I know the short answer is “they’re f**ked” but I want to hear some long answers.
There must be a lot of people who
are too young and not disabled enough for Medicare
do not have and cannot get a job that provides health insurance (possibly because they are disabled enough to make this difficult)
have some health condition that makes insurers who provide individual insurance avoid them like cooties(like diabetes or past history of cancer)
I imagine that such folks
A)spend a huge amount of their income (if any) on health care
B)live under the threat of financial ruin in case of big time health crisis
C)don’t live so long because they can’t afford A
Are there any solutions for such people? Don’t some states require that you cannot turn anyone down? So you could at least move to one of those states?
This is only one data point, but I can tell you about my friend’s sister. She didn’t have health insurance so she didn’t go to the doctor that much. As a result, when she did go to the doctor about some pain she had been having for a long time, it turned out she had cancer and it was very far advanced. She ran up a lot of bills on her credit cards, so did her parents, and my friend, her brother. Then she died and left her loved ones thousands of dollars in debt.
Medical expenses are the leading reason for personal bankruptcy in the U.S. (a fact that people in most of the industrialized world find baffling). So, for a lot of people, it does mean financial ruin. A lot of people simply die with treatable problems. I haven’t gone bankrupt or died, but I did take out a loan and max out my credit cards to get my ruptured quad tendon repaired (if you wait too long, it’s too late and you’re permanently crippled). Still trying to get out of that hole.
In most states, emergency rooms aren’t supposed to turn anybody away, so a lot of patients with no other options show up there. ER care is expensive, and if they just can’t pay, I guess it generally ends up coming from public money in some way.
And of course people without health coverage don’t get the regular preventative care that can prevent or postpone major problems later on. An ounce of prevention really is worth a pound of cure, but that ain’t how we roll in the States.
Also, those who do not have coverage and are in dire need of medical care, can usually find help through the city/county on an as needed basis (maybe only in major cities?). Those who are eligible (poor with kids, disabled) get Medicaid help, which really rivals that of private plans.
Sometimes, though, you are just plain screwed, and will run up big bills and declare bankruptcy. Those costs are then passed on to higher medical bills/insurance premiums for the rest of us.
They can’t turn you down - but they CAN quote you ridiculously high premiums, or refuse to cover almost anything.
Last time we tried to insure my husband outside of employer-sponsored insurance we were quote $1200/month and they wouldn’t cover anything to do with his feet, legs, back, bladder, kidneys, pancreas, liver, lungs, heart, or vision. Nor would they cover medications for diabetes (which he has), heart disease, asthma, or his chronic pain. That leaves — what?
We have been trying to get him on disability for the last 8 months. It’s a long, hard slog. Then there’s a waiting period before he can qualify for Medicare. Meanwhile I lost my job and our health insurance last November.
If either of us gets sick or injured we are fucked.
As far as I can tell, people without insurance are supposed to go die under a bridge or something. It’s disgraceful that many Americans still call this the “greatest country on earth.”
I would think that emergency rooms, which are generally separate corporations affiliated with hospitals, declare unpaid bills as losses just like any other business.
It’s also important to realize that although they can’t turn anyone away, they still do find ways to send people to crappy hospitals in another part of town, and they give the very minimal level of care to get the person back onto the street. Then they bill the person until their credit is beyond redemption, assuming they had any kind of a credit rating to begin with.
It’s not how they roll under the NHS in England, where preventive care is unknown. I asked about a mammogram while I was living there (I’m at that age) and I was asked “Why, do you feel a lump?” My spousal unit had never had his PSA levels done (he was at the right age) and when I got him to ask about it the doctor affected to not know what a PSA level was. He’d also never had a routine chest x-ray - not once in his entire life!
The uninsured who show up at my hospital are referred to the social workers who try to get the uninsured person enrolled into a state insurance program. All our patients are pregnant, so they usually qualify for aid.
It is actually much better if you are truly poor in these situations than if you are anywhere from lower middle-class to upper-middle class and don’t have insurance. There are plenty of programs to help the poor. Most states have state research hospitals and charity hospitals that cater towards the poor and give excellent care. The TV series ER is set in Cook County General Hospital which is a cutting edge teaching/research hospital and gives a fairly accurate depiction of the care the emergency patients receive. Likewise, if you suffer a gunshot wound, New Orleans Charity Hospital is where you want to be regardless of income. Those aren’t rare and serve the poor, the indigent, and everyone else. They tend to have state of the art services although the clientele may make them seem a little gritty.
There also plenty of facilities like nursing homes, cancer treatment centers, and hospices that are run by the state and will take care of the poor until they die no matter how long that is. There are also world-class private charity hospitals like St. Judes and the Shriners Hospitals that care for very sick kids no matter what their parents can afford.
The gap comes if you are middle-class and have anywhere from a moderate to catastrophic clinical loss. You really are screwed then. My wife and I are 34 and we are pushing about half a million in claims over the past 5 years mainly because of the loss of an infant daughter and I am not sure what would have happened if we didn’t have top notch insurance.
The problem has to be described correctly because the truly poor do quite well under the U.S. system because they can’t be turned away and they have nothing to lose.
We are fortunate enough in Centrahl oregon to have a clinic run by volunteers that provides all of the services of a regular clinic and refers to specialists.
