Health Insurance Woes: The Middle Class Killer

Many of us don’t like to think about it, but a lot of us are one bad, medical emergency from poverty — even if you have insurance.

What’s supposed to be there in an emergency can be easily ripped away with the stroke of one red pen. The New York Times took a look at the killer trend that’s destroying bank accounts and lives — the sagas of the underinsured.

Health insurance is supposed to offer protection — both medically and financially. But as it turns out, an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.

And so, even as Washington tries to cover the tens of millions of Americans without medical insurance, many health policy experts say simply giving everyone an insurance card will not be enough to fix what is wrong with the system.

Too many other people already have coverage so meager that a medical crisis means financial calamity.

More after the jump.

“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”

Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”

“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified. (New York Times)

I think about this every time I get in a car. I could get in an accident, need medical attention and be unable to pay for my own care. One of my parents could become gravely ill and we would be at the mercy of the insurance company to see if they would cover it. And even if they did, would they cover all of it?

At the same time, the Obama Administration is trying to craft a response to the broken health care system, but it is all so Byzantine, so expensive and in such dissarray, what would the effect of government-based medical insurance be on the system?

I’m for some sort of government plan, but I want to know how they will fix the problem of medical costs for all, even those insured. How will it be paid for? How can we stop insurance companies from taking advantage of people by refusing coverage for medical necessities? How can we stop health woes from killing the middle class, the working class and the poor?

24 thoughts on “Health Insurance Woes: The Middle Class Killer

  1. I’m fortunate enough to still have coverage under my past employer, although I left that job almost two years ago. And in a few months, I’ll get picked up under Medicare. But there are millions who aren’t that fortunate and I empathize with them. It’s really a mess and I don’t how they’re going to fix it. These right-wingers are even scaring me about the costs of universal healthcare. I feel like we’re in a sinking lifeboat and we have to choose which person to throw off. Oh, please, Lord, don’t let it be me!

  2. I think it is a generally accepted myth that insurance will cover everything. I suggested that people start taking care of themselves. I don’t see why I should have to pay more in taxes to cover others.

  3. Because that’s only one small(ish) chunk of the pie, scott. I was born with an autoimmune disorder, a (mostly) inherited disease. It’s something that has no cure and I’ll live with for the rest of my life. Even with health insurance, some of the medical bills I receive in the mail make me weep. It makes me count my lucky stars that I am married to someone who makes enough money to set aside for my medical mishaps- without that, I’d be S.O.L.I’m a very healthy person, I hit the gym 5 days a week (when I’m not flaring or ill), I eat very healthy. I work at a gym, for crying out loud! I was the last person people thought would ever get sick. And yet two years ago the symptoms started popping up and that was that. I was giving a big old F you from fate or God or whatever and now I’m stuck with a disease that can ultimately kill me…along with racking up some very expensive medical bills. Did I ask for it? Nope. Did I take care of myself? HECK YES. And here I am.As are millions of other Americans. Do the overweight and the smokers make up a chunk (no pun intended, heh) of all of this? Sure. But let’s look at the whole problem here, okay? Let’s not be that dense.

  4. I re-read what I posted and I apologize if I come off snippy. Being someone that does work in a gym, I definitely used to be of the ilk that if people just exercised more and quit smoking our healthcare system would be so much better. Would it be? It would certainly help. But being diagnosed with Lupus has completely opened my eyes to another face of healthcare, healthcare I certainly need to have but can barely afford myself. I wonder how others in my same situation do it, and it completely freaks me out. I could see how this could easily bankrupt someone, and it is SCARY.

  5. Chloe:For people like you, some type of gov’t insurance may be a good thing. We have a friend with similar health problems and probably the only reason she is alive is that her husband used to be a steel worker and had very good benefits. My wife works in primary health care and I hear all the time what a difference people could make in their own health if they choose to do so.

  6. The only way a true impact on the cost of healthcare will ever be made is to restrict the amounts doctors and hospitals are allowed to charge, but we live in a capitalist society and healthcare is BIG BUSINESS so that will probably never happen. As long as doctors charge inordinate amounts in order to cover their ridiculously overpriced mal-practice insurance (the amounts of mal-practice suits also needs to be restricted) there will never be a way to get healthcare costs under control.My husband recently had a simple outpatient procedure, it was really more of a test, and it turned out he is completely fine. The procedure took about 20 minutes, including a short stint in recovery for the anesthesia to wear off; we were at the surgery center for maybe 2 hours tops. The total bill was nearly $8000 (thank God my insurance covered all but a few hundred dollars, but I have a $2000 deductible!). Now we fully appreciate that the doctor, anesthesiologist, nurse etc in the room all had skills that are valuable, without which there would have been a lingering question regarding my husband’s health. But I find it so hard to believe that the 7 people who were in the room during the procedure (I have no idea why it required 7 people) put in an effort that warranted more than $500 an hour.The same goes for the pharmaceutical industry you have no idea how many MILLIONS of dollars these companies waste each year “researching” new drugs. They literally throw parties for the doctors who conduct their clinical trails in order to get on their good sides. And those costs get passed right along to consumers, all while they claim they would never be able to develop those drugs for less. I know because I used to work for a pharmaceutical research company and I’ve been to the parties.

