Frontline's "Sick Around The World"

Matt and I love Frontline. Every Tuesday night it's this: Nova at 8, Frontline at 9. It's a total nerd-fest, and we wouldn't have it any other way.

If you haven't seen this, please watch (grab some popcorn and plop down in front on the laptop). In "Sick Around the World", Frontline dissects the health care of other democratic nations (who aren't "socialist" by golly!!!). and just how they do it. Maybe my readers aren' t one the 48 million Americans who don't have health care, but you never know...you very well might be soon enough.

PBS's Coverage of "Sick Around the World"

"Sick in America"

From Frontline's "Sick in America" (click here to watch):

At its best, American health care can be very good. For Microsoft employee Mark Murray and his wife, Melinda, their employee health plan paid for eight years of fertility treatments and covered all the costs of a very complicated pregnancy. "If it wasn't for our health insurance," Murray says, "we wouldn't have a baby boy right now." The Murrays' medical bills totaled between $500,000 and $1 million, and their plan covered every penny.

But beyond large, high-wage employers like Microsoft, FRONTLINE learns that available, affordable, adequate insurance is becoming hard to find. Small businesses face a very bleak outlook for finding and keeping coverage. Coverage is becoming more expensive and less comprehensive, with high deductibles, co-pays and coverage limits. Georgetown University Research Professor Karen Pollitz explains that for many people, the current system is "like having an airbag in your car that's made out of tissue paper: I'm so glad that it's there, but if I ever get in a crash, it's not going to protect me."

Outside of employer-based health care plans, matters are even worse. Americans seeking insurance in the individual market must submit to "medical underwriting," and if they have a pre-existing condition, they will likely be denied. Kaiser Permanente Chairman and CEO George Halverson says frankly: "I could not get insurance. I've had heart surgery, and so I am completely uninsurable in the private market. So it's important that I keep my job."

Across the U.S., FRONTLINE finds people making life decisions based on health insurance, stuck in jobs because of so-called job lock. One such person is 23-year-old Twin Cities, Minn., resident Matt Johnson, who put his career dreams on hold to get a job at Menards home improvement store because its benefits package covers his ulcerative colitis. Americans even stay in bad marriages, says Professor Pollitz, "because they just can't afford to divorce their health insurance."

For those Americans who find health coverage in the private market, there's no guarantee it will protect them. In 2007, Palm Desert, Calif., realtor Jennifer Thompson received a letter from Blue Cross accepting her for coverage that read: "Congratulations! You have been approved for coverage with Blue Cross of California. ... The immediate value of your coverage is peace of mind." But then Thompson discovered she had a cancer that required surgery, and three days after leaving the hospital, she received a letter from Blue Cross saying that her insurance was "rescinded," leaving her uninsured and owing more than $160,000 in medical bills. Blue Cross cited Thompson's previous history of cancer and results from a recent doctor's visit as the reasons for the rescission. "Our system is not working," says Professor Pollitz. "It's designed to cut out on you right when you need it the most." When questioned about Thompson's case, Sam Nussbaum, chief medical officer of WellPoint, which owns Blue Cross of California, told FRONTLINE that because of legal considerations, "I can't speak to that circumstance ... but no one likes to see a situation like this. People are buying health security."

In the past, some states required insurance companies to cover everyone but found that many people waited to buy insurance until they fell ill, causing "adverse selection," or a higher ratio of unhealthy to healthy people in the insurance pool. As a result, insurance companies stopped doing business in those states. Today, only five states—New York, New Jersey, Massachusetts, Maine and Vermont—guarantee everyone insurance, a "privilege" reflected in premiums. "If we look at the average premium of those states," says WellPoint's Nussbaum, "that premium is three times higher on average—maybe $600 to $700 versus a [state] where the insurance market has allowed medical underwriting."

For some Americans, life becomes a quest to find and keep health insurance. In 1994, Nikki White, a Bristol, Tenn., native with dreams of becoming a doctor, was diagnosed with lupus, a serious but treatable autoimmune disorder. Too ill to work, she lost her health insurance for several years, but then received coverage from the state's Medicaid program. Soon, budget cuts made her ineligible for the state program. A few months later, White was rushed to the ER with severe lupus complications and racked up nearly $1 million in medical bills. She finally secured insurance under the government HIPPA law, but her condition was too advanced, and in 2006, at the age of 32, she died. White's primary care physician, Amylyn Crawford, tells FRONTLINE: "Nikki didn't die from lupus. Nikki died secondary to the complications of a failing health care system."

