Moving on to Section 3 of the TIME magazine article “Bitter Pill: Why Medical Bills Are Killing Us“.
3. Catastrophic Illness — And the Bills to Match
People, especially relatively wealthy people, always think they have good insurance until they see they don’t.
This quote from billing advocate Patricia Palmer says so much in so few words. Millions of Americans still obtain insurance from their employers, with little understanding of what deductibles, copays, and coinsurance actually mean. If you were to ask the average American about their insurance plan – most of them couldn’t tell you their monthly premium or what is covered by their plan. The fact of the matter is that in the quest to obtain health insurance, people are either unaware of what their insurance actually covers because it comes from their employer, or knowing full well the limits of their plan, they have no other options and are desperately willing to take risks to secure coverage. If this sounds strange or wrong to you – it should. In the world’s wealthiest nation, we shouldn’t have to risk our health and our livelihood simply for the ability to obtain medical care.
And yet we do. People like Sean and Stephanie Recchi and Rebecca and Steve S knew that their insurance coverage was inadequate or contained coverage limits in the fine print. But the Recchis and the “S” family bought what they could afford; they chose between having health insurance and not having health insurance, even if the choice to obtain coverage left them vulnerable. Anyone else in their situation would probably have done the same. Because in the United States, having health insurance is the first gateway to health care access.
But probably the most important lesson of Steven Brill’s article is this: while having health insurance dramatically improves one’s access to health care, health insurance does not serve as a guarantee to affordable care. I’ve avoided trying to make the “Bitter Pill” article into an all-out political issue, but this is where money, medicine, and politics collide head on. When we talk about the uninsured in this country, conservatives (read: Republicans) see a group of lazy people who choose to not buy health insurance and then freeload on the rest of us taxpayers, while ignoring substantial evidence to the contrary. Liberals (read: Democrats) see a group of people who are desperately in need of assistance in obtaining insurance, while ignoring the fact that coverage does not actually equal access. Using these terms, the Affordable Care Act (ACA) essentially forces these “freeloaders” to buy insurance or pay a penalty/tax and to help the desperate obtain coverage through subsidies, Medicaid expansions, and state insurance exchanges.
As much of a champion as I am of the ACA, it does little to solve the problem that the Recchi’s or the “S” family encountered. After all, they already had insurance – and yet their insurance wasn’t adequate. They fall into the category of people who are underinsured – they have insurance but still can’t afford necessary medical care. True, the ACA does eliminate coverage limits, high deductible plans, and pre-existing conditions, but in doing so, it only makes health insurance more affordable. In truth, even though it is called the Affordable Care Act, the health reform law does little to make care truly affordable.