My mom died because she was too poor to afford a doctor
September 23, 2017 9:01 PM   Subscribe

 
I grew up wonderfully and invigoratingly poor. /s (not to the poor part). My mom and step dad both had blue collar jobs and white collar minds and piss poor insurance. When I was 6 or 7, my dad got the crap end of the stick with leukemia. He passed away 18 days after my 8th, 3 days after his 45th.

Growing up, we never quite dug out of that giant pile of bills. Every month was a dodge around which bill collection was really serious this time. I think it took my mom's inheritance from my grandparents to settle the tab, twenty some odd years after.

I cannot fathom the willingness to sanction this kind of cruelty - this kind of nihilistic surrender to fate in a nominally Christian society. (Rich, coming from the atheist).
posted by drewbage1847 at 9:30 PM on September 23 [56 favorites]


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posted by limeonaire at 9:31 PM on September 23


This. This. This.

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posted by AlexiaSky at 10:04 PM on September 23


I cannot fathom the willingness to sanction this kind of cruelty - this kind of nihilistic surrender to fate in a nominally Christian society.

Medical Calvinism, the human price of which is immeasurable.

Per Noah Smith, "The future of American health care is a single-payer system that gets set up and then abolished again every time Congress changes hands." Why should we doubt that? Outside the US, conservative parties inherited universal healthcare on an electoral promise to manage it better than the socialists who instituted it, and were obliged to do so. In the US, where there is a stupid necessity to show up and vote every two years only heeded by one side of the ideological spectrum, conservatives can inherit universal healthcare on a pledge to once again let people die of manageable conditions and will get sixty-odd million votes to back them up, even from people who will die of manageable conditions. I don't see how that changes any time soon.
posted by holgate at 10:20 PM on September 23 [28 favorites]


My cousin's fiancé died for the same reason. He worked full time and had done so since he was a teenager. He had his first heart attack in his 20s but there was no follow-up care because he had no insurance. Every time we hung out with him for the holidays he'd disappear upstairs to lay down because of "heartburn." Right around his 40th birthday he had a massive heart attack and died.
posted by xyzzy at 10:33 PM on September 23 [5 favorites]


well holgate - all I can say is a pox on all that. Seriously, it's bizarre. And yeah, I live in California, I see the "yoga, clean living, be free from worry" thingy in the flesh as the liberal side of it. And I know you can discount the twins of American culture: "don't tell me what to do, I'm free and government is a bare necessary evil" and "those shirkers are getting the same as I do and I work hard and that's unfair".

It's just so frustrating.
posted by drewbage1847 at 10:36 PM on September 23 [2 favorites]


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posted by Emily's Fist at 11:52 PM on September 23


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posted by greermahoney at 1:24 AM on September 24


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posted by Fence at 1:42 AM on September 24


I work in healthcare education (UK) and I am sickened, beyond anger, that this is how you live. It is barbaric, cruel and over here would have caused a revolution.....



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(warning Rant ahoy: all my links are generally to the Guardian or government sites)

however, element of US healthcare policy is creeping slowly into the NHS reorganisations simply because we are getting older, iller, fatter and more demented and the funding envelope of our current model simply can't keep up. Most people would agree to a tax increase but that doesn't sit idealogically with the administrations of both hues since 1987 who started to introduce market reforms into the NHS (don't get me wrong, there was and is lots we can reform in the NHS and make it more efficient, and we have done huge amounts since 1987, e.g. Length of stay in Hip and knee replacement ops is coming down from a ridiculous amount to a manageable amount with enhanced recovery and education of staff about early mobilization of patients)

But when sections of NHS services were awarded in a market driven bidding process to private sector like Virgin Care getting Surrey's sexual health services (eponysterical) or Circle Health getting the running of Hinchingbrook Hospitial it quickly becomes clear that there is not a lot of profit margin left because we have gone so far in making the NHS more efficient for the taxpayer and so the private provider pulls out causing massive hassle for the NHS and serious concerns for the stafff who were TUPEd over.

Quite a number of US organisations like Kaiser Permanente are actively investigating business options here and some of them are lobbying the Department of Health. I honestly would invite any of them to save their huge investment and spend a week in any A&E department or ITU (open offer, I can arrange this for any health care professional if you pay your own DBS checking fee) you would quickly see how lean the services now are, there is no profit margin I can see, at least in the acute care side of things. In fact, as has been so painfully demonstrated, relentless focus on targets and bottom line (along with appalling leadership & mismanagement) gave us Mid Staffs & Morcambe Bayscandals.

