Uninsured=financial ruin

[HM2VikingRN, RN]

admittedly this is anecdotal but the story still speaks to a larger issue. having affordable access to health care is an essential part of the social contract. being uninsured and lacking access to health care puts patients at risk for early death and is one of the single greatest causes of personal bankruptcy in the us. both of these eventualities are quite likely to play out in this woman's life.

from daily kos: http://www.dailykos.com/storyonly/2007/1/14/1438/61856

(emphasis added)

a woman came to the emergency room with advanced cancer. against the advice of several doctors, she decided to delay treatment until she was sure she had been accepted by medicaid.

...

i must tell you from my vantage point, we have evolved into a society where there are tiers of citizenship.

one tier for those who are barely hanging on.

another tier for those who have slipped through the thoroughly destroyed safety net.

and a tier, for very fortunate people like me. people who can afford to patch together a life and pay for healthcare when the insurance company refuses to honor the social contract.

what you're going to read is about honoring the social contract.

a woman, let's call her inez, came to the emergency room last week. she was complaining of various symptoms (which i'll spare you) but they weren't good.

turned out she had advanced cervical cancer. naturally, it was recommended that she begin treatment immediately. chemo, radiation, surgery. she was an uninsured amercan. perhaps had she been insured, she would not have waited until her symptoms became acute to seek treatment. but she did wait, fearing financial ruin--not for herself, but for her family.

she was frightened, proud and tentative. finally, as she spoke, all the pieces of the puzzle began to fall into place. she was uninsured. she had applied or was in the process of applying for medicaid but was still not approved.

her doctor told me she said over and over, "i can't leave my family with a mountain of bills."

i am worried about inez because he said she was resolute. she absolutely would not think of beginning treatment until her medicaid application was approved. that begs the question, will it be approved? and what will happen to her if it isn't approved. i. don't. know.

most tragic, she was certain that her country would come through for her. again, her doctor related to me what she said. "how can they not accept me?" "i am sick, but i am an american citizen."

i'll tell you why they may not accept you, inez. because in the united states of america, health care is only a right if you are rich, powerful or an elected official.

[caliotter3]

Know of people who could not get help from govt when kids (who did nothing to warrant bad tx) were involved. Says plenty about this country. Have sat in an ER waiting for medical help myself, noticed the appearances and behaviors of people who did get taken in for care, vs lil ol me. Creates impressions on a person that can never be forgotten.

[Freedom42]

The uninsured aren't the only ones who have to worry about financial ruin. So do the insured, sadly. From Health Affairs:

"In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9-2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick."

Single payer, single payer, single payer!

[GingerSue]

what can be done to change/improve these situations?

[JeanettePNP, MSN, RN, NP]

because in the united states of america, health care is only a right if you are rich, powerful or an elected official.

how do you explain medicaid then?

don't confuse the issue. the problem is not that only rich people can afford health care. the problem is that we punish the hardworking low-wage earner while rewarding those who contribute the least. so if you are unemployed, you are eligible for medicaid (which provides reasonably decent coverage if you can get it) but if you have a job, working hard and barely scraping by, you are eligible for nothing. that's the injustice.

[Halinja, BSN, RN]

How do you explain Medicaid then?

The problem is not that only rich people can afford health care. The problem is that we punish the hardworking low-wage earner while rewarding those who contribute the least. So if you are unemployed, you are eligible for Medicaid (which provides reasonably decent coverage if you can get it) but if you have a job, working hard and barely scraping by, you are eligible for nothing. That's the injustice.

I agree. There was a time when my family was in that category of uninsured working family. Not enough money to pay for insurance, too much money to qualify for medicaid. It was very hard not to be resentful of those who paid nothing in and were getting basically free health care.

Happily, I'm not in that position any more. But I do think it reflects badly on us as a country that there are millions of citizens who do contribute to the general welfare and yet cannot afford healthcare.

[Ginger35]

Know of people who could not get help from govt when kids (who did nothing to warrant bad tx) were involved. Says plenty about this country. Have sat in an ER waiting for medical help myself, noticed the appearances and behaviors of people who did get taken in for care, vs lil ol me. Creates impressions on a person that can never be forgotten.

Hi There,

I am not sure how to take this nor do I understand how this particular ER was operating that you had went to for treatment. However, the ERs that I have worked in - we (us ER nurses) don't have the time to figure out exactly who the third party payer source is. We triage by the patients chief complaint and what they present to us clinically. Those who seem most critical or the most ill go back first. I can honestly say that I have NEVER triaged according to how the bill was going to be paid.

[canoehead, BSN, RN]

We aren't allowed to ask in triage because of EMTALA. So it's all in the nursing assessment.

[TinyNurse, RN]

my own father........after 30 years of working, and now on unemployment having an acute anterior MI in cardiogenic shock (died) was so madddddddddd before he was intubated because he knew he could not pay for the bill at these hospitals.

my sister and I never applied for any estate, because we knew it would be taken entirely by medical bills.

[HM2VikingRN, RN]

How do you explain Medicaid then?

Don't confuse the issue. The problem is not that only rich people can afford health care. The problem is that we punish the hardworking low-wage earner while rewarding those who contribute the least. So if you are unemployed, you are eligible for Medicaid (which provides reasonably decent coverage if you can get it) but if you have a job, working hard and barely scraping by, you are eligible for nothing. That's the injustice.

I agree with your point that the system is thorougly broken. The point of the poster on kos was just that that the social contract is broken.

[EmerNurse, BSN, RN]

Know of people who could not get help from govt when kids (who did nothing to warrant bad tx) were involved. Says plenty about this country. Have sat in an ER waiting for medical help myself, noticed the appearances and behaviors of people who did get taken in for care, vs lil ol me. Creates impressions on a person that can never be forgotten.

When I'm in the back, and I go through the charts to see who's next, I have NO idea what these folks look like. I'm looking at the chief complaint and the triage nurses' assessment to decide who to bring back next. The bolded part of the quoted post (emphasis mine) seems to indicate that folks of a certain appearance get back first. That'd only be true if the triage nurse indicated a lovely green or ashen grey coloring to a person's skin. Otherwise, the toothache for 6 weeks waits, regardless of how they look.

[HM2VikingRN, RN]

From: http://editorialcartoonists.com/cartoon/display.cfm/29369

Single Payer will help people get to a living wage!