Last month, Steven Brill published an article, "Bitter Pill: Why Medical Bills Are Killing Us," which directed national attention to our health care system in a more serious way than has been the case since the 2009 debates over the Affordable Care Act (Obamacare). It was a nuanced, comprehensive, and thoughtful account of a broken system. Yet unlike many political issues, health care is one that impacts all of us, all the time, whether or not politicians and pundits are addressing it. Every day, people live, suffer through, survive, and die in the health care system.
As such, health care is discussed in all the conversations I have with folks across Ohio. I want to share an excerpt from one of these conversations that comprises almost all of the trends I have encountered: resistance to insurance, prohibitive costs, misinformation, unhealthy habits, acceptance of assistance, decades-long illness, and dependent adult children. To consist of all the trends means to contain contradictions. This conversation does just that. And still, it is a very typical one.
Paula and Billy are from a bucolic small town in southwest Ohio. Billy works full-time as a truck driver and part-time as the caretaker on a nearby farm. Paula works full-time as a secretary at an accounting firm in the nearest city. They have three children in their twenties, all of whom have their own children, and only one of whom is married. Paula and Billy intermittently house, pay the bills, and buy groceries for their kids in times of need. That is, in part, why their savings account is empty.:
Paula: We definitely vote, yes. I make him and the kids vote too, haha. I don't have a party I vote for in particular; I vote for who I feel I like the most. So, I'm independent. This year I went Republican. Health care is out of this world. I want the freedom of choosing. I don't like being told by government that I have to have something, because it costs me and that's hard. It's asking for me to put up more money, and where are we going to get that? I have an HSA account through the firm. Our deductible is high: five thousand dollars. With accounting there are a lot of heart problems and stress. Our firm has thirty-five people in it and we've had several people that have had heart attacks and surgeries, so our insurance, it's really high. Billy doesn't have any health insurance; we have to pay as we go. I told him, you can't get sick and if you do you have to die, haha. It's a terrible way to look at it.
Billy: No, never had health insurance. Oh ya, I've been sick, but not bad enough to go to the hospital. I don't do doctors appointments. I'm not going unless I have to. Last time I saw a doctor? I don't know. They just tell you stuff you don't want to hear.
Paula: Now that we have to get health insurance, I'm looking into it. But it would be another very high deductible. And my office provides that so that's why I have it. I've had cancer before, yes, I've been sick. So thank goodness I had it. I had cancer 25 years ago. Got that taken care of, it was thyroid cancer. I'm on medicine all the time for that. I have asthma. So I'm the sickly one, and he's like a horse, haha. Knock on wood. But I'm looking into the insurance because we're going to have to have it or be fined $1,400 and then it continues to go up. But to look at it and okay, be fined $1,400 a year versus paying $3,000 a year for insurance... I don't know. He's a smoker. So to try to get insurance for a 51-year-old smoker, smoking up to a pack a day... I tell him daily to slow down. He goes full throttle. He's not listening to anyone but himself.
Billy: Some days I might just smoke one cigarette. I smoke a lot while I'm driving.
Paula: My son has health insurance through work; he has that. My two daughters are on the low-income bracket so they have government assistance for health insurance.
Billy: We're the ones who are messed up! And we keep passing out the money. This picture just ain't right.