Broken Health Care: What It Really Costs Us

Sometimes, when you're up to your chin in alligators, it's hard to focus on the fact that there's a big, broad, alligator-free world waiting somewhere out there, beyond the edge of the swamp.

In this case, it's hard for most Americans to even imagine that nobody in the rest of the developed world lives this way. We've been living inside the restrictions and making the trade-offs required to hang onto our all-important health care coverage for so long that we don't even realize that we're cutting those deals, or what we're giving up, or how thoroughly those choices have come to dominate and limit our lives.

If you're an American under 40, you can't remember a time that the health care system didn't work this way—or that keeping coverage wasn't a dominant factor in making your life choices. If you're older than that, the memory of another, happier era beyond the swamp is dim, and fading fast.

This was one of the things that struck me hardest when I arrived in Canada five years ago. The swamp-blindness was so dark and deep that it took a while to adjust to a world without alligators. It's almost impossible to describe to folks back home how different life is when health insurance simply doesn't factor at all into how you choose to live your life. There's almost no language for it. Rather than even attempt it, I sometimes just ask my American friends and relatives to open up their imaginations, and answer the question for themselves:

• How would your life be different if you never had to worry about getting, keeping, or affording health care again?
• What other choices might you have made?
• Where else would you be right now?
• How would it change your plans for the future?

I've seen people reduced to tears of rage and frustration by these questions. When you really stop and think about it—pause for a few minutes to take it all in, past, present, and future—it becomes clear that the full absurdity and the sheer enormity of the sacrifices we have to make for an almighty health care card are the greatest obstacle to life, liberty and the pursuit of happiness that most of us are burdened with today.

Polls say most Americans who have health care are satisfied with it. But nobody ever asks them if they're satisfied with what they've had to do to get it, keep it, or afford it.

What would you do differently? I watch my Canadian neighbors live their lives, and the world beyond the swamp comes into sharp and stunning focus.

My neighbors go to the doctor when they need to -- and often, when they don't. If they're just feeling funky for a day or two, they go. If the splinter is too big to handle with a needle, they go. Anything goes a little bit sideways—they go.

By American standards, they're probably overusing the system. (My husband once asked an employee who was nursing a cough, "Have you seen a doctor about that?" The guy just looked at him, confused. Of course he'd seen a doctor. Up here, only an American would ask such a stupid question.)
But the upshot is that the small symptoms of really big things—little lumps, creeping blood pressure, wounds that don't heal right, coughs that don't go away—are caught and diagnosed early in a GP's office, instead of months or years down the road in a full-blown crisis at the ER, which is now the American way. And this is central to cost containment: getting emergent problems calmly headed off right away in a $30 office visit is a lot more cost-effective than having to deal with the full catastrophe later on in a $3,000 emergency-room drama scene. And it allows people to maintain their good health through the years, instead of delaying treatment until it's too late to recover it and permanent damage is done.

My neighbors heal, recover, and go on with their lives. The U.S. disability rate last year was 19.1 percent, and rising fast. In Canada, it's 14.3 percent—and Statistics Canada believes that the only reason their stats are creeping up these days is that people who once hid their disabilities are now more willing to admit them.

That disability rate affects the country's economic competitiveness. Americans just don't have the time or money to spend on a proper recovery after a major event, or get the full course of treatment that a chronic condition requires to be truly well-managed. Fearing for our income or our jobs, we hurry back to work too soon. Our insurance doesn't cover necessary follow-up therapies, so things may not heal thoroughly or properly. We can't afford the drugs, so we cut the pills in half, or stop taking them entirely.

The result is that too many of us end up far more impaired than we need to be—and may, in fact, never be quite right again. Deferred maintenance—which is what this is—takes a ferocious toll on the American workforce, which is now being forced to compete with workers around the world who get better care, make better recoveries, and are able to return to work at full strength.

My neighbors start small businesses. Americans routinely stay chained to jobs they hate because they can't afford to lose coverage. Canada has an exuberant entrepreneurial culture, fueled by favorable tax structures for small business and a preference for Main Streets over malls. Canadians may bet the house and the kids' college funds on a new venture; but they never think twice about whether or not they can afford to leave BigCo because they'll lose their insurance, or what will happen to the new business if they get hit by a delivery truck, or how they'll afford some kind of minimal coverage for their new employees. Unburdened by health care costs or concerns, their ventures are far more likely to thrive.

