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The Profit of Health

Emily Becker never had to worry about her health. Both her parents had good jobs and every little toothache was covered. That was until her father, Bob Becker a former CEO of a heating company in Jersey, lost his job in August of this year.

Like millions nationwide Becker’s father lost his job during a recession-induced layoff. “When my dad lost his job, I lost my insurance,” the senior University at Albany student said. Emily’s mother is also currently unemployed and as she does not have insurance herself, could not cover Becker.

For Becker this drop in coverage couldn’t have come at a worst time. A few weeks after her father lost his job she was rushed to the hospital with abdominal pains. She needed to get her appendix out immediately.

“Luckily I was still covered,” she said, explaining that because it was in the same month her father’s insurance was terminated she was still under his coverage. The cost of getting your appendix out is about $17,000, but because Becker is a student she was able to get the bill dropped to $2,000. Becker’s total medical debt that has accumulated in the last year is $5,000, which she is paying herself.

To make matters worse Becker has suffered from asthma since she was 12. Once a month she comes down with some type of respiratory infection that keeps her out of work.

“I’m a waitress I depend on my tips to pay the bills,” Becker says. “Being sick means I lose shifts. I would go to the doctor more if I knew I wasn’t going to get a huge bill. I’m the sickest I’ve ever been now that I don’t have health insurance.”

Like many of her peers Becker did not realize the importance of having health insurance until it was gone. Many recent college graduates, after being dropped from their parents plan, do not find it necessary to seek out insurance. When you are young your health isn’t one of your top priorities. A sense that “it couldn’t happen to me” is causing the youth of our country to ignore the vital need.

Students may have the option to go to the University Health Center when they are feeling a bit under the weather, but they still do not have coverage if something serious were to happen. They cannot get the proper preventative care and they cannot go to the health center once they graduate.

This is the underlying problem in our health care system today. Health insurance is not seen as a basic need, but a luxury that many can’t afford. The way the current system is set up insurance companies have the freedom to charge way too much for basic coverage and our government lets them, leaving millions uninsured. Fathers, mothers, sisters, brothers; everyone knows someone who is uninsured.
In a leading world country this should not be the case. We should not be the only developed country without universal health care. Countries like Argentina, Cuba, Kuwait, Canada, and the UK all have some form of a universal health care system. We should not be the only developed country without universal health care.

One in 13 Albany County residents do not have adequate health insurance, according to Albany Medical Student Chris Atkinson . These figures, which are low compared to the one in seven uninsured nationwide, are still numbers that should not be tolerated.

46.3 million Americans do not have health insurance. If they get sick they have to actually weigh their options before getting care. They should not have to stop and think.

It is the foundation of the current system that has created the gap in health coverage. In the U.S. health coverage is broken up into two sectors: the private and the public. Medicare and Medicaid along with other programs that make up the public sector, help to provide extremely affordable health coverage to millions. U.S. Veterans have some of the best care facilities in the world and Federal Employees get some of the best coverage for cost.

However, there are strict guidelines you must meet in order to qualify for government aid outside the military and government employment. Each year the government creates a sliding scale of need based on the national poverty level. In order to qualify you must make under $21,200 a year, if you make over that you cannot qualify.

“I have been filling out forms for Medicaid since August. I get one done and get another in the mail.” Once Emily can prove she is an Albany resident she will then wait 4-6 weeks to know if she has been accepted. However, until then she is stuck with very limited options regarding her health.

On the other side of the spectrum is the private sector. If you can afford a plan with CDPHP, Capital District Physician’s Health Plan, at $857.55 a month, then you can have basic HMO coverage. CDPHP’s plan ties with Empire Health Choice for the cheapest in Albany County, according to the Oct. 2009 Premium Rates for Standard Individual Health Plans report.

An amount like this is completely out of reach to someone like Emily who is literally living paycheck to paycheck.

Private health insurance companies take $0.20 out of every dollar for profit and $0.30 for overhead. Overhead is what it costs to have bureaucrats fight on the phone to get bills paid. CDPHP charges more to small businesses than large, giving discounted rates and better benefits the more people you insure.
Medicaid only takes $0.03 for overhead and none for profit.

Some people also get coverage through group plans offered at their jobs or from family members with benefits. New York State employees receive comprehensive and affordable health benefits, but there are many who still cannot afford the plans their jobs offer.

These problems are not new, as Bernie Fetterly, who has been working on improving health care since the 1970s will tell.

“We are going backwards in health care,” Fetterly said. “You can’t have a health care system that doesn’t care about the people.” Fetterly, co-organizer of Single-Payer New York, a health care advocacy group, says the roots of the dysfunction were planted back in the World War II era.

