COVID-19 Pandemic Exacerbated by America’s Uninsured
Saving Money by Hiding From the Doctor
In winter 2009, I was growing up in a lower middle-class family and attending public school in rural Tennessee when I caught the most severe flu I’d ever had. I remember suffering through fever and intense coughing for several days at home until I was forced to go back to school to avoid truancy.
Most parents would not send their ailing child back to school to possibly infect other children, but mine had no other choice. We didn’t have health insurance. Without much disposable income, my parents could not afford to send me to the doctor unless it was an absolute emergency. Since visiting a doctor over the flu wasn’t an option, I could not present a doctor’s note to my school administration to excuse my absence.
So back to school I went, even though I could hardly muster the strength to lift my head off my desk. Aching, fever, coughing, chills. I was completely debilitated. Thankfully for me, my lack of performance went practically unnoticed because every other student was sick, too.
To be heard over the constant eruption of loud coughing, our teachers shouted our lessons until their voices became horse. Finally, even our teachers succumbed to the illness. Sapped of all energy, they cowered behind their desks and inattentively played movies throughout the school day to pass the time.
The illness slowly traveled up the chain of command until it reached the administration, and school was cancelled for a week.
Around the same time that I was recovering from that flu, the media began breaking news alerts warning the public of an H1N1 pandemic, also known as Spanish flu or swine flu.
My whole community was petrified. On Sundays, pastors were preaching about the advent of the End of Days. Dooms-day preppers were barricading themselves in their homes, ready for a Contagion-like scenario. My dad came home one night describing the state of my town’s only grocery store: completely empty.
It dawned on me at some point that we had nothing to fear because we must have already contracted the virus and survived. I took advantage of the intermission from daily life until the hysteria passed and school restarted.
Thankfully, I successfully healed from that flu before medical intervention became necessary. On other occasions, maladies cropped up which required real treatment. In that case, we resorted to the emergency room only when my condition worsened to the point that my parents feared for my life. Resorting for help, I always felt ashamed that I had selfishly subjected my parents to medical bills that we couldn’t afford.
By the time I was eighteen years old, I’d already racked up almost ten thousand dollars in medical debt. Reading the charges on my medical bills, one might assume that I suffered a chronic illness. However, all that debt actually came from one ambulance ride and some brain scans.
Sadly, an even more life threatening pandemic is sweeping the United States today, while approximately 30.4 million Americans are uninsured. With COVID-19 assaulting the nation, how exactly will those vulnerable Americans respond?
I can say from experience, that many of the uninsured will merely hope and pray that they don’t get sick. They will hesitate to take their children to the doctor’s office. They will avoid addressing their symptoms. They will misuse emergency services. They will go to work and send their children back to school. Tragically, some of them will inadvertently perish due to their fear of financial ruin in the form of medical bills.
The U.S. continues to lead the world in confirmed coronavirus infections, with nearly 400,000 of the global total of more than 1.4 million https://t.co/Z7RI9id0TD
— The Wall Street Journal (@WSJ) April 8, 2020
Uninsured and Under-Insured in the Land of Opportunity
Unlike Canada or France, U.S. citizens do not have access to free universal health care. The United States relies on a mixed insurance system: citizens use employer sponsored insurance, public insurance, or individual insurance, the particulars of each varying by state and are not regulated on the federal level.
Uwe E. Reinhardt, PhD and professor of Economic and Public affairs at Princeton university describes the common American insurance enrollment experience as, “Your employer, when you sign on, gives you a menu of health insurance companies. You pick one. You pay a little, they pay the bulk, but in fact, of course, you pay it through your paycheck. And there are over a thousand private insurance carriers in the country, so it’s an extremely complicated hybrid system.”
According to the Keiser Family Foundation (KFF), approximately 49% of U.S. citizens enjoy employer sponsored insurance, while 34% use government sponsored care, 6% have different non-group plans, and about 9% of the nationwide population are completely uninsured.
The U.S.’s uninsured population is mostly comprised of low-income laborers and their dependents who exist in a financial limbo of earning too much to qualify for federal and state programs, earning too little to afford non-group insurance, and work for an employer that does not provide health insurance.
