Health Care Taking a Financial Toll on Americans
Envision San Diego & KPBS Special Report
Wednesday, February 25, 2009
SAN DIEGO Tonight, on Envision San Diego and KPBS' special program Right to Health, you’ll meet a woman who tried to refinance her house to pay for an MRI, and a man who went blind because he couldn’t afford to see a doctor. And we’ll tell you about a patient whose care in a hospital cost more than a million dollars – he can’t pay, the government won’t pay. So just who’s picking up the tab? You’ll be surprised.
These stories replay themselves in just about any city in America. It is the fallout from a privatized health care system that is bloated with administration costs.
Would universal health care make us healthier?
We asked the Canadian Broadcasting Corporation to help us answer that question.
Here is the CBC’s Waub Rice in Winnipeg, the coldest big city in the world, right in the middle of Canada.
Waubgeshig Rice: Hello, Joanne. Canadians have had universal healthcare for more than 50 years. We don’t call it socialized medicine here. Doctors remain in private practice – only they don’t bill their patients, they bill the government for their services.
Tonight, I'll tell you how people cope when they have to wait, and you'll meet some seniors who say they would never trade universal heath care for American-style medicine – but they would like to see some changes here in Canada. Joanne.
Joanne: Thanks, Waub . I’ve lived on both sides of the border. There is a great mythology that surrounds the American healthcare system in Canada – and one that exists here too about the Canadian system.
There is the belief that America will leave you to die on the street if you can’t pay your hospital bill. And here in the U.S., many believe in Canada you may die waiting to get care.
So let’s begin there. What happens here in San Diego County when you don’t have health insurance and you don’t have any money? Meet Leigh Anne Brady.
Fifty-two year old Leigh Ann Brady loved being a waitress. But she hasn’t worked for more than a year. She has back pain and can’t lift her arms above her head.
Leigh Ann Brady: I could no longer carry the plates without severe pain, shaking.
Brady needs an MRI to know what’s wrong with her back. But like 46 million other Americans – that’s one in seven – she doesn’t have health insurance and can’t afford to pay for the test.
A few years ago, Brady even tried to refinance her house to pay for an MRI. She couldn’t. She had bad credit.
Brady: If I needed back surgery right now, forget it. I mean, I’ll probably wind up crippled.
Dr. Gordon: I actually think her shoulder would get much better if she could have surgery.
Dr. Jeoffry Gordon is Brady’s doctor. He sees her regularly for about $15 a visit – about one tenth what a doctor could bill for an office visit.
Dr. Gordon: So it’s this gap. This—what I would only call—shocking gap…
Gordon lectures other doctors on what’s wrong with America’s healthcare system.
Gordon: It’s set up to make money for insurance companies and pharmaceutical companies and surgical instrument companies.
According to the California Medical Association, private health insurance companies made more than four billion dollars in profit last year and spent another 6 billion on administration costs.
In this country, if you have the money or good insurance you’ll virtually never wait for something like an MRI. But if you’re broke, you’ll never even make it on a list.
Gordon: Don’t get sick in America that’s the way it is.
Doctor: Nice deep breath.
If you do get sick in America, and you don’t have insurance, you will probably end up here. In the emergency room. A federal law requires all emergency rooms to treat patients regardless of their ability to pay.
As a result, emergency room doctors are seeing patients for illnesses that should have been diagnosed and treated by primary care doctors.
Dr. Kirk Raeber: Such as renal disease, heart disease, diabetes, hypertension that could have probably been prevented had they had ongoing health care. They could have probably prevented them from coming in with this acute problem and a huge bill and hospitalization.
We met Betty Anne Bayliss in the emergency room. She has insurance, but it only pays for her breathing medication for ten months a year.
Betty Anne Bayliss: I can’t afford it too much so I have to skip one day, two days, three days, four days at the most of my medicine.
Making the problem worse is the increasing cost of health insurance. Premiums have nearly doubled in the past eight years. And that’s affecting the middle class. Their employers are dropping them from health care plans or their premiums are so expensive they’re dropping out on their own.
Dr. Gordon supports a publicly funded health care system like Canada. He tells the story of his Canadian friend’s son who hurt his knee in California and didn’t have insurance.
The doctor’s advice, fly home to Canada.
Reporter: I bet you people in Canada are saying, “I wonder how long he waited to have his surgery.”
Dr. Gordon: Waiting is much better then going without or going broke or going bankrupt or having to take money from you home equity or your kids college fund to pay for you medical care.
Joanne: More than half of all bankruptcies filed in the United States are triggered by medical bills. Evidence the system takes its toll financially. But are we healthier in the U.S. than Canada? We took a look at a very common disease caused by an even more common condition…diabetes and obesity. The statistics tell us we’re the fattest nation in the world. And it’s making us sick – even blind.
