What Bacteria Do, And How Health Insurance Won't Help

I spend a lot of time here talking about the damage that bacteria can do, and how sick they can make you. I don’t spend much time talking about their collateral damage: the hospital stays, the unbelievable costs of care, the bewildering complexity of the American healthcare and insurance systems, and the disillusionment that encountering both of those leaves behind.

To rectify that, I’d like to introduce you to my acquaintance Kevin Zelnio.

It wouldn’t be fair for this story to claim that Kevin and I are friends. We’re part of the same crowd in the science blogosphere and in the real-life annual bloggers’ meeting called Science Online. I like him and I’m impressed by his spirit and talent, but I can’t say that we’re close — which is just to say, this post isn’t written with any inside knowledge.

So: As Kevin tells it on his blog at Scientific American, his 6-year-old son came down a week ago with what looked like the flu: tired, fever, no appetite. Kevin and his wife watched him for a few days, dosed him with OTC meds when his symptoms needed a little help, and waited for the next day to see which way things were going. The next day, his son’s hands and feet were blue.

They hustled him to an urgent care center. In the waiting room, his son started having trouble breathing. The urgent-care staff sent them across the street to the ER. One X-ray later, they had a diagnosis: The boy had pneumonia, courtesy of S. pneumoniae, and was going to be admitted to the hospital.*

Once he got over his relief at knowing his son would be cared for, here’s what Kevin thought next:

I didn’t want to believe it, because I knew a hospital visit was going to financially crush us.

Kevin is self-employed and works more than full-time. With what he earns, he supports his wife, son and daughter. What he can’t do, with what he earns, is afford health insurance.** He’s one of the almost 50 million Americans — one-sixth of our population — who are going without access to the healthcare they might need, because they can’t afford it. He’s run the numbers — in his post, he breaks them down — and the cost of non-group insurance, which is what he would be eligible for, just isn’t available on the money he makes. In fact, it probably wouldn’t be available even if he made much more than he does.

 I tell my kids not to do things that I certainly enjoyed doing as a kid, like don’t climb high on trees, run a little slower on the trail, watch out for roots and stones! It’s not just the usual parental concern either. I’m consciously thinking “oh my God, I cannot afford to fix them if they get broke!”
This is the luxury gap between the between the 20% of non-elderly Americans who are uninsured and the rest. The luxury is, of course, being able to just walk into a doctor’s office and see them at the appropriate times.***

I have a bias here, and I’ll declare it freely: I don’t think healthcare should be a luxury product that only a few can afford. I was born in the United States, but I grew up partly in England under the care of the National Health Service, and I spend a fair amount of time in countries where single-payer systems persist. Here’s the thing: They work. They take care of people (even people who don’t contribute to them; see Steve Silberman’s experience in London last summer for one example). They don’t permit families to be crushed, either by fear of bills, or by the thuggish actions of collection agencies.

And, double bonus plus, they keep track of the health of their populations in such a way that they allow countries to see epidemics coming, and to solve them when they arrive, often faster than we can.

The inarguable reality — there is way, way too much scholarship on this for me even to excerpt, but you could check the Kaiser Family Foundation for a good initial immersion — is that our system doesn’t extend adequate care, does suck up vast amounts of money, and inevitably curbs entrepreneurship and economic growth. And for all but the few, most secure Americans, it’s become an object of fear and dread. It’s bad enough, and utterly normal, to be frightened of being ill, and having to go into the hospital. It’s absurd to be more frightened of what the hospital bill might do to you afterward than you are of an operation or a disease.

At this point, Kevin’s son is better, though not out of the woods; a few days ago, he was transferred to a higher-level pediatric hospital a few hours’ drive from where they live. Numerous commenters at Metafilter have testified that Kevin’s situation is not unusual. Mike the Mad Biologist has described how absurd it seems that Kevin is in such straits when Mike himself (pseudonymous, but obviously an academic researcher) had a four-day bout with a kidney stone, including surgery and office visits, and paid only $200 because his insurance is so good. Friends of Kevin have started an online campaign to help him defray costs.

I’m not asking you to donate, constant readers. But I am asking you to think. Jobs are so unstable now that, even if you currently have good insurance, this could be you. And it shouldn’t have to be any of us.


(Some initial notes, to forestall the most obvious likely snark:

  • *Don’t bother saying Kevin and his wife should have gotten the kid to the doctor faster. Kids can go south incredibly fast.
  • **Don’t bother saying he shouldn’t have had a wife or kids if he couldn’t afford their healthcare. When they got married and had kids, he had a full-time job with great benefits.
  • *** And do NOT bother pointing out that, in his post, Kevin mentions allowing his kid to play with a Kindle Fire while in the hospital. It was a gift. And even if it were not, the $199 cost of a Kindle Fire is not going to cover any insurance premium.)




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