SSince the shooting death of UnitedHealthcare CEO Brian Thompson, the polarizing debate over America's health care system has continued unabated, with thousands of Americans continuing to share their struggles to get health insurance coverage. .
Hundreds of people from across the country also shared their frustrations with the Guardian, describing how their experiences seeking medical care in the US had shaped their lives.
While many people have reported that the health insurance system has gotten worse in recent years, especially in 2024, Elizabeth, a 64-year-old retiree from Maryland, said that when she lived in California more than 20 years ago, her health insurance system deteriorated. They had already experienced the brutality of the system. A serious car accident occurred in 2002 while on a business trip to another state.
“I was treated in a trauma hospital for three days,” she recalled. “My insurance company denied coverage because the treatment was not pre-authorized and the accident did not occur in California. That was insane.”
She said it took just a few phone calls from her employer's human resources director to finally convince the insurance company to cover some of her treatment. “I've been very, very lucky,” Elizabeth said. “Health care in the United States is a constant battle. You're always trying to cover things up, and you're always being told that things are being denied.”
She said the same insurance company then refused to cover standard chemotherapy drugs that her oncologist wanted to treat her stage 3 breast cancer.
I was very ill for two years, but I had to keep working.
Elizabeth from Maryland
“My doctor convinced the pharmaceutical company representative to donate the medicine,” Elizabeth said. “I had been very ill for two years, but I had to keep working. My husband had just been laid off and I had health insurance.”
After getting her husband insured, Elizabeth's premiums more than doubled, and she recalled that chemotherapy made her so nauseous that she threw up in her coffee cup or in her car after work. . “It was very difficult. After I beat cancer, I decided I needed to look for a job at the university because it had to offer health insurance, which small businesses and nonprofits might not be able to offer. I did.”
In order to get hired for a job at a university that she was overqualified for, she removed two master's degrees from her resume and accepted a significant career drop and a huge pay cut that she never made up again. “I know a lot of people who have ruined their careers this way just to get health insurance,” she says.
People of all states, ages, and backgrounds have told us how they have been denied coverage for prescribed, often critical treatments, or faced long delays and months or years of arguments with insurance companies. Finally, and in many cases, they shared how they were approved only with the help of a lawyer.
Many people report that their insurance companies send them automatic denials, ignore their communications for months, or arbitrarily and frequently change their coverage rules, and these actions can lead to a loss of coverage. It was recognized that this was an act to avoid the situation.
“The abuse of our system is so consistent and so ubiquitous that most of us have long ago settled into a kind of learned helplessness,” said Liz, a doctor in Minnesota. 43) says.
“I work in the medical industry and have “good” insurance, paying $10,000 a year in premiums. Since we hardly ever use it, it was a great deal for the insurance company. Yet, when my son broke his arm last month, they didn't hesitate to charge me an additional $600. ”
This system is designed to wear us down until we give up.
Liz from Minnesota
Seven years ago, Liz's husband was refused cervical decompression surgery because he was not in pain, she recalled. “I appealed twice through the standard appeals process and was denied two more times. In the end, after a tearful phone call, the surgery was approved. This humiliating process It is clearly designed to wear us down to the point of giving up, while we and our loved ones suffer.”
Although some felt their health care was decent, usually thanks to generous workplace health insurance, the majority of respondents said it was always difficult to get insurance and receive treatment.
Dozens of people have testified that they had to pay high medical bills despite having insurance, including Stephanie Moan, 68, of Boston, last year. He said he is thousands of dollars in debt because his insurance company refused to cover about $20,000 in medical bills.
“It's been a nightmare,” Morgan said. “I needed occupational therapy because I broke my finger. My husband needed hearing aids. It was all 'It's not covered,' 'It's out of network,' and 'I didn't meet my $2,500 deductible.' It must be done.” After all, we had to go into debt. We're not poor, but as far as I know, we don't have health insurance, even though we pay about $400 a month in premiums. This never happened before. This country is facing big problems. ”
Many respondents, who have relied on the U.S. health care system for years, believe that over the past few decades, corporate greed has made the system increasingly less accessible, less secure, and overwhelmed by rising bureaucratic hurdles. However, I feel that the cost has become high.
“Today, more and more hospitals are run by corporations,” said Cecia, 64, of Houston. “We used to have profits, but now we want bigger profits and continued growth. It's similar to the story of a frog in the water and someone slowly raising the temperature while the frog doesn't notice. ”
Nearly a quarter of U.S. hospitals are now run by for-profit organizations, and by 2021, 5,779 physician practices will be owned by private equity, up from 816 hospitals in 2012.
