A New Book Looks at How the Healthcare System Fails
For his new book, Sick, Jonathan Cohn, a senior editor at The New Republic and senior fellow at Demos, a policy think tank in New York City, traveled the country talking to people about their run-ins with the U.S. healthcare system. He describes, in sometimes chilling detail, medical encounters that left people worse off than when they started, both physically and financially. Cohn spoke with U.S. News about what he saw and what he believes are possible fixes.
Q: How would you summarize the problems that you saw as you traveled the country talking with people?
A: Every person's experience was different and unique, of course. But a few themes emerged. And the biggest, I suppose, was the extent to which people who "played by the rules"had a job, tried to take good care of their families, and so onhad their lives completely upended because they had a serious medical problem and yet couldn't pay for the treatment it required.
This was true of middle-class people with insurance, like Russ Doren of Denver, a public school teacher whose supposedly excellent benefits stopped covering treatment for his wife's mental illness, and Elizabeth Hilsabeck, an affluent housewife in Austin, whose blue-chip insurance didn't cover the physical therapy recommended for her disabled child.
It was true for middle-class people without insurance, like Janice Ramsey, a successful entrepreneur with diabetes who couldn't find coverage because no carrier would take on her pre-existing condition, and Gary Rotzler, who was able to replace his income but not his family's insurance when the downsizing wave hit his region. And it was true for low-income people like Ernie Maldonado in rural Tennessee, a longtime shop owner who lost his access to prescription drugs when Tennessee cut its state assistance program. In each of these cases, people who had worked (or were in families with working breadwinners) thought their medical needs would be taken care of, only to lose their insurance at precisely the moment they needed it most.
Q: Was there a common thread among all the folks you talked with apart from the fact that they had all been sick?
A: For most of these people, there was a real lack of self pity. They were very pissed off, though, and had this sense that this shouldn't happen in this country. That this is just not right. Most never thought that this would happen to them. The folks that were poorlike the guy in South Central LA who has diabetes but no insurance, and never checked his blood sugar or went to the doctor and then had a strokefelt this less. They had a certain sense that life is disappointing in a lot of ways, and they're used to things not happening well. But among middle-class people, they were sort of surprised. They didn't think this could happen in their lives.
Q: You described the story of an engineer in central New York state who lost his job and his health insurance, then wasn't offered coverage at his new job. Money was tight and so his wife didn't go to the doctor until it was too late. She died of breast cancer. Employer-provided insurance is the backbone of our current system, but slowly, employers are cutting back. What are your thoughts on that?