2008-10-02 by Sandy Lahmann
The United States is currently in a period of great turmoil and difficulty. We are experiencing financial collapse, which experts are starting to compare to the Great Depression. Banks and businesses are failing, unemployment is high, and inflation is out of control.
Unfortunately when times get hard, it is generally the citizens with the fewest resources who suffer the most, and, in this case, it is certainly people with disabilities. I have recently corresponded with many U.S. legislators about the situation people with disabilities are experiencing. In the responses I have received, those legislators say that they are sympathetic, but there simply isn’t any money to make any changes at this point. But they promise changes when the financial situation improves. For many people with disabilities, that will be too late.
Let’s start with health care
Our health care system is a privately owned system. Hospitals, doctors, insurance companies, and pharmaceutical companies are all for-profit and the mighty dollar is paramount. Health insurance hopefully comes as a benefit of employment or is privately obtained through purchase.
However, the cost of such insurance is prohibitive. The cost to insure a person with a disability keeps rising and rising. At present, it averages $800 per month. As a result, more and more employers are no longer offering health insurance to their employees or they are discriminating against and not hiring employees with disabilities so they don’t have to pay the high premiums. As a result, there are significant numbers of people in the United States without any health insurance.
Even if you do have insurance, many insurance policies are inadequate. Most insurance companies do whatever they can to avoid paying for anything and a person must spend an astronomical amount of time arguing with their insurance company. When I was insured, I was unable to get my insurance company to pay for my wheelchair. I am unable to walk through a grocery store, but I am able to walk a short distance inside of my home. All insurance companies in the U.S. say if you can walk in your home at all, even if it is just for a few steps, you don’t need a wheelchair. So I had to pay for my wheelchair out-of-pocket. I was unable to afford it and put it on my credit card. Literally, thousands and thousands of similar stories could be told.
What if you don’t have heath insurance?
First of all, you will be charged more for health care. If a person with no insurance goes to the hospital and receives the same procedure as a person with insurance, the person without insurance will be charged a much higher rate than the person with insurance, EVEN BEFORE the insurance is applied.
And those expenses are getting out of control. I no longer have health insurance and I recently went into the emergency room at my local hospital for a need which required a blood test, a urine test, and a three minute exam. I went to the emergency room because no doctor’s office would see me without insurance. (The emergency room has turned into one of the only places a person without insurance can get health care.) For my two simple tests and three minute exam, I was charged $3000, much more than a person with insurance would be charged.
Medicaid and Medicare
We do have a couple of government programs designed to help people without insurance, namely Medicaid and Medicare. However, frequently a person’s ability to access Medicaid or Medicare is based on income and if you make any money at all, you don’t qualify.
I’m attempting to qualify for a Medicaid program for people with disabilities and chronic illnesses which is based on the need for health care, not on bizarre income limits. I filled out one lengthy application and sent it in. Then I was sent another application with slightly different questions. I filled out that application and sent it in. Then I needed a home visit from a nurse. Next, they sent me a third application with slightly different questions. I filled that in and mailed it last week. I have no idea what happens next. Nobody seems to know what the process is. However, so far I have spent three months on this and I have no idea when I might actually receive services.
Keep in mind, however, that Medicaid and Medicare don’t cover much either. They also won’t pay for a wheelchair if you can walk only two steps in your home. Doesn’t matter that you can’t walk in the grocery store or walk at your job. Medicaid and Medicare set the standard that the private insurance companies follow.
There are some nonprofit clinics available to provide health care for the uninsured and low income. Don’t try to go to one if anything is urgent, though. Application procedures exist and sometimes it can take six weeks or longer to get an appointment.
So once again, we are back to receiving health care in the emergency room. Sometimes the waits are bizarre. You show up as a walk-in patient and you may wait five, six, or seven hours to be seen at some places in the U.S.