During the 1940s pay was suspended at different times in order to help feed the war machine the U.S. was building. In order for employers to keep people contently working they introduced benefit packages. In these packages were health care incentives that sparked the birth of the private health care industry.
Making health care a benefit to the employee instead of an obligation of the employer created the bogusly competitive system we have today.

Since this introduction the system has been slowly sliding to segregate two groups: the well-off, who can afford the inflated premium costs of private insurance companies, and the average middle-lower class citizen, the 2.3 million people in New York who are among the uninsured. These people are the working class. This problem touches people of all ages, races, genders, and ethnicities.

Some feel if you lack insurance it is your own problem. That as long as they are healthy and covered they shouldn’t have to care that the only way their neighbor can get care is by going to the emergency room.

Emergency rooms are not places you want to be unless you absolutely have to, especially if you are uninsured. They are usually hot, crowded, it smells like a hospital, and you always wait. Having no insurance adds another level of stress that any doctor would agree does not help healing. But a trip to the emergency room is the only option for the uninsured if you are unable to pay a doctor up front.
There are many myths about the uninsured that have been used to justify the discrepancies within the system. There are those who will claim the uninsured are illegal immigrants or poor citizens who don’t work. However, 79 percent of the uninsured are U.S. citizens. 1/3 fall below the poverty level and cannot afford coverage. 81 percent work at jobs that do not offer health benefits.

According to a study done at Harvard University, of the staggering amount of uninsured individuals around 45,000 will die each year because they lack coverage. People get sick everyday, but when they do not have health coverage small illnesses and skipped check-ups can lead to serious problems that can be too late to fix.

Denise Clow, 46-year-old single mother of two, seemed to be heading down this path. Clow has lived in Albany her entire life, working at a local Price Chopper for 11 years. She has a 14-year-old daughter, Karissa Urbanski, and a 22-year-old son, Ian Kipp. Clow was uninsured for 10 years, four years ago she injured her back at work. After years of intense surgery and rehabilitation Clow is out of work and on disability.

“I was the face of the uninsured. The income level dropped from month to month, week to week,” Clow said. “If I didn’t have workmen’s comp, I don’t know where I would be.”

Last fall as Clow was going through more back surgery she began to re-evaluate her situation.
“If you don’t have your health you have nothing,” she admitted. When you have to decide whether to put food on the table or pay for health care there is something seriously wrong.

To raise awareness of the problems in health care we are facing today, groups across the country have been coming together to fight for better coverage for all citizens, regardless of income.

Albany Medical students have been trying to raise awareness ever since they saw the staggering statistics released by the Census Bureau earlier this year. Saturday Oct. 10 over 100 people gathered in protest, and following Thursday around 40 students and supporters held a vigil in honor of the thousands who die each year due to lack of insurance or being underinsured.

“Health care movements are going to be the civil rights movement of our time,” Naazia Husain, a second year medical student, said during the vigil.

The group of medical students leading the events has been pushing for a form of single-payer health care that is modeled after our own Medicare system and the single-payer system used in Canada.
This plan would create a system in which one payer, the government, does two things: determines medical fee rates and pays the medical bills of patients. This would eliminate out-of pocket expenses, high deductibles, and high prescription drug costs, while only creating a 4.5 percent income tax increase.

“Although most of the bills going through Congress say they are deficit neutral none of them lower costs,” Rebecca Elgie, Co-Director of Tompkins County Health Care Task Force and single-payer advocate says. “We need to get to the point where we are thinking about other people.” Elgie, who attended both events, believes only a single-payer system will truly solve the problems of the uninsured.

The people fighting for this single-prayer health care plan do not believe the present Congressional plans, like HR 3200, will cut it without specific amendments that include a single-payer plan.

According to Richard Lauchmann, a public policy professor in the Sociology Department at the University at Albany. “A single player plan would put the private insurance companies out of business. They have been able to block any government plan that threatens their interests. Until we get public financing of Congressional elections that is unlikely to change.”

What he is implying in this statement is that because private health insurance companies spend millions each year in lobbying for bills that would keep them on top, the representatives of our government are unable to look past the capital gain to see the underlying injustice a privately dominated system creates.

“Health care is not something to be put into a profit sharing system,” Father Ratmeyer, an Albany Med clergymen, said during his speech at the vigil. “We are not dealing with buying cars or batteries. We are dealing with people.”

Along with students and universal health care advocates there are many health care professionals that are calling for a change.

“I don’t think medicine can be restricted to what just happened in the exam room,” Dr. Andrew Coates, professor and internal medicine physician at Albany Medical Center, said. “There are too many injustices, we need to get back to equal access.”

Coates is a member of the Board of Directors for the group Physicians for National Health Plan, which involves 17,000 physicians who advocate for a single-payer system.