I mananged millions of pounds of education & training investment after those for compassion awareness training, research, Schwartz rounds, etc., when the fact of the matter is the vast majority of healthcare professionals come to work to give compassionate care, the system sometimes drives that right out of them by placing a newly qualified nurse with a health care assistant on an acute medical ward alone at night with responsibility for 28-30 patients and huge holes in the medical rotas meaning 1 or 2 relativey junior doctors covering the whole F**king hospital at night scenario.

NHS=THERE IS NO MORE FAT TO BE CUT! if your company is thinking of investing millions to lobby, research & devise ways to bid for huge parts of it (e.g. Greater Manchester may go to external bid) I am CERTAIN they know this and will cherry-pick parts of the health services and leave the acute parts to the NHS, the worst of all possible outcomes.
posted by Wilder at 2:25 AM on September 24 [58 favorites]


It was a deeply touching personal story, but the title is a little misleading unless there are facts I'm missing - her mother did not die because she could not afford insurance, but because the ambulance arrived too late the third time she had a stroke.
posted by Laotic at 2:28 AM on September 24


Laotic, people who have health insurance get treatment after their first heart attack she, or their second, to prevent a third. for example, bypass surgery, blood thinners, blood pressure meds, beta blockers...also nutritional support, cessation therapy for smoking, and fitness counselling if lifestyle is an issue.

As you can see on this chart, the US death rate for heart attack is above the UK or Canada by a fair bit.
posted by warriorqueen at 3:33 AM on September 24 [41 favorites]


her mother did not die because she could not afford insurance, but because the ambulance arrived too late the third time she had a stroke.

She couldn't get her underlying heart condition diagnosed and treated because she didn't have health insurance and couldn't afford to pay out of pocket.
posted by nangar at 3:34 AM on September 24 [34 favorites]


I'm so sorry, and so angry this happened. This made me think about my own family and a very different story. It's basically "How socialism made my mother's end bearable, and saved our sanity."

A couple of years ago, my elderly mother's body failed her. Both strokes and heart attacks, and she passed away at the age of 95. But my mom was always strong and she held on to life for quite a long time. She was on Medicare. Her lengthy hospital stays and frequent doctors visits were paid by Medicare. And her hospice care was fully covered by Medicare. This allowed her to spend her final weeks at home surrounded by people who loved her.

I never saw a bill for either. I was under considerable stress about taking care of her, but I never had any financial stress. All I had to do was call or show up, present her Medicare card, and she'd get the care she needed. I can't tell you how much that helped. Not only in getting the needed services, but in allowing me to spend my time and energy on caring for her without additional worries.

I live in a very Republican area and I frequently tell this story of what socialism really means. This is the coverage anyone & everyone deserves, not just the people over 65.
posted by Teegeeack AV Club Secretary at 4:04 AM on September 24 [35 favorites]


Heartbreaking. The part where she was using other people's medicine... awful. She sounded like a kind and wonderful person and I'm so sorry for your loss.

And this is a reminder of what life was like before the ACA for many people. I don't know if the writer's mom would have qualified for Medicaid expansion, but Medi-Cal looks like it covers 12M people in CA now. In the 90s I remember that when we went to the ER in NYC it was packed with people in similar circumstances (chronic diseases that needed regular attention but clearly weren't getting it). At least now we have some sort of safety net in Medicaid expansion states. That republicans want to go back to that horror show is unbelievable.

i think privatizing the NHS sounds like an insane idea. If profit is a necessity, care will likely get worse. I assume Kaiser believes they can make the systems more efficient, as they are fairly advanced in US terms in the management of electronic records across providers, etc. The best and least expensive insurance and care I have had in the US was with Kaiser if that's any consolation.
posted by rainydayfilms at 4:28 AM on September 24 [1 favorite]


This was a tough read. But I'm glad it was shared. Why is so much in our society broken? Ugh.

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posted by Fizz at 4:52 AM on September 24


> As you can see on this chart, the US death rate for heart attack is above the UK or Canada by a fair bit.

warriorqueen, that is a fascinating table for multiple reasons, but one of them is how this singular metric (CHD Mortality) hardly correlates with anything, seemingly.

