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Wheeler: The many agonies of our health care nonsystem

Leslie Boyd's story of struggling to find health insurance for her son

Leslie Boyd, founder of Life O' Mike, talks about her son's struggles to obtain health insurance before he died of colon cancer.
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Leslie Boyd, founder of Life O' Mike, talks about her son's struggles to obtain health insurance before he died of colon cancer.

Nothing like the joy of insurance-enrollment season and a $1,200 jaunt to the ER to force a person to contemplate the craziness of our health care system.

Adam Linker of the N.C. Justice Center’s Health Access Coalition refuses to even call it a system. Nonsystem is more like it, he said when asked to help make sense of the nonsensical.

Does it make sense that my out-of-pocket ER bill is the insurance company-negotiated rate and that the people expected to pay the highest bills presumably are the uninsured who can least afford it? Does it make sense that the United States spends more than $9,000 per capita on health care while the United Kingdom, where every person is covered, spends $3,400? That we ranked 11th in efficiency, access, equity and healthy lives and 11th overall among 11 countries the Commonwealth Fund rated in 2014, while the United Kingdom ranked first in nine of 11 areas?

That, despite the highest levels of spending, we had the lowest life expectancy at birth and the highest infant mortality rate? Who are the people who are satisfied with this?

To find out at the end of a seven-hour ER ordeal that my son, a college student waiting tables, had indeed picked up a horrific microbe from a sick restaurant patron, there was a $77 blood test, a $160 metabolic panel, a $54 blood test, a $68 blood test, a $78 blood test, $21 just to take the blood to test, $80 for a bag of fluids, $110 for the medicine to put in the fluids, $110 for more fluids and $130 for the medicine to put in those fluids.

It cost $288 just to walk in the door.

Now it’s time to calculate my insurance choice for next year by adding the chances of another emergency to the variables of monthly premiums and individual deductibles while factoring in the complexities of a Health Savings Account and tax ramifications. Is this algebra or geometry? All I know is there ain’t no Pythagorean theorem to solve it.

My Facebook feed is full of frustration from insurance-shopping friends, one saying: “Any recommendations on health care plans outside of ACA-conforming? Our current conforming plan is going to $1,615 monthly with 70% coverage & crazy deductibles. Please message me. #NotAffordable”

A large reason it’s this complicated, costly and exasperating is because we refuse to just cover everyone. The United States is the only developed country in the world that doesn’t have universal health care.

It’s unfathomable that critics seem unwilling to acknowledge that they are paying for others anyway. They are paying for it in headline-grabbing higher insurance premiums. They are paying for it in $100 IV bags in the ER. They are paying for it in Affordable Care Act subsidies.

And they are paying for it when a beloved son leaves $1 million in unpaid medical bills that must be absorbed in 100 hidden ways when a $1,000 colonoscopy might have saved his life had he been able to be insured.

“In the end, we still pay for this care,” Leslie Boyd said in a recent blogpost for WNC Health Advocates, an Asheville group she founded after the death of her son, Mike Danforth, from colon cancer at age 33. “My son’s surgeries, chemo and radiation cost taxpayers nearly $1 million, when we could have saved his life for about $1,000 a year. When you allow someone to go without needed preventive care and chronic disease management, they become very sick – and very expensive.”

And there’s the crux. Even those who can’t seem to summon up some compassion can appreciate that covering everyone simply cuts down on costs in myriad ways.

32.5 Average percentage increase in insurance rates Blue Cross and Blue Shield of North Carolina ACA customers will see next year

78 Percentage more the “Silver” plan costs in North Carolina than it does in the cheapest state, Indiana, as priced for a family of four, with two 40-year-old parents and two children

28.8 Percentage of uninsured West Virginians ages 18 to 64 before Medicaid expansion

12.2 Percentage of West Virginians uninsured now

27.5 Percentage of Arkansas residents uninsured before Medicaid expansion

15.6 Percentage now

22.5 Percentage of North Carolinians in that age group who are uninsured now

244,000 Number of North Carolinians with no access to Medicaid or ACA exchange subsidies who would be eligible for Medicaid if the state were to accept federal funds to expand coverage

17.1 Percentage of the U.S. gross domestic product spent on health care in 2013

50 Percentage higher that spending was than in France, the next highest spender

$75,345 Average price of heart bypass surgery in the U.S.

$42,130 Average price in Australia, the second-highest country

Asked to name the nation with the best universal health care system, Linker of the Health Access Coalition said copying another country isn’t necessary. Every country does it differently based on its own unique history, he said. No need to have the much-vilified Canadian system. The United States could include more involvement from the private sector, with some level of government rate-setting, he said.

“Some people view that as a negative, but there’s a lot of purchasing power,” he said. “You can come up with a unique system even built off ACA that makes a lot more improvements and covers everyone. There’s no reason to leave people out except for politics.”

In Britain’s entirely nationalized system, the one with all of those No. 1 ratings, doctors work for the government and the hospitals are owned by the government. Like a lot of countries, it uses a value-added tax to fund social services, Linker said, with the idea being to have a whole lot of people paying a little bit of tax on a whole lot of things.

In other words, they pay for everyone’s health care in small amounts when buying services rather than in ridiculous amounts in the ER.

To me, access to health care seems even more fundamental than public education. As Linker said, you can’t think about public service, about being a parent or a spouse, about contributing to your community or your church or working and paying taxes if you’re sick or having to worry about sick loved ones and how you’re going to pay for their care.

One way or another, we’re all paying. The bottom line is that we are choosing to be a country that perversely prefers to spend $1 million on medical bills for the dying rather than $1,000 on a colonoscopy for the living.

Wheeler: 919-829-4825, bwheeler@newsobserver.com, @burgetta_nando

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