Politicians and journalists take note. In the last several days, a segment on 60 Minutes and a personal story in The Nation have shown what’s wrong with U.S. health care in no uncertain terms. The public needs to know how Washington intends to fix the problems that were so clearly illustrated by both stories.
Perhaps because of the absence of strong health care leadership from the White House and a Congress that dithers over placating the special interests, the press—both the bloggers and the mainstream—has focused on the politics of the public plan. You might call it the public plan Preakness—who’s winning, who’s losing, but not much about who (and what) is in the running. Most people don’t care about Beltway politics; they just want to know if they will be the next casualties in America’s health care wars.
60 Minutes paints a heartbreaking picture of Las Vegas cancer patients who cannot get their treatments because the Nevada Cancer Institute no longer provides oncology services at University Medical Center. The segment shows how the lack of seamless care makes a mockery of all that fancy talk about improving medical quality. Some patients came for their treatment only to be turned away at the door. A sixty-three-year-old woman with lymphoma said cutting the cancer services amounted to “a death sentence” for her.
The Center, a county hospital, is the safety net for some two million people. But when the state, hard hit by the recession, cut its budget, the hospital had to cut its oncology services along with prenatal services, outpatient dialysis, high-risk obstetrical care, and outpatient mammography. More cuts may be on the way. Hospital CEO Kathy Silver said what’s happening in Las Vegas is happening all over the country: “We’re a demonstration project, if you would, of all the things that can go wrong at once.”
Silver told 60 Minutes correspondent Scott Pelley that there were a couple of medical assistance programs for the very poor, and that those “patients are being taken care of.” So the people being hurt are the middle class—those making $30,000, $40,000, $50,000, who have lost their jobs and their health insurance. But Pelley makes clear that even those who use the county’s medical assistance program for the poor may not really get help. Pelley told of Roy Scales, a laid-off security guard ill with lung cancer. Scales called at least twenty-five doctors and oncology practices trying to find care, but doctors wouldn’t accept insurance from the county program.
The Nation featured a first person account by Kate Michelman, former president of NARAL Pro-Choice America, who tells a different story—that of a middle class family with good insurance beset by accidents and the trials of growing old. Her daughter, who was uninsured, became paralyzed from a horse-riding accident, and the family had barely recovered from those medical expenses when her husband, who suffers from Parkinson’s disease, took a nasty fall that landed him in the hospital for months.
Michelman wrote that he had generous insurance benefits that covered “most” of the bills for surgeries, hospitalizations, and drugs. But “most” can still mean thousands of dollars of uncovered expenses. Despite good or even great insurance compared to many families, they were underinsured—like millions of others who don’t realize it until catastrophe strikes. The worst, though, was yet to come. Her husband entered an assisted living facility, where Medicare and his long-term insurance policy were not much help paying the $9,000 monthly bills.
Michelman learned what too many families learn—families are pretty much on their own when it comes to financing long-term care, the health system’s stepchild. She now cares at home for a severely disabled spouse who needs round-the-clock nursing care—which costs less than an assisted living facility, but more than what’s left in the family bank account. Soon, she says, “expenses will simply be more than we have,” adding that even the most frugal planning isn’t enough to cope with surging health care costs.
Michelman’s conclusion: the situation won’t change for anyone until political leaders get serious about comprehensive reform. “By comprehensive, I mean that piecemeal approaches will not work—not economically, not morally,” she says. But piecemeal is what the country is likely to get. Some enterprising reporter needs to take these stories further and show exactly how piecemeal will or won’t help those falling through the cracks.
How would a public plan option (seemingly the only thing talked about these days) help people like Roy Scales—or would it? Would it solve the dilemma of paying for long-term care that Michelman’s husband needs? FYI: No one has talked at all about long-term care during the presidential campaign or afterward. It’s like the need for it doesn’t exist in the political mind. Why isn’t the COBRA provision in the stimulus package helping middle class folks laid off in Las Vegas? Will reform actually change the way medical care is financed, to ease the budget squeeze on safety net hospitals? How will reform deal with the growing problem of underinsurance?
The pols and special interests have been touting the notion that Americans who have insurance can keep what they have. But do Americans really want to keep those policies that send them to the poor house when serious illness happens? These are a few of the things the public needs to know to engage in a debate that will certainly affect them.