The state of Texas has the most uninsured, with about 18% of people lacking coverage from an employer or public program.
Part-time employees do not usually qualify for employer provided insurance, and non-group insurance is very expensive due to the lack of resources that can be pooled together when you’re not included in a group.
Even for the fortunate workers who do enjoy employer provided health coverage, their status can be jeopardized at any moment when they are fired or quit their job.
Worse yet, having insurance does not exempt patients from grave medical debt. Approximately 28% of U.S. adults who have employer sponsored health insurance and 42% of those who have non-group plans, are under-insured as of 2018. This means that almost half of American adults have medical bills which significantly exceed their insurance benefits, if they receive any benefits at all.
With the absence of universal health insurance, one might think that the U.S. government saves a lot of money. However, the U.S. health system is the most expensive in the world. In 2018, the U.S. spent about $10,600 per capita on healthcare. That’s about twice as much as the average amount spent by the other top ten richest countries in the world.
Why is the U.S. paying so much for healthcare when they don’t even offer basic universal insurance to every citizen? One might try to blame the high rate of utilization or, perhaps, the premium quality of American healthcare, which would drive up costs.
Contrary to both of these, Americans consume slightly less healthcare than citizens of other developed countries and the U.S performs worse on common health metrics like unmanaged asthma and diabetes, infant mortality, and life expectancy than those other countries.
The reason the U.S. pays so much money is because prices are tremendously high. Considering the average cost of common medical services, it’s evident that prices are steep: a night in the hospital costs $5,220, an MRI costs $1,119, an ambulance ride costs about $1,000 to $4,000 depending on the services required and distance from the hospital, an appendix removal costs $15,930, and giving birth costs $10,000 – $16,000 depending on if the baby arrives by natural birth or by c-section.
About one in four non-elderly Americans owes medical debt, many of which incurred the debts even while having insurance.
Millions Struggling With Medical Bills
For the 30 million Americans who don’t have access to health insurance, avoiding the doctor helps keep the lights on and food on the table. Consequently, the uninsured are more likely to forego preventative care and ignore health problems, gradually aggravating their condition, thus unwittingly requiring treatment which is more invasive and expensive.
Because they often delay needed care and tend to go without screenings, preventative care, or immunizations, studies suggest that those without insurance experience greater health decline and higher mortality rate.
When uninsured patients cannot pay their medical bills, that burden falls upon the rest of the population: doctors, hospitals, governments and insurance companies, eventually reaching the insured community in the form of increased health insurance premiums.
This vicious cycle of defaults and price increases may be one of the sources of the U.S.’s sky-high cost of healthcare. Some of the alternative factors that influence steep prices are administrative costs, defensive medicine practices, and lack of government negotiation in price-setting.
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In 2017, an estimated $38.4 billion in medical care went uncompensated, meaning that neither patients nor insurers paid those expenses, adding up to about $620 billion in unpaid medical bills since the year 2000.
Thankfully, uninsured people cannot be denied emergency medical treatment. However, if the patient cannot pay for the visit upfront, a doctor’s office or an urgent care clinic do reserve the right to turn patients away based on insurance status. The result is that uninsured people are forced to abuse emergency services to receive the medical care they need, as emergency services do not require up-front payment.
Not to mention, uninsured patients’ medical care is priced higher than insured patients who have a carrier to negotiate prices. As a result, not only are the financially vulnerable patients not entitled to a reimbursement, but they are charged more than their wealthier counterparts.
For uninsured Americans who fall ill with terminal or chronic illnesses that they can’t afford, their last hope is turning to charities or crowd funding sites like GoFundMe. In 2019, GoFundMe’s CEO Rob Solomon announced that one third of all donations on the site are to cover healthcare costs. According to a recent survey, 8 million Americans have started crowdfunding campaigns for themselves to help pay for medical bills. Likewise, more than 12 million Americans have started a campaign for someone else.
