I’m not sure why anybody would argue with this statement, but people do.
As a disabled person, I’m furious about how very broken it is and how hard people have to work to be treated anything resembling properly. It shouldn’t be this hard, but it is – and it’s really important that we talk about it.
The system is inaccessible to many – and the accessibility is overly impacted by politics
The first thing to recognize is that the healthcare system is broken because such a large percentage of the population of this country simply aren’t able to participate in a meaningful way.
Over 27.5 million people in the US had no insurance coverage whatsoever in 2019, with many more people being underinsured. Now it’s down to 26 million people(a much-celebrated 9% of the population). Not coincidentally, in 2019, President Trump was defunding the ACA and allowing regulations limiting its power to be passed. In 2022, President Biden has invested in the ACA and focused on Covid-19 mitigation in many forms including Medicaid expansion and reducing consumer healthcare expenses.
Why are so many people uninsured? Well, many people simply can’t afford insurance due to the way the system is built.
The most common form of coverage(55%) is supplied through an employer. Generally, to get insurance this way, you need to be a full-time employee to be eligible, and you often need to pay into the system, and pay extra to cover others in your family.
So, right there, many people are left behind. With insurance being linked directly to employment, the moment you lose your job or have your hours cut, you can no longer participate in the system.
Also, anybody underemployed(working less than 32-35 hours a week) for a single employer can become ineligible because they aren’t considered full-time(employers are only legally required to provide health insurance to full-time employees).
Many people working hourly jobs simply aren’t given the hours necessary for their employers to have to offer them insurance.
For those of us living with disabilities, most cannot participate in full-time work. So, we generally need to get on some form of government assistance, both for income and insurance.
The two government insurance programs available are Medicare(covering 17.8%) and Medicaid(covering 17.9%). Both of these have their own flaws.
Medicare covers everybody participating in the Social Security System entitlements system. While much of this population is 65 and over, people who are disabled and have enough of a work history to be eligible also participate.
Medicaid is messier.
It’s a Federal concept that is enacted differently with different rules in every state. Under the Obama administration, states were encouraged to expand their Medicaid programs to cover more people – basically to increase the minimum accepted income to be eligible for Medicaid benefits.
In the ideal definition, Medicaid is supposed to cover all low-income people(the definition of low income also varies), including disabled people and older folks who aren’t eligible for Medicare.
With each state interpreting things differently, Medicaid has become the backup insurance you hope to get, but won’t know until you apply(or have researched your state’s rules).
The number of people who simply aren’t insured was rising, a situation badly exacerbated by COVID-19, as many employers dropped many employees causing them to lose their health insurance at a time when they were especially likely to need it.
This is why Medicare For All is so important – it’s a way to make sure that everybody is covered and increases the chance for all patients to be treated fairly.
Health Insurance Options are intentionally complicated
If you’re fortunate enough to get health insurance, you then need to face the myriad decisions that accompany it.
Every plan has its own premium, deductible, and maximum expenses(if you’re lucky enough to have that option), and each plan has its own set of preferred networks.
Wading through the details, exceptions, exemptions, and expectations is often exhausting and difficult work, and many of these rules change annually.
Why are these plans so complicated?
Because it provides more money to the middlemen, and because it makes it that much harder for each person to pick a plan that will truly help them.
If you don’t understand your plan, you are less likely to use it, and less likely to push back if your insurance company fails to cover services.
Healthcare providers only really want healthy clients
Those of us with chronic health conditions and other disabilities face a system biased against us. Insurance companies primarily make money when they spend less on their clients than they earn in premiums.
Seeing your Primary Care Physician and getting your annual wellness check is relatively inexpensive.
Visiting multiple specialists and taking a variety of medications is much more expensive – both for you and your provider.
This is why pre-existing condition clauses were created – and why the Affordable Care act struck them down.
The more complicated your individual needs are, the more likely it is that your healthcare plan will either deny your coverage or put so many layers of red tape around you getting the benefits that you give up.
