The High Cost of U.S. Health System Dysfunction

Mike & Friends Blog

Donna Smith

Donna Smith, American SiCKO, is executive director of the Health Care for All Colorado Foundation

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August 3rd, 2012 12:32 PM

The High Cost of U.S. Health System Dysfunction

While the human costs of our dysfunctional health system are staggering in terms of death, suffering, and financial trauma for patients and families, we pay a steep economic price over the long haul when we follow patients and discover the ongoing costs and the collateral damage to our economy. A patient whose care is compromised early on in their treatment often is much more costly to the system over time. Such is the case for me and millions of other insured, working Americans who get hurt or sick. We need Medicare for all for life to protect our national economic interests in the future.

This could be an ode to Aetna and the company’s current practicing of medicine without a license to do so as it denies the medications my doctor ordered, but then again that’s a story being played out all over the country millions of times over as the insurance giants modify their playbooks to make sure their shareholders’ wallets stay healthy. But that’s not the whole story.

I will say over again that though I am sickened (literally) and saddened that Aetna is choosing to override my doctor’s orders, this could easily be said of most, if not all, of the major insurance companies. And while we wait for Aetna to review my latest appeal, my doctor was quick to send me the link to a foreign pharmacy website where I could choose the plan and price and at least have a way to secure some medication for my gut pain, though it was still pricey and I have to wait up to three weeks for the shipment to come from somewhere in the U.K. The doctor sees these problems way too often not to have a back-up to offer patients, and as he said, “People in this country just don’t get it yet.”

When Michael Moore and his producers selected my family as one of the case studies for SiCKO back in 2007, they did so not because we were unique but for just the opposite reason – my husband and I are highly typical of working class families. Though my husband has now aged into Medicare, thank goodness, I still have many years to go during which I will be dependent on private health insurance coverage as I have been for all of my working life. My health has suffered as a result, our family’s finances have suffered, and all of the economic systems with which the work of my life intersects have also been altered. The care I was able to afford or have coverage for 20 years ago is now most definitely making the care I need now more expensive.

When I first fought cancer more than a decade ago, I was scared to death to miss much work lest I be replaced or seen as a liability. After extensive abdominal surgery and against medical advice, I returned to work too soon. But I believed it was the only way to protect our income and the benefits upon which our family depended. I developed a huge abdominal hernia, ignored it for months as I worked to pay off the deductibles and out-of-pocket costs from my first cancer surgery, and eventually needed even more extensive abdominal surgery including the placement of a large prosthetic mesh. A few months later, and back at work again, another hernia higher in my abdomen developed and it was back to surgery for the third time. Bills, endless medical bills, and the stress from trying to stay employed were enormous. My husband had his own fight with serious medical issues, but I was the one who was to keep us afloat – he was too sick. My problem, after all, was just my belly. His was his heart. His heart won that gruesome contest outright.

So fast forward to my current struggle with medical issues: those many long ago surgeries necessary mostly because I always had to put money and protection of our benefits ahead of my own health had far-reaching health consequences and high residual costs. As my doctors now struggle to properly diagnose and treat me for serious problems in my gut, all that old surgical work complicates current efforts enormously. Scar tissue and adhesions and the meshes make less invasive procedures more difficult, and doing any additional invasive work must be kept to a minimum lest we create even more scar tissue. I’m in a healthcare Catch-22.

I am not unique among American patients. I am a working person who has made decisions always with an eye to keeping myself so. And because we have such a dysfunctional healthcare system that forces working people to make healthcare decisions like I did and do still today, the costs are much higher for my more complicated care. I now feel like such a liability. And when I get sick and need help, I am often denied what I need either by Aetna’s actuarial staff or by the ongoing terror of being working class and needing to protect my job and benefits. The stress is awful. And my gut pain and upset is too.

It was a huge personal victory to survive long enough to get my husband to Medicare age. I know that, and I now have seen up close how much better his access to care is and how much less he ever has to pay out-of-pocket for his care. He is never denied. Let me repeat, he has yet to be denied a needed medical treatment or medicine since he became Medicare eligible. We do pay for a supplemental policy, but that Humana policy rarely pays much out against the $285/mo premium we pay.

Medicare for all for life would have spared me the terror and these current traumas with Aetna, but it also would have provided me access to appropriate care years ago that could not have been lost while I recovered from those surgeries. Medicare for all for life isn’t just the right thing to do; it is also a cost-saving plan working families need in America. Join the fight and sign the petition lest you join my all-too-common ranks.