Since the deadly taking pictures of the UnitedHealthcare CEO, Brian Thompson, polarised discussions concerning the US medical insurance system haven’t abated, with 1000’s of Individuals persevering with to share their struggles in having their healthcare coated.
Lots of of individuals from throughout the US shared their frustrations with the Guardian, too, explaining how their lives had been formed by their experiences of attempting to entry healthcare within the US.
Whereas many reported that their well being protection had worsened lately, significantly in 2024, Elizabeth, a 64-year-old retiree from Maryland, already skilled the system’s brutality greater than 20 years in the past, when she lived in California and was concerned in a critical automobile accident throughout a enterprise journey to a different state in 2002.
“I used to be handled at a trauma hospital for 3 days,” she recalled. “My insurer denied protection as a result of the care had not been pre-approved, and since the accident was not in California. It was insane.”
Solely repeated calls by her employer’s head of HR persuaded her insurer to ultimately partly cowl her therapy, she mentioned. “I used to be very, very fortunate,” Elizabeth mentioned. “Medical health insurance within the US is a continuing battle. You’re all the time attempting to get stuff coated, you’re all the time informed that issues are being denied.”
The identical insurance coverage firm later denied protection for the standard chemotherapy drug with which her oncologist wished to deal with her stage 3 breast most cancers, she mentioned.
“My physician persuaded the drug consultant to donate the medicine,” Elizabeth mentioned. “I used to be very sick for 2 years, however I needed to preserve working. My husband had simply been laid off and I had medical insurance.”
After including her husband to her coverage, Elizabeth’s insurance coverage value greater than doubled, whereas the chemo made her so nauseous that she threw up in espresso cups and in her automobile after work, she recalled. “It was very exhausting. After surviving most cancers, I made a decision I needed to discover a job with a college as a result of they must present medical insurance, whereas a small enterprise or non-profit won’t.”
She took two grasp’s levels off her CV to get employed for a college job she was overqualified for, accepting a hefty profession downgrade in addition to a considerable pay reduce she by no means made up once more. “I do know lots of people who’ve wrecked their careers on this method – simply to get medical insurance,” she mentioned.
Individuals from all states, ages and backgrounds shared how protection for prescribed, typically important remedies had been denied, or solely been accredited after prolonged delays and months or years of arguing with the insurer, and infrequently solely with the assistance of authorized counsel.
Scores of individuals reported that their insurer had despatched them automated rejections, ignored correspondence for months, or modified the principles for protection arbitrarily and continuously, strikes they perceived as efforts to evade paying out for claims.
“The exploitation of our system has been so constant and common that the majority of us have way back settled right into a form of realized helplessness,” mentioned Liz, 43, a doctor from Minnesota.
“I work in healthcare and have ‘good’ insurance coverage – we pay $10,000 per 12 months in premiums. We barely use it, so it’s been a reasonably whole lot for my insurance coverage firm. Nonetheless, they didn’t hesitate to cost me $600 additional when my son broke his arm final month.”
Seven years in the past, Liz’s husband was denied a cervical backbone decompression surgical procedure as a result of he was not in ache, she recalled. “I appealed twice by means of the usual enchantment course of and was denied twice extra. Ultimately, I bought the surgical procedure accredited after calling and crying on the cellphone. A humiliating course of, clearly constructed to put on us down till we hand over, whereas we and our family members undergo.”
Though some individuals felt their healthcare was respectable, normally due to beneficiant office medical insurance, the overwhelming majority of respondents mentioned getting protection and accessing therapy was perpetually tough.
Dozens of individuals mentioned that they had needed to foot expensive medical payments regardless of having insurance coverage, amongst them Stephanie Maughan, 68, from Boston, who mentioned she had been saddled with 1000’s in debt after her insurer denied masking medical prices of about $20,000 final 12 months.
“It’s been a nightmare,” Maughan mentioned. “I broke my finger and wanted some occupational remedy. My husband wanted listening to aids. It was all ‘that’s not coated’, ‘you’re out of community’ and ‘it’s important to meet your $2,500 deductible’. It provides up, we needed to take out a mortgage. We’re not poor, however so far as I’m involved we’ve no medical insurance, regardless of paying about $400 a month for a premium coverage. It didn’t was once like this. This nation is in huge bother.”
Scores of respondents who’ve been navigating the US healthcare system for a few years felt that company greed had progressively made the system much less accessible, much less protected, extra exhausting as a consequence of mounting bureaucratic hurdles and costlier over the previous few many years.
“Increasingly more hospitals are run by firms at the moment,” mentioned 64-year-old Thesia, from Houston. “There was revenue earlier than, now they need larger earnings, continuous development. It’s a bit just like the story concerning the frog within the water, and somebody slowly mentioning the temperature whereas the frog doesn’t discover.”
Almost 1 / 4 of US hospitals are actually run by for-profit entities, and by 2021, 5,779 doctor practices have been owned by non-public fairness, up from 816 in 2012.
