In “Uninsured in America,” Susan Starr Sered and Rushika Fernandopulle attempt to find out “where the bodies are buried” in our health care system where over 45 million people have no insurance. The book is a patchwork of profiles of people who got sick at times when they lacked insurance and the often devastating effects this had on their lives. The authors, who describe this phenomenon as the “death spiral,” don’t find so many bodies buried (although they do find many in jails or on the street) but they do find health problems that are allowed to become critical before state assistance will kick in and doctors actually pay attention, and emergency rooms used as primary care resulting in crippling debts.
Without getting bogged down in dry facts and figures, the authors provide a pretty good understanding of how the number of uninsured Americans hides how many Americans are functionally uninsured, covered by plans that have expensive premiums, deductibles and co-pays, that refuse to pay for the very “pre-existing conditions” that people most need health care for and slipping in and out of the patchwork system of Medicaid, charity, clinics and emergency rooms.
The book reminds me of an experience working for the health care workers union, doing community organizing among poor souls on Long Island whose medical debts were referred to collection agencies. Although the non-profit hospital where they went to the emergency room was required by law to provide a certain amount of charity care, these patients were never informed of the option to apply for the charity. Instead they were treated, charged tens of thousands of dollars that they could not possibly afford and had their lives turned into nightmares of bill collectors, bankruptcy and foreclosure. One family actually had good health insurance won through a union contract, but a bureaucratic error at the hospital resulted in the patient – not the insurance company – being billed. The insurance company and the hospital fought, refusing to admit error, and the hospital simply referred the matter to a collection agency. The rest of the people had no insurance. A surprising number of them had children with asthma who had bad attacks that required a visit to the emergency room. Just like that, the family became poor.
This patchwork system results in poor health care for all of us, I think. I hate going to the doctor with any kind of health complaint. I never get any kind of satisfying diagnosis. Usually, the doctor just guesses at a diagnosis and prescribes some kind of medication, without running any tests, and there’s no follow-up. I think the paperwork and bureaucracy is too much of a hassle. Fortunately for me, if my doctors miss something big, the care will be paid for by insurance so I won’t have to wait until I get so poor and so near-death that the state will finally pick up the bill, like the people profiled in “Uninsured in America.” Of course, why would I really want to push for tests that would confirm a medical condition, if that will only be used against me in seeking insurance in the future?