They are called Volunteers in Medicine. VIM. Look for one or something like it in your area. They deal with working people with no insurance.
The county provides a free clinic for all in most areas. Dont wait. Stay healthy.
I’m not poor by any means, and I have solid consulting business that pays the bills. But I’m going to rejoin rank-and-file employment next week (giving up my business) because I can’t find any insurance company to take me - at any price, even with a $10K deductible.
So, in my case, it (fortunately) has not affected my health or finances (yet), but has caused a professional change.
You get sick and lose the insurance, while you don’t recover. At some point you can’t work and all the money is gone. You are financially ruined, and Medicare screws you over forever. You can’t fight for your needed care yourself, because you’re to sick to do anything. It’s impossible to get back on your feet, because you are to deep in a hole to get out yourself. In America it’s get sick, tough shit, nobody will help you, go away, because as the politicians put it, America can’t afford to help sick people. You had better hope you have family member’s that care or you’ll die homeless in the street. The politicians will always get all the health care they need of course. You are not better off poor and sick. There are programs for children. You have very little recourse with low or no income.
I am self employed, but have health insurance under my wife’s policy from her work. She is leaving her job on Thursday of this week forever, because she is now disabled with an incurable disease. We can afford her COBRA insurance, but at over $6,000 per year, I haven’t got the money to continue my insurance. As of the first of February, I will have no health insurance. If I get sick, I plan on being a burden on society, until something is done about this mess.
Yeah; don’t want to use profanity in GQ, but they’re fucked.
Shagnasty described the way I understand things to work. My under-employed cousin who has no health insurance goes to a county-run clinic; she waits around all day long to see an overworked doctor (a different one every time, she says) who makes as quick a diagnosis as he or she can, then ushers her out the door.
I’m probably the best-insured person I know, and I still pay about $4500 out of pocket for my incredibly good but too expensive dermatologist and, of course, the small team of mental health professionals who keep me going. (IME nobody covers long term counseling; you have to have an “event” that provides an excuse for limited counseling, which is 8 visits per year).
I’ll be the first to explicitly draw fire: we need universal health care, or socialized medicine, or whatever you want to call it. Libertarians and Republicans (and, sadly, many Democrats) seem to think that the only concern is “market efficiency” and that it would be less economically efficient or result in patients overusing medical resources because they’d be too removed from the actual costs. But you know what? Fuck that. I’m a human being and live in a world with other human beings, and market efficiency is not anything that humans should care about when considering medical coverage for poor people.
I just spent the last two days in hospital with no health insurance. The hospital social worker just had me fill out some forms and told that my bill will be sent to the county and if the county doesn’t pay the hospital will discount it 100% (essentially eating the costs). This includes treatment by staff doctors, but not by my so called “personal physician” :rolleyes: .
When I had my car accident, the ER where I was being treated sent a billing guy 'round. He gave me some forms to fill out and I had to send in all my bills and whatnot, but charity picked up my $3k hospital bill. I had to pay the Dr., X-Ray techs, and ambulance out of pocket however. Also since I could not afford to see a hand specialist rather than the county ortho, I have permanent disability in my left (non-dominant) hand. I DO have insurance now and have seen a nice ortho. He said to fix it now would require some gnarly surgery. So I keep my funky knuckle.
I realize that I am very lucky in how this was handled.
Actually, condition B will make you eligible for Medicare: Medicare comes in three basic packages, one set up for the elderly (over 65), one for the disabled and a third variety for those with end-stage renal disease. A history of black-lung will also get you access to Medicare.
Most states’ Medicaid programs will also cover the disabled, and many states Medicaid programs are set up to offer coverage to children under the age of 18, and a single caretaker of those children. Some offer coverage to anyone below the poverty line.
Finally, the emergency rooms of most community hospitals are often used as replacements for primary care: ERs can’t turn patients away until they’ve been evaluated by an MD, and usually at least one hospital in any community of any given size will admit patients irrespective of their insurance status. The problem with that is that patients are unable to follow up on ER docs instructions to see specialists (who will turn away uninsured patients if they can’t pay up front).
If you’re too young, too healthy, unencumbered by kids and making just enough money to be ineligible for state-sponsered insurance, most hospitals will offer payment plans to allow you to pay your bills off over the course of time without being referred to collection agencies. Unfortunately, that isn’t an option for preventive care, or for treatment of ongoing conditions.
Hospital systems write off huge amounts of bad debt every year, increasing the costs of all care, which in turn jacks up costs to insurance companies, who in turn raise rates beyond affordability for those unable to be insured by their employers.
Your ‘personal physician’ likely is a private doctor who is not an employee of the hospital. The hospital can’t write his bills off in the way they can other costs. And if the doctor doesn’t charge for his services, he doesn’t eat.
You received free care other than the bill from the physician? And you’re rolling our eyes? Ingrate.
I had to have a blood test last week so I went to an ACL lab, on the wall was a notice stating for those who don’t have insurance payment is due immediately, no money no blood test. They have some humanity however they do take: cash, Visa, MasterCard and Discover.
I work at a small savings & loan company and run credit reports every day, you would be surprised to know how many bankruptcies, collections and civil judgments there are because of medical bills. We tend to overlook medical collections because so many people can not afford or get coverage.