At the core of the idea that health care is a human right is freedom. The for-profit health care system in the United States severely restricts our freedom in a number of subtle and not so subtle ways. Instead of freedom there is fear.
The health care crisis impacts every aspect of our lives down to the most seemingly insignificant personal decisions we make. This national bully terrorizes and forces us to live in fear. It determines what is possible and not possible, it crushes hopes and dreams and imprisons people into lives they did not choose. For decades in this country we have accepted the barbaric consequences of a profit driven health care system that bullies and denies us basic freedoms. Therefore, we are not free.
How does the bully do this? Let me count the ways.
Arguably one of the most inhuman consequences of the health care crisis is the predicament of the mentally ill. People with serious mental illness encounter stigma, discrimination and difficulty accessing treatment. Millions of adults and children suffer from a variety of treatable mental health problems: depression, anxiety, schizophrenia, and pervasive developmental disorder. But insurers avoid covering those with a diagnosed mental disability because of the chronic nature of the problem, which means treatment is often needed for years, and medications are expensive. This cuts into profit margins. Moreover, mental illness is not covered on a par with physical illness by most health insurance policies. The number of visits to mental health providers is limited, typically 20 sessions with a therapist per calendar year, and admission to inpatient psychiatric hospitalization is often restricted to fourteen days and not reimbursed at a hundred percent. This discrimination is perfectl
y legal and even in states where parity laws have been passed coverage is still uneven. A study titled, “Design of Mental Health Benefits: Still Unequal After All These Years,” found that forty-eight percent of workers in employer-sponsored health plans were subjected to the limiting of inpatient days, caps on outpatient visits, and higher co-payments. Leaders in the field of mental health have made the case over and over again that treatment must be both affordable and open-ended because mental illnesses donít respond to rigid time tables.
The barriers for those with insurance coverage are numerous, but for the mentally ill who are uninsured they are almost insurmountable. In major cities, streets and shelters are full of mentally ill people who are not receiving any type of treatment. Most qualify for Medicaid. The problem is actually getting Medicaid coverage. For people with a serious and persistent mental illness  especially the homeless  to negotiate the system and gather all the information needed to apply is almost impossible. They need proof of homelessness and income, a birth certificate, photo identification, copies of bills and a mandatory interview with a case worker. Good luck. The consequence is hundreds of thousands of mentally ill are eligible for coverage but donít get it. Instead, they wander the streets talking to themselves, hearing voices, dirty, hungry, and begging for money.
And they end up in jail. Itís shocking: jails and prisons have become de facto psychiatric treatment facilities for the mentally ill. The US Department of Justice reports about sixteen percent of inmatesí  more than 300,000 people  has a mental illness. One study found that Los Angeles County Jail and Rikers Island in New York City each held more people with mental illness than the largest psychiatric inpatient facility in the United States. In fact, Los Angeles County Jail, to its shame, has become the largest mental health care institution (if you can call a penal institution such a thing) in the country. The jail treats 3,200 seriously mentally ill prisoners every day! For many, itís the first time theyíve ever received treatment and some inmates improve quickly. But once they are dumped back on the streets without structure, access to counselors, and medication, they deteriorate. Homeless, delusional, and out of control, they are inevitably rearrested for behaviors related to their untreated mental illness.
The mentally ill are not free.
Those with addictions are similarly discriminated against. Addictions to alcohol, opiates, crack/cocaine, and prescription drugs are mental health problems that need ongoing treatment. Here again, insurers restrict benefits to save money. Inpatient treatment used to be twenty-one days, now it has been cut in half to ten, and some plans provide even fewer days. Outpatient treatment is typically twenty visits with a therapist per calendar year. For people struggling with a long-standing addiction, twenty sessions is a cruel joke.
The shortage of treatment slots results in millions being denied care. According to the Illinois Alcohol and Drug Dependence Association, in 2004, 1.5 million Illinois residents didnít receive treatment because they couldnít afford it. A report by Join Together, a national resource center, reported that in San Francisco, 1,500 drug and alcohol users were shut out of treatment daily.
Methadone maintenance, despite being the most successful, and cost-effective treatment for heroin addiction, is in seriously short supply. There are roughly 810,000 heroin addicts and only 170,000 funded methadone treatment slots. The wait lists are legendary, at one point in the state of Washington the wait was up to 18 months, and in New York there were 8000 people on a waiting list! In Columbus, Ohio it took Heather Bara 18 months to get into a methadone program. While waiting, she overdosed twice.
The drug addicted are not free.
The health care medical industrial complex is an enormous part of the economy and health care spending now accounts for 16 percent of Gross Domestic Product. Half of all personal bankruptcies are caused by illness or medical bills. The number of medical bankruptcies has increased by 2200 percent since 1981 (Health Affairs, Feb. 2005). Have you ever tried to pay back half a million dollars for an unplanned and uninsured “stay” in an intensive care unit? Shit-out-luck stroke that I had! But even those with insurance have good reason to fear bankruptcy, just ask the parents of three-year old Elly Bachman. She was bitten by a snake. The treatment for the bite  including antivenins and several surgeries to save the leg  cost the family nearly $91, 000 after insurance paid out. The hospital, in a moment of charity, waived $49,000. Now the Bachmanís owe $42,000. They have set up a website. Go to www.ellysnakebitefund.org to make a donation.
