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If we had  a functioning healthcare system, sick people would be able to access care and healthy people would not fear the financial consequences of illness.

We're told by politicians from both political parties that we Americans need to take personal responsibility and buy private, for-profit health insurance. We need to buy this junk insurance when we're healthy and pray we never need to use it.

Pray indeed.A cancer diagnosis even for someone with insurance, is a battle for your life, and a battle to avoid bankruptcy.  Because skyrocketing copays and deductibles put so much of the financial burden on the shoulders of patients, sick people are having to decide treatment plans based on cost, not what may be most medically efficacious.

We live in a country where healthcare is a privilege of the affluent, and for those who still have  employer provided coverage. But employer coverage, long the backbone of the U.S. healthcare system, is unraveling at a frightening pace.

Paul Krugman has a link this morning to an explosive report on the declining number of Americans with employer health coverage.

The report has some very bleak information.

Between 2007 and 2010, the share of children and working-age adults in the United States with employer-sponsored health insurance dropped 10 percentage points from 63.6 percent to 53.5 percent, according to a new national study by the Center for Studying Health System Change (HSC). The key factor driving the sharp decline was the enormous loss of employment during the Great Recession, which officially started in December 2007 and ended in
June 2009.
There is an equally insidious reason why the United States always ranks last of the industrialized nations in healthcare outcomes. It's the huge costs-- the co-pays and deductibles we Americans are required to pay, which make a trip to the doctor a luxury few, even insured Americans can afford.

Deductibles and copays have only one purpose--to place a financial disincentive in front of you before accessing healthcare. If you're required to go out-of-pocket and spend a large amount of money on healthcare, so the theory goes, you'll get good and sick, you'll think long and hard before going to a doctor.  Score one for the insurance industry. This is exactly the behavior they're counting on, when they sell you a product that assigns large first dollar costs to you.

I've been asked why I refer to private health insurance as junk insurance. Here's why. If you are healthy and rarely seek medical care, private insurance is fine if you can afford the huge monthly premium. It's not fine, if you find yourself in a medical pickle and need more comprehensive care. That's when you discover all the costs you will be saddled with.

I haven't been writing much lately because I've been dealing with my own quite aggravating health problems. I am seeing first hand, the huge toll co-pays and deductibles inflict on all of us. If you're healthy and go to the doctor once or twice a year, a $50.00 co-pay may not seem like such a financial burden.  But what happens when you're not going to the doctor twice a year, you're going to multiple doctors three, four or five times a month.  Then the $50.00 co-pay becomes a real obstacle between you and the healthcare you require.

The same is true with the fee most insurers now impose for any surgical procedure. In my case the fee for any surgery is $300.00. When you buy insurance you evaluate the supposed 'benefits' you are paying for, and you get the insurance you can afford, not necessarily the insurance you might need. If you've been relatively healthy, the concept of the fees you will be paying if God forbid you actually need to use the crap insurance is a theoretical exercise in denying that any illness could ever strike you.  But then something unexpected happens and the theory flies out the window. All you think about is the cost of every doctor visit, and will the doctor visit result in tests, hospitalizations, surgery, the list is endless of what the insurer may or may not pay.

This chart explains the problem of cost related access.

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Those of us studying the Affordable Care Act are deeply worried that if the law is fully implemented, the cost of insurance on the newly created exchanges will be prohibitive, and most people will be relegated simply by financial necessity to buy the cheapest product with the least generous benefits.  

Why does the United States consistently rank last in outcomes?  It's because healthcare is rationed based on your ability to pay.  

U.S. ranks last in healthcare outcomes

Who are these people who are being bankrupted by medical bills? Most were solidly middle class before illness struck. Two thirds were homeowners, and three fifths had gone to college. Why did they go bankrupt? In many cases, a breadwinner got sick. As a result, medical bills hit just when income went down, because the breadwinner either lost time from work or couldn't continue to work at all. Those who lost their jobs typically lost their health insurance, too.

More than half of the households bankrupted by medical bills had private health insurance when the bankrupting illness struck. Yet because of high deductibles and co-pays, they ended up owing an average of $17,749 in medical bills. If you lost your job, could you keep your house if hit by a bill of this magnitude?

Rose Ann De Moro, the head of National Nurses United wrote eloquently last month in the Huffington Post about the catastrophic collapse of the U.S. healthcare system.

While the ACA had some undeniable positive elements, such as permitting young adults up to age 26 to remain on their parents health plan, and a few limitations on insurance industry abuses, such as barring them from denying coverage due to pre-existing conditions, our health care nightmare is far from over.

And, as nurses have reported repeatedly the past year, the economic crisis has great aggravated the suffering with broad declines in health status that are directly linked to job loss, unpayable medical bills, and families having to choose between paying for food, housing, clothing or healthcare.

As to the law itself, despite its name the ACA has done little to actually make healthcare affordable. Out of pocket health costs for families continue to soar largely unabated. Nurses now routinely see patients who have postponed needed care, sometimes even life-saving or life-prolonging care, because of the co-pays and deductibles.

Now we all await the SCOTUS ruling. And just to be sure you have a pleasant Sunday, take a look at this report from Kaiserabout what may happen if the SCOTUS rules the mandate unconstitutional.  

There remains only one solution to this national catastrophe and that improved and expanded Medicare for All.

Originally posted to nyceve on Sun Mar 18, 2012 at 10:52 AM PDT.

Also republished by The Democratic Wing of the Democratic Party and Single Payer California.

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