Tale of Two Health Crises

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    Maria IJT CURRENTTwenty two years ago I received shocking news: I had Hodgkin’s disease, a cancer of the lymphatic system that affects primarily young people. At the age of 30 I began a long and to date successful effort to fight the disease and regain my health.  I was lucky: I had good health insurance, access to top doctors, friends and family with the wherewithal to help. I also had a good education that helped me navigate the health and insurance systems and also remain employed. I also had a home to go to after each round of chemo and, three years later, after hospital treatment for a recurrence.    “Scott” is not so fortunate. Twenty-seven years ago, at the age of 21, he lost his left leg after a car hit him.  A month earlier, he had lost his job as a forklift operator, and with that, his health insurance. Unable to afford his own home, he was living with his mother. The money he recovered from the driver of the car that hit him barely covered hospital expenses and the lawyer’s fees.

    Through his state’s department of rehabilitative services, Scott was able to get a prosthetic leg. Finding work was challenging. For a year he had a job—and health insurance—with an office supply company, but when the company went bankrupt, he was out of work again. He worked as a migrant laborer for a while—with no insurance. When a relationship ended and he moved out, he had no place to go. He’s been homeless on and off ever since.  His family is too poor to help. He is bright and personable, but lacks the education that might help him get a job. He is on multiple waiting lists for housing but has no place to live but the streets. He is searching for work but with a disability and without a home he has so far been unable to find one. Now his other leg is showing signs of problems. What would have happened to me had I been in his place when I was diagnosed? I doubt I would be alive today.  Without health insurance, I would probably not have gotten the early intervention that helped save my life, or access to top doctors, or the latest treatments. Without a home to live in, I doubt I would have survived the depressed immune system and consequent infections that followed my treatments.  And if I were alive, I’d probably have had a much harder and longer time recovering physically and emotionally from the rigors not only of disease but of treatment.  The consequences of lack of access to health care are devastating. The average life expectancy of homeless people in the U.S. today is 30 years less than that of the rest of the population. Homeless people suffer disproportionately from both acute and chronic disease, such as diabetes, arthritis and lost limbs. Disability benefits are extremely difficult to apply for and receive: Except for about a one-year period long ago, “Scott” has never received them, despite his obvious disability. Health care reform is now on the table in Washington, D.C., and it’s long overdue. But to be meaningful, it must include people like Scott. Medicaid, the federal health care program for poor people, does not currently cover all low-income people; in fact, 70% of homeless people are currently uninsured. The program must be reformed, and barriers to it eliminated, to cover all homeless and poor people. It must include primary and preventive care for people like Scott, and not just because they need it desperately. Right now, emergency room care is the primary medical care available to homeless people. Without access to regular, easily available primary care, homeless people have no other recourse. Yet this is the most expensive care, costing an estimated 3-4 times as much as a doctor’s visit, and the most burdensome for all involved. It must include reasonable access to disability benefits for those who are disabled. Currently, about 40% of homeless people suffer from mental or physical disabilities, or both. Yet only 11% receive federal disability benefits due to barriers including address requirements, missing identification documents, or lack of funds to obtain birth certificates and other records required to apply.  Perhaps most important, it must include access to housing. Without a home, virtually no treatment will be effective—for the person, or for taxpayers. A 2004 nine-city study compared the cost of providing supportive housing to homeless persons, including those suffering from mental illness and addiction, to the cost of allowing people to live on the street. In all nine cities, supportive housing was significantly less expensive, and the health care costs were several orders of magnitude less expensive.  Supportive housing reduces health costs by reducing expensive emergency department visits.  For example, the study found that San Francisco hospital costs were over $2,000 per day, while supportive housing was under $50 per day.  We all need health care and we all need housing. It’s part of being human. I had this brought home to me dramatically when I received that diagnosis.

    It’s time to recognize that these are also basic human rights.