I come from a country with a traditionally socialist health system where everyone gets all the care (although the general quality may be lower) and our CHD mortality is still 3x that of the U.S. Interestingly, that is also the difference between Vietnam's and Laos', two neighbouring countries which are very similar in many respects.

Also, what are Ethiopia, Mozambique and Zimbabwe doing down there among the countries with the lowest CHD mortality? I guess we'd need to bring in more factors, like mean life expectancy at birth, for instance.

I'm just against knee-jerk reactions.
posted by Laotic at 5:11 AM on September 24 [1 favorite]


It was a deeply touching personal story, but the title is a little misleading unless there are facts I'm missing - her mother did not die because she could not afford insurance, but because the ambulance arrived too late the third time she had a stroke.

Since you're wondering if there are facts that you missed:

She didn't have strokes. She had heart attacks. It says that right there in the article that you ostensibly read. Also, it says that if she had been able to afford better follow-up care, there would not have been a second heart attack, much less a third.

So yes, not having health insurance killed her.
posted by EmpressCallipygos at 5:11 AM on September 24 [15 favorites]


EmpressCallipygos, I made a mistake, sorry for that. I was only vaguely aware that a stroke is different from a hearth attack.

As I wondered in another medithread, I cannot wrap my head around the fact that people in a developed country would be left to literally die if they don't have a health insurance. I just cannot comprehend it. If your death is preventable, and they just don't give you the medicines, because they cost too much?

Which is probably why my brain looks for a different rationalization.
posted by Laotic at 5:18 AM on September 24 [5 favorites]


Good god.

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posted by queseyo at 5:24 AM on September 24


Gut-wrenching.

The ACA is not universal health care, but it was a massive step in the right direction. I went to medical school just pre-ACA, at a top 10 school located a few blocks from the center of the crack epidemic. There was definitely a tiered system of care based on $$, which is one of the major reasons I chose to move elsewhere for residency.

her mother did not die because she could not afford insurance, but because the ambulance arrived too late the third time she had a stroke

First off, it was a heart attack, not a stroke, but hey, minor quibble. But her mother absolutely did die of a preventable disease, because she could not afford insurance. A lot of the secondary prevention measures after a heart attack or stroke are lifestyle (exercise, quitting smoking, healthy diet) which you could argue are outside the scope of insurance coverage, but they do track very closely with poverty, and PCP visits are the place where most of that motivational counseling happens. Also, that nitroglycerin her mom was bumming off friends? That's the cardiac version of an Epipen. Fantastic short term treatment, opens up your arteries in the way an Epipen helps open up your airways, but is not equivalent of actual medical care.

On preview, seeing your update: "If your death is preventable, and they just don't give you the medicines, because they cost too much?"

Yes. That is the system in the US. America has the best health care system in the world, as long as you have cash, because America has decided, repeatedly, that cold hard cash is worth more than a human life. This is because America has decided that your worth as a person is directly proportional to your reserves of cold, hard cash. Like I said, the ACA helps in that it makes sure people at least have insurance, and the bare minimum of what that insurance must cover (e.g. pediatric care, one annual PCP visit per adult, the vaccinations and screenings recommended by the US Preventative Services Task Force, prenatal and maternity care). But given the struggles to prevent repeal of even that, I don't expect that America will be able to pass universal health care in my lifetime.
posted by basalganglia at 5:27 AM on September 24 [18 favorites]


warriorqueen, that is a fascinating table for multiple reasons, but one of them is how this singular metric (CHD Mortality) hardly correlates with anything, seemingly.

I was providing it to counter the idea that the US medical system is the best in the world, if only the ambulances would be faster.
posted by warriorqueen at 6:08 AM on September 24 [1 favorite]


I am a diabetic. I need to inject four times a day (short-term insulin three times a day, long-term before bed).

I am technically homeless. My wife and I are living with my parents after job losses. We sold everything we could - we went from a nice one-bedroom apartment to living out of two suitcases and a dozen boxes in storage (and not large boxes either) with books and disks and clothing we didn't want to sell for sentimental reasons.

I am jobless. I have no income. The state turned us down for food stamps because we are living with my parents, and because my wife lost her job due to injury when temping, they called it 'quitting' and we're not eligible to get financial assistance or any other kind until October (this happened to her in July; my job loss was in January, followed by medical issues in February that kept me off the job market until May).

We were middle class. We lost everything due to some bad luck (I got laid off, she got hurt).

