Pretty much every weekend I head to my cabin in rural Illinois for some R&R. At some point, like any reasonable city person, I grow a tad bored with the clean air, wildlife, and all those trees and head into one of the many small towns in the area to compare main streets, sadly bereft of bustle with their resale shops, tattoo parlors, and boarded-up shop windows.
When I actually go into a store, I usually see something at the checkout register that I never see in the big city: a color copy of a handmade poster featuring a photograph and a plea to donate money.
The posters are heartbreaking variations on a single theme.
“Billy Johnson, 12, from Middletown was struck with an unusual form of leukemia (…or bone cancer or brain tumor). His single mom, Mary, is in danger of losing her night job at the Wal-Mart because she spends so much time caring for Billy and driving him to doctors for his chemotherapy. She may lose her home because of mounting medical expenses…”
Taped to the poster of a child (almost always frail, frequently bald, and with sad sunken eyes) is an empty plastic margarine container with a hole cut into the lid for sympathetic shoppers to leave some change or maybe a bill or two. I asked a clerk if I could peek at what had been collected in one such container: $4.34 for the week.
Visit another town and it’s a different homemade poster, a different Billy, maybe this time an Amanda. The story’s largely the same in every case, though, and often after a few weeks Billy’s poster and collection tub are replaced with a new one. Maybe a young mother with breast cancer, a premature baby fighting for his life, the local librarian with end-stage diabetes.
In small-town Illinois I see more of these posters than I do the plastic-flowers-and-cross roadside shrines on two-lane blacktops, placed to commemorate someone’s fatal road crash. Keep in mind the people who will say a prayer of thanks for the coins in their margarine tubs are not victims of road crashes. They’re still living, though their lives are difficult for many of us to imagine.
By the way, the one place you’ll never see these poster/donation boxes is in the checkout line at a Wal-Mart. Could this have something to do with the announcement last week that the chain will stop offering health insurance to new US part-timers working fewer than 24 hours weekly and that it will cut by 50% its contribution to employee health expense accounts (used to pay medical bills not covered under their plan)?
Back to the cash register…and a fundraiser
Sometimes instead of the collection tub there’s an announcement of an actual fundraiser, usually a bake sale but occasionally an evening party with an ersatz rock band for entertainment. These are held in church basements or down-at-the-heels American Legion halls.
I went to one of these fundraisers recently. Middle-aged women sat behind tables laden with paper plates holding cookies and cupcakes. Some sold hand-crafts like crocheted bookmarks, needlepoint–you know the selection. I guessed they’d raise about $40 tops for the evening, even though I left with a handful of bookmarks (you can never have too many crocheted bookmarks) and a plate of smiley-face cookies.
In yet another town, the poster announces a memorial, the local Billy having died and his mom now virtually bankrupt.
I think about my own comfortable life, kids secure, the ability to fall back onto my fairly good health insurance in a crisis, and I try to imagine what it must be like to be Mary, alone in her dark bedroom at night, numb with exhaustion from a long shift at Wal-Mart, reviewing Billy’s medical bills, food shopping, meal prep, pharmacy, house a mess but nobody’s coming over anyway, lying there thinking about her son in the next room with his cancer. She’s wondering about their futures and she’s really, really frightened. Not only of her son’s almost certain death but also—and she berates herself for this—about the impending bankruptcy that will shatter her fragile hold on her world.
She’s not poor enough for Medicaid, but that likely wouldn’t help anyway. Illinois is so far behind in its payments that most specialists won’t accept Medicaid.
The American Cancer Society recently reported that more than one-third of the people under 65 diagnosed with cancer are uninsured, and that 75% of this group have lost their insurance because of high premiums or a pre-existing condition exclusion.
Mary’s pay at Wal-Mart is a couple dollars above minimum wage, but medical expenses on her high-deductible policy eat up a full 20% of her gross income (that’s $4000 of the $20,000 she earns). As you might guess, a cancer diagnosis is the single greatest risk for bankruptcy. If Wal-Mart lets her go because she spends too much time with her son, she’d be eligible for Medicaid, but she’d likely lose Billy’s oncologist, who wants to get paid himself.
Light-years away, on the other end of the healthcare universe (and the distance is at least that far) and requiring no bake sales whatsoever, the five largest for-profit health insurers netted $11.7 billion in profits in 2010, up 51% from 2008 profits, attributable primarily to a combination of premium increases and the fact that insured patients skimped on medical care to avoid costly co-pays and deductibles.
As a reward for these record profits, the CEOs of the five largest companies garnered $54.4 million in compensation in 2010. That’s right: five CEOs, $54.4 million, the champ being Cigna’s David Cordani at $15.2 million. Meanwhile, the industry’s lobbying group, America’s Health Insurance Plans (AHIP), funneled $86.2 million into the US Chamber of Commerce in 2009 with the goal of weakening or even eliminating the Health Care Reform Bill, even though in its existing form they will profit mightily from it.
What keeps these CEOs awake at night is the public option possibility sometime in the future, so-called Medicare For All or single-payer care.
These days, in addition to the big money from premium increases, more wealth for the insurers comes from a combination of simply not paying claims plus cherry-picking healthy enrollees with no pre-existing conditions. To quote the CEO of WellPoint, “we will not sacrifice profitability for membership increases.”
The insurers are using any tactic imaginable to shift the cost burden onto the enrollee (that would be you).
According to the AMA, every fifth claim (19.3%) submitted to a for-profit insurer is incorrectly processed by them to deliberately delay payment long enough that the patient herself will be billed for a service that should have been paid by her policy. (By comparison, Medicare has an error rate of 3.8%.) Physicians received no payment whatsoever on 23% of the claims they submitted to commercial health insurers.
These figures come via Physicians for