    Maria Foscarinis is founder and executive director of the National Law Center on Homelessness & Poverty, a not-for-profit organization established in 1989 as the legal arm of the nationwide effort to end homelessness.  She is a primary architect of the Stewart B. McKinney Homeless Assistance Act, the first major federal legislation addressing homelessness, and she has litigated to secure the legal rights of homeless and poor persons.  Ms. Foscarinis writes regularly about legal and policy issues affecting homeless and poor persons, and her work has appeared in legal journals, general audience publications, and books. She is a frequent speaker at conferences and other events, and is frequently quoted in the media.

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    25 Comments on "Tale of Two Health Crises"


    Guest
    cleaningtent
    Dec 19, 2012

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    Guest
    Nate
    Aug 17, 2009

    Anne it is very easy to feel self rightous when your never held accountable. If you find a way to deliver the best care in the world at an affordable price then I am all for it. You can’t do it though. Instead you will make a bunch of promises, break them all, and leave us with care worst then we had to start with.
    85% of Seniors hasd no problem paying their own bills before Medicare. They where promised a new better plan that would protect them if they where in the hospital for a long time. It not only didn’t offer that long term protection, it skyrocketed cost and resulted in worse care then what they where getting.
    I don’t even need to detail the failures of Medicaid to deliver what it promised. If you find honesty to be hard hearted I could care less, I find lying hypocrats to be disgusting. To build false hope and take advantage of our needest is dispicable. If you can’t deliver what you promise then don’t make the promise!

    Guest
    Anne from Texas
    Aug 17, 2009

    Nate has a soft head and a hard heart and his comments contribute nothing — but thanks Ms. Foscarinis for the great column.

    Guest
    Kathleen
    Aug 17, 2009

    My experience is similar to that of the author. Despite life-long excellent health habits, I was diagnosed with a brain tumor about 12 years ago. I am here today (and able to continue contributing to society) only because I had the good fortune of being able to get the expensive neurosurgery that was required. I happened to have good health insurance at the time, which allowed us to keep our home and most of our savings intact. Our home and savings represent a lifetime of work by both my husband and me to contribute to society and to *not* be a burden on anyone else. Since the surgery, and despite my focus on seeking jobs with the best insurance available, my coverage is inadequate today for another such surgery. I fear that I, or someone like me, will not get the surgery they need because of an inability to pay.
    Only those who have never had the misfortune of a serious and undeserved health problem, or a child with such a problem, have the audacity to claim that Americans have no right to basic health care. It is absolutely a basic right, as evidenced by the fact that we provide basic health care to our worst criminals in the prision system.

    Guest
    Nate
    Aug 15, 2009

    Peter your forgetting state premium taxes, regualtion and other artificial increases that create the 20%. I have said on here many times carrier loss ratios run around 80%, not all of the remaining 20% goes to the carrier.

    Guest
    MD as HELL
    Aug 15, 2009

    SteveH,
    Maybe Scott had an issue not revealed in the touching vignette that was comon to the story, like alcohol abuse.
    Maybe the office supply company went broke because of the absence of requiring EHR and the necessary computers to run it, too many taxes and too few government regulations requiring endless paperwork.

    Guest
    MD as HELL
    Aug 15, 2009

    Peter,
    Caps are not tort reform.

    Guest
    Peter
    Aug 15, 2009

    “Anything ran through insurance cost 20% more then if you paid for it outside insurance. Can anyone please explain the logic in paying for preventive care through insurance and wasting 20%?”
    Nate, I thought insurance admin/overhead costs were about 5%, or that’s the number that’s come up in the past. That was the reason given for not cutting insurane companies out of the healthcare payment loop. By the way the local urgent care PCP I see charges the same for insurance or cash pay, and the state hospital (UNC) charges 4-5 times for cash pays over what they accept from insurance.
    I would also assume (advocate) that universal insurance would have a mandate to pay for coverage (not necessarily to insurance companies – my preference), IF costs are brought down. I will not be mandated to pay existing rates based on a broke system based on greed.
    Anyway, healthcare reform should be about healthcare reform, not insurance reform.

