By Farooq A. Kperogi
I thought I had written enough about American healthcare to bore my readers to death. I was wrong. Readers who have followed my previous articles on the topic have emailed me several questions which I feel compelled to respond to before I move to another issue. The questions can be reduced to two: One, what happens to temporary visitors to America who have the misfortune of falling sick during their visit? Two, why did I once describe the concept of health insurance, especially as it’s practiced in America, as one huge, elaborate fraud but now seem to be advocating it for the nearly 50 million uninsured Americans?
I will start with the first question. Tourists or other temporary visa holders who fall sick during their stay here have at least three options. The first is to get a visitor’s insurance before their visit. However, only visitors who will stay here from between 5 days and 12 months are eligible for a visitor’s insurance. Of course, as you would expect, a very good visitor’s health insurance that will be tenable in all U.S. hospitals is expensive. So this is only an option for people at the upper end of the social scale.
The second option is to go to what Americans call “mini-clinics.” Mini-clinics are small, bare-bone but nonetheless well-equipped health centers created to handle routine and minor ailments like the flu, fever, etc. They are usually found in such ubiquitous retail stores as CVS Pharmacy, Wal-Mart, Walgreens, Target, Publix, etc. Unlike regular hospitals, no appointment is required to see a nurse practitioner or an on-call doctor, and people can be treated even if they don’t have health insurance. The clinics are also relatively inexpensive and typically charge less than $50 (about 7,400 naira) an office visit. Plus, they accept payment in cash, which is a good deal for visitors especially from cash-based economies like Nigeria.
However, mini-clinics cannot handle complicated medical emergencies. So what happens when a visitor has a medical emergency? Well, there is only one option: rush to the emergency room, which by current law can’t refuse to treat patients on account of inability to pay. In many such cases, my friends here tell me, American tax payers end up picking the bill since emergency room bills are often so atrociously extortionate that ordinary mortals can’t afford them. (By the way, after my insurance company paid 80 percent of the $4100 bill I received for a fever I was treated for at an emergency room, I paid $840, that is, about N125,000, from my pocket, which is still inordinately high-priced for the treatment of a mere fever).
And this brings me to the reason for my repulsion against the whole idea of profit-driven health insurance, especially as it is practiced in America. First off, the idea of paying upfront for a service you currently have no need for, and may never even have a need for, strikes me as singularly dishonest. I have been paying into a health insurance account for all the years I have been here and had never had a reason to visit a hospital until recently. Yet, I won’t be refunded the money I paid in the past for services I never used.
Perhaps, I find this practice anomalous and counter-intuitive, even fraudulent, because I come from a “pay-as-you-go” consumer culture. I probably would have opted out of having health insurance if I had an option. I have health insurance because it’s part of the terms of my employment. My employers, by the way, also pay a periodic premium on my behalf to the insurance company—in addition to what I pay from my pocket. That’s why insurance companies here are some of the top-grossing business concerns here.
My second problem with American health insurance flows from the first: the utter moral perversion in the idea of making conscienceless profit from people’s misery. Insurance companies here have a whole host of devious tactics that they deploy to refuse to honor their subscribers’ claims. The most common is what they call “pre-existing condition.” That means if you have an illness, say cancer or sickle cell, prior to signing up for a heath insurance, the insurance company would not pay for any complications arising from these conditions.
In theory, it will only pay for sicknesses you contract after you have signed an agreement with them. That is what killed Barack Obama’s mother in 1995, and that’s why he’s personally and emotionally invested in reforming the healthcare system. His mother’s insurance company said the cancer she was diagnosed with was a “preexisting condition” and refused to pay for it. So she died a slow, painful death because she didn’t have the money to pay for expensive cancer treatment, although she had paid thousands of dollars to her insurance company in the past. Thousands of other people have died and continue to die in similar circumstances.
