An Emptyness That Isn't So Empty

Such timing.

This never occurred to me. Not once. That Americans are against Health Care because they think it actually costs tens of thousands of dollars for a broken arm, hundreds of thousands for a complicated birth, millions for cancer treatment.

I’ve had these same drops before living in the UK. They cost me seven GBP.

It’s the exact same drug, same steroid, same strain of antibiotic. But somehow the US gets away with charging $100 for a generic non brand version of a drug which is easy to create and widely used. It’s downright robbery, but also a form of eugenics through poverty and class warfare. You keep the poor poor by making sure basic necessities remain unattainable and then you make it seem like the norm so no one fights it.

The rest of the world is not like this.

I’m in the exam room, post diagnosis and with pill bottles in hand, and in walks the one nurse I’ve been able to speak to the entire time. She pats my hand and tells me (and this is verbatim—I will never forget this conversation as long as I live), “I’m so sorry. We had to run those tests, and they are expensive. You don’t have insurance so you will have to cover the full cost.”

I start crying.

She continues, softly, as if telling me someone has died, “It’s going to be three hundred.”

I start sobbing, certain I’ve misheard, certain that I would be absolutely fucked, broke and going into debt in a foreign country. “Thousand?” I clarify.

Her entire demeanor changed, and she looked at me as if I had sprouted four extra heads. “No,” she says, “euros.”

They’re so completely, utterly ludicrous, that you dismiss them. These are the stories of people whisked to the fae realms and healed by magic.

In America, the costs are in thousands of dollars. And they trick in, week after week. You get charged a few hundred here, another few hundred there. A $1300 consulting fee for a radiologist you never saw, $200 for that pill they brought you while you were waiting to see if that pain in your side was a heart attack or a pulled muscle. Informed consent is a joke. No one wants to talk to you about the cost, none of the staff knows. You’ll just be billed later, is all.

And then we’re told “I was in London when I broke my ankle and they charged me for parking.” and it just sounds like we’re being made fun of. That these American bumpkins don’t understand that of course medical care costs money, and they need to quit whining. It’s all so ridiculous, it has no connection to the world we experience.

And of course we’re so very afraid of the medical field, of the bills and bills and bills, and being sent to specialist after specialist without once being listened to and finally after the cost of a car giving up because this is just our life now - so gods, it must be So Much Worse if you’re a foreigner, we would never dare go to a hospital in France or Japan, we could never afford it.

My dad worked in administration in one hospital in the US for 20+ years. When he left in the late 90s, it was entirely because of how disgusted he was by the American healthcare insurance industry. He went on to get his PhD in healthcare consultation and wrote his thesis on how lack of affordable primary care increases healthcare costs overall, and results in poorer outcomes for patients. Essentially, this man changed careers at 45 in order to spend 15 years getting a terminal degree so that he can criticize the US healthcare system PROFESSIONALLY.

I give you his main talking points:

Because US healthcare is so expensive, people do not or cannot regularly go in for basic annual physicals. This means that:

1) diseases like cancer are missed until they are passed the treatable point

2) physicians are unable to effectively educate and work with their patients on manageable chronic conditions like diabetes. It’s not just being able to afford the medications - it’s knowing how and when to take them and understanding what signs and symptoms to look out for.

3) even if you do get to see a primary care physician, you might only get 15 minutes of time with a stressed out, distracted doctor who doesn’t seem to know your name, much less your medical history. You can thank insurance companies for pushing doctors to spend as little time talking with patients as possible - talking doesn’t bring in money

4) people are forced to rely on emergency visits for things that can and should be treated/managed by their primary care physician. If, for example, a person has what they need in terms of medication, patient education, and support from their healthcare team to manage their diabetes, the actual cost is in the cents per week or something ridiculously low like that. If they can’t get these, and regularly end up in the emergency room because they passed out or suffered other secondary complications, that’s way more expensive even if the insurance companies billed fairly (which they do not). This is the fault of the insurance company, not the patient

5) a more advanced progression of any medical condition often requires a specialist. Specialists are more expensive. Again, true even if the companies billed fairly. Again, the need for so many specialist visits is still the fault of the insurance companies, not the patients.

Additionally, the mere existence of the insurance companies makes medical treatment more expensive. You know how doctors don’t know how much your visit will cost? It’s because it takes an entire billing department to parse through the codes of each plan of each insurance company and figure out the final bill. For some hospitals, more than 1/3 of the staff are just there to figure out billing. The cost of all those salaries gets rolled into your bill.

And because billing is so complicated, small offices and practices just can’t afford to stay open or hire the staff for billing. So you know what companies like UHC do? They swoop in and buy up smaller practices and use their power to push doctors to spend less time with patients, make more specialist referrals, and limit options for treatments. And then many truly excellent medical professionals leave their field because of the mental toll of working with these insurance sleezebags.

Just to top it all off, you get insurance companies and the right wing blaming it on you: YOU didn’t go to the doctor at the first sign of illness (because you couldn’t afford to take time off from work just to pay $100 for something that could be nothing), YOU didn’t take your insulin (because you couldn’t afford it, or because you didn’t understand the instructions given in the 10 minutes of actual face-to-face time you had with your physician), YOU waited until it was an emergency to get treatment (because it was your only option).

@ gaurav