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Nevada Today

Nevada Today is a nonpartisan, independently owned and operated site dedicated to providing up-to-date news and smart analysis on the issues that impact Nevada's communities and businesses.

HealthNevada LegislatureNews and informationPolitical Analysis

Dude, Where’s Our Health Care? – The Cost of Care

health care, COVID-19

Health care can be a very complex and complicated issue. In the last five years, we’ve become accustomed to hearing politicians try to boil everything down to a few buzzwords. 

There’s a steep cost to this kind of refusal to acknowledge the reality we live in. And sadly, far too many Americans face far too steep of a cost just to access the health care they need.

WARNING: Today’s story includes discussion of sensitive topics, including suicide and self-harm. We’re also using a bit of adult language. Reader discretion is advised.
First, a much needed update on my father
health care
Photo by Andrew Davey

Fortunately, my dad made it back home. Earlier this week, he landed in the hospital… again. This time, he was suffering a strange bout of pain and fatigue that got everyone worried.

Following my dad’s heart surgery and subsequent struggles over his post-surgery treatment, he needed two more trips to the hospital to treat internal bleeding. I was worried that he was suffering another round of internal bleeding. However, his test results show no signs of internal bleeding or other severe organ damage.

health care
Photo by Andrew Davey

With that said, his very trip to the hospital yesterday became incredibly melodramatic due to his insurance company’s insistence that he visit a specific hospital in his HMO network. Even though my dad’s primary care physician specifically told him to go to the hospital, and even though my dad traveled to the exact hospital that his doctor and his insurance company requested, that hospital wouldn’t run the tests that the doctor whose office is walking distance from this hospital specifically requested.

In case you’re sensing déjà vu, you’re not alone. After my dad called Medicare and received confirmation of his right to obtain the emergency medical care that his primary care physician recommended, he returned to the first hospital he stayed in immediately following his November 2019 heart attack. At least at this hospital, they quickly checked him in and did the tests that his doctor recommended. That’s why we now know he’s not suffering further internal bleeding, and that’s why he’s now safe at home again.

Can we finally stop trying to shove our entire health care system into the usual misleading memes?
Photo by Andrew Davey

As I vocally complained before the 2020 Democratic Caucus, and as we discussed further during the general election campaign, “choice” can come at a steep price. You might complain about “politicians fucking around” with that super cheap insurance plan you found. But when you find out that “junk insurance” doesn’t cover any of your hospital bills, that’s probably when you change your tune and wonder why you have to start a GoFundMe to pay off those medical bills.

While my dad doesn’t have any kind of “junk insurance”, he faces another problem that sometimes plagues people who otherwise have the “right kind of health insurance”. In January 2020, my dad and his medical team at the third post-heart attack hospital had to file a claim appeal just to get his heart surgery approved and scheduled. In April 2021 he had to call Medicare just to get confirmation that he could do precisely what his primary care physician told him to do, and I still worry about the potential of another claim appeal fight with his insurance company.

For all the right-wing fear-mongering over how a “Medicare for Allsingle-payer health care system would lead to more bureaucracy, fewer “choices”, and more rationing of care, we’re already experiencing the rationing of care and the limitation of patient choices. The main difference is that America’s more privatized system allows private insurance companies to ration health care instead of single-payer countries’ public health authorities making such decisions. And while some rationing of care will probably always be necessary for the sake of a better functioning system that works for more people, our system that outsources rationing decisions to private insurance companies is actually less efficient than other countries’ systems, even in places like The Netherlands that utilize private health insurance, that standardize basic benefits and incentivize lower administrative costs.

No really, drop the memes and ditch the conspiracy theories. Health care is more than just another thing to fight about on Twitter.
Bernie Sanders, health care
Photo by Andrew Davey

Now that we (again) cleared the air on a go-to talking point against “Medicare for All”, we also need to remember why “Medicare for All” alone probably won’t solve all our health care problems. After all, Sweden has a single-payer health care system that has often been considered one of the world’s best, yet Sweden now suffers its own health care crisis because its national government has refused to adopt stronger health safety rules to prevent further spread of COVID-19.

As Vox’s Dylan Scott explained in January 2020, Taiwan implemented a single-payer health care system in the 1990’s that became wildly popular thanks to its very generous guarantees for a robust suite of patient care options. But because Taiwan’s national government did not ensure sufficient tax revenue to keep up with what they essentially turned into a “health care on demand” system, they eventually had to confront thorny issues like what exactly their system can cover, who’s going to pay for it, and who will be there to actually provide all this care.