“Money has gotten in between providers and patients,” Coates explains. “Right now we have a problem with quality—we need to build an infrastructure that is planned to meet the needs of the people.”
As he talked about the “problems with the system,” he described a fundamental disparity that pits rich against poor, black against white, rural versus urban. “We need to pool resources to reverse the disparity.”

Health care costs vary case-to-case, but the expenses of a serious accident or illness increases as we get older. The American Academy of Actuaries 2006 Medical Expenditure Panel Survey estimates the average care cost for 18-24-year-old to be $1,441 with rates increasing to $8,776 for 65-plus.

Although many remain uninsured across the state, N.Y. has made significant strides to increase coverage of children. State Children’s Health Insurance Plan, or SCHIP, introduced in 1997, has been working to get coverage for any child under the age of 19. Also earlier this fall Gov. David Paterson signed a bill allowing parents to keep their kids on their plans until they were 29, giving them the ability to be insured even if they didn’t have the option through employment.

“It was comforting to know even if I didn’t qualify my daughter would be covered,” Clow says when talking about the process she went through to get coverage. Without coverage her daughter wouldn’t have been able to go to the eye doctor.

Clow’s eyes filled with tears as she described how worried she was when they found an abnormality in Karissa’s eye. Their first thought was cancer.

Karissa did not have cancer, one test could tell that. However, if she didn’t have health insurance she wouldn’t have been able to fix the problem, she could have lost her sight.

When you are sick it usually only takes a few simple tests to figure it out. However, those few simple tests can add up to a pretty costly bill. According to a report done by the Urban Institute, majority of the uninsured gave one reason for not seeking insurance. The reason given most often was cost.
That is why there are places and people in the Albany area that are there to help.

Whitney M. Young Health Center, located in downtown Albany, provides affordable services to 20,160 patients regardless of income level. 85 percent of WMY patients are below 200 percent of the Federal Poverty Level and are either uninsured or underinsured. Walking through the center there was a constant flow of patients and staff, but it didn’t feel crowded. It was a welcoming atmosphere and the staff seemed genuinely eager to help anyone coming in.

“At some point people are going to have to go to the hospital, we don’t have everything,” Mary Alice Russo, public relations director, during a tour of the facilities. “We find because we have our own lab and we don’t have to send tests to a big lab we are able to cut costs for our patients. This makes them much less reluctant to get testing done which in turn improves their overall health.”

“We need to bring the testing and health care to the community.” WMY stresses the overall quality of health of its patients, by offering a range of services from child asthma to diabetes care and general checkups.

“We mirror the philosophy of care that I grew up with in the sense that we provide care to anyone,” Chief Medical Officer Dr. Kallanna Manjunath said.

Manjunath, born in India where he began his study in medicine, has worked in the Albany area as a pediatrician since the mid 1980s when he completed his residency at Albany Med. He grew up in a public health care system where when you were sick you went to the town doctor. The current system here seems to contradict the doctors original understanding of health care’s purpose.

“Albany has seen a shield from the recession—unemployment hasn’t happened here as much as other places,” Manjunath comments. Although this would seem to be true it does not mean there is not the need for further reform. More people are losing insurance than gaining it, but there are avenues out there. There are ways to get covered.

Denise Clow found a way. Last fall, during a series of intense back surgeries, Clow saw a Fidelis Care commercial on the television and decided it was worth a shot. Because it is hard for her to get around, Fidelis representative, Jeffrey Ramirez, went to her house and helped her fill out the necessary paper work. Within a month she had full coverage for her and her daughter.

Clow, whose son recently served in Iraq and has medical coverage through the military, could not find the words to describe the weight that was lifted off her shoulders when she found out she was covered.
“I know I keep saying this, but I just feel so blessed,” Clow is now able to get routine check-ups and emergency services at no-cost. Not everyone who is accepted by Fidelis has a cost-free plan, however, with monthly payments ranging from $34-$100, depending on family size, it is coverage that is truly affordable.

“We look at the number uninsured, not the number covered,” Jeff Collins, Marketing Director of Fidelis, said. “We exist to provide care for the poor and underserved.” Fidelis serves approximately 16,500 people in the Albany area and is completely government funded. It is not a Medicaid governed program but is modeled after it.

“Government insurance companies don’t have pre-existing conditions clauses,” Collins said. Unlike the private sector there are no risk pools, the main deciding factor is income.

Fidelis Care is just one of several plans that offer help to the uninsured. Healthy NY, a state-funded program designed to offer affordable and comprehensive coverage to those whose employers do not offer health benefits, and several advocacy groups like Single-Payer N.Y. are working to improve coverage for all.

Although programs like these have been making significant strides in improving our current system there is still a lot of work to be done.

“We have thousands of people dying because of a medical error in the system,” Fetterly said. This is the health of our country; it shouldn’t be a matter of dollar signs. 

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