  7. I think that it is a myth that the problems with health care are due to free markets and profit motive. The health care industry we know today, like our retirement program, was entirely accidental. If all anyone knew of american health care was "Sicko" than god help us. So it’s time to take a good LONG look at our health care and focus not only on those without( the breakdown of who makes up that group is an eye opener) but also folks who Snob says are "one diagnosis away".What scares me is I don’t believe the Administrations OCD use of the word pragmatic. I think that they are coming from a hard left welfare state ideology and that’s exactly what they are going to pass. So instead of fixing the problem it’s just going to get worse. It’s going to get worse because public dollars will suffocate private dollars and no one, except the true rich and government employees, will have any other option. The irony here is that now they are toting a Bush era plan as a way to successfully implement government health care. That would be the medicare prescription drug benefit part D. The one every conservative talking head says they parted with Bush on. And has been used repeatedly as prime evidence why he was never a true conservative. Apparently, It keeps costing less than half of what it was expected to cost. This is while there is still a private market to use as cost control, mind you.

  8. Last year, I lost the ability to walk. Literally watching television and making dinner, and then suddenly not able to stand. They still don’t know whats wrong with me. I exercised everyday, didn’t drink or smoke, took vitamins, and suddenly found myself in a wheelchair. My job at that time involved going up three flights of stairs to get to my desk and I was a contract employee, so guess what happened to my source of a paycheck? I can guarantee you that asking a person before an interview if they are wheelchair accessible means your interview is going to be mysteriously canceled. And if you do make it, suddenly another candidate emerges with better qualifications. My wheelchair was my scarlet letter, and I’d like to know how I was to care for myself if I had children and was in this situation.I’m not on unemployment, or social security, because thankfully I have no children and I have family/friends who I took care of in my prosperity who are willing to pay me back. I can walk now, but still have days where I need the chair to accomplish basic tasks. I used to agree with you Scott, but I took care of myself and I have health insurance and now I’m in debt and unemployable. How is a person who loses their job because of a disability and racks up $47,000 in health insurance payments and copays in just one year (and didn’t even get a diagnosis) supposed to care for themselves if they have children? That is something that I shudder to think about. Its not as simple as "people need to take care of themselves". That goes without saying. I’m not a right leaning independent. However, all parties in US medical industry work the system they have to make themselves profitable, it doesn’t make people well. It is a failed system, especially when one considers how our country spends more than any other country on health care per individual (almost $2,000 more than the next country, Switzerland) yet 28 countries have lower infant mortality rates than us. 28 other countries are spending less, and getting better results in one of the most straight forward medical procedures. Are people in the United States too fat? Yes. Are we too excessive in alcohol, drug, and cigarette use? Of course. Are we $2,000 per person more unhealthy than Switzerland and many thousands more unhealthy than Slovenia, which has a 22% obesity rate yet ranks over 20 spots lower in infant mortality rates than we do. That is indicative of a major problem that can’t be blamed on a lack of self-sufficiency. One dollar out of every 700 spent on health care in the United States goes to the salary of United Health Care’s President. It sounds like the system works for that guy.

  9. 60% of all personal bankruptcies are caused by MEDICAL BILLS.75% of those folks HAD INSURANCE.You know which way is up. PUBLIC OPTION NOW!!Healthcare is a RIGHT.

