Thursday, March 05, 2009

Talking to each other about health insurance failure

Serendipity: flipping to two websites at lunchtime, I first read a Wall Street Journal article about under-insured Americans saddled with crushing health care costs. The stories concern families with serious illnesses who have jobs and "health insurance" -- and medical bills in tens and hundreds of thousands of dollars over and above what insurers will pay.

The three Cox children have a rare disease called Shwachman Diamond Syndrome, which curtails the production of bacteria-fighting blood cells and digestive enzymes needed to absorb nutrients properly. It can lead to life-threatening infection, bone-marrow failure or a deadly form of leukemia.

After Samuel, 7, Grace, 12, and Jake, 15, were diagnosed with the genetic disease earlier this decade, landing a job with good health benefits became the biggest priority for Mr. Cox. He gave up plans to run his own home respiratory-care business to work as a salaried medical-equipment salesman. In 2006, the family moved to North Carolina from Kansas City to be closer to specialists at Duke University.

But the Coxes' insurance covered only part of the children's care, which includes regular gamma globulin injections to boost their immune systems. At times, the children have seen specialists outside their insurer's network, requiring the Coxes to pay 30% of the bills. The companies that have insured the Cox children deemed some of their treatments experimental, which they don't tend to cover.

Until recently, the Coxes stayed afloat on a patchwork of Good Samaritan efforts and rising home prices. The parish of their former church, Abundant Life Baptist of Lee's Summit, Mo., rallied around them, even after they moved from the Kansas City suburb to North Carolina. A medical fund set up by the church raised tens of thousands of dollars. A separate annual fund-raiser organized by neighbors has generated more than $50,000. And the Coxes tapped more than $100,000 of equity from their former Kansas City home to finance travel to far-flung hospitals before selling it in 2006.

But the economic crisis is rattling their makeshift network of assistance...The Coxes face more than $40,000 in unpaid medical bills as the commissions that Mr. Cox makes on top of his $47,000 base salary dwindle. At the same time, the family's medical and dental premiums at Fisher & Paykel Healthcare, the respiratory-device maker that employs Mr. Cox, jumped about 13% to $876 a month for 2009.

Next, I flip to Swampland, and find that Karen Tumulty is bringing the health care crisis home -- to herself and to her readers:

Like most journalists, I do my best to operate in a comfort zone of detachment. But the subject of my cover story in the upcoming edition of TIME is one about which I won't claim the slightest bit of objectivity. It is about my brother Patrick. Last summer, he found out his kidneys were failing; a few weeks later, he found out his health insurance wasn't going to pay for his treatment.

I used to think I was something of an authority on health care; I've covered its policy and its politics for 15 years. But when my family took its own trip through the frustrating maze that is this country's health care system, I discovered how much I had to learn. Health problems are behind half the bankruptcies in this country, and three-quarters of those bankrupt people had health insurance when they got sick. Just about anyone could be one diagnosis away from catastrophe. My editors decided to put this story on the cover not because it is so extraordinary, but because it is so common, and becoming more so every day.

So please read this story. And after you do, go find your health insurance policy and read it, too.

UPDATE: A number of Swampland commenters have suggested that we give our readers a chance to share their own stories. That's a terrific idea. There's now a link in the third paragraph of the story where Facebook users can share their own experiences. (You then scroll to the bottom of the page.) It's not perfect, technologically, but it does give us a way to gather feedback. Please give it a try.

Perhaps the nation is reaching a tipping point, at which we recognize that we are all vulnerable -- if not uninsured, then underinsured, or potentially under- or uninsured. The stories are everywhere, and they are Dickensian, as sharp a shame to our society as brutal orphanages and child factory labor became to Victorian England.

Meanwhile, over at TNR, Jonathan Chait notes that Obama, as he seeks to marshall the country in support of health care reform, is avoiding focusing solely or primarily on the plight of the uninsured. Not only is he spotlighting health care costs -- a matter of the country's long-term fiscal viability -- but he's also speaking in terms of Jacob Hacker's great risk shift:

But Obama also presented the cost problem as a problem for individuals--one that was crushing the insured as well as the uninsured, and in many cases transforming the insured into the uninsured:

In the last eight years, premiums have grown four times faster than wages. An addition 9 million Americans have joined the ranks of the uninsured. The cost of health care now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. Even for folks who are weathering this economic storm, and have health care right now, all it takes is one stroke of bad luck--an accident or an illness, a divorce, a lost job--to become one of the nearly 46 million uninsured or the millions who have health care, but really can't afford what they've got."

The emphasis is mine, because that's the argument Obama and other reformers need to make. Pollsters will tell you, accurately, that the phrase "universal health care" does not play that well with the voters. That's because, when it's phrased that way, middle-class voters thinks that simply means paying more taxes so that people without insurance now can get it. What Obama is trying to do here is to suggest that everybody--the uninsured and insured--are vulnerable today, and that neither will be totally secure until we do something to guarantee coverage and make health care less expensive.

If Time and the WSJ are indicators, Obama may have the media behind him as he drives this message home.

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