My neighbors go back to school. Low-cost government-subsidized universities combined with assured health care make it easy for people to make mid-course career adjustments, pursue their passions, and expand their horizons. The upshot is a better-educated, more capable workforce that's constantly improving its skills.

My neighbors quit jobs they hate. "Take this job and shove it" is a lot easier—and sweeter—when your boss isn't holding an almighty health care card over your head. Bosses know this, too, and working conditions are often better as a result.

My neighbors stay home with their kids. They can afford to do that, because they're not wholly dependent on whichever breadwinner can manage to find a job with a decent health care plan.

My neighbors invest. They've got stable household budgets that aren't being thrown off by surprise health events. Because Canada doesn't have a mortgage interest deduction, most Canadians reduce interest costs by taking out 10- or 15-year mortgages. The payments really squeeze the family budget for that decade—but by their 40s a lot of them own their homes outright, something most Americans will never achieve. Home ownership, college savings and retirement funds are all big-money investments that you simply can't commit to if you're liable to be hit with five-figure medical bills at any moment.

My neighbors travel. Americans don't get vacation time; and when they do get it, they tend to stay in-country. A lot of Canadians take three weeks off in the winter to go somewhere fabulous and warm (understandable, given the climate). The sheer variety of these escapes boggles me yet: They fly off to build schools in Guatemala, or take holiday jobs in New Zealand, or learn French in Morocco. Even the guy who paints my house can afford to do this, because he's not spending half his annual income on health care premiums. That $15K-a-year savings will buy a whole lot of margaritas in Cancun.

The result is a population with broad global awareness, and extensive global ties—a necessary thing for a country whose economy depends completely on trade. And it may be an important factor in keeping Canada progressive. According to Diana Kerry, who ran her brother John's overseas campaign in 2004, Americans who own passports vote Democratic three to one. So travel makes you liberal. Who knew?

My neighbors seldom go bankrupt. The Canadian bankruptcy rate has soared in the past year to 4.3 per thousand. In the U.S., it's 11.1 per thousand. The entire difference between these two figures is accounted for by the fact that 62 percent of all U.S. bankruptcies were driven at least in part by medical expenses.

But tidy numbers like this elide a harder reality: Bankruptcy doesn't just cost us financially. It also destroys the foundations of our social capital. When the house, the dreams, and the future are gone, very often the marriage is the next thing that goes, too. Bankruptcy travels in close company with domestic trouble, divorce, drug use, homelessness, and broken families. (After medical-bill refugees, the second most common people in bankruptcy courts are recently divorced women.) If, as conservatives like to remind us, the family is the basic unit of civilization, then our health care system is directly making its profits by pulling down our social foundations -- and ultimately undermining our ability to hold our civilization together.

My neighbors have never seen anyone die because they didn't have health care. With 22,000 Americans dying every year due to a lack of health insurance [1]—that's one every 24 minutes—there aren't many of us who don't know someone who lost a loved one because they couldn't get the treatment they needed. (For me, it was my father.)

But when I share this factoid with Canadians, they invariably do a long double take. They lean back, squint, stare, and pause to reassess my credibility (if not my sanity). It's literally unbelievable. They can't even process it. I must be making it up, or at least exaggerating. It's just beyond the realm of imagining that a rich nation like America would let that kind of thing happen -- let alone let it happen sixty times a day, for years on end.

And yet, they know things are bad down here, because everybody who goes South buys travel insurance before they cross the border. Everybody has heard scary stories about people who got sick or hurt and ended up in an American ER with a five-figure bill to pay. It's just a stupid risk, and they're not willing to take it.

What would you have done differently if you'd never had to worry about health insurance? How would life be different now? How would it change your plans for the future?

Go ahead. Think about it. Let yourself get good and angry. The current system has robbed an entire generation of Americans of their full potential. It has made us serfs. It has narrowed our horizons. It has undermined our families and communities. It has deprived us of the chance to save, to own a home, to educate ourselves and our children, to see the world, to retire in comfort, and to live to a healthy and robust old age.

It has left us in this swamp, chin-deep in alligators. And the first step in getting back out is getting very clear in our own minds that there are other places where people don't live this way -- and then angry enough to lean on our leaders, and make it just as clear to them that we don't intend to live like this any more, either.

Your representatives need to hear from you. Today. [2] Because your future is still out there—and the most important thing you need to get there is a health care plan nobody can ever take away.