  10. I don’t think people are thinking about this clearly. This is not about individuals, it’s about the collective. What do I mean? I know a woman who started a small business. It’s doing well. She was able to hire 10 people. But she might have to close. Why? Because she can’t get health insurance for her kids. Now, you may well ask, what’s wrong with her kids, surely it must be some dire condition that they won’t cover. Uh no. It’s eczema. Yep, you heard me right. She can’t buy a policy for her kids because they essentially have dry skin. So, she’s looking to go back to work for someone else where she can get a group policy. There goes those ten jobs. Small business, you know those small businesses conservatives claim to care so much about? They’re being strangled by health insurance premiums. My husband’s employer spends 10k a month for absolutely crappy insurance that’s only used by about half of his employees! That’s money he could invest in new equipment, thus making more jobs. Or he could hire more people to work there! More jobs people. But no, it goes to the insurance companies who do their damnedest not to pay when you file a claim. Plenty of people would start new businesses, but they can’t because they fear losing their health insurance. Innovation and productivity are being strangled in this country by this issue. We had a group plan until my husband got laid off two years ago. We had to relocate to a new city. His family plan would cost approximately a quarter of our monthly income. Keep in mind, this isn’t great insurance. We’ve been fighting with these dingleberries for a year over a freaking MRI, but hey it’s insurance. We have to pay a higher premium for my son, even though his pediatrician says his BMI is perfect, according to the insurance numbnuts, he’s overweight. I can’t get insurance at all, even a policy with a 10k deductible. Why? I have an insulin disorder and take metformin for it. And no, I don’t eat junk food, exercise regularly and watch my weight. I’m not diabetic, the drug keeps me from developing diabetes, but because of that, I live in perpetual fear of bankrupting my family if I were ever to get ill. That’s just two snapshots. I’m not asking for anyone to take care of me. We’re more than willing to work hard and take care of ourselves. But that’s not enough. When you get rejected for freaking eczema there’s something seriously wrong with this system.

  11. rikyrah:Since when has health care ever been a right? Since you decided it should be? Who is supposed to pay for this new right? Are there any other things you would like to declare that are rights?

  12. Scott, who told you healthcare is not a right? Who decides what’s a right or a privilege except the majority of the people themselves.

  13. I don’t know about rikyrah but I’d like to declare Human Dignity as a rightHave you ever had to go to the public health clinic or an emergency room for routine medical care Scott? Have you ever had to watch someone you love die a painful death because of an administrative ruling not to provide access to a treatment that would save their life? Have you ever watched a parent who is underinsured make a decision between purchasing pills and food for the family?We are an interconnected community. We will not survive without concerning ourselves with the general well being of our countrymen.Tune in next week for: the interconnectedness of our world. gasp!

  14. Scott,There is no reason beyond greed that every man, woman and child in this country should not have access to good, affordable healthcare, if not outright FREE healthcare.I thought the ME generation went with the 80s but I guess they are alive in well in the 21st century.My mother, a woman who saved all her life, lived within her means, paid her bills like clockwork, had good health, took care of herself and never asked anyone for anything developed a catastrophic illness that bankrupted us both. Since she was a poor candidate for chemo, the doctors chose steroids, Thalidomide to combat the cancer. But guess what? One month’s supply, 120 tablets cost $7,800.00. Thalidomide is not a new drug, it has been around since the 50s but it is a highly controlled drug because it causes catastrophic birth defects in pregnant women. The pharmaceutical company was not trying to recoup cost for R&D and even if they produced only small amounts of the drug, explain to me way it cost $65.00 per tablet? That comes to $280,800.00 for a three-year supply of ONE drug and that is the cost WITH insurance! Now pile on the other drugs, the hospitalizations, the office visits, the specialists, the tests, etc., etc. Her illness cost over half a million dollars with insurance.And if you are wondering why Medicare Part D Drug Plan did not cover the cost it did not go into effect until 3 years after (2006) she developed cancer and she did not qualify for the drug company’s assistance program. But what really gauls me is that once Medicare Part D Drug Plan did go into effect about 3 months before her death, after I enrolled her into one of its plans, the cost went to $60.00 per month for the drug.My only solace is that she died before I had to sell her home to TRY and cover her other drug and medical bills and she never knew that I lost my life savings and my 401K in the attempt to save her. It has taken me 3 years to pay off the rest of the bills but I did it. Now what happens if I get sick? Honey, unless you have the type of insurance that is afforded the rich or the U.S. Congress and Senate do not EVER get truly sick in this country. I am so screwed.

  15. Folks, since ALL other industrialized countries–Japan, Switzerland, France, Belgium, Germany, Canada, Norway, etc.–have universal health systems (some are single payer; others, like Switzerland and Germany, instead have HEAVILY REGULATED health insurance systems where premiums are tied to income), all have better health outcomes than the U.S., and pay less for health care to boot–this strongly suggests a pattern–namely, that it’s impossible to have cost-effective health coverage UNLESS everyone (all ages, medical conditions, and employment status) is provided sufficient basic medical coverage as a baseline.This would avoid tragedies like the family profiled in today’s New York Times article, whose lack of true health insurance (a policy with "limited benefits") is sending this couple on a financial rollercoaster. I had my own, less dramatic episode with a different type of underinsurance, with the same company as the couple in the article, Aetna (hmm, another pattern?), which I mention in more detail at the link below.It’s time to write your Congressional representatives and Senators to let them know that they must vote for the public option in the proposed health care reform package, if we want to have a future as a nation.Coming and Going

