The sad-but-true reality is that health care in America is rationed not by medical needs, but by income. Those with means have access to care at a minimal cost because of their eligibility for or ability to afford health insurance, while those who subsist on minimum wage incomes with no health insurance fend for themselves, often forsaking preventive care because of the substantial costs involved.
There is a young woman — she’s probably 25 — who cleans my house in Down East Maine one afternoon every two weeks. In the mornings — early mornings — she works as a stern man on a lobster boat, removing lobsters from traps and rebaiting the traps for resetting. It’s a strenuous job for anyone, much less a woman who weighs probably 100 pounds soaking wet.
Betty (not her real name) has a live-in boyfriend, and they’ve been together for some years. He is a carpenter and finds work sporadically. Both earn minimum wage, and neither one of them has health insurance.
Betty discovered a few months ago that she was pregnant in an unplanned sort of way. She and her partner weighed the options. Without health insurance, having the baby, given prenatal care and delivery costs, will cost the couple at least $20,000, assuming there are no complications. A premature baby might run $40,000, maybe even more, depending on the complications involved. Betty’s other option was a $600 abortion.
She has decided to have the baby, the costs be damned. “I know I’ll be paying the hospital $100 a month, or whatever I can afford, for the rest of my life, but that’s OK. I want this baby,” she says.
It’s regrettable that America has such a dysfunctional health care delivery system that women without means are put in this position. Have an abortion, or have a baby for 33 times the cost of an abortion.
If Betty lived 100 miles up the road, in New Brunswick, Canada, the cost of having a baby, premature or not, would be $0. That would also be the cost of an abortion. Clearly, she would be paying higher income taxes for that medical care entitlement, but she wouldn’t find herself in debt for years to come as punishment for wanting to be a mom.
Every health care delivery system rations care. In America, it’s rationed by income. In Canada, it’s rationed by waiting times, although those with life-threatening needs go to the front of the Canadian medical care queue. Meanwhile, even Americans of means are forced to endure a health care delivery system that reflects dismal results in terms of outcome, including truly dismal results with infant mortality.
Compared with five other developed nations — Australia, Canada, Germany, New Zealand and the United Kingdom — the U.S. health care system ranks last or next-to-last on five dimensions of a high-performance health system: quality, access, efficiency, equity and healthy lives. The U.S. is the only country among these six countries without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes.
The irony of the endless national political debate over “health care reform” is that no effort is being made to reform health care, in terms of quality of medical care and outcome of treatment. All this movement is hoping to achieve is enrolling more people into a health care system that is badly broken. It’s akin to pulling a train into a station, encouraging those on the platform to climb aboard, while failing to recognize, much less do anything about, the fact that the last four cars in the train are on fire.
It seems clear that the only way to survive the American health care system, both physically and financially, is to do everything you can to stay out of it.
Tom Walsh of Gouldsboro is a medical and science writer and a member of the National Association of Science Writers.