Affordable Health Care in America

Recently, I was asked to provide comments on the affordability of health care and mental health care in America today in light of new policy changes.  In this 2-part series, I wanted to share my thoughts on these issues.

In American politics today the current discussions center on the cost of health care to the nation but neglect to discuss the affordability of health care for its citizens.  Health is a human right, as a right health care must be accessible to every individual in order to realize this right, and thus must be affordable.  Whether covered by a private insurance policy, a government health plan, or their own savings, Americans know that health care is patently not affordable in this country.  Copays, deductibles, and coinsurance rise each year putting an increased burden on each individual to obtain the care they need.  Often this means a complete barrier to health care.

This in mind, we must consider that access to health care does not just apply to seeing a doctor but encompasses all aspects of health care including pharmaceuticals, mental health care, and specialist care.

Pharmaceuticals

I have already harped on this point several times, but feel it is worthy of presenting yet again.  As I wrote in earlier posts on the Cost of Living, studies show:

  • Since 2006, prices for the top 100 commonly used medications rose by 6.6% according to the Government Accountability Office compared to a 3.8% increase in medical costs
  • In 2009, prescription drug spending totaled approximately $250 billion
  • In 1996, out-of-pocket spending for prescription drugs averaged $247
  • In 2001, 21% of adults spent 10% or more of their income on out-of-pocket costs.  In 2010, 32% of adults spent 10% or more of their income on out-of-pocket costs
  • In January 2011 alone, the cost of 75 top-selling drugs rose another 4%
  • Because of the expense, more than 25% of those prescribed a medication don’t take it and 23% cut their pills in half or skipped doses

Yet pharmaceutical companies are left unchecked, holding monopolies on patents for life-saving medicines. You may note the very few provisions for changes in access to pharmaceuticals in the Affordable Care Act (ACA).

Pharmaceuticals are a key part to health care.  While the generic market has made pharmaceuticals affordable and while the “donut hole” fix by the Affordable Care Act has helped and will continue to help seniors on Medicare afford their medications, many pharmaceuticals are still too expensive.  Generics do not exist for many medications.  Co-pays or co-insurance still place a high financial burden on patients. Some drugs are exorbitantly expensive, which is not helped by recent drug shortages.  There are are patient assistance programs offered by many pharmaceutical companies, but these are only available to those with very limited income and no health insurance.

Consider for instance that, according to the American Cancer Society, the average cost of a 30 day cancer drug prescription was more than $1,600 in 2006 and it’s even higher today.  Last March, Forbes.com brought light to the high cost of cancer care in the wake of Geraldine Ferraro’s death.  They highlighted her comments in 2007 on the cost of treating cancer, which really apply to every type of care.

It just is a very, very expensive thing to do, very expensive thing to do, and that’s the one thing that bothers me,” she told Today. “Having to come in twice a week, that doesn’t bother me. What bothers me is that what’s available to me is not available to every person who has cancer in this country and it should be. It should be.”

Mental Health

(I will discuss more on how the ACA will effect access to mental health care in the private insurance sphere in the next post.)

Health care also includes mental health.  Though laws have been around for years espousing mental health parity (meaning mental health benefits must be provided at the same level as medical/surgical benefits with respect to the application of aggregate lifetime and annual dollar limits under a group health plan), which would effectively mean mental health care should be as affordable and accessible as going to your primary care doctor, affordable mental health care is rare.  Often those struggling with mental health illnesses have no means to address their conditions with mental health professionals.  And as research shows, when mental health illnesses are not treated, a person’s entire health declines – sometimes meaning that person will end up in the hospital.

Specialty Care:

What happens when you break your elbow and need surgery and physical therapy?  Or need a colonoscopy?  Or have need a stent put in your heart for heart disease?  Or are diagnosed with cancer?

The cost to see a specialists like an orthopeadic surgeon, physical therapist, gastroenterologist, cardiologist, oncologists – let alone the procedures they may prescribe – is out of most American’s financial means.  And the barrier of affordability may delay treatment for those who desperately need treatment.  February is American Heart Month, and the American Heart Association tells us that

…nearly half of cardiovascular disease patients who said they had difficulty paying medical expenses had delayed getting needed health care and filling a prescription, 42 percent had delayed a routine check up, and 31 percent had delayed a screening test that helps identify disease earlier.

While having insurance will help many gain access to specialty care, again the co-pays, deductibles, and co-insurance may still prevent many from affording the care they need.  It took me 4 years to pay off my knee surgery for a fairly simple surgery for a torn meniscus (a tear which literally made it impossible for me to stand up after I fell because the torn portion got lodged between the joint) and even then, the doctor who performed the surgery finally gave up on me being able to pay the bill and waived a huge portion of the bill.  I had insurance, but the cost of care was extraordinary.  I couldn’t even afford the physical therapy needed after the surgery.   I spent my college funds on jaw surgery for a deformity I grew up with which left me unable to eat solid foods by the time I was able to have the surgery.  Then too, I had insurance and the costs were beyond my means thou I was lucky to have some resources at the time which many do not.  And in expending those resources for care I needed, I then placed myself in debt which will take me decades to pay off. Debt which grew when I was diagnosed with type 1 diabetes and celiac disease.

What about the millions of Americans who need surgeries, tests (like MRIs or X-rays), and procedures for their injuries and illnesses.?  Specialty  care is simply not affordable in America and the ACA does not provide much relief.

Affordability of Health Care in America:

We do not have affordable health care in America and thus we do not recognize or protect health as a human right.  We must strive to ensure affordable health care for all in regards to primary care, specialty care, pharmaceuticals, mental health care, and other aspects of health care.

Though our rhetoric centers on the rising costs of health care, this is not the reason that health care is unaffordable to individuals.  Health care costs are high but that is more a product of the commercial enterprise health care has become.  Health care can always be affordable if we are concerned about people being healthy. In fact, health care is more affordable when we choose provide it now, then when we have to provide it in an emergency circumstance in the future for someone who did not get preventive care.

As a health policy attorney, and through my own personal experiences, I have seen how so many struggle to afford health care.  I have seen many blame and judge others for their health and financial circumstances instead of assisting them to become and remain healthy so they might realize their full potential.  I have seen many refuse to even recognize the problem, themselves not having had to face the obstacles of obtaining health care.  Few are willing to realize that the copays to see our doctors and get the tests we need, the expense of pharmaceuticals to attend to our health, the amount we pay to receive mental health care, are all the costs to live – costs that are too high for many.  I have watched the government in small steps and against political rhetoric and infighting  try to make care more affordable, but they are not doing enough.  Health is a human right and should not be extended to only those who can afford it, but to everyone, wherever they live, whatever government, laws, or policies they are under, no matter their race, national origin, sexual orientation, religion, age, disability, or gender.

Vast disparities of wealth and opportunity divide us… Nowhere are the disparities more shocking than when it comes to health… The wonders and promise of modern medicine must reach everyone, not just a privileged few. (http://www.oneworldhealth.org)

Some drugs are exorbitantly expensive, which is not helped by recent drug shortages.

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One Response to Affordable Health Care in America

  1. I consider this amazing post , “Affordable Health Care in America Health as a Human Right”, highly
    engaging and the post was in fact a terrific read.
    Many thanks-Tammi

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