Come health or high water

In 1992, while working for a suburban New York newspaper, I wrote a story about a woman who had to go deep into debt to get surgery for a thyroid condition. She's probably still paying it off.

The point of the story was that 16 million Americans lacked health insurance.

But Bill Clinton had just been elected president, and this woman was confident that her young daughter would never face a similar struggle.

As it turns out, though, those were actually the good old days. Today we have an estimated 50+ million uninsured in America, based on the most recent Census Bureau data. And last year, a study by Harvard researchers concluded that medical debt was involved in about two-thirds of the roughly 2,300 randomly selected bankruptcy cases they studied.

My son, Mike Danforth, was one of the 45,000 people in the U.S. estimated to have died in 2008 due to lack of health insurance. He had a high cancer risk, but he couldn't afford the colonoscopy needed to diagnose the disease while it was still treatable.

If Mike had lived in Asheville, he probably would have survived, because he could have gone to one of the free clinics here and gotten a referral to Project Access, a program of the Buncombe County Medical Society that coordinates charity care.

The problem is that not every place has such a program; Savannah, Ga., doesn't, so my son went without.

Community charity is wonderful, but Project Access shifts the burden to physicians, who are already being squeezed by ever-lower reimbursement rates from insurance companies and government programs alike.

Buncombe County doctors and hospitals donate millions of dollars' worth of treatment and services each year, but this recession has stretched them thin, and waiting times for appointments with Project Access physicians are increasing as more people seek help. Our safety net isn't made of titanium: It can unravel.

As I write this, a young man in Georgia is going into debt because his insurance company refused to pay for his treatment to overcome addiction to the pain pills they'd paid for after he was seriously burned.

The paltry measures being taken by Congress now are not enough. How can I tell? It's easy — just watch insurance companies' stock prices skyrocket as the government steers 30 million customers their way with few new regulations to rein in industry greed. And that's on top of the billions these companies already pocket in profits. CEOs get paid millions of dollars while working folks die from lack of care.

Everywhere I go, people tell me their stories. They pray to stay well, they try to eat healthy and exercise. But fall off a bicycle and break a leg and you're $15,000 in debt. Develop cancer and you may just have to go without chemotherapy and die. Get an infection and the antibiotics to treat it can cost hundreds of dollars.

Insurance companies won't be able to deny coverage for a pre-existing condition, but they can charge four times their normal rates. Not many people can afford that.

One man who owns a small business told me the insurance company wants $2,000 a month to cover him and his wife. He had to drop his coverage. Another man, who turned 50 last year, told me his premiums increased by $500 a month because of his age; his daughter might be uninsurable because she was treated for depression and anxiety after she saw a friend die in an accident.

Sure, preventive measures can lower medical costs. The Asheville Project has reduced the city's costs dramatically. Health educators and pharmacists help city employees with any of five chronic conditions — asthma, diabetes, high blood pressure, high cholesterol or depression — manage their condition. In return, all their medications and supplies are provided free.

Managing chronic illnesses is an important measure of a health-care system's effectiveness, but ours doesn't do it. Instead, mental illnesses are allowed to progress until people can no longer function in society and wind up on the streets. People with diabetes are left to try to manage their blood glucose levels via guesswork and luck, leaving them vulnerable to stroke, kidney failure, diabetes and infections that may necessitate amputation.

Besides being heartless, it's economically unwise.
People can eat well, exercise and manage stress levels, quit smoking, drink a glass of red wine every day and still get sick or injured. And when they do, they deserve care.

This is the United States of America, not 50 separate, sovereign nations. Citizens should have the same access to care in every state.

I don't mind a solution that includes the private sector, but it can't just be to hand the insurance industry everything it wants with few strings attached.

We already have an excellent single-payer system in Medicare. My stepfather and my mother both died between Christmas and New Year's Day. They lived long and productive lives, and when their bodies failed, they were cared for and their pain was managed.

In contrast, my son suffered horribly: ignored until he was down to 104 pounds, neglected when he got sick again, a life-threatening infection left untreated until Duke University Medical Center took him in as a charity patient.

Still, he had to separate from his wife to get Medicaid to pay for his chemotherapy and numerous other medications, and his first disability check arrived a week after he died.

This is not how the supposedly greatest country in the world ought to treat its people. We need to keep shouting, keep pushing, keep insisting until our health-care system achieves its potential by becoming the best in the world.

We can't afford to settle for anything less.

Former newspaper reporter Leslie Boyd is president of Life o' Mike, a nonprofit health-care advocacy-and-education agency. She can be reached at lifeomike@gmail.com.

Buncombe County doctors and hospitals donate millions of dollars' worth of treatment and services each year, but this recession has stretched them thin.