For most of us with disabilities, healthcare costs are a huge concern, and we often have fewer options than abled folks. We also need more medications, more specialist visits, more testing, and more treatment options.
All of these are things that make covering us more expensive and our coverage requests more complicated and frequent.
Even disabled people who are able to work and earn a reasonable income still spend a disproportionate amount of that income on their healthcare needs.
The healthcare system currently in place in the US reinforces the push of disabled people towards poverty, and of worse health outcomes for poor people.
Marginalized people are most commonly provided the worse insurance options and experience worse health outcomes
Poor people are the most commonly uninsured, especially the working poor.
If they do have insurance, it’s likely to be Medicaid, and Medicaid coverage often includes long waits for services and struggles to find appropriate doctors, especially for mental health concerns.
While COVID-19 is raging around the world, the statistics in the US are dismal, with Blacks and Latinos dying from the disease at a much higher rate than whites.
Without insurance coverage, the idea of going to the doctor or to a hospital is terrifying, because medical debt is the largest reason people claim bankruptcy.
This is an experience I can testify to, as my partner, Al(who is a Latino man), had to file for bankruptcy due to his accident.
Despite having quality health insurance when he was injured, the bills still added up, especially when he realized that he couldn’t return to his job.
None of this is easy. But it sure seems like the medical system is yet another space in which bias and discrimination hold sway.
Medicare for all or another single-payer health system is a useful first step
The US is the only “first world” country with no single-payer health system in place.
When I say single-payer, I’m referring to the federal government as being the only source of a singular healthcare package, as opposed to our current system where there are multiple insurance companies constantly competing with one another for the clients.
This is a good thing.
It would help manage drug prices, hospital costs, and medical bills, while allowing all people to participate in the system.
It also would decrease the profit motive that insurance companies generally focus on, which would reduce the risk of corruption.
While it would not solve all of the problems mentioned in this post, it would help mitigate some of the worst problems.
Instead of having many people with no health insurance, a single-payer system would allow everybody in this country to get the medical care they need.
In turn, this would help the working poor and the disabled communities to improve our health without many of the fears that currently surround healthcare.
This also would help mitigate some of the issues Medicaid patients currently deal with, since these patients are often not able to see many doctors who make more money from patients on other forms of insurance.
Having a single-payer system would make all patients financially equivalent, so while some people may have longer waits than they are used to, it’s less likely to be due to the struggles associated with being low-income or otherwise having less-than-stellar healthcare coverage.
Having a single-payer system won’t correct the other aspects of the racial issues – we’ll still have medications primarily developed by and for white men, still have too few black doctors, and may continue to have race-based disparities in treatments and outcomes, but it’s a big step in the right direction, and one that would help not only the 27.5 million people without coverage, but also those covered by Medicaid or by low-quality plans some jobs may offer.
Added benefit of universal healthcare: separating healthcare from employment
The biggest benefit for many, though, including the disabled community, is this: healthcare would no longer be connected with employment.
Many disabled people(including myself) hold a lot of fear around losing their disability benefits. Often the deepest-seated part of that fear is the fear of no longer having health insurance. I’ve written about working while disabled, and the bigger part of the fear has always been about losing health insurance, rather than losing the money.
Now, when you truly are in a situation where you can’t work at all, then all of it is vital, and I certainly am living on my financial benefits at the moment. But the thing that has held me back, has frightened me more, has been being without insurance.
That’s why when I’ve been doing well, I haven’t put all my energy into working and getting off my benefits – I’ve been deeply aware that even if I could earn the money my benefits currently pay me, replacing my insurance would be a much more difficult feat.
If we had universal healthcare, I’d be a lot less worried about my healthcare benefits and feel freer to focus on earning money.
This isn’t a statement about the reality of my condition – I have Functional Neurological Disorder (FND) and it is extremely stress-responsive. But removing the fear of losing my healthcare would reduce my stress, and my worries wouldn’t be as severe.
