Cross posted on Daily Kos
For some time, I’ve wanted to write about a friend who was hospitalized without insurance several months ago.
Today I noticed that this Sunday, 60 Minutes is broadcasting a segment that parallels the situation of my friends almost letter for letter.
Sunday, Mar. 5, 2006
IS THE PRICE RIGHT? – Are hospitals discriminating against patients without insurance by making them pay more than insured patients for the same services? Dan Rather investigates. Michael Rosenbaum is the producer.
In early January, the wife of a friend had an emergency hospitalization for an acute onset delusional psychosis.
She was brought to a NYC emergency room by paramedics who were called by her husband when she appeared on the verge of suicide.
She was uninsured. She remained in the hospital for over 30 days.
The bill has arrived. The hospital portion alone is around $60,000. This does not include incidentals like a CAT scan, and MRI, numerous specialists, medication etc.
My friend is a naturalized American citizen. He was born and raised in Italy. His wife is Chinese, she holds a Green Card and an Italian passport but is not yet an American citizen.
As an uninsured patient in an American hospital his wife has been charged the “retail price”. Although my friend has private Italian insurance, this insurance will only pay the negotiated rate paid by insurance companies. The disparity between what insured and uninsured patients are charged is the focus of the 60 Minutes story.
His wife is in the “self-pay” category because she has what is known as indirect insurance. With indirect insurance, the insured foots the bill, and is then reimbursed by the insurance company. Hospitals classify this sort of patient as “self-pay which means uninsured.
Uninsured patients (known in hospital billing departments as self-pay patients) pay the full price. Insurance companies pay a far lower negotiated rate for their insured clients.
So the population of uninsured receive these heart-stopping bills which they can ill afford which in effect subsidize the low rates paid by insurance companies.
The system is so fucked up. If the uninsured can’t even afford to purchase health insurance, how in the world can they afford $100,000 hospital bills?
My friend expects that the private Italian insurance will cover some of the bills. At best, it will be a negotiated settlement with the hospital, or worse, a fight.
If the Italian insurance company does not receive the preferred insurance company rate from the hospital, they have already indicated they will only be responsible for that portion of the bill that they deem any American insurance company would pay. If this happens, my friends will be left with a huge balance.
This morning the front page of the New York Times reports on the dire health care problems of immigrants.
Even for those of us privileged (and make no mistake, it is a privilege to have health insurance in the United States), to have decent insurance, the health care system is a blizzard of paperwork, claims forms, poorly-trained customer service clerks, claims denials, care denials and bureaurcracy.
Being poor, uninsured, or an immigrant only makes obtaining health care in America even more daunting.
The New York Times reports that:
Noncitizens are two to three times more likely to lack health insurance than citizens, studies show, and the gap has widened, even for children. Even legal immigrants qualified for government medical coverage often think twice about accepting it.
Throughout this ordeal, I have felt nothing but shame as I have attempted to help my friends navigate our broken healthcare system.
My Italian friend who has spent most of his life living in a civilized country where healthcare is a right not a privilege, is truly shocked about what we think of as normal here.
In Italy as in most civilized countries, its citizens are entitled to receive healthcare from a taxpayer supported system of public hospitals and clinics. Some Italians purchase supplemental private insurance, which by the way, is not expensive, in order to receive treatment in private hospitals. My friend has this private insurance. Most Italians, even those with private insurance, use the public system because the care they receive is excellent and free!
If I’m not mistaken, the Gemelli Hospital in Rome where the Pope was treated, is a quasi-public institution.
My friend who spent ten years of his life working and living here hoping to fulfill a lifelong dream of becoming an American citizen sits staring at the mounting bills and asks me why we Americans accept this terrible state of affairs.
I have no answer. Then I say, now you’re one of us so fucking vote, you’ve earned the right, now do it!
The New York Times reports that after the avalance of bills arrives people forgo further necessary treatment. This makes sense. Even people with insurance complain that the difference between what the insurance company pays and what the hospital charges is frequently enormous.
Medical debt and inadequate insurance coverage is destroying American families.
Medical bankruptcy, whatever its actual frequency, is an extreme example of a much broader phenomenon. Medical debt is surprisingly common, affecting about twenty-nine million nonelderly adult Americans, with and without health insurance. The presence of medical debt, even for the insured, appears to create health care access barriers akin to those faced by the uninsured. Policymakers, researchers, and medical providers should consider medical debt a risk factor for reduced health access and poorer health status. Simply reducing the number of uninsured Americans would be a hollow policy victory if the problems arising from medical debt persist.
Recent research findings cry out for new measures to assess how well our country is addressing the health care access issue. It is now documented that medical debt resulting from being uninsured or having inadequate insurance reduces access to care and undermines the financial security of American families. Thus, this debt is, in itself, a risk factor for reduced access and poorer health status.
http://content.healthaffairs.org/...
My friends are lucky. They can return to Italy if necessary, and receive excellent heathcare from the taxpayer funded National Health System.