Thesia, who enjoys a high-end insurance coverage coverage his employer closely subsidizes, feels he’s getting “a great deal” by paying about $5,000 yearly for a most well-liked supplier group (PPO) plan masking himself and his spouse, given the usual of care they’ve been receiving whereas with the ability to freely select their physician.
“For that, the insurance coverage pays 80% and I’ve to give you the opposite 20%,” he mentioned. “This 12 months we paid between $6,000 and $8,000 out of pocket, and I believe that’s honest.”
Some years in the past, nonetheless, when his spouse was actually sick, she was refused protection for an MRI, based mostly on the advice of a physician working for the insurer. “I came upon who the physician was. Not solely was he not a specialist, he was not licensed to follow drugs in our state. I reported this to the insurer. They didn’t reply, they only accredited the MRI,” Thesia recalled, an expertise that chimed with that of many different respondents.
Barack Obama’s Reasonably priced Care Act (ACA), often known as Obamacare, Thesia felt, had improved medical insurance entry for some teams of individuals, significantly these with pre-existing medical circumstances. Others famous the landmark reforms didn’t go far sufficient, complaining concerning the excessive value of Obamacare plans, the necessity for referrals by a main care doctor and the overwhelming complexity of the medical billing system.
“Even after the ACA, well being protection continues to be tough,” mentioned a 59-year-old knowledge scientist from New Hampshire. “I’ve needed to change from my longtime physician as a result of that workplace stopped taking any ACA plans. However even now that I’ve a non-ACA plan by means of my employer, I’ve needed to change prescriptions as a result of insurers select what they cowl. A go to to the emergency room prices over $1,000 and I keep away from getting any additional medical exams as a result of they’re not all the time coated.”
For-profit healthcare suppliers, he felt, have been all the time looking for further methods to extend billing and cut back protection, as an example by having out-of-network specialist suppliers inside hospitals which can be in-network.
“Each single time I’ve used my medical insurance aside from for an annual checkup I’ve paid my portion after which they determined they have been masking much less and I used to be met with a shock invoice months later,” mentioned Marcus, from Texas, who was amongst many who complained about hidden prices and sudden payments surfacing lengthy after they accessed healthcare, starting from enamel cleanings to pre-approved surgical procedures.
Many reported that they struggled discovering a physician after their earlier one had dropped out of their insurer’s community as a consequence of untenable new phrases imposed on them by the insurer, with numerous individuals saying their insurer had requested them to journey for an hour or longer to see a physician they might cowl.
A number of individuals mentioned that they had been unable to search out a physician who was accepting new sufferers, and plenty of mentioned sudden prices now made them keep away from looking for medical assist.
Marta, a 31-year-old from North Carolina, was amongst plenty of individuals who critically in contrast the US system with their expertise of healthcare and insurance coverage overseas.
“In Germany we have been paying far more as a household for insurance coverage, due to our excessive revenue,” she mentioned. “Right here, as a comparatively wholesome household, we truly find yourself paying much less, even with every go to costing about $200.”
Like others, Marta conceded that ready instances to see a physician in different international locations – the UK, Germany and Poland in her case – have been normally considerably longer than within the US.
Lisa Markey, a Briton dwelling in New York, described her expertise of utilizing the UK’s NHS not too long ago as “a catastrophe”. Within the UK, she mentioned, she couldn’t entry therapy for her retinopathy and almost misplaced her eyesight because of this. It was mounted swiftly, she mentioned, upon her return to the US, the place she skilled “extraordinary protection” whereas she had company insurance coverage by means of her employer.
The dearth of upfront pricing info within the US, nonetheless, in contrast unfavourably with experiences of healthcare overseas. “The primary time I went to a physician right here, I believed, ‘Nice, I solely pay my copay,’” Marta mentioned. “Two months later I bought a invoice for $400. It’s a big gamble. I’m grateful that we’re properly off sufficient to not have to fret about the price when going to a physician, but when I used to be incomes much less, I’d suppose 5 instances earlier than getting medical assist.”
Seth Polansky, 52, a solicitor from Washington DC who has a take-home annual wage of about $80,000 and at the moment pays roughly $800 month-to-month for his well being plan, mentioned he had been together with his insurer, one of many largest within the nation and regarded to be one of many least expensive, for years.
“They worsen yearly,” he mentioned. “Till 2018, I’d been on the identical dosage of my medicine for twenty years. Then they determined I might solely have two tablets a day as an alternative of three – it doesn’t matter what my physician argued. This 12 months, they fully eliminated my medicine from protection.”
Two of his long-term docs, Polansky mentioned, had not too long ago moved out of his insurer’s community, as a result of the insurer had modified its contract phrases. “I already need to pay deductible charges of $8,000 per 12 months on prime of my premiums simply to have the ability to use my insurance coverage, however I went out of pocket to see my outdated physician who is aware of me.
“I’m in all probability going to delay my retirement due to these bills. Final 12 months, [UnitedHealth Group] had over $20bn in earnings. How a lot is sufficient?”
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