The true cost of being uninsured in America

In a New York Post article dated January 23, 2019, the author states how Americans without health care insurance hit 13.7 percent. This 2.8 percent increase means an additional seven-million Americans lack health coverage as noted by the Gallup survey period.

This is not far behind the 18 percent recorded just before the Obamacare mandate in 2014.

Everyone is blamed in this article except the culprits. Do you think for one moment that insurance premiums have not continued to go up over the past four years? In fact, since the launch of Obamacare, the nation has seen a 12 percent increase in premiums as of January of 2018. Imagine physician’s incomes dropping by $18 billion between 2013-2015 and continuing to drop? So, patients, as well as physicians, are giving up incomes to insurers, the government, and pharmaceuticals. Yes, they are indeed “left behind.”

Are we all dumbed down enough to blame the lack of an Obamacare or ACA-like structure for not lowering premiums and making health care affordable? You can call it anything you like — it’s insurance!

I see it in my practice every day and hear it from my patients all the time. After all, in the trenches, the truth always comes out.

Many, too young for Medicare or generally healthy defer buying health insurance altogether. Although Gallup has polled this number to be the lowest on the East Coast, I see a very different picture. I see hard-working young professionals without job-provided health insurance biting the bullet, paying in cash for minor office procedures and, at times, even pre-negotiated minor hospital or surgical center procedures. Rather than having an out-of-pocket deductible upwards of $5,000 before their health coverage kicks in, they dare survive without it.

The trend is growing. Hospitals now collect co-pays before they even “stop the bleeding” so to say.

It’s become a desperate dog-eat-dog scene in our new and improved “health care” landscape. People are working crazy hours and taking on jobs they hate simply to get the worst possible — albeit some sort of — health care coverage. Well-known insurers that boast of large networks of physicians often wind up sending patients 25 miles or more from their residences to find such “in-network “physicians. Many times, this is in the least desirable neighborhoods and not necessarily the highest rated of providers.

Further unraveling the true face of our nation’s health care are all the apps, gizmos, telehealth, visiting nurses, APNs and NPs (not to mention required patient portals, MIPS, MACRAs, population health) that are continually diluting the quality and value of a precipitously declining state of medical care.

I often see the face of panic on my patients and hear of their trepidations should a medical disaster strike. And it comes as no surprise when I see how excoriated the health care playing field has become.

No wonder physicians’ offices are wary of patients and their insurers as they fear not getting paid and even refunding payments more and more given the more aggressive nature of today’s health insurance industry. After all, when you consider all players equally, it is the physician who most often does not get paid for his or her work. There should be a law against contractually working for free — which doesn’t apply to doctors. As a result, more and more physicians are choosing to get out of various insurance companies, go out of network or be employees of large entities, further helping to water down the quality of and increase the morbidity and mortality in medical care.

You won’t hear about this on TV commercials, news articles or the media as the powerful health insurance industry comprises one of their most prized sponsors.

Cutting to the chase, people are left to scramble between paying their rents, feeding their children, perhaps paying for auto insurance by deferring unaffordable health care premiums.

What about seniors? Are they so much better off when they get their Medicare cards?

How do you think a social security check that is inversely proportional to the growing cost of supplemental or co-insurance premiums, drug prices, being served “donut holes” in drug benefits and rising co-pays fare? This being especially so if these poor souls are only on Medicare is but a glimpse of reality-based health care survival?

I often see cash-strapped families deferring health insurance to afford purchasing expensive drugs for their parents. After all, Obamacare and others were intended to provide health care for “our nation’s families.” Could we ever admit that it as well as other “health insurance products” benefit only insurers and never prioritize the public? They — unlike physicians — are never “policed” in their practices. I think we need to admit these harsh facts before any change can ever take place. We need to stop being the medical ostriches we are and lift our heads as we observe and take in reality.

I wonder why the Gallup polls never question the victims of unaffordable care rather than just confirming they are on a rapid ascent?

I guess the true pictures physicians see every day wouldn’t reflect as well on the health insurance industry. It’s certainly not a pretty picture.

There’s no question it’s something Americans, our legislators and the industry needs to hear and deal with. It won’t just go away — it will undoubtedly get worse and unmanageable.

As healers, we must do more than practice our skills as we must also stand up to the obstacles of our profession. Norman Cousins said it well when he posited how: “It is reasonable to expect the doctor to recognize that science may not have all the answers to problems of health and healing.”

Michael Weiss is a cardiologist and can be reached on Twitter @HeartAndSoulDoc.

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