I just read drchelo's very moving diary about his/her work with a charity clinic and s/he mentioned that Thursday is "health care change" night at dailykos so I thought I'd share my story.
I spent 1995 through the fall of 2006 in the ranks of the uninsured. During those years I grew angrier and more frustrated over the state of health care in this country. I finally got health insurance late in 2006. That's when I really got angry.
I was uninsured for over 10 years, not because I couldn't or wouldn't pay for insurance, but because not one company would sell me a policy. I was in grad school until 1995 and during those years was able to purchase an affordable student policy. After I left school and became self-employed, I discovered I couldn't get insurance. Since I was an individual and not part of a group, insurance companies weren't required to offer me a policy. And because I was overweight, no one would. I tried company after company and was told no every time. Several told me flat out that no insurance company would write an individual policy for someone with my height/weight ratio.
So for the next few years, whenever I had to go to the doctor, I paid cash. On the rare occasions I had to have expensive tests (CTs, MRIs) would be expected to come up with several hundred or several thousand dollars. I generally tried to negotiate with the hospital's billing department ahead of time, and sometimes (rarely) I was able to negotiate a reduced rate if I agreed to pay the entire cost up front. I often asked about paying the amount charged to insurance companies rather than the amount charged to individuals who self-pay and was told a flat no.
Then something incredible happened. In the fall of 2006, for reasons I still don't understand (but which, as it turns out, saved my financial future and possibly even my life as I would find out in December 2007 I had cancer) a major insurance company offered an open enrollment in my state. Between September and November 2006 any AL resident could sign up for Blue Cross, no questions asked, no restrictions. I had pulled up the website and was filling out the form before the commercial finished airing, my fingers were trembling. When the insurance card came in the mail I actually cried. The deductible was a little high, and I had a year before any pre-existing conditions would be covered, but I was insured.
The change was immediate. Automatically the cost of my prescriptions dropped by $5-$20 each -- simply because I had an insurance card. Not that Blue Cross was paying any portion of it, of course, just that they had negotiated a cheaper rate with the pharmacies. At the doctor's office I no longer had to pay the $60 - $150 for a visit, I paid what Blue Cross had negotiated, usually around $40 (until my deductible was paid). The mammogram I'd previously paid over $100 for was now $29. For the first year I was insured, Blue Cross never paid a single claim for me, not one cent to my pharmacy or to any doctor or for a single test, and yet I was charged hundreds less than I'd paid before.
The discrepancy between what someone with insurance is charged vs. what the uninsured is charged was really brought home to me once I was diagnosed with cancer. Doctor visit after doctor visit I would see claim statements that said things like
Charge: $900
Ins allows: $350
The most egregious example is the heart cath I had to have just prior to my surgery (as part of making sure I was okay for surgery). The hospital billed over $11,000 for the heart cath. My insurance company allowed just over $2,000 for it and dismissed the rest of the charges. You can bet that if I'd gone in as self-pay and not insured, I would not have been charged $2000 but $11,000.
Of course, the truth is, if I hadn't been insured I wouldn't have been billed $11,000 for a heart catheterization because the cath would never have happened. My oncologist was able to be "very thorough" with my pre-surgery testing only because I was insured. Had I not been, many of the tests he requested would have been turned down by the hospital as unnecessary. During the cath, I actually had a lively chat with my doctor about the upcoming elections. (Note: I don't necessarily recommend engaging your doctor in rousing debate while he's threading a piece of wire into your heart. Just sayin') He claimed that if Clinton won the election he would retire because he wouldn't be able to make any money. I asked him if he didn't care about the uninsured patients who couldn't afford the tests and treatments that might keep them alive. He got indignant at that point (yes, while still threading the wire through my artery) and said huffily that he'd never denied care to a patient in his life. I'm sure he was telling the truth, but as I explained to him, he'd never be in a position to deny care. That happens in the business office before he ever knows of a patient's existence.
Bottom line for me, although I save money every time I pick up a prescription or walk into a doctor's office, simply because I have insurance now, it doesn't make me happy. It makes me furious. The very people who can afford it the least -- those who either can't afford or can't get insurance -- are the ones who are paying the most. They can't go to get a mammogram and say "I'm only paying $30 because that's what those with insurance pay. They have to pay the $100 plus. They're charged $800 instead of $200 for an ultrasound. And those are the ones who can actually get the tests they need. The ones who really can't afford it aren't going to the doctor's office because don't have the cash, and it's a rare doctor who will take a patient without insurance unless they pay up front. No, those people end up going to the Emergency Room and being charged $1000 or so for what can often be handled by a $75 doctor's visit. Of course, many of them can't pay the ER bill, so that money falls back on the hospitals and the taxpayers. It's no wonder trauma centers all around the country are closing because hospitals can't afford to keep them open. ERs have become very expensive doctor's offices where a growing percentage of the patients can't pay. It's a self-perpetuating system that benefits only those at the top of the chain and is simultaneously bankrupting public hospitals and those without access to insurance.
As Barack told his campaign workers after winning the nomination, we have to win. The whole country is counting on us. Whether they realize it or not.