Our health care system keeps squeezing families, with no relief in sight

Published on
March 5, 2020

It’s hardly a secret that health care is a dominant theme this election season. It has been the subject of almost every Democratic debate, fodder for political pundits, and top of mind for voters. Exit polls in the early primary states indicate “Medicare for All” motivated large numbers of voters. Last summer well-known Harvard health policy and polling expert Dr. Robert Blendon prophesized that the election hot topic would be medical costs, not coverage. By that Blendon meant that there would not be a big push to bring health insurance to more Americans. So far, the election has been about both cost and coverage. The power of those twin concerns helps explain in part Bernie Sanders’ popularity.

The public is jittery about health care. The willingness to acknowledge that our current system is not working well and to consider aspects of foreign systems are indeed striking, something I’ve not seen in 40 years of covering this topic. The public’s dissatisfaction appears much deeper than in the past, when pols could sway voters with empty slogans like “affordable quality health care for all,” and the insurance industry could change the course of debate with its infamous “Harry and Louise” commercials. Recall that Harry and Louise were the couple who delivered the message “If the government chooses, we lose” that helped sink the Clinton health plan.

Too many bad things have happened to the health and finances of too many Americans since Harry and Louise dominated the airways nearly three decades ago. Most people realize that something is seriously wrong with the U.S. medical system, and they are less likely to be swayed by slogans and clever commercials. It’s the realization among the electorate that we are all financially vulnerable when our bodies don’t work right for us or our family members. Something bad can happen even when we play by the current rules of America’s health care game. Increasingly, families realize they could be wiped out even if they are insured and have what they believed was “good insurance.”

A few days ago came a tweet from Dr. Margaret Russell, a physician at a federally qualified health clinic that treats indigent patients. Her tweet was not about her patients, though, but about herself. “Think you have ‘Good Health Insurance’? So did I until I needed to use it,” she tweeted. Russsell caught a virus, became dehydrated, and needed IV fluids to recuperate. She got a big bill for an in-network hospital visit. She mentioned her experience to two doctor friends who had similar experiences.

One who had been an inpatient at an in-network hospital and cared for by in-network doctors received a huge bill from a radiologist who read an imaging test. The radiologist was not in the network. How are patients lying ill in a hospital bed supposed to check on the status of a radiologist and demand a different one? It’s more likely you’ll never learn the name of the doctor until a bill arrives. Russell’s other doctor friend learned that an outpatient lab test had been ordered by an in-network doctor and collected at an in-network lab. The sample, though, was processed at an out-of-network specialty lab. In fact, none of the labs in the state that process the particular test the patient needed were in-network. How are patients supposed to know this, especially when they’re sick? Is the next step to research out-of-state labs to find one that will cover a service supposedly covered by a patient’s insurer? What sick patient who is nervous about the results of a lab test will do that? More important, why should the health system demand that they do?

Experiences like those of Russell and her friends are multiplied throughout the system every day and feed into the unease and financial fear Americans feel when they get sick. I don’t see an end to the practices Russell experienced. They are likely to grow as health care becomes more corporatized and owned by big, for-profit groups like hedge funds, while Congress remains heavily lobbied and gridlocked.

A recent email from a reader in the Midwest told me she and her family now regularly go to the emergency room when they need a doctor. Why? “All the private doctors are being bought out by these big hospitals and their practices are being run by nurse practitioners,” she told me, adding that the thought of not having a real doctor around was “an extremely dangerous practice.” Dangerous or not, I’d wager paying nurse practitioners is cheaper than keeping a full-time doctor on call.  

A New York City hairdresser who has insurance from a company established by venture capital firms that expect a good return for their money found that some services in connection with a routine colonoscopy that she thought were fully covered in fact were not. She had to pay out of pocket for the anesthesia that was administered during the procedure and for removal of benign polyps found during the examination. “What kind of insurance is that?” she wanted to know.

A young Indiana family needed to take their year-and-a-half-old son to the emergency room at a local hospital because he was having trouble breathing. After giving the child an IV and watching him for a few hours, the doctor decided overnight observation was in order. But since the hospital had no pediatric unit, the boy was transported 10 miles to a facility that did. The bill for the ambulance ride, in which the family says no medical attention was given and no emergency lights were flashing, came to $19,000, or $1,900 a mile. The insurer Anthem Blue Cross denied the claim, leaving the family to negotiate directly with the hospital.        

Such out-of-pocket expenses would be considered absurd in England, Japan, Germany, or Canada.

Far be it from me to predict what will happen to our health care arrangements after the election. But I suspect Americans will experience more of this financial craziness. Families will be hurt and the fear of financial ruin won’t disappear until policymakers come to grips with the system’s inordinately high cost.

How bad must the situation become before our polarized politics lets through some legislative solutions? We’re about to find out.

Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care column.