I have to borrow money from my parents, who are past retirement age, to get my insulin, and it's the Wal-Mart brand you don't need a prescription for, and which is the stuff created in the 1960s. This is not really good for me, but it's all I can afford. I'm afraid of what it's doing to my insides. I'm afraid of a stroke, or a clot, or blindness, or losing a foot because of this, and making it even worse for my wife.

I am already planning, if something like that happens, to take four shots, at 50 units each, of the short-term insulin. It will kill me. I will pass out and die because there is nothing in my body to run it with that much insulin in my system.

I am too poor to afford a doctor. I am too poor to afford health insurance, and the state will not give me Medicaid. So I am left to plan my own death to make life easier for the people I love. I am nearly fifty years old, sick, looking for work and wondering if it's going to be trying to find a way to the fucking malls for Christmas stockroom work just to be able to buy my wife a Christmas present. I had to make a card for her for our anniversary because I couldn't afford it.

I am an ordinary American in 2017.
posted by mephron at 7:03 AM on September 24 [77 favorites]


In one of the conditions that is almost universal in care in the US is ESRD which requires dialysis, undocumented immigrants are left in the lurch and there are states that literally will not treat or treat very very poorly reducing outcomes dramatically(It's an automatic qualifier for medicare and/or Medicaid for life for citizens)

Occasionally, the hospital I work at gets people who move to IL for better dialyisis accesses. You can forget about transplants. It's absolutely terrifying because some states will not treat until fluid overload.


2016 NPR article

Dialysis for the undocumented immigrant
posted by AlexiaSky at 7:07 AM on September 24 [1 favorite]


Because she had no health insurance, there were no plans for follow-up care, no prescriptions, nothing but her cut-up clothes in a plastic bag marked PERSONAL PROPERTY.

Fucking hell.

I watched my patients die of poverty for 40 years. It's time for single-payer health care:

Consider how our current multi-payer health insurance system affects hospitals, clinics and patients. I have practiced at three hospitals along a two-mile strip of Ogden Avenue in Chicago. I spent 17 years at Cook County Hospital, now the John H. Stroger Jr. Hospital of Cook County, rising from intern to chief of general medicine. When I practiced at Cook County Hospital, it was largely a hospital for the uninsured. Despite many improvements, largely because of Medicaid expansion under the Affordable Care Act, many services, such as screening colonoscopies and hip replacements, are still beyond reach for patients and their doctors. I spent a decade at Mount Sinai Hospital, a not-for-profit hospital for the poor in North Lawndale, a neighborhood of concentrated poverty in Chicago. Sinai cares for a mostly minority population that is mostly uninsured or on Medicaid. In my 27 years at these two safety-net hospitals, not one of my patients received an organ or bone marrow transplant. Yet the organs that fed the transplant centers across the region came from the dying patients in these hospitals. Our patients — the poorest of the poor — gave, but they never received.

[...]

My experiences also reflect the observations of Princeton economist Angus Deaton, who noted that the United States virtually has an apartheid health-care system. As structural racism has concentrated black and brown poverty into certain Zip codes, the hospitals and clinics serving minority neighborhoods often face severe resource challenges compared with those serving affluent neighborhoods of concentrated advantage. This inequity is only magnified by the way health insurance has been distributed across America. But it not just the poorest who are at risk. Our current multi-payer for-profit health insurance system perpetuates premature death by putting many people at an extreme disadvantage when it comes to affording care. Those who have better health insurance policies can access better care. However, even patients with insurance cards face skyrocketing co-pays, deductibles and pharmaceutical prices that keep them from seeking care. Last year, 27 percent of Americans said they had postponed or avoided getting care they needed because of the cost; 23 percent said they had skipped a recommended test or treatment due to cost; and 21 percent said they had chosen not to fill prescriptions for medication because they couldn't afford it.

posted by mandolin conspiracy at 7:15 AM on September 24 [19 favorites]


She couldn't get her underlying heart condition diagnosed and treated because she didn't have health insurance and couldn't afford to pay out of pocket.