We also frequently see chatter about the U.K.’s National Health Service (NHS) either providing the “best health care ever!” or the “worst health care ever!” Here’s the reality: The U.K.’s NHS regularly beats America’s mostly private health care system on overall quality of life metrics, yet some Britons complain about wait times at clinics and longer waits for surgeries at the hospital because the system is focused on the overall quality of care for the entire population. The NHS goes beyond just single-payer health insurance to provide a wholly public health care system from top to bottom, it has a very public and universal rationing system in place to set prices and decide on treatment availability, and it only functions as well as Britons are willing to fund it

So what’s being done about the weaknesses in our health care system here?

Last night, President Joe Biden delivered an official address to a joint session of Congress and called on them to take up the American Families Plan that he unveiled earlier this week. The $1.8 trillion American Families Plan includes major health care policies like the permanent expansion of the American Rescue Plan’s enhanced patient premium tax credits that are currently in place through 2022, and a new national paid family and medical leave program that provides up to $4,000 for workers in need.

Closer to home, State Senator Nicole Cannizzaro (D-Las Vegas) has introduced SB 420 in the Nevada Legislature to establish a sort of public option for patients to access through Nevada Health Link. More specifically, SB 420 would require any and all insurance companies that want to offer insurance plans to Medicaid recipients to offer similar plans to individual consumers and small businesses through the new Nevada Public Option program. While it’s not the same public option plan that the Legislature passed (and then Governor Brian Sandoval [R] vetoed) in 2017, and it’s not exactly the same Medicaid-based public option that U.S. Senator Jacky Rosen (D) endorsed in 2018, SB 420 at least holds the potential of providing more patients the kind of insurance that delivers more health care with lower administrative costs thanks to the federal government establishing baseline standards for Medicaid patient care and system costs.

While both of these proposals fall short of more ambitious policy ideas like “Medicare for All” single-payer health care and global budgeting to set hard caps on health care expenses, we’re at least seeing top Democrats at the federal and state levels push policies that have potential to lower costs for more people. Now they need to prove they can deliver the goods, as thousands of Nevadans and millions of Americans need such solutions to actually materialize soon.

Ugh. Here’s where I need to talk about myself.
COVID-19, COVID-19 Vaccines, vaccine science, health care
Photo by Andrew Davey

In the past, I’ve opened up about my own mental health struggles. Earlier this week, I didn’t respond well to my dad’s latest health scare. In fact, I actually had to take my own advice and message into the Crisis Text Line because I was starting to spiral pretty hard. Yet at the same time, I also grew more afraid… of potential hospital bills. Quite a few times in recent years, I worried about what would happen if I attempted suicide, failed, landed at the hospital, and finished with an enormous hospital bill.

How fucked up is it that I have more fear of a hospital bill than I do of suicide? What’s even more fucked up is that I’m one of the fortunate ones: I have Affordable Care Act (ACA, or Obamacare) compliant health insurance, and my insurance plan caps hospital bills and other out-of-pocket patient costs.

As we discussed last month, one of the greatest barriers to mental health care is potential patient cost. And as the old saying goes, talk is cheap… unless it involves talking with a licensed mental health professional. When it’s easier for people with mental health struggles to access deadly weapons than actual mental health care, we should realize that we have a serious problem on our hands.

Conclusion (for now)
COVID-19, COVID-19 Vaccines, vaccine science, health care
Photo by Andrew Davey

Between my dad’s health scare and my own struggles this week, I’ve faced personal reminders of the real challenges that remain in America’s health care system. And as the Commonwealth Fund’s 2020 health insurance survey reminded us, one of the greatest barriers to care is simply the cost. 

For so long, so many politicians loved to boast of “American Greatness”. Yet while they were boasting of “American Greatness”, many of us noticed Americans seeking help with their medical bills at GoFundMe. How exactly is this “great”? And if we can all agree that this not-exactly-silent crisis of care is anything but “great”, when will we actually act to prevent further loss of life and livelihood to something like health care costs that we have the ability to address?

If you or someone you know is facing a major life crisis and struggling with thoughts of suicide, help is available. The National Suicide Prevention Lifeline is always there at 1-800-273-8255 (TALK). So is the Crisis Text Linewhere you can start a conversation with a volunteer counselor by texting “START” to 741741. And for LGBTQ+ youth in need of immediate help, the Trevor Project has a 24/7 hotline at 1-866-488-7386 and a text option (text “START” to 678678) available.

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