Health as a Basic Human Right: An Example and Discussion of How the American Health Insurance Model Fails Patients
Image description: a pink square with the words “Healthcare is a human right, not an opportunity for profit.” There are pink and black paint splatters and a pink and black stethoscope with an EKG.
I got a call from my pharmacy first thing this morning, letting me know that my insurance had denied coverage for my medications. When I contacted my insurance company, they informed me that I was no longer covered as of June 30th. This month (July), I left my job of two years and will be starting medical school in two weeks, and I had arranged to have health insurance through my employer through the end of July since my school’s health insurance coverage doesn’t start until August. After a morning of debilitating panic attacks and frantic emails to the HR folks at my former employer, it turns out there had been a mistake on either their end or the insurance company’s end, and they reinstated my health insurance.
I consider myself lucky to have avoided a month without health insurance. Living with a disability and having just had surgery, I rely on insurance to be able to afford my medications and doctor’s visits. The past couple of years, I have been privileged to have “good” health insurance, which covered almost everything I needed, give or take a couple of urgent care visits. But today’s incident reminded me of how many people struggle to access and/or pay for the care they need. Under the United States’ capitalistic model of healthcare, insurance coverage, accessibility of healthcare, and now, legality of certain types of healthcare (ahem, gender-affirming care and abortion care) is a constant question for many patients. My mom was one of them.
Back in 2017, my mom was let go from her job as a clinical nurse specialist after 38 years with her employer. She later found out that they had let her go because there was a plan to sell the hospital, and they were trying to make it seem more profitable. Because she had served the hospital for so long and was receiving healthcare benefits which allowed her to manage her physical disability and chronic illnesses, she was one of the first people they decided to let go to reduce hospital costs. Nevermind the 90-something patients who were ultimately left to the single nurse left in her clinic, the hospital decided their profit was worth the risk placed on both my mom’s health and the health of the 90-something patients she managed in the clinic. They even offered to hire my mom back on a per-diem basis but would not give her health insurance. She had to decline the position because she relied on insurance to survive, and she would have lost the Medicaid insurance she enrolled in after losing her job in the first place. She would have been employed again and would not have met the poverty guidelines making her eligible for Medicaid. But, her insurance would have been so expensive that she could not have afforded it in addition to her other basic needs. She would have been working part-time with no health insurance and not making enough to afford insurance.
The last five years of my mom’s life were riddled with anxiety, depression, and endless fights with her insurance company trying to afford the healthcare she needed to survive. She had a heart attack in 2019, which was likely precipitated by the stress she had been under from trying to manage her health and the cost of her healthcare. I lost my mom earlier in 2022, and truthfully, I would not be shocked if the stress she had been under the past five years contributed to her untimely death. I can’t count on both hands the number of times I saw my mother cry in the hospital and over healthcare bills her insurance wouldn’t cover. She knew she needed this care to survive, but because her employer deemed her unprofitable, she spent the last five years of her life fighting to access it.
Why is it that our worth is dependent on what we can contribute financially to society? Why is it that our healthcare has become tied to this worth? Healthcare is a basic human right. Without it, we die. It’s as simple as that. Access to healthcare is a driving factor behind disease prevention, emergency response, quality of life, and yes, survival. So, how did we, as a country, as a society, decide that those who are able to work full-time are the ones worthy of affordable healthcare, and those who cannot work full-time are not?
A 2020 paper from the Journal of Health Politics, Policy, and Law discusses the ideological differences in support for public health insurance through Medicaid. (1) It mentions how some states support healthcare and health insurance for all, whether through private or public insurance, and recognize that high healthcare costs can lead to other financial strain and more dire consequences. Other states only seek to provide public health insurance for those who are “truly in need”. But, how does one define “truly in need”?
If a person is employed but does not receive benefits through their employer, are they not “truly in need”? Private health insurance is expensive, and a person’s part-time pay is usually not enough to cover health insurance, rent, food, transportation, utilities, and emergency expenses. And if they are employed part-time and make above a certain amount of money per year OR work fewer than a certain number of hours per year, they may not be eligible for public health insurance (2).
If a person is disabled but married, are they not “in need” enough? People living with disabilities often require more healthcare to survive and, thus, incur more healthcare costs. But, when disabled people get married, if they are receiving disability insurance to help cover the costs of their healthcare and other basic living expenses, they lose all benefits and must rely on their spouse to pay for their healthcare expenses. If they can work, they may be able to get health insurance through their employer, or they may not. If they cannot work, both their spouse and them will rely on one income with no additional support to counter healthcare costs. And if their spouse works one or multiple part-time jobs, neither one of them may have health insurance.
The variety of situations which necessitates public health insurance is vast; yet, it is not a feasible option for many. And even when it is, the accessibility of the healthcare they are able to receive pales in comparison to the accessibility of healthcare for folks who are employed full-time and have private insurance, especially folks with PPO insurance. If a patient is referred to a specialist they need to see for potentially life-saving or life-sustaining care, there is no guarantee that specialist will be covered. Even patients who are full-time employees but have HMO rather than PPO insurance may not receive coverage for all of the care they need, or their coverage may end up costing them more money than their salary affords.
The question I hope to leave you all with is the following: Why is it that accessibility and affordability of healthcare has become tied to our productivity and economic worth in society? Why is this basic human right a question of cost for most and profit for a select few?
Sources:
1) Grogan CM. Medicaid's Post-ACA Paradoxes. J Health Polit Policy Law (2020) 45 (4): 617–632. https://doi.org/10.1215/03616878-8255541.
2) Aron-Dine A, Chaudhry R, Broaddus M. Many Working People Could Lose Health Coverage Due to Medicaid Work Requirements. Center on Budget and Policy Priorities (2018). Web. Accessed 5 July 2022. https://www.cbpp.org/research/health/many-working-people-could-lose-health-coverage-due-to-medicaid-work-requirements