Jeannie: For a diabetic, bacon does not count as a meat.
Every Monday, at this support group at the Center for the Blind, Armando Carrillo learns about what he shouldn’t eat to control his type-2 diabetes. It’s information he should have had years ago – information that could have saved his sight.
Maria: It was a slow thing…he slowly lost more vision.
Carrillo was working at a California restaurant back in the 90’s when he got sick. He was weak and constantly going to the bathroom. For years he didn’t see a doctor because he didn’t have insurance. He was finally diagnosed with type-2 diabetes in an emergency room when he hurt his knee.
Soon after, Carrillo went blind.
Jeannie Teague: At least Armando has his life still. And so many of the people who have come through this center this was fatal to them this lack of insurance.”
Type-2 diabetes is preventable.
In the U.S., one in 13 people are affected by the disease. Among the Latino population that rate is even higher – one in ten.
Obesity – one of the main causes of type-2 diabetes.
The U.S. is the fattest country in the world. In just one generation, obesity rates have doubled, tripled among children.
Dr. Jerry Phelps, UCSD Wellness Center: What we’re seeing now is cardiovascular disease in teens, and that is very scary.
Fast food and TV contribute to our waistlines…
So does all this sitting in traffic.
And as the economy struggles, it’s becoming more difficult for Americans to buy healthy food.
Dr. Phelps: For example, a hamburger costs less than a veggie burger or a turkey burger.
On average, people living in low-income neighborhoods have five fast food outlets and convenience stores near their home – twice the number than their more affluent neighbors.
Obesity rates are higher in America than in Canada – especially among women.
And despite the year round good weather, and access to all this, more Californians are overweight than in Manitoba, Canada – where cold weather and snow keep people indoors six months a year.
Experts say it may come down to healthcare and a simple visit to a family doctor.
But government programs like Medicare don’t kick in until people with diabetes are on dialysis.
Carillo: My brothers…my aunt…my uncle…my mother…
Carrillo lists all his family members who also have diabetes. He’s learning now why the disease has affected his family.
And now that Carrillo’s blind and had a kidney transplant, he has two government funded healthcare plans.
The irony of the American healthcare system is not lost on a man who worked all his life but couldn’t afford to see a doctor to prevent a disease that, in the end, cost him his vision and a kidney – and now costs the government tens of thousands of dollars in care and disability.
Joanne: The U.S. spends more money than any other country on healthcare. But it’s not buying us longevity. Canadian men and women live at least two years longer than Americans. We wanted to speak with Canadian expatriates living in San Diego about which healthcare system they preferred. Where do you find a Canadian in California? At the hockey rink, of course.
This isn’t hockey night in Canada. It’s hockey night in Escondido, California.
Joanne: Who’s from Canada?
Almost all of the Scorpians are Canadian, a handful from Winnipeg.
Many have spent time in American hospitals.
Doug Frost: We’ve all been cut playing hockey, and you go the wrong hospital, if you’re just new…
When they’re asked about which country has better health care – Canada versus the U.S.? – There’s no clear winner.
Rob Kerr moved here years ago from Alberta. His 22-year-old daughter can’t get insurance because she once had a benign cyst on her ovary.
Rob Kerr: So now it’s a pre-condition. So she can’t get healthcare anywhere.
Geoff Liebl: That’s the difference we were talking about, who falls through the cracks?
That’s Winnipegger Geoff Liebl. He’s an immigration lawyer.
He moved to San Diego 15 years ago and has a successful law practice helping thousands more Canadians immigrate to the U.S.
Geoff: Canadians biggest fear moving to the States is without a doubt the healthcare system.
But it’s a misconception that is usually cleared up when they visit an American doctor or see the inside of an American hospital.
Liebl’s first experience with the healthcare system happened just months after he arrived in the States. He had pain in his leg for weeks. When he finally saw a doctor, he learned he had a blood clot.
Liebl says if he’d been living in Canada, he probably would not have seen a doctor. He assumed he’d have to wait weeks or even months for an appointment. And that could have been fatal.
Geoff: As a Canadian growing up, I feel that everyone should have access to healthcare and the last thing you want to be worried about when you’re sick is, “How am I going to pay for it?” Or “What am I going to do? Am I going to get a hundred thousand bills?” But you also should have access to good healthcare, immediate healthcare. There’s no point in having free healthcare if you’re going to die waiting for it.
Canada spends about 10 per cent of its gross domestic product on health – the U.S. 16 per cent. But one out of seven people in America has no health coverage.
Jan Spencley, Executive Director of San Diegans for Healthcare: A lot of people will not agree with me on this, but I’m gonna tell you healthcare should be a right for every American.
But not the way they do it in Canada, Jan Spencley says. She’s a former hospital administrator turned advocate.