    Guest
    Nate
    Aug 15, 2009

    “3.Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.”
    This is why people who don’t understand insurance should have their mouths taped shut and sat in the corner till the healthcare debate is over. These people are TRYING to find ways to waste money.
    I think we all agree everyone should have preventive care. Inteligent people would want that care to be as cost effective as possible so people first get the care and second it doesn’t break the system.
    Anything ran through insurance cost 20% more then if you paid for it outside insurance. Can anyone please explain the logic in paying for preventive care through insurance and wasting 20%?
    There are 303 million people in the us. If each had $150 in preventive care that would be 45 billion dollars. If insurance paid for it that would be 9 billion dollars wasted. Thats not 9 billion spent to improve care, or offer better service that is just 9 billion thrown down a hole.
    Lynn why do you want to waste 9 billion dollars for no good reason?
    Why do reform adocates never define Exorbitant, I have a feeling Lynn is talking anything over a few hundred, again a huge waste of money.
    “Discrimination for Pre-Existing Conditions”
    Yes I see no mention of reverse discrimination where people wait till they are sick to buy insurance, is that still going to be allowed? The only reason pre-ex exist is becuase people tried to game the system. To blame the insurance companies for pre-ex shows a complete lack of serious intent to fix the problem. Pre-ex is the solution to a problem, until you fix the original problem you have to have pre-ex.

    Guest
    Aug 15, 2009

    P.S. I would also suggest that we make our public programs far less complex if we want them to be effective. If you think private insurance companies have a lot of rules, do a little research on your state Medicaid program sometime.

    Guest
    Aug 15, 2009

    The unfortunate reality is, it is very difficult to separate those who genuinely need public assistance from those that want a “free lunch”. Our public programs have failed because our elected officials have not made a committment to protecting the integrity and original intent of the programs. Now we’re looking to increase the size of those programs with little mention of improving the way they are administered. Doesn’t sound like a winning approach to me.

    Guest
    Peter
    Aug 15, 2009

    “2.Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.”
    Lynn, aren’t those alrady capped under existing insurance contracts? And will it “cap” what insurance companies can charge for premiums? If not then #2 costs (and #s 1-8) above will be passed on to premium payers, so only those who win the sudsidy lottery will see THEIR costs go down. My costs will rise AND my taxes will rise.

    Guest
    Lynn
    Aug 14, 2009

    Reform provides security and stability to those with or without coverage:
    1.Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
    2.Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
    3.Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
    4.Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
    5.Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
    6.Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
    7.Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
    8.Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.

    Guest
    Nate
    Aug 14, 2009

    Peter once again you manage to lower expectations of your intelligence. No I don’t offer HSAs that would require an insurance license. No I don’t handle HSA accounts cause that would require being an apporved custodian.
    Do you ever tire of being a dumb ass? Is it really asking to much to have at least a slight clue of what you are talking about before you start typing?
    If HSAs took off I would lose a huge chunk of my business. Might not even be able to survive it. Try wrapping your simple little mind around that, someone advocating doing the right thing even if it comes at great personal cost. About the exact opposite of you progressives always doing stuff at great cost to others, maybe that is why you can’t grasp it?
    Sob stories are a dishonest way to sell anything. You hold up a suppoosed set of facts and based solely on those facts we are suppose to agree with you, even though we have no ability to question any of them.
    How is a family to poor to offer him an address to use, bath to clean up in and even a sofa to crash on? Sounds like the family doesn’t want him or he chooses not to take what is available.
    “The average life expectancy of homeless people in the U.S. today is 30 years less than that of the rest of the population.”
    And this is due to lack of housing and not their drinking, drugs, and smoking? Conditions that usually contribute to being homeless in the first place.

    Guest
    SteveH
    Aug 14, 2009

    “1. Why did Scott lose his job one month before his injury?”
    Indeed, why didn’t he wait until after his accident to lose his job. In fact, what did Scott do to make a car hit him?
    “3. Why did the office supply company go broke?”
    I can only suspect it was hit by a car driven by the same driver who hit Scott.