I believe Paul Ryan would tell you that she chose not to be able to afford diagnosis and treatment. He sleeps soundly at night.
posted by Thorzdad at 7:23 AM on September 24 [3 favorites]


My current insurance plan I hit my out of pocket for my family (it's really low for US but still like 4,000 use) due to fertility related issues and the fact that they are covered. (Don't look up IVF costs)

Now that I hit it, it's like omg o need that hysterectomy to resolve my endo because I won't pay anything out of pocket for the rest of the year. I need that MRI for migraines I've put off forever. I need that pulmonary appointment for my asthma that has been managed by my PCP. I need an allergy test because I think I'm wheezing to antibiotics in a class thought I wasn't allergic too, but now I'm not so sure but talking medicine and gauging my asthma is hard because I always have a wheeze.

I have fantastic insurance and I know I have delayed care or ignored it.
posted by AlexiaSky at 7:31 AM on September 24 [7 favorites]


Now that I hit it, it's like omg o need that hysterectomy to resolve my endo because I won't pay anything out of pocket for the rest of the year. I need that MRI for migraines I've put off forever. I need that pulmonary appointment for my asthma that has been managed by my PCP. I need an allergy test because I think I'm wheezing to antibiotics in a class thought I wasn't allergic too, but now I'm not so sure but talking medicine and gauging my asthma is hard because I always have a wheeze.

Yeah, hitting your deductible and out-of-pocket expenses (basically, a second deductible) is a magical finish-line that opens-up all manner of possibilities to get much-needed and highly expensive care done. Unfortunately, it's also a ginormous red flag to your insurer that, perhaps, next years premiums (and, probably the deductible) should be quite a bit higher, because you're not supposed to hit the deductible in actual practice.
posted by Thorzdad at 7:38 AM on September 24 [4 favorites]


My insurance is through my employer so it won't change much, but that's my unique case that I'm well enough to work but need expensive care.

Though, that could change and my missed work due to combined causes is high. Part of the reason for a hysterectomy is to reduce work missed due to pain.

But yeah, if I ever have to pay for a market plan I'm fucked.
posted by AlexiaSky at 7:54 AM on September 24 [1 favorite]


There was a Twitter thread last week that I can't dig up (because Twitter) about how although modern medicine is amazing, it comes with a focus on "cures" (particularly in the US) when what it actually does is create a large population of people who can survive as long as they have the capacity to manage their conditions. American culture wants magic treatments from hero doctors that make everything better. American healthcare is shit from top to bottom at continuity of care.

Yeah, hitting your deductible and out-of-pocket expenses (basically, a second deductible) is a magical finish-line that opens-up all manner of possibilities to get much-needed and highly expensive care done.

Anyone with a chronic illness in America who has health insurance works on how to time appointments and refills of meds/supplies in the back half of the year so that there's at least a small hoard to get through the annual bullshit "negotiation" with insurers over what's medically necessary without it being a huge red flag. One of the many reasons for opioid abuse is that doctors got into a habit of prescribing "hoarding amounts" of painkillers.
posted by holgate at 7:54 AM on September 24 [9 favorites]


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posted by kwaller at 7:56 AM on September 24


Yeah, hitting your deductible and out-of-pocket expenses (basically, a second deductible) is a magical finish-line that opens-up all manner of possibilities to get much-needed and highly expensive care done. Unfortunately, it's also a ginormous red flag to your insurer that, perhaps, next years premiums (and, probably the deductible) should be quite a bit higher, because you're not supposed to hit the deductible in actual practice.

I'm not sure if you were speaking historically with regard to the time period described in OP's link, but one of the most significant impacts of the ACA is that medical underwriting (changing premiums for an individual based on the individual's usage of their healthcare benefits or medical condition) is not permitted. Under the ACA, insurance companies may only underwrite based on age and smoking status. This doesn't mean that an individual's premiums can't increase year by year, but they must do so based on cumulative healthcare costs among that individual's demographic (again, based on age and smoking), not because that person hit their deductible.

This was a hard story to read. I started working in healthcare in the US in 2014, after the ACA was made law, and although I still see inequity and injustice everyday, I see a lot of people working really hard within the system to get care for people who need it. We routinely keep people in the hospital if we have to to keep them safe while we're sorting out their follow up appointments and prescriptions. Although there's a lot of paperwork and red tape involved, the most basic post-MI (heart attack) care is not something I have ever seen a patient go without.
posted by telegraph at 8:02 AM on September 24 [5 favorites]


I'm not sure if you were speaking historically with regard to the time period described in OP's link...

Yeah, I'll admit my comment re:rising premiums is based more on my pre-ACA experiences with private health plans. Back then, I had premiums jump from around $700/month to $1,200/month year-to-year. Sadly, if this congress ever actually gets its act together, we will see the return of just such "market-driven" pricing.

