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Death or debt — this is why we need health insurance guarantees

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No nurse expects to go to work and leave a trail of blood from his or her unit to the emergency room. Neither did I.

In 2011, a piece of broken equipment dropped an 85-pound lead plate and crushed my foot while I was working at the hospital. The injury was so severe that a neurologist who saw the accident later told me he had expected me to come back from surgery an amputee.

{mosads}Six years later after multiple surgeries, follow-ups with specialists and 26 months of physical therapy, I have finished treatment with bills reaching nearly $250, 000. I am lucky. I was covered.


In my 10 years as a nurse, I have heard from patients who struggle with medical bills. But I learned firsthand what many American’s don’t realize. Without insurance, we are all one accident or illness away from bankruptcy.

The defeat of Graham-Cassidy marks the beginning of a conversation to reform rather than gut our health care system. For the system to work, everyone needs coverage, despite the debate surrounding how we make this a reality.

Jimmy Kimmel recently influenced a heated debate over the moral imperative to provide insurance coverage by revealing his own son’s diagnosis of congenital heart disease and spawning the term “the Jimmy Kimmel test” to benchmark coverage.

As a nurse practitioner, I agree universal coverage is a moral imperative. Yet many Americans believe the government is not obligated to provide coverage for those who are unable to pay. Still, the United States is the only country where almost 650,000 people claim bankruptcy annually due to medical bills. The other 30 industrialized nations: zero.

Even those with private health insurance have a system that is stacked against them. Many people who have insurance coverage may choose not to use it due to high deductibles and other out of pocket costs.

Some consumers may be unaware that private health insurance companies may consider their most urgent responsibility is to their shareholders. It is in their best economic interest to make strategic choices that drive profit, not necessarily what is in a patient’s best interest.

Insurance companies such as United Health Care and Aetna recorded record-breaking profits in 2015-2016. At the same time, healthcare providers like myself have realized more paperwork to prior-authorize crucial testing and a narrowing list of what is “reasonably” covered.

For proponents of a free market, it seems a free market system doesn’t work with healthcare. Simply put, healthcare is not like a car or cable television. It’s a commodity we can’t live without. For patients with chronic illness or disability it is something they have to have, regardless of the cost. The other option is death or debt.

The current system allows the cost of private insurance to go unchecked. If all private insurers raise their rates, the companies have no incentive to control costs to the consumer.

A “public option” provided through a system such as Bernie Sanders (I-Vt.) Medicare for All bill would provide a medical safety net option for everyone while private insurance companies compete for those consumers who want to buy insurance. A similar system in Australia has been effective in driving competition and quality, with everyone having Medicare coverage and about half of the population opting for private coverage.

Several congressmen, such as Sen. Paul Ryan (R-Wis.), suggest that freedom means you can purchase pieces of insurance “al la carte” like a steak. The trouble is that if you don’t have full coverage, by the time you have late stage brain cancer, like his colleague Sen. John McCain (R-Ariz.), you have become uninsurable.

I have witnessed patients who wait until their cancer becomes so severe that they qualify for disability. Forced to wait for Medicaid eligibility before they begin treatment. This is exponentially more costly and more likely to be terminal. Without insurance, patients beg me to avoid treatment, knowing that this treatment would bankrupt the family they leave behind.   

Regardless of how we provide universal coverage — whether through private insurance, government funded programs or some mix of the two — it will come with sticker shock, similar to the spike in spending we observed after the Affordable Care Act expanded coverage to millions.

The logistics of covering an additional 28.2 million people while avoiding disruptions in current coverage will be an additional hurdle. In spite of this, the long-term gains in providing access to preventative care will make the system sustainable well into the future. This is well worth the effort.

This road to fixing what is broken with the U.S. healthcare system is guaranteed to be rocky, but outside of the ethical debate surrounding universal coverage, it’s a fiscally responsible choice.

No one in this country should have to decide to live with debt from healthcare costs or die.

Melissa D. Kalensky, DNP, FNP-BC is a family nurse practitioner caring for older adults in an internal medicine clinic in Chicago. She is an assistant professor in the College of Nursing at Rush University and a Public Voices Fellow of The OpEd Project.  

Tags Bernie Sanders Health care Health insurance John McCain Paul Ryan

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