Around the world, other developed democracies offer universal health care, requiring insurance companies to cover everyone. People are mandated to buy it; insurance for the poor is subsidized; and governments control prices by setting the cost of everything from doctors' salaries and hospital rooms to drugs and MRIs. But efforts to implement similar policies in the U.S. have proven unsuccessful. In 2006, Massachusetts implemented reforms mandating everyone be covered by health insurance, but there are still problems of affordability. FRONTLINE profiles the Abramses, a Massachusetts family of four earning $63,000 annually, who found that although they were too prosperous to receive a health care subsidy, they could not afford to buy a health care insurance policy at around $12,000 a year. "What we're finding out in Massachusetts," says veteran insurance industry executive and consultant Robert Laszewski, "you can mandate that people have health insurance, but if it costs more than they can afford, it doesn't matter."

As President Obama launches his plan for reforming health care, Kaiser Family Foundation President Drew Altman tells FRONTLINE: "This is the first big opportunity for health reform since ... [the] early 1990s. And a question is again, pointedly, whether we will blow the opportunity again this time or [whether] we will actually get it all done or get something significant done." But consultant Laszewski wonders if Americans have the will to make it happen. "Every doctor I meet says he's underpaid. I've yet to meet a hospital executive who thinks he or she can operate on less. I have yet to meet a patient who is willing to sacrifice care. So we have this $2.2 trillion system, and I haven't met anybody in any of the stakeholders that's willing to take less. And until we're willing to have that conversation, we're just sort of nibbling around the edges."

Gas, Insurance, and Death Stares

Managing my health care has become a full-time job. I have four doctors, one fickle insurance company, and a real full-time job that often requires me to travel (mainly locally or just to NYC) and has night events, where you just have to be “on”. (By “on”, I mean a dazzling smile, a firm handshake, and chipper small talk. Matt thinks these work events I go to are “fun”. He says “You get a good dinner!” That’s when I shoot him a death stare and climb into bed. I do not want to talk to anyone – not even the dog - after those busy evenings.)

Yesterday was one of those such days. I worked in the morning, had a last minute CT Scan in the afternoon and missed several hours of work, and then drove an hour away for a night event that ended at 10 pm.

I had my CT Scan scheduled for this week at the same facility that conducted all my other CT Scans, and which my surgeon (well, one of them, ha ha) is affiliated. We wanted the same team of radiologists to look at this CT Scan, and of course have access to all my past records. Then my insurance company called yesterday morning and dictated I go to another facility (a cheaper facility) and have it done. It would take at least 48 hours for them to send the results to my doctor. So I had to move my surgical consult to next week (and thank god there was an opening – the next one was the last week of April!) and book it home to gather all of my past medical records and CT Scan CDs so I can make it to the facility in time to drink the barium, have the CT Scan done that day, and then book it 40 miles away to the work event.

I know I am complaining, and it’s awfully unbecoming. But that work event was tediously awful; my body was not responding well to the barium and my stomach was loudly gurgling during speakers’ presentations. Although not ladylike, I had gas like you couldn’t believe. My clothes were stretched tight and I spent 15 minutes in my car prior to walking in just trying to fart as much as possible. (Yes, I said fart.) These weren’t baby farts, either. They were eight second long ditties, I tell ya. Where did all of this air come from?! Throughout the night I sat squirming in my chair and at one point just had to escape to a private area to “relieve” myself (empty stairwells are very good for this).

When I climbed into my car to drive home, I removed my hosiery and undid my skirt so my big belly could breathe. I drove tilted on one butt cheek so the air could escape without restriction (this is not a fabrication).

Now, you may think this gross, but I’ve gotten over bodily anything over the past few years. Or you may think I’m embarrassing myself. Whatever. Everyone farts, everyone poops, and everyone has an anus! So there.

I didn’t mean for this post to be a diatribe on flatulence. I actually wanted to speak about this week’s Frontline, which detailed the vast shortcomings of America’s healthcare system. That’s why I started out about my (unnamed) health insurance company.

I am terrified if I lose my health coverage through work. I – like so many Americans – am not insurable through the private market. And I know, with my tests and doctor visits, I am raising my colleague’s insurance premiums for next year. Lovely.

Affordable healthcare for all Americans shouldn’t be a privilege, but a right.

My next post will have the link, and information, regarding “Sick Around America”, which aired Tuesday evening on PBS’s Frontline.

I would not say it’s an “enjoyable” program, but one that is essential to watch.