drug in America and not a cheap one. I assumed I wouldn’t be able to get actual Claritin, but I wanted something similar, something that would stop my sneezing without making me drowsy. I speak zero Czech. I resorted to that time-tested American tactic of miming and speaking too loudly. “Ah-CHOO, ah-CHOO,” I said, pointing at my red nose. “Claritin? Claritin!” Finally, a woman said, “Ahhhh, Claritine!” and walked me over to a display where boxes of the familiar white pills were stacked up for the taking. No prescription needed. A whole box cost about the same amount as one pill in the U.S. I filled my purse with as many as I could carry and took those Czechoslovakian allergy pills for years.
We have grown accustomed to bad medicine in America. We let politicians tell us we have the best medical system in the world, when there is no evidence to support it. We do not have the best medical system. It is among the worst. We have a system where big pharmaceutical companies are allowed to rob us rather than treat us. We have an unconscionably high maternal death rate, and our life expectancy rates are falling. Our quality of life is falling too. There is simply no way to be truly well in such a sick system.
In America it often takes weeks to see a doctor, even with insurance. Maybe you’ll get to see a nurse while you’re suffering from that virus, but the virus will likely have worked its way through your system or killed you by the time you get to see your primary doctor. The drugs to treat what ails you will run two to six times higher here than in other nations—and those are conservative estimates. In many cases, you could save money by purchasing a plane ticket and then buying the drugs you need elsewhere.
The Affordable Care Act (Obamacare) didn’t solve these problems, but it helped. It put a stop to insurance companies refusing coverage to people with pre-existing conditions, a heartless practice that resulted in the preventable deaths of many Americans. It encouraged broader participation in the health insurance system by younger, healthier people who might otherwise forego purchasing insurance. It offered a safety net for the poorest Americans, who desperately need it. But it isn’t perfect. It is pretty darned expensive and the deductibles on affordable programs remain terribly high. In our house, we’ve yet to exceed our deductible in any given year, so we pay all our medical expenses out of pocket. And, yes, we have a health savings account for those expenses. We are fortunate to be able to save money, but I know many people who cannot. A health savings account is useless for a family who doesn’t make enough to save. Tax credits are useless if you don’t make enough to claim them.
That is why the American Health Care Act (Trumpcare) will make things even worse. Note the absence of the word “affordable” in the official title of this proposed legislation. They don’t even pretend to care about how much it costs the average American. The only stated goal is to slash government spending. It isn’t about helping people and it isn’t about health. It’s about making sure that everyone pays his or her own way, which sounds fine until you realize that one catastrophic medical bill could send most Americans into bankruptcy. The cost is too high for any one person or one family to bear. Unless, of course, you are part of the much discussed one percent, in which case you can absolutely pay your own way and, under the Republican plan, turn your back on everyone else.
There is an easier way to shift the burden of health care more equitably among all Americans. We could eliminate all corporate-sponsored employee health benefit programs. In other words, people would no longer get health insurance through their jobs. Everyone would buy individual insurance on the open market, even members of Congress. Many of us are already dealing with this reality. It’s been a dozen years at least since I had any health insurance through a job. Same for my husband. People who’ve never been forced to buy insurance on the open market have no idea what it’s like. It’s incredibly difficult to find the right plan and the insurance companies are not transparent about anything. You don’t know what you’re going to pay until you get sick and you have no options left. Obamacare improved our situation immensely. That recurring eye infection my husband has? That’s a pre-existing condition. My allergies? Ditto. For years my insurance wouldn’t pay for any allergy-related medications or treatment. It was pretty much the only medical expense I had during those years, so my insurance was worthless and very expensive.
If everyone were forced to buy individual insurance for one year, we’d see single-payer health care passed and implemented in the most bipartisan piece of legislation ever. But, of course, Congress isn’t about to give up its own tax-payer funded insurance for the benefit of the greater good. They don’t care about the health of American people. That’s the fact we should all strive to remember as they attempt to push these flawed bills through the system. The real disease isn’t the one that will attack us as we age. The thing that’s killing us is the very system under which we live. America is sick and getting sicker. No one is really looking for a cure.
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