The Bachmans are not free.
Credit/debit cards are increasingly used to pay for co-pays, deductibles, medication, medical supplies, routine exams, and diagnostic testing. An MRI costs over one thousand dollars. If you had a suspicious mass in your brain would you put the MRI on your Visa? MRI one-thousand dollars, hospital charges two-thousand dollars, medication three-hundred dollars. Piece of mind that you donít have a malignant brain tumor: PRICELESS! Except there is a price. Many hospitals and clinics prominently display their price list like a menu, as if purchasing health care was akin to going to a restaurant: Iíll have the mammogram, well done, please.
A study titled Borrowing to Stay Healthy: How Credit Card Debt is Related to Medical Expenses by Cindy Zeldin and Mark Rukaivan (www.accessproject.org), illustrates how deeply indebted millions of people are due to the high cost of health care. The cost of health insurance continues to outpace inflation and wage growth. In other words, health care is more expensive and there is less money to pay for it. Now, about 29 million adults have medical debt and  no surprise here  debt acts as a disincentive to filling prescriptions, and following through with recommended treatments or diagnostic tests. If there were still debtors prisons 29 million people would be in them.
According to the study, the uninsured have an average credit card debt of $14,512 in medical debt and those with insurance have $10,973. The average credit card debt for those in households with children was $12,840 and those without children 10,669. The numbers canít convey the reality of what debt costs families and individuals in terms of quality of life. It means parents canít buy their children other things: a computer, trumpet lessons, Hannah Montana tickets (if you could even get them), or a week in Disneyland. For adults, it means a working life dedicated to paying off medical debt instead of buying a home or taking vacations.
The credit card industry has recognized the growing market for patient out-of-pocket-costs and has designed “medical credit cards” specifically for medical expenses. Business is good. In 2001, patients charged $19.5 billion in health care services to Visa cards. Highmark Inc., a health insurer in Pennsylvania, offers a “Health Care Gift Card.” The card costs $4.95 (plus shipping and handling), and can be loaded with as little as $25 to as much as $5,000. Now you can give your partner that colonoscopy the proctologist recommended. Or buy yourself that brain shunt for your birthday. Oops, I donít think $5,000 will cover it. Put the outstanding balance on another credit card.
We are not free.
Medical debt is related to another crisis in this country ñ the mortgage crisis. Another finding in the study by Zeldin and Rukaivan is this: among those households that refinanced their homes or took out a second mortgage, 60% paid down credit cards with the money. A recent story in The Chicago Reporter illustrated the connection between the two. Edward and Thaida Booker bought a home in 2001 with a loan carrying a 6.2 percent interest rate. She was diagnosed with cervical cancer a couple years later and they had to refinance their mortgage at a higher interest rate to access some of the equity to pay off unexpected medical bills. Thaida died and without her income Mr. Booker was on his own to pay a mortgage that had gone from $800 a month to $1,425. The problem is Booker is retired and his pension and disability payments canít cover the new amount. With help from a housing counselor he was able to negotiate new terms with his lender, but still has to rent out a room in the house and work side jobs to make the mortgage payment.
Edward Booker is not free.
Have you ever stayed in a job that you hated because of the health insurance and you or a family member had a health condition that required frequent doctor visits, labs, and expensive medication? Itís called job lock. An article in BusinessWeek titled “Held Hostage By Health Care – Fear of Losing Coverage Keeps People at Jobs Where Theyíre Not Their Most Productive” exposes an aspect of the health care crisis that has been little discussed. Workers are chained to jobs for one reason; the employerís health insurance. The article alleges there is “A health care refugee in every office.” I would wager there are millions of Americans who are desperate to leave their jobs but without coverage, medical bankruptcy and/or a health emergency make the risk of quitting impossible. So we put up with the boredom and abuse (and think we are “lucky” to have medical benefits), but if insurance wasnít tied to employment we could tell our boss to “Take this job and shove it!”
Kathryn Holmes Johnson is a health care refugee profiled in the BusinessWeek article. For a decade Johnson wanted to leave her job to find one that she really loved, but her husband and two children all have asthma and other health problems. The entire family is covered through her medical plan. The $2,000 a year in co-payments for the familyís prescription drugs would have turned into $85,000 without insurance. When she considered changing jobs, the critical factor was the prescription drug coverage that a new employer would offer. She wondered, “In what other country would that be the deciding factor?” Only in America  a nation of health care hostages.
We are not free.
HELEN REDMOND is a Licensed Clinical Social Worker and a member of Chicago Single-Payer Action Network (CSPAN). She can be reached at redmondmadrid@yahoo.com