Still, under ACA, I've had premiums effectively jump quite a bit simply due to my current insurer pulling-out of my market, and the only similar plan being offered by another insurer being much more expensive. My current insurer has already announced they are pulling out of the market. I'll be 60 next year and I just might have to pay the penalty and go without insurance.
posted by Thorzdad at 8:19 AM on September 24 [1 favorite]




> Mitch McConnell's Heart

[citation needed]
posted by tonycpsu at 10:53 AM on September 24 [30 favorites]


I screwed up a COBRA payment and have no health insurance and I'm 62, so, yeah.* Hospitals must provide emergency care, but not chronic care, not well care. You survive the heart attack but you can't afford the nitroglycerine or other meds. You don't get your cholesterol and blood pressure checked at all, certainly not regularly. You don't have a doctor looking out for you, asking about diet, etc. This is exactly a case of lack of insurance killing someone, and it's tragic. And it's fucking avoidable and immoral.

The US spends a massive amount on the military and appears to be preparing to spend a lot more. This is despite the fact that we're hardly at war in Iraq anymore, and less at war in Afghanistan. Military budgets were boosted because we were in 2 wars, but let's give them even more. Partly because we've decided to be some kind of World Cop, and partly because there is an enormous military-industrial complex that is enormously profitable, and the only other group with better lobbyists is the NRA. We could choose to spend a bit less on the military (they have so very much surplus equipment, they left many tons behind in Iraq, they give it away to police departments and they store it in the deserts). We could choose single-payer, in whatever form we can get it implemented. We could recognize that if the health care industry makes massive profits, it's coming out of all of us. I have literally heard a person who was reasonably well off state Prescription prices are too high; my co-pay is X and a few sentences later Yeah, my healthcare stocks are doing great. with no irony. We are a wealthy nation, every person could have decent health care. We just choose not to make it happen.

I will be able to get insurance in January, or when I get a job, whichever comes 1st.
posted by theora55 at 12:00 PM on September 24 [9 favorites]


And this is just ONE anecdote; and all anecdotes similar to this are worthy and important and there are millions of them.
posted by erattacorrige at 3:06 PM on September 24 [5 favorites]


There are about to be millions more if they pass that health care bill.
posted by Autumnheart at 6:29 PM on September 24 [1 favorite]


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posted by MissySedai at 9:11 PM on September 24


> There are about to be millions more if they pass that health care bill.

Well, let's not paint the devil on the wall, as we say in my language. I looked into this and found a well-written Guardian article, according to which the number of people who might die due to missing health insurance would be in the tens of thousands (per year).

I can well imagine that some people would consider that an acceptable, calculated risk which would be offset by the hypothetical savings.

Also, according to the 2006 European Standards to prevent repeat heart attacks, quitting smoking and exercise alone could reduce repeat attacks by 80%. While to you and me this might mean that investing in prevention and education might be worthwhile, I can also imagine that some people on the right will say: see, you don't need the meds, you need to quit smoking and take up jogging.

Which is a bit at odds with the American "let me do whatever I want even if it kills me", usually espoused by the same demographic.
posted by Laotic at 4:19 AM on September 25


This was interesting (from the article linked by mandolin conspiracy above):
...not one of my patients received an organ or bone marrow transplant. Yet the organs that fed the transplant centers across the region came from the dying patients in these hospitals. Our patients — the poorest of the poor — gave, but they never received.
posted by amtho at 5:57 AM on September 25 [7 favorites]


My dad didn't die because he didn't have access to healthcare. In fact, he racked up millions of dollars of charges for chemo, radiation, surgeries, and more, through his excellent employer health care plan. He paid a ton to continue it through COBRA after he had to leave, though, because he knew his other options would be even more costly.

What he did do, was die the day before his health care was due to expire. His last 14 days alive included 2 ambulance rides, multiple ER trips, blood transfusions, a hospice nurse, and lots of medication. I don't exactly know what would have happened, financially, if he were to have lived beyond then and continued to need the same type of care, creating huge medical bills. I assume it would have been taken from his estate, which really wasn't too much, dollar-wise, but it helped pay for the time I was out of work and taking care of him, and publishing his book that I promised him I would publish and distribute to his friends, in place of a memorial service or funeral. It helped cover the cost of the flights to and from my home in New Jersey and his home in Arizona, and the travel expenses of family members who came out to help pack and clean his house, or just to provide support for a day or two. It covered the prorated rent for the time it took to do so.

