When I went to the hospital with a swollen hand the size of a baseball mitt, I noticed a flaw in the Romney-Ryan platform on health care.
One of Romney and Ryan's fundamental ideas is that consumers should help control health-care costs. If consumers had to shell out more than a co-pay or a deductible every time we had a swollen hand or a sinus infection, maybe we'd cut costs and shop around. That's why, according to recent analysis by Reuters, Romney is likely to expand types of health coverage that make consumers more responsible for their medical spending--like health savings accounts and high-deductible plans.
But it's hard to be frugal when your health is stake.
I already do most everything I am supposed to do to stay healthy, which typically keeps my medical bills low. But the problem that sent me to the hospital was not about exercise and green leafy vegetables. It was bad luck and a split-second lapse in judgment a few weeks ago, when I reached out to stop my cat from lunging out the back door to fight with a neighbor tom--and she bit me.
I bought myself a visit to the doctor's office right away and started taking antibiotics. Twelve hours after the bite, an infection had spread to the lymph node in my armpit. I tried to save money by going to an urgent care clinic. But they kicked me down the road to the emergency room, where I got an intravenous dose of antibiotics. It didn't work. A day and a half later, I was at risk of developing an often-lethal systemic condition called sepsis, and my doctor dispatched me in a cab to the hospital. I stayed for three days. Total cost--more than $13,000. My out-of-pocket costs--nearly $2,000, after getting a check from my employer's reimbursement program.
Though I have a generous health plan, it's still a financial hit for my husband and me, living on the modest salaries of a social worker and an editor. A decade ago, in the underemployed moments of my 20s, the costs would have made me think twice about making even the initial doctor's office visit. I might not have understood the risks. I might have iced the wound, taken ibuprofen, and hoped for the best. And I might have died.
Cost is a disincentive to see the doctor. In the RAND Corporation's 1982 Health Insurance Experiment, still the most significant long-term study of the effects of health coverage on individual decisions, patients who had to pay a portion of their health care costs more often avoided preventive care (e.g., women got fewer pap smears). And poorer patients were even more likely to risk their health to save money. Low-income children without access to free care were 44 percent less likely to get treatment for severe medical problems. A 2012 Oregon study reported similar results: low-income adults who received Medicaid reported feeling mentally and physically healthier and were more likely to get cholesterol checks, mammograms, and tests for diabetes. A recent study by RAND showed that consumer-driven health programs that require out-of-pocket spending, such as health savings accounts, led people to cut back on preventive care.
There are more preventable deaths in the United States than in 16 other high-income nations--nearly twice as many deaths per 100,000 people as in France, which spends about half as much per capita on health care. The reason for the United States' poor performance, according to the researchers, is lack of universal health coverage.
Romney and Ryan imply that it's liberating to get the government out of your health care. They want consumers to cover more of the costs of regular medical expenses, like check-ups and routine doctor's visits. They say their plans to cut Medicaid funding and roll back the Affordable Care Act will help control costs. But that simply means Americans will shoulder more of the burden--12 million more people will be uninsured, say researchers with the Commonwealth Fund, many of them children and low-income families.
The more we cut public health services, the more we require Americans to cover the high-costs of medical care, the less likely they'll be to make decent health choices when they're sick and money is tight. And there's nothing liberating about that.