Posted on March 11, 2003

Need stitches on that gash? Try living without health insurance


By Jamie Smith. Jamie Smith lives in Pearl River, N.Y

March 11, 2003
Chicago Tribune

I don't have health insurance.

Unlike many of the 40 million Americans without health insurance, I could get coverage fairly easily. I am a speech pathologist by training, and it would not be hard for me to get a job with health benefits. But I have three small children, and when the oldest was a baby I decided to do what it took to stay home. What it takes is living without good health insurance.

We live, the five of us, on my husband's modest income. We live simply, in a small apartment. We have no car and we eat a lot of lentils. Mostly, we prefer it that way. I like lentils. The problem is health care.

We practice preventive medicine as far as possible. I breastfeed; I childproof; I serve my family nutritious food; I am a hand-washing fanatic. But breastfed babies can still get ear infections. Toddlers can split their heads open on a worrisome array of innocuous-looking objects. And 4-year-olds can still get pneumonia, vitamin C and hand-washing notwithstanding.

We have almost always had some sort of coverage--cheap policies with high deductibles from companies you never heard of. But we have never gotten a dollar back from one of these policies. We buy them just in case--just in case somebody gets cancer, or falls out of a window, or gets hit by an uninsured driver. When we received the notice that the premium for our last policy was rising by 35 percent, I went rampaging around my apartment. "I could have stood on the roof and flung the money into the wind for all the good this policy has done me, and now they want more money for the useless thing?" And then I paid the bill.

Just in case.

I follow the newspaper coverage of the health-care crisis. The articles are all too familiar. "Doctors raise charges for patients without insurance," the paper tells me, as I observe grimly that I have been charged $140 for a 10-minute well-child exam. An insurance company has the clout to announce that it will pay only a third of that amount; the uninsured patient who tries that strategy will quickly find himself in the hands of a collection agency.

"Premiums rising," the headlines say. Don't I know it.

I used to think that was just the way things were--until we moved to Scotland for two years. While the National Health Service has many flaws, it was a revelation to see how well universal coverage could work. When my oldest son fell and needed stitches, I took him to our local children's hospital. We were treated promptly and professionally; he has a tiny white scar and pleasant memories of the hospital. We chose to have our second child while we were living there, and I was struck again and again by the wisdom of the British system of perinatal care: cheaper, safer, smarter, accessible to any pregnant woman regardless of the vagaries of her employer's benefits plan.

When we returned to the U.S. I found myself questioning the third-party payer system. Why do we pay so much money to insurers, who make a profit based on how little of it is passed along to the people who provide the services?

What if we cut out the middleman? Why have for-profit entities been afforded so much decision-making power?

Back in the U.S. my second son fell into an end table on a Saturday afternoon.

As I surveyed the gash on his forehead, I found myself wondering how much an emergency room visit would cost and how big his scar would be if we didn't go--hating myself for making the calculation, making it anyway. A friend had been billed $1,000 to repair a comparable injury. We stayed home. With shaking hands and butterfly bandages I brought the edges of the cut together. But I am no doctor. His scar is not conspicuous but it is present. And every time I see it I feel guilty.

I know I am far from alone in my frustration. Every time health insurance comes up in conversation, more questions surface about the long-term cost of the third-party payer system. How many children lose out on having a sibling because of the cost of maternity coverage? How many people abandon the dream of owning a business because of the cost of providing health coverage for a family? How many retirement-age employees slog on at work to provide health insurance for a spouse?

In the busy pediatric clinic where I worked before my first child was born, almost all the receptionists who became pregnant returned to work after their maternity leaves. The pay was meager (especially given the cost of child care) but the benefits were good; they needed the insurance.

After his second post-doctoral research position, my husband decided to switch career directions and get off the academic track. I was relieved at the prospect of having health benefits, but I found myself with more questions.

Would it be unethical to participate in a system which is so fundamentally unjust? Would I really have the gumption to decline health benefits on ethical grounds? I didn't need to worry; another headline intervened--"Employers cutting dependent coverage." My husband's company offers no benefits to dependents. I could buy insurance if I paid 15 percent of his monthly take-home pay to do so.

I declined. You can buy a lot of lentils with that amount of money. But the questions remain: Is it right to participate in a profoundly unjust system?

How many people have to demand other options before other options become available?

I'm still waiting for answers.