The point is, if he had lived longer, he would have ended up with a massive medical debt that his estate (me) would have been responsible for. If not out of pocket, then taken from his estate. I needed that money. I probably would have ended up deeply in debt without it.

It is a really, really hard thing to reconcile, wishing your parent had been around longer, but also knowing it could have meant financial ruin for each additional day he was alive.
posted by rachaelfaith at 8:41 AM on September 25 [6 favorites]


Well, let's not paint the devil on the wall, as we say in my language. I looked into this and found a well-written Guardian article, according to which the number of people who might die due to missing health insurance would be in the tens of thousands (per year).

Why do you keep coming back to say "it isn't that bad, only tens of thousands will die, maybe it was her fault after all"? The Americans in this thread are telling you it is that bad. It is literally that bad. This article was written by a mefite. We are here, and we are telling you how bad it is. Please stop telling us that we are wrong.

The millions more are not just the people who will die in the first year. It includes the people who will keep putting off seeing a doctor. It includes the people who will begin reducing the preventive medication they take because they can't afford it, or because they can't afford the co-pay to see the doctor to get it renewed. It includes the people who take less effective medication because it is all they can afford. It includes the people who don't treat their own conditions because they can only afford to pay for treatment for their children. It includes everyone who is living this story one day at a time, waiting for the year when they will become one of the tens of thousands who die due to lack of care.

Please stop pretending that this “isn’t that bad” in the presence of people who know just how bad it is. Just stop.
posted by a fiendish thingy at 9:09 AM on September 25 [21 favorites]


I don't know why the GOP is wasting so much time coming up with shitty Obamacare replacements. They already have a working model to base their policy on. Find out more here.
posted by Big Al 8000 at 11:03 AM on September 25


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posted by LeftMyHeartInSanFrancisco at 1:12 PM on September 25 [1 favorite]


Laotic, I'm an American doctor, and I'm telling you that yes, it is that bad.

This is part of what I wrote on a friend's Facebook page earlier this year, when the last attempt at an ACA repeal was making the rounds, and I cosign every word again today: I'm not a policy wonk, just a humble doc who wants to reduce human suffering. I can't tell you how many people will die if the ACA is repealed or partially repealed. I can tell you that lack of insurance coverage leads to people putting off essential preventative services, meaning what was a little problem becomes a big problem and therefore a more expensive problem. I can tell you that before the ACA, medical bills were the leading cause of bankruptcy for both individuals/families and hospitals (eg St Vincents in NYC, which served a largely marginalized population -- including the first AIDS patients on the East Coast -- before finally closing in 2010). I can tell you that before the ACA, the triage system in this country was purely monetary -- if you had $$$ you got care; if you didn't, well, sucks to be you. I can tell you that the whole concept of "pre-existing conditions" is bullshit (I'm not just talking about the list of actual conditions, I'm talking about the very idea that the people who need care are denied care), and I can just about guarantee that insurance companies have been lobbying Congress HARD to repeal that particular clause.

If you're actually looking for an economic analysis of the Graham-Cassidy bill, you should stop reading the Guardian (!) and look at the Congressional Budget Office: "the legislation would reduce the on-budget deficit by at least $133 billion....The number of people with comprehensive health insurance that covers high-cost medical events would be reduced by millions." It's vague, because the bill itself is vague. But pre-ACA, 47 million Americans did not have health insurance. If we return to that number -- hell, let's even round down to 45 million -- that comes out to $2955.56 saved per person who loses insurance. Less than $3000 per person thrown under the fucking bus in order to fund another Mar-a-Lago trip.

That's why the Americans in the room are telling you over and over that this is not ok.
posted by basalganglia at 7:15 PM on September 25 [8 favorites]


While to you and me this might mean that investing in prevention and education might be worthwhile, I can also imagine that some people on the right will say: see, you don't need the meds, you need to quit smoking and take up jogging.

I know you personally didn't mean this seriously, but it's total bullshit. My dad had a heart attack in his late 30s and actually did quit smoking, improve his diet in every way suggested at the time, and started jogging a minimum of 5 miles a day nearly every day. He kept that up until the day he died at 46, while on his morning constitutional with a few friends over at the park literally half a mile from the hospital.