  16. The "everyone should just take care of themselves" is great in theory. The reality is that even those of us who do take care of ourselves are going to run into healthcare quirks as long as the system remains the way it is. I developed a funky condition earlier in the year called Frozen Shoulder (yes, ouch). I ignored it as a strain and tried to loosen it up at the gym.. not good. Long story short I went and saw the best ortho guy in Dallas. I’m blessed that my older brother is a doctor and got me in to see this guy who has waiting lists upwards of EIGHT MONTHS. He has treated a record nomber of these this year and was able to prescribe new agey phycial therapy that I had to attend 3 times a week of six weeks straight. Now I have (what I thought was) excellent health insurance, turns out that this treatment is so new, the insurance company would not cover all of it. So I paid over $200 a visit. Do the math, $200 times 3 times a week times 6 weeks straight. Can someone say OUCH with me? Again, blessed that I had stashed rainy day money away and was able to pay for with only a grimace or two. Very aware that not everyone could do it. I went back to the ortho guy yesterday and he said I’m one of the few people who have beaten this condition in this amount of time. Doing it the old way (in other words the inexpensive way) takes up to a year or major surgery to correct. Healtchcare reform may not be in the neat, tax-free package that we want but at this point some change is better than no change at all.

  17. I am fine with the idea of making sure we are all healthy – because I see that spending money on health can save us money down the road. But some of the numbers on the health plan scare me. 50 million of us reportedly are uninsured. The new health plan will still not cover 34 million of those. Providing for the 16 million that we are going to pick up is allegedly going to cost 1.6 tril over ten years. That is $10,000 per person, per year. How are you tryin’ to tell me we should pay $10,000 per year per person when the insurance Obama, McCain and myself have costs $3000 per year?(that includes what the Federal employee pays and the government subsidy)What am I missing? A government run insurance plan, that many say is too generous, costs $3000. A proposed government insurance plan that does not provide as much coverage, costs more than triple. Once again I find a divergence in my feelings about a policy I can support, and my government’s terrible version of how they are going to give it to us.

  18. And I must disagree with rikyrah – I don’t think health care is a right. If you look back to our Bill of Rights, the logic behind "rights" is that they are freedoms that should not be taken away from us, i.e. free speech, religion, association. We don’t have the right to have something given to us. Education is not a right, but equal protection (treatment by our government) is a right. Ergo, as a child I didn’t have the right to a public education – but since our government provides public education, I did have the right to get the same public education as anyone else.Health care is not a right, I do think it is a necessity. Sometimes our government pays for necessities, some times it doesn’t because there is no obligation to do so.

  19. My state is the second most obese in the nation and with that follows diabetes and all of its compilations. Not to mention all the folks I see smoking and drinking to excess. All are preventable if folks care about there bodies. Yes sometimes folks do suffer from "health quirks". and that is what insurance is for, not for things that you can prevent.It has never been and shouldn’t be the government’s job to provide folks with heath care. We don’t live in a socialist nanny state. If we start deciding what things are rights based on voting that will surely be the end of this nation.

  20. Cannot say that i have much confidence in a govt health care restructure that wont disenfranchise some group ( Over 70% of Americans are satisfied with their health insurance plans . when a president achieves a 70% approval rating he(or possibly she) is almost certain of getting reelected. However what type of track record does the govt have with medicare , medicaid….. And now they want to keep the insurance companies honest? when have they been for the last 30 years?

  21. It starts with the system. We all hear about medical tests or procedures which cost hundreds of thousands of dollars in the U.S that cost a couple thousand in India. Finding logic in those exorbitant costs strains the imagination. And at the same time, our food supply and environment is being polluted by corporations in ways that directly and devastatingly affect health. What about all the carcinogenic sugar-free sweetners that are allowed onto the market. The FDA turns an intentionally blind eye making us unable to make informed choices about our health. Cancer and diabetes becomes the order of the day and everyone from doctors to the pharmaceutical industry stands in line to put you in the poor house. Universal health care is a bandaid on a broken leg. We have to first target the medical industry for it’s abusive practices and corporate food producers (as well as the FDA for being toothless and negligent) for their lack of transparency of just what exactly are they doing to our food.

  22. Scott, good health is not promised to anyone and you never know when your run of luck will come to an end. There are some things you simply can’t prevent.

  23. Isobel,I’m a public radio producer interested in talking with you about featuring your story on our program The Story ( If you’re interested, please email me at rmccarthy [at] wunc [dot] org with your contact information.

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