Would I immediately start earning a huge amount of money? No, that’s not how business works, but it would encourage me(and many others) to think more about working, earning income, and feeling comfortable in finding a full balance between managing my condition and earning income. It also would save mental energy, as currently, we have income ceilings to consider as well as minimal income levels to make our businesses viable.
On the racial front, universal healthcare would allow all people the opportunity to get wellness checks and regular testing without fear of the bill sinking them into poverty and would help take the financial aspect of the fears out of the equation.
That alone could save a huge number of lives. Many of the cancer issues mentioned in this post’s sister article are partially due to less-frequent preventative screenings, and there’s a potential for universal healthcare programs to create more space for deeper conversations about stress management and healthier diets to happen.
While not THE solution(we need sweeping change) going to a single-payer program would be a huge step towards fixing our broken healthcare system.
So what can we do now?
Keep an eye on politics. Currently, getting a single-payer program is looking unlikely, as neither of the presumptive presidential candidates are endorsing such a program.
Voting for senators or members of the House of Representatives who support single-payer programs may help, and asking for these social reforms may increase the chances of this occurring.
We need to question things – why these systems are the way they are, how they could be done better, and what steps it might take to fix these problems. These systems need to change, and it’s only going to happen if enough people push for it.
I am not surprised at the state of healthcare in the US. Earlier I would come across headlines about the system, but last year, I was in the US for specialised surgery paying out of pocket and I realised how backward the system is.
To illustrate a simple example of the weirdness of the system – I received a bill for a list of blood tests without the blood tests being named . The bills were not itemised. There was no way for me to clarify anything. I received no help from the admin that looks after international patients. I was given the run-around for multiple issues of their billing system. It took them 8 months to send me a semi-itemised bill for all my hospital costs – doctors obviously charged separately. There was no rate card – seemed like random numbers were thrown at you after the procedure was done (because before procedure everyone is so blank about money and certain standard costs).
Okay enough of a rant. But it made me feel lucky that I don’t need to live in this system otherwise I would really struggle to fight it and deal with my health.
I hope things change for US because many people desperately need it to. What’s happening is just not fair.
Thank you for explaining all this so well 🙂
Thanks so much for your comment! The system is deeply flawed, and overbilling is extremely common too.
Every hospital works with multiple insurance companies, each of which has its own rules, regulations, and costs (and cost bundling), which leads to a lot of extra paperwork. It’s all pretty disturbing, and there is a lot that needs to be done to fix it!
Healthcare and wellness is so important , and it’s sad when ‘progression’ of a society becomes a regression of humanity, because that just defeats the purpose, doesn’t it.
First of all, I am so sorry to hear what happened to your partner, Alison.
This is a super comprehensive breakdown of health care in America. I catch bits and pieces here and there, but rarely all in one place. I mentioned passing your videos on to my husband. I will forward your article to him as well because there is no way we are moving back during all this.
As for your comments on books about medical bias and history, this is a favorite topic for me. I have read books for the examples you mentioned and I also just read Being Mortal by Atul Gawande, which focuses on health care at the end of life – yet another example of how the US is failing another population – our seniors. (His book does give hope, though. Beautiful read.)
Regarding how women are treated (or ignored), my eyes were wide open after reading Invisible Women: Data Bias in a Male Dominated World. It made me pretty mad! But sometimes anger is good for me because it challenges me to address these types of things head on.
Great tips on what to ask and how to work with doctors in this current broken state of affairs. I hope it gets easier for everyone.
Thanks for your thoughts, we are getting through alright.
Thanks so much for sharing these recommendations! The system is so broken, it’s vital to recognize that first, then work around those issues. It’s really important to affirm that we aren’t the problem, and it’s not our fault the system is broken.
Then we need to take a deep breath and make sure we get the care we need, despite the system being broken!
As someone who spends a lot of time in hospitals I have to admit that I’ve never thought much about medical bias. And yet, unconsciously, I know it’s true. I am grateful you’ve exposed me to different thoughts on what’s happening behind the doors and I look forward to thinking through this more.
Glad to be of service! I really want to help folks understand the challenges faced(or avoided) and that there’s a reason so much of this is so hard!