Also keep in mind that private insurance companies, Medicaid, Medicare, and nonprofit clinics do not cover alternative health care. I have found acupuncture and traditional Chinese herbs to be significantly more helpful to me than prescription pharmaceuticals for multiple sclerosis. However, nobody covers acupuncture or Chinese herbs. It costs me $150 a month to receive the acupuncture treatments and herbs I need to keep me functioning. Nobody covers that. However, when I did traditional health care and pharmaceuticals, which made me sicker and sicker, the cost was $2500 a month for pharmaceuticals and another $350 a month for doctor appointments. Why do insurance companies and Medicaid/Medicare prefer paying $2850 a month for traditional care over $150 for alternative care?
Keep in mind that insurance companies will probably find some way to get out of paying the $2850 a month anyway. When I was insured, they were endlessly spouting reasons why charges weren’t covered.
The health care system in the United States is broken
If you have a lot of money, you can pay for and receive some of the best health care in the world. If you are not wealthy, you don’t get adequate health care.
I am currently not receiving the health care I need and as a result, my physical condition is deteriorating. So, how does health care in the United Kingdom compare?
Top of page
I am so pleased that Sandy has agreed to publish her article in my blog: her column Disability 101 was the inspiration for me to start writing about disability. I also feel very strongly about the subject of disability and health care in the US because I worked there for four years and one of my daughters is American. At the time I witnessed first hand how some of my visually impaired clients at the ASB Centre of Philadelphia were affected by their lack of medical insurance and this subject is very close to my heart. Thank you Sandy for talking about this complex subject: I think the British National Health Service is by no means perfect but offers very good standards of care and is offered to anyone as long as they are officially resident in the country. But I do not know about the subject myself very much and I hope that perhaps some of our readers will offer their opinion as to how the US and the UK systems differ?
Maria 2 October 08
One of our great UK institutions is the National Health Service. Universal health cover for anybody that needs it regardless of income. It is by no means perfect and of course is subject to the pressures of economics and has finite resources, but it is there and it works for most people and as disabled people in the UK in principle we do not have to worry about impairment and eligibility for service. However, personal experience tells me that there is underlying discrimination within the system and all is not necessarily equal. For example last year the then disability rights commission in this country was following up progress around health inequality and disabled people. An investigation called “equal treatment closing the gap” found that disabled people and particularly people with learning difficulties and other health problems are more likely to have serious health problems, getting younger and die sooner than other citizens. Over 50% of people surveyed reported difficulties with trying to access their doctor because of staff attitudes and lack of training, inflexible appointment systems and accessible information. Maybe the fact that we are concerned about this here actually highlights the fact that generally the system is working. We want to make it work better, but least we have a right to treatment.
David Morris 15 October 08
With the National Health Service, what are individuals charged for health care? Is it free, or must you still pay some type of charge as in a co-pay? What type of charges are common? (Surely it’s not free, is it?)
Are people given the opportunity to choose their doctor or must you see whichever doctor is assigned to you?
Who decides what types of medical durable equipment or types of services are covered and what is not? Does the doctor decide, do administrators at the National Health Service decide, or does the patient decide? What if the patient disagrees with whomever is deciding?
Is there much paperwork for patients? Is there much arguing between patients and the National Health Service as to what is covered?
Are nontraditional types of services such as chiropractic care and acupuncture covered?
Sandy Lahmann 16 October 08
In Tucson, Arizona, the City hasn’t made the Eastside City Hall accessible from the main street as required by the Americans with Disabilities Act. They’ve been asked for years and now they don’t have the money but they did expand a nearby dog park. In a bad economy, just fight harder.
On private ownership of healthcare, some of us have the options of public university health centers or not-for-profit hospitals and I go there wherever possible. The for-profits have tried for the last time to cheat me by exploiting a new Medicare loophole supposedly intended to give us more choice in healthcare. It forces us to agree to pay any and all charges not covered by Medicare including such things as medical errors which Medicare no longer covers.
