Wow, you survived cancer? What's your secret to health care?
As absurd as that sounds, its a question many Americans who get sick are still asking as we ring in the year 2020. Getting health care in this country is still so circuitous it often does feel like a secret a maze deciphered in private that's never quite mastered. The reward for solving it? Perhaps your life; perhaps the loss of your life savings. And thats if youre lucky.
Even with the Affordable Care Act, almost 30 million are without health insurance in the U.S. And if youve perused plans on the ACA marketplace, youll know why. Theyre pricey, and a new year brings fears that insurance premiums are once again rising. (Who knew the inflation rates on a pap smear were that high?!) Meanwhile, 14 Republican-led states are still refusing to expand Medicaid as stipulated in the ACA, even though the federal government would pay for 90 percent of the cost. Why? Something about repeal and replace or socialism. Its hard to keep track.
Even with the Affordable Care Act, almost 30 million are without health insurance in the U.S. And if youve perused plans on the ACA marketplace, youll know why.
I traveled to three states, each with their own unique health care access challenges, for my new MSNBC special "Red, White, and Who? Between Texas, New York and Utah there are major differences in how easy it is to see a doctor without going bankrupt. But every single person I spoke with regardless of job, socioeconomic status or even political affiliation had one identical anxiety: healthcare in one of the most advanced countries in the world is ridiculously, hopelessly complicated.
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Im retired, but I feel like a have a job, Larry Chiuppi told me sitting outside at an RV park in Houston, blocks from one of the top cancer treatment hospitals in the country. Larry has been caring for his wife Nancy Raimondi, who has blood cancer, for over a year. During that time, he himself was diagnosed with prostate cancer. Even with her Medicare and his private health plan under the ACA, navigating the billing systems for the endless hospital visits, specialists and tests each with their own separate charges requires a huge amount of time and vigilance. He tells me they once got a $14,000 bill for a stem cell transplant because someone forgot to link Nancys Medicare. Larry imagined many people wouldve just tried to pay it. And most Americans dont have a retirees free time and Larrys persistence to help them through the bureaucracy, an added burden of getting well.
We also dont all have a mother like Sandra Stein. She and her family live in New York, a state where the uninsured population is less than five percent, and 6.5 million are on Medicaid. I met Sandra on a street corner in upper Manhattan, where activists were flyering for the New York Health Act, a bill that would give every New Yorker state-funded care. Sandra believes in single-payer healthcare because she has experienced the mind-numbing labyrinth that is the private insurance system firsthand.
When her son was nearly three, he developed a rare neurological disease that left him unable to walk or speak. At the time, she and her husband had private insurance, which was relatively good insurance, according to Sandra. But that didnt make things easier. When they first went to the hospital in an ambulance, the doctors there didnt take their insurance even though the hospital did. Her son ultimately stayed in three different hospitals over the course of 15 months.
When we got home it was my job to figure out the pile of bills and the collections threats, she told me. Its been eight years, but Sandras voice cracked like the memory happened yesterday. I couldnt imagine how hard it mustve been to be afraid for your childs life while collections agents breathed down your neck. Sandra says the billing department sought her out even while her son was in the ICU, and that there were so many billing errors that she ultimately asked for an audit.
And yet, Sandra, Larry and Nancy are the lucky ones. They have health insurance, and they have the time and resources to be able to make their way through the bureaucratic hall of mirrors and toward a fighting chance at getting well.
Its this cruel opacity of the private insurance system, on top of the rising monthly costs of just having a plan, that can be the difference between life and death. And it keeps a surprising number of Americans away from the system altogether. Like a rodeo cowboy I met in Texas, whose story youll just have to watch (Im not spoiling it all!). Its also led Americans like Sandra to believe that a massive simplification of our health care system is far overdue.
For many, that simplification comes in the form of cutting out the profit motive and moving toward government-funded insurance, like Medicare for All, which Big Pharmas enemy number one Sen. Bernie Sanders and I hashed out over bagels in a New York City deli.
Ultimately what became clear through my travels is that healthcare in America is often overpriced and even dysfunctional, but its the lack of transparency that can be the most insidious. You pretty much have to be a health care policy expert, or have a loved one who can quit their job to become one, in order to ensure proper help.
Its also strange that in a country that loves the free market as much as we do, we the consumer have no idea how much anything costs when we walk into a hospital. Why would we? Our health is priceless, so we are simply at the mercy of an ineffective system. That is, unless we fight for something different.
Red, White, and Who premieres on MSNBC on Dec. 29 at 9 p.m. E.T.
Francesca Fiorentini is journalist and comedian. She is the host of "Red, White and Who?" on MSNBC and Newsbroke on AJ+. Follow her @franifio.
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