The one thing he didn't get much of during the intervening years? Health care. Even with my mom being on Medicare due to permanent disability, the coinsurance added up given how much she was in and out of the hospital, as did the cost of medication, being long before Medicare had drug coverage aside from what was given at the hospital. Thus, the rest of us mostly went without seeing a doctor unless it was acutely serious.

So yeah, saying that cardiac care is unnecessary if the patient makes the appropriate lifestyle changes is just ignorant. Even if the first was relatively mild and treated aggressively and you keep healthy habits, you may well still have a problem lurking that could be resolved with regular follow up care. That's just one of many conditions that becomes far, far worse without continued treatment.

Back when, multiple sclerosis led pretty quickly to disability for most people since treatment options were basically non-existent beyond palliative care and physical therapy in the early stages. Good insurance and Medicare would keep that part from bankrupting you and your family. Nowadays, if you have good insurance so you can afford the doctors and medication, you may well never get to that point. In some ways it's more cruel than there being no treatment to begin with if you don't have good insurance to make it all possible to pay for.
posted by wierdo at 9:03 PM on September 25 [4 favorites]


Well, let's not paint the devil on the wall, as we say in my language.

Stop. Please. Just stop. You haven't the foggiest notion what you're talking about, and there's something really horrific about opining that someone's death was their own fault WHEN THEIR DAUGHTER IS RIGHT HERE IN THE DAMNED THREAD.

Have a fucking heart, man.
posted by MissySedai at 8:03 AM on September 26 [8 favorites]


Well, let's not paint the devil on the wall, as we say in my language. I looked into this and found a well-written Guardian article, according to which the number of people who might die due to missing health insurance would be in the tens of thousands (per year). I can well imagine that some people would consider that an acceptable, calculated risk which would be offset by the hypothetical savings.

Would you feel it was an acceptable risk if your mother were one of those people who died? Your child? Your spouse? You?
posted by EmpressCallipygos at 8:16 AM on September 26 [7 favorites]


Beyond the appalling and disgraceful reason for her mom's death - healthcare is a goddamn human right and the US needs to start treating it as such - I want to extend all my sympathy to the author for the manner of her mother's death.

I was 23 when I let my mother die: she had a heart attack and was in a permanent vegetative state, the doctors gently suggested not treating a kidney infection to end it. This was in Italy, with socialized medicine, but the choice remained mine. I am so, so sorry that you and your sister had to face that. It is not something that I, as a daughter, have ever quite come to terms with even knowing that it was the right choice to make. It's been 8 years and I think of holding her hand in that hospital room every damn day.
posted by lydhre at 9:20 AM on September 26 [5 favorites]


I looked into this and found a well-written Guardian article, according to which the number of people who might die due to missing health insurance would be in the tens of thousands (per year).

You seem to think this isn't very many?

Let's put it in context.

First of all, the specific number mentioned in your source isn't in the "tens of thousands" as in 10,001 or something, it is 45,000 people dying prematurely per year, indefinitely.

That isn't a few, that is a LOT.

For example, the Vietnam War is usually considered to be a fairly bloody conflict, administrations were toppled over the death toll (particularly to U.S. soldiers), etc. That was about 150,000 total casualties per year for nine years and about 33,000 allied soldier casualties per year.

So with 45,000 people dying annually, simply due to lack of medical care, we're talking about 1/3 of the Vietnam War fatality total annually, and 136% of the allied soldier fatalities.

On an ongoing basis, forever.

Yeah, those totals ought to be enough to topple an administration or two. That is an awful lot of angry people and angry families with not a lot to lose.

Furthermore, the fatalities are just the tip of the spear, so to speak. For everyone who actually dies due to lack of medical care, there are another 50 to 100 have their quality of life or ability to work or enjoy life impaired or destroyed.

Just for example, about 33,000 people are killed by motor vehicles annually in the U.S. while another 2.3 million are seriously injured.

The ratio of actually killed to seriously injured if we eviscerate the medical system is going to be quite similar. And don't kid yourself that because it is labeled as "just an injury" it isn't serious--many of these preventable injuries will be essentially life-ending.

In short, you seem to think that 45,000 annual preventable fatalities and millions of people annually ill or injured or disabled unnecessarily isn't much of a big deal.

You're wrong--it IS a big deal, and from a political perspective, more than enough to topple administrations and leaders and parties.
posted by flug at 12:55 PM on September 28 [2 favorites]


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