Many of us fall through the holes. My wife and I both have disabilities. My disability qualifies me for Medicare but my wife’s disability does not because she didn’t work enough hours. My Social Security income for disability is too much for her to qualify for Medicaid which you can’t get until you’ve burned through all your remaining savings. Then you can’t pay your property taxes and you lose your home.
Much of my knowledge of the UK healthcare system comes from the old TV show Doctor in the House, but even that would be a great improvement.
Dale Roose 17 October 08
In reply to Sandy’s question, I can talk from personal experience but upon moving to our current residence in London, I found a nearby doctor, I applied to become a patient, together with my daughters and in a few days I was invited for a free check up. Then each time I need to see the doctor I make an appointment and usually they see me by the next day or so. Each prescription medicine costs 7.95 pounds for everyone but are free for children under 14 and mothers within a year of giving birth and pensioners and people on state benefits or low income. Any service or consultation that the doctors sends you to (CAT scan, breast exams, blood works, gynecology, etc.) is completely free. A new service has been introduced called ‘NHS Direct’ to avoid overcrowding of emergency rooms, which is a hotline that you can call and a nurse takes your details if you have symptoms you’re not sure of. This way if it’s nothing to worry about a doctor or nurse call you back and you don’t have to go to the Emergency room.
The only thing that is difficult to get on the NHS is a dentist and even then only basic dental work is covered. Crowns and implants cost more but usually you can pay in instalments.
The NHS is not perfect but by golly, upon returning from living in the US for four years I was so relieved that I could look for a job and not worry if it had health benefits or not. When I was in the US my employer paid my premiums but I had to pay $40 for each service or medicine and we could not afford to insure my husband. I had to because I was pregnant at the time and upon giving birth we received a bill of $1200 by the hospital. This is horrifying for a new family with so much to think about and I was truly disappointed by the level of care in the US.
Senator McCain has recently said that health care is a ‘responsibility’. I’m afraid I disagree: it’s a human right and any self respecting democracy should provide reasonable healthcare to its citizens. And for those who said it can’t be afforded, I tell you: the Iraq war should not have been afforded. I hope that with the new elections a new dawn of true justice is ahead for Americans, you have waited far too long for it.
Maria 18 October 08
Dental care in the US is a separate insurance policy from health care. People with health insurance may or may not have dental insurance. Usually dental insurance covers only preventitive care – x-rays once a year and cleanings twice a year. Everything else generally must be paid for by the patient.
Vision insurance is generally not provided. A few lucky people may get vision coverage from their employer but the vast majority of people do not have vision coverage. This can be a major problem. In my own case, my glasses are falling apart and the prescription is no longer adequate but my last pair of glasses cost $750 two years ago and I can’t afford a new pair. So I’m out of luck.
Do you have vision coverage in the UK?
There has been a lot of talk about reforming health care in the US but no one ever does anything to change it. Hillary Clinton first started talking about it 16 years ago and she was thwarted at every step.
It is frightening to live in a country that can be so committed to involvement in Iraq but not be committed to basic human rights at home.
Sandy Lahmann 19 October 08
I’d like to reply to Maria. I heard that McCain said healthcare is the citizen’s resposibility.
It would be great if access to all healthcare services were equal and the prices were equal. I believe that ‘responsibility’ should be each person wisely using the services they need to keep themselves in the best health possible.
I too have found alternative services to be beneficial. Many medical services worsened my situation. I have paid for the alternative services myself, accept for one provider who researches grants for her services – then provides the services at $5 per treatment.
I live in the US, and am paying for health expenses out of my own funds. I do have a major medical plan, which would cover a portion of the hospital if I were in an accident. But for my everyday needs, I mostly choose alternative services which I pay for myself.
For me, caring for my health and that of my family comes first, at the expense of ‘toys’ or vacations or other things. I thank God that I have the resources at this time to manage.
Anne Cowles 19 October 08
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