Tesia, whose employer has heavily subsidized high-end insurance, pays about $5,000 a year for a preferred provider organization (PPO) plan that covers her and her wife. I feel that it is a good value considering the standard of medical care. Patients are free to choose their own doctor.
“In order to do that, insurance would have to pay 80% and I would have to come up with the remaining 20%,” he said. “This year I paid between $6,000 and $8,000 out of pocket, which I think is fair.”
However, several years ago, when his wife became seriously ill, she was denied coverage for an MRI scan based on the recommendation of a doctor working for her insurance company. “I found out who the doctor was. Not only was he not a specialist, he was also not licensed to practice medicine in our state. I reported this to my insurance company. They did not respond. , they just approved the MRI,” Tesia recalled, an experience that echoed that of many other respondents.
Tesia felt that President Barack Obama's Affordable Care Act (ACA), also known as Obamacare, improved access to health insurance for some people, especially those with pre-existing conditions. Some said the landmark reforms didn't go far enough, and complained about the Obamacare plan's high costs, requirement for family physician referrals, and overwhelming complexity of the medical billing system.
“Even after the ACA, health insurance coverage is still difficult,” said a 59-year-old data scientist from New Hampshire. “I had to change my long-time doctor because the clinic no longer accepts ACA plans.However, even though I have a non-ACA plan through my employer, my insurance company still does not accept my coverage. To make the choice, I had to change my prescription, which can cost more than $1,000 and require additional medical tests that aren't always covered by insurance. I avoid that.”
He felt that for-profit health care providers are always looking for additional ways to increase billings and reduce coverage, such as placing out-of-network specialty providers within in-network hospitals.
Every time I used my health insurance, I received a surprise bill a few months later.
Marcus from Texas
Marcus from Texas said, “Every time I used my health insurance for anything other than my annual checkup, I paid my own share, but it was decided that my insurance coverage would be reduced, and I had to pay for it for several months. “I was later presented with a surprising bill.” Some of them are frustrated by hidden costs and unexpected charges that surface long after they visit a medical provider for everything from teeth cleanings to pre-approved surgeries. there was.
Many people report having difficulty finding a doctor because their previous doctor is no longer in their insurance company's network due to unbearable new conditions imposed on them by their insurance company. said their insurance company required them to travel more than an hour to see a doctor. The doctors they cover.
Several people said they were unable to find a doctor willing to accept new patients, and many said they were avoiding seeing medical institutions because of unexpected costs.
Marta, a 31-year-old from North Carolina, is one of many people who critically compare the U.S. system to their medical and insurance experiences abroad.
“In Germany, we paid more as a family in premiums because our income was higher,” she said. “Here, we are a relatively healthy family, so even though each visit costs about $200, we actually pay less.”
Marta, like others, acknowledged that in other countries (in her case the UK, Germany, and Poland), wait times to see a doctor are often significantly longer than in the United States.
Lisa Markey, a British national living in New York, described her recent experience using Britain's NHS as “horrible”. She said she had no access to treatment for her retinopathy in the UK and almost lost her sight as a result. She said the issue was quickly resolved upon her return to the United States. There, she says she experienced “extraordinary coverage” while purchasing commercial insurance through her employer.
However, the lack of up-front pricing information in the United States compares favorably with overseas medical experience. “When I first went to the doctor here, I thought, 'Wow, I only have to pay a co-pay,'” Marta says. “Two months later, I get a $400 bill. That's a gamble. I'm grateful that I'm wealthy enough to not have to worry about costs when I go to the doctor, but if I had less income, I would think about it five times before seeking medical care.”
How much profit is enough?
Seth Polanski from Washington DC
Seth Polanski, a 52-year-old lawyer in Washington, D.C., has a take-home pay of about $80,000 a year and currently pays about $800 a month in health insurance premiums, but he is not paying $800 a month for health insurance. He said he was working and was thinking about the following: It remains one of the cheapest products for many years.
“The symptoms are getting worse every year,” he says. “Until 2018, I had been on the same dose of medication for 20 years, and it was decided that I could only take two tablets a day instead of three, no matter what my doctor insisted. This year they completely removed my medication from insurance coverage.”
Mr. Polanski said two of his long-time doctors recently left the insurance company's network because the insurance company changed the terms of their contracts. “I already have to pay an $8,000 annual deductible on top of my premiums just to have insurance, but I'm willing to go out of pocket to see my old doctor who knows me well. I did.
“These expenses will probably delay your retirement. Last year, (UnitedHealth Group) made more than $20 billion in profits. How much is enough?”
