Tale of Two Health Crises

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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cleaningtentAnne from TexasKathleenDeron S.Lynn Recent comment authors
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cleaningtent
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cleaningtent

Thanks to the awesome articles on the blog I am quite serious in the following paragraphs and you also include truly aided us. We’ve just told several of my personal close friends concerning this about Facebook and they really like your content just as much as i carry out.

Nate
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Nate

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… Read more »

Anne from Texas
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Anne from Texas

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

Kathleen
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Kathleen

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… Read more »

Nate
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Nate

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.

MD as HELL
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MD as HELL

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.

MD as HELL
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MD as HELL

Peter,
Caps are not tort reform.

Peter
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Peter

“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… Read more »

Nate
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Nate

“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… Read more »

Deron S.
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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.

Deron S.
Guest

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.

Peter
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Peter

“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.

Lynn
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Lynn

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… Read more »

Nate
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Nate

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… Read more »

SteveH
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SteveH

“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.