But there is an even more insidious health insurance fraud called rescission, which is basically a big term for the arbitrary termination of people’s insurance policies midstream when they develop expensive conditions, such as getting cancer or AIDS after signing up for an insurance policy. A recent investigation by the U.S. House of Representatives, for instance, found that insurance companies make billions of dollars from this unconscionably depraved and ungodly policy. In fact, it was discovered that bonuses for health insurance company workers were, and still are, often dependent on how many people with expensive conditions they are able to successfully “rescind,” using such dubious industry legerdemain as the fraudulent re-interpretation of intentionally vague disclaimers in the fine prints of the agreements people sign with them.
Insurance companies can also refuse to honor a bill from a hospital because the hospital is not in their “healthcare network,” or because a hospital, though in their “healthcare network,” did not call them prior to admitting and treating a patient that has insurance with them. They also pick and choose what illnesses to cover in the insurance policies. My own policy, for instance, does not cover dental treatment, treatment provided in a government hospital, routine physical examination, etc.
If I have a need for these services, I have to either pay from my pocket or extend my coverage by paying an extra premium. Just three weeks ago, a friend of mine, who is a full-time professor, was diagnosed as having a predisposition to heart attack, so her doctor advised her to go for treatment. But her health insurance does not cover heart surgery and she does not have the kind of money needed to fund a heart surgery. So she is listlessly resigned to fate now.
Insurance companies also typically target young and healthy people (who often have no need to visit hospitals and therefore literally give them free money) and reject old, vulnerable, and illness-prone people who need the most medical help. They are able to make this shifty discrimination because before you sign up for a health insurance policy here, you have to disclose your medical history. They use this disclosure to determine whether or not you will be a future financial burden on them.
I just think that American health insurance companies are a bunch of criminal, rapacious, malevolent, blood-sucking enterprises that no nation should tolerate. They have ensured that although America has the world’s best healthcare facilities and personnel, it has the worst health record among the world’s 16 most industrialized countries, according to a recent survey. And this is so because healthcare has been colonized by these predatory, cold-blooded and crass private sector wolves to the complete exclusion of government.
The Obama administration wants to reverse that by changing the law so that government can also invest in health insurance and compete with the shameless private sectors vultures. Conservative Republicans in the US Congress (who are sponsored to their posts by insurance companies) have derided this as “socialized medicine.” And they have got poor, ignorant people to rise up in violent, vitriolic, race-tinged demonstrations against Obama for this.
However, according to opinion polls, most Americans now want government involvement in health insurance to keep costs down. This is called the “public option.” Insurance companies and their minions in the U.S. Congress are scared shitless at the prospect of this option. Government involvement in health insurance would mean the end of, or at least a substantial check on, insurance companies’ exploitation of people’s misery for profit.
Fox News anchor Shepard Smith captured it well in a recent face-off with Republican Senator John Barrasso when he said, among other things: “Over the last ten years health care costs in America have skyrocketed. Regular folks cannot afford it. So, they tax the system by not getting preventative medicine. They go to the emergency room in the last case and we all wind up paying for it. As the costs have gone up, the insurance industry's profits, on average, have gone up more than 350%. And it is the insurance companies which have paid, and who have contributed to Senators and Congressmen on both sides of the aisle to the point where now we cannot get what all concerned on Capitol Hill seem to believe and more than 60% of Americans say they would support, which is a public option.”
However, not having health insurance at all is a lot worse than having to contend with the current deformed and immoral system. Over 45,000 people die in America every year because they have no health insurance of any kind. And emergency room bills account for more than 60 percent of bankruptcies in this country. That’s why a Newsweek writer recently described America as “No Country for Sick Men.”
The good thing is that the Obama administration is working very hard to fix this embarrassing mess. So what I advocate for the millions of uninsured Americans is both access to health (which only the current malformed health insurance system can guarantee for now) and the opportunity to benefit from a reformed health insurance, which insurance companies have so far spent over $21 million to either derail, dilute or thwart. But it doesn’t seem like they will succeed this time.