Jan: I don’t want to wait a year for an MRI like Canada does, and I don’t want my father, who needed hip surgery, to wait for more than a year for hip surgery because it was debilitating. So I think that we have to not—First of all, I don’t use Canada as the only model. I think we have to be picking and choosing what fits our culture and our world.
Doug Frost: I think it all comes down to is it a privilege or is it a right? I think in Canada they see it as a right, here we see it as a privilege.
Leibl believes health care is a right – but like a lot of Canadians accustomed to waiting, feels privileged he has immediate access to care here in San Diego. It’s something he wishes for his parents back in Canada.
Geoff: Sometimes I get the urge to say, get on a plane and get on down here and we can get that treatment down here quick and then you take the results back home and have them deal with it. They haven’t done it yet, but I can see it happening.
Joanne: Now, a story about a man who, after spending a year recovering in a hospital, made his way to the top – as president of one of San Diego’s largest healthcare provider. Chris Van Gorder is president and CEO of Scripps Health. And just wait until you hear what he has to say about healthcare in America.
With five hospitals , 10 clinics and 12,000 employees,
Chris Van Gorder: Morning. Morning.
Chris Van Gorder runs one of the largest corporations in the county.
Chris: Hi guys. Good morning, sir.
Scripps Health is a non-profit healthcare provider.
Today, Van Gorder is sharing some good news with his employees.
Chris: So what do you think, top 100?
Scripps has made Fortune Magazines list of top 100 companies to work for.
Chris: Mayo Clinic is three below us.
It’s been an unconventional road to the top for Van Gorder.
He started out as a police officer, but was critically injured on duty. Van Gorder spent a year as a patient, and eventually left the force and changed careers, working his way up in the world of hospital administration.
Chris: So I really started in this business as a patient. So I had a, I guess, a fairly unique perspective on healthcare.
When Van Gorder sat down to tell us about his perspective on healthcare, he was direct. The system in place now, isn’t working. It’s full of gaps and has left hospital emergency rooms holding the bag.
Chris: I mean, we really do have a national healthcare system. It’s called the emergency room but it’s a very expensive way to get healthcare.
By law, emergency rooms have to treat people regardless of their ability to pay. According to a San Diego study, nearly half the people in emergency rooms could have seen a family doctor instead.
Chris: But we literally have generations of families that believe the emergency room is their doctor’s office because their parents got care in the emergency room, so their children now get care in the emergency room because no one else will take care of them.
This kind of treatment is expensive. Scripps absorbed almost 240 million dollars in medical bills that were never paid last year.
Other hospitals in the county report similar costs. Sharp spent more than 257 million dollars on unpaid care.
Van Gorder tells the story of a 63 year old man who walked into a Scripps emergency room almost three years ago. His diabetes was so out of control he needed his leg amputated. He spent a year recovering in ICU. He had no insurance.
Chris: Cost us over a million dollars to take care of this gentleman. That’s at cost. A million dollars.
The story doesn’t end there. The man had no where to go when he was better, but wasn’t well enough to live on his own. So Scripps paid for the patient to live in nursing care…at a cost of 86,000 dollars a year.
Chris: I mean, this is a gentleman that, because there is no other program in this country that will take care of him, and he came to our hospital emergency room, we have now had to assume responsibility for his life and we could be caring for his care, unless another system develops, for the rest of his life.
Those costs eventually get passed on to people who do have insurance. It’s just one of the reasons hospital fees are so expensive these days and insurance rates are climbing.
Van Gorder believes health care would be cheaper for everyone if everyone had health care. That is, a more regulated system that allowed everyone to buy in at affordable rates.
Chris I can’t imagine looking at somebody that needs healthcare and saying, “Oh, I’m sorry. You don’t have healthcare. I’m just gonna leave you now.” You can’t do that as a healthcare provider. These are human beings that have a right to healthcare because we have the ability of delivering that healthcare. The issue isn’t the desire of providers to give care. It’s the economics of healthcare. That’s the problem. We need to fix the economics of healthcare.
If America’s healthcare system is broken, how do we fix it?
It’s something President Barack Obama has had a lot of time to think about. His mother died from cancer at 53. While on the campaign trail, Obama spoke often about her battle with insurance companies.
Now he promises to change things. He says his plan would save the average family money on their insurance premiums -- about $2,500 dollars a year.
And, he promises affordable access to everyone.
President Barack Obama: If you don’t have health insurance, then what we’re going to do is to provide you the option of buying into the same kind of federal pool that both Senator McCain and I enjoy as federal employees, which will give you high quality care, choice of doctors and lower costs because so many people are part of this insured group.
The President admits his plan costs money. But in the long run, Obama says, a more efficient system that includes a greater pool of people, with government negotiating premiums, is a system that will be cheaper and more equitable.
For KPBS and Envision San Diego, I’m Joanne Faryon.