Now I am the first to admit that I am no scholar of Obamacare, or what other countries offer for state/national insurance. However, I do know that what we have is a culture in which those who rely on state-issued insurance (in NY, it's Family Health Plus, Child Health Plus, and/or Blue Choice Option depending on one's income level) are looked at as less than, and do not have access to equal and humane health care.
I am not a scholar of insurance, and I get bogged down in the SCOTUS arguments, but I do know that I have been using Medicaid and state insurance on and off since I was an adolescent and I want to relate my own experience of a parent who has had to watch her children get substandard care, or be refused medical care because we are not middle-class enough to afford private insurance.
There are a few things about this:
1. Many doctors refuse to take Medicaid patients at all, or have those less experienced in their practice or hospital care for those patients.
2. Private insurance companies AND Medicaid are able to negotiate fees with medical providers, whereas it is almost impossible for an uninsured patient to enter into those same negotiations, thereby having to pay much more for services than the provider would get paid through insurance.
3. Medicaid is a pain in the you know what to work with for doctors, so I kind of understand that they don't want to deal with the hassle of fighting to get paid for their services, so the state insurance system itself is partially at fault for all of this - but who suffers for it?
4. Private insurance is ridiculously expensive. The last time I had the opportunity to purchase it through my employer, it would have cost over $500/month to insure my family. And I was making just enough too much money to qualify for Family Health Plus. So we had to go without insurance. This is not an isolated case.
5. The hoops you have to jump through to qualify for state insurance are confusing. I have been told confidentially that they are purposely difficult. If you are self-employed, you can pretty much forget it for at least the first year. Paperwork gets "lost," phone calls are not returned, caseworkers are abusive.
6. My family has been refused treatment by a number of doctors, "misdiagnosed," and treated poorly by more office staff than I care to remember, by virtue of having Family Health Plus, rather than private insurance. Does that sound paranoid? I assure you, it's not. I have spoken with a number of trusted medical professionals who assure me that this is the norm, and I personally know many families who have had this same experience, both in Pennsylvania where I lived for 30 years, and here in NY state.
The last time I lived in Monroe County, my caseworker was so abusive and mismanaged our application and renewals so badly, that I tried to work with her supervisor. He never returned any of my phone calls, the caseworker's voicemail was always full, which bounced me into a neverending loop of "press 0 to talk to an operator," which went to another menu, which returned to original menu, which eventually hung up on me. I eventually ended up having my case managed through the County Commissioner's Office, because even the ombuds(wo)man was unable to untangle the knots of evasion and abuse that were happening in the Assistance Office.
Now, I'm white, college educated and pretty savvy. I can't imagine what it's like for the many city residents who are black or hispanic, uneducated, cannot advocate for themselves, and don't know how to bark up the food chain for fair treatment based on their income. I mean, I only knew to call the Commissioner's Office because my mom is a retired nurse and knew what the next step was. It's certainly not published anywhere easily accessible that this is an option.
This is only going to (and I'm sure has) become worse, as unemployment rates hover around 10%, businesses stop offering insurance benefits, and private insurance options have not caught up to Obama's vision of affordable health care. The system is surely flooded and overwhelmed, and is filled with untrained folks who have grown up in a culture of racism and prejudice against the "poor."
Since my husband is self-employed, and I've worked a variety of part-time jobs while finishing my BA and M.Div, we have been using state insurance in all its varieties (paying some, paying nothing, going uninsured) for almost 10 years now. The latest frustration was that my daughter had a defect in her tooth, and getting it taken care of in a timely fashion, with competent medical professionals was a long, arduous, humiliating, and frustrating experience. I could not be more grateful to be getting health insurance through my chaplaincy residency in September. But wait! Even that won't cover the dental care two of my children need without bankrupting us with thousands of dollars in co-pays! So, I still have to go back in and apply for supplemental state insurance to assist with that.
There are very few dentists, and almost NO pediatric dentists that take state insurance in Monroe County, where we now live. There are exactly ZERO dentists in Wayne County where we lived for 4 years, so those folks must travel to another county to get dental care. For a number of years, adult state insurance didn't cover dental care at all. A year ago was the first time I was able to go to the dentist for a regular check up in seven years.
We are lucky to have found a wonderful pediatric dentist who takes a conservative approach to dental care, and is kind and patient with my kids. However, my daughter's tooth required a root canal, and there are NO pediatric or other endodontists that take state insurance that she could refer us to. We could go to the dental clinic, but it's first come, first serve (requiring hours of waiting) and our dentist assured me that the head endodentist, while excellent, does not see Medicaid patients and that we would have to see a resident, first-come first-serve, which means that though they are supervised, they may have very little experience with the kind of care a person might need. I don't have anything against residents myself (being one), but I do have a problem with a supervising doctor creating an atmosphere of discrimination against Medicaid patients with their staff and residents.
I also know that one can get great care at the dental clinic - and one can get abysmal, dangerous "care" there, and that the supervising attending is not always present.
Eventually, after an all-night ER experience, where I had to fight for pain management for my child, educate the on-call ER dentist (who had very little pediatric experience) that whatever it was that he might choose for his child didn't apply to me because he had awesome private insurance and I don't - and by the way, he's now working in a city hospital with an economically diverse set of patients, so he might want to eliminate the phrase, "If it were my child," from his vocab until he goes into private practice - and eventually have an adult molar removed, because the damage was so advanced, we are now looking at the necessity of orthodontic intervention (again, with huge co-pays) to avoid other damage to her teeth because she couldn't get timely care because we have state insurance. (I apologize for that astonishing run-on sentence).
The point? My story is not an anomaly. As a matter of fact, my story is probably better than a lot of people that live in this city and state and country, because I'm a pain in the ass and can politely demand what I know is reasonable, humane, and ethical for my children's care without getting thrown out for my skin color, accent, or other identifying features. My point is that my story, while better than many others, still sucks. Health care in this country is a hot mess.
My other point is that it's not just "poor, white trash," or "blacks" or "hispanics," who are "lazy and milking the system" who are using state insurance. It's many, many people, of all races and means who have been effected by the global economic collapse, whose employers find ways around offering benefits, who fall between the cracks because they work part-time in the food service but still make too much money to qualify for assistance. It's time to stop making assumptions about "the system" and those who use it. It's time to start treating all people with respect and dignity - because we really don't know the whole story 99% of the time. And after all, we are the 99%.