Millions of Americans are struggling to pay their medical bills. They’re receiving worse healthcare, overpaying, and dying more. The uninsured are lower-class, exposed members of society who are doing anything to keep their heads above water: ignoring their own health problems, defaulting on their medical expenses, even pleading with strangers on the internet for financial support. Admitting that the United States pays more for healthcare than any other country in the world attests the unmistakable breakdown of healthcare management in the “Land of Opportunity.”
The Disadvantaged Can’t Afford to Acknowledge This Pandemic
Now that coronavirus is sweeping the globe, many governments are recommending public safety measures in the hopes of slowing COVID-19 propagation before medical institutions become too overwhelmed.
The CDC recommends screening as many people as possible for symptoms, encouraging sick employees to stay home, and engaging in social distancing when possible.
This defense against the outbreak will only prove useful with the cooperation of the public. However, facing the exorbitant cost of healthcare, can uninsured Americans afford to heed the CDC’s advice?
For many uninsured Americans who are struggling to pay their bills, undergoing catastrophic medical expenses or sick leave from work is simply not an option.
“If I actually had to go to the doctor, it would absolutely drain my savings and change everything. I wouldn’t be able to get married this fall, wouldn’t be able to contribute to a down payment on a house, and I’d probably have to sell my car and cash out my 401k from a previous job,” explains Terryl Banta, a 30-year-old restaurant manager in Washington state.
The exceptional number of Americans without health insurance poses a considerable risk of exacerbating the pandemic by ignoring their symptoms and powering through work to feed their families.
I used to work in the food industry.
I can’t tell you how many times the people who handle your food – who are already overworked & underpaid – show up sick to work because our country refuses to guarantee healthcare or paid sick leave.
We need #MedicareForAll.
— Alexandria Ocasio-Cortez (@AOC) February 25, 2020
“I can’t tell you how many times the people who handle your food — who are already overworked & underpaid — show up sick to work because our country refuses to guarantee healthcare or paid sick leave,” said New York Rep. Alexandria Ocasio-Cortez on Twitter.
Even worse, not only will these Americans lack the financial resources to follow CDC guidelines and prevent further propagation of the deadly virus, they also will more than likely struggle to afford the vaccine which is currently under development.
On Feb. 26, Alex Azar, Secretary of Health and Human Services and former senior executive at a pharmaceutical company, announced that the price of the vaccine would not be controlled, and therefore, could not guarantee that it would be affordable to every American.
At a hearing regarding the budget for the outbreak, Azar told members of Congress, “We would want to ensure that we work to make it affordable, but we can’t control that price because we need the private sector to invest. Price controls won’t get us there.”
After receiving intense backlash from the public, Azar backpedaled, stating, “I have directed my teams that if we do any joint venture with a private enterprise, that we’re co-funding the research-and-development program, that we would ensure there’s access to the fruits of that, whether vaccine or therapeutics.”
On March 2, U.S. President Donald Trump said during a press interview that the White House will “see if it can help” the uninsured people who have COVID-19. However, the Trump administration is currently bringing a lawsuit to the Supreme Court to appeal the Obama administration’s Affordable Care Act, hijacking healthcare coverage from at least ten million Americans.
What happens when millions of desperate, underprivileged people are forced to choose between feeding and clothing their families, and risking contracting an invisible, potentially lethal menace? One thing is certain: no one will be left unscathed in the wake of this epidemic.
The COVID-19 outbreak is a positive sum game, meaning that if some are losing, everyone else is too. Sure, some of us are more affected than others. The poorest and most vulnerable members of society are on the front lines of the outbreak, endeavoring to pay their bills and stay healthy. However, the trials of the uninsured will diffuse into the upper-class, though viral propagation, death, and economic loss. The more the United States tries to ignore the disadvantaged, the more the effects of this virus will be highlighted.
In the context of a public health emergency, you want everyone to be able to access the healthcare system. You don’t want people with a contagious illness deciding, I’m too afraid.
— Matthew K. Wynia, Director of the University of Colorado’s Center for Bioethics and Humanities
Editor’s Note: The opinions expressed here by Impakter.com columnists are their own, not those of Impakter.com — In the Featured Photo: Baby and mother during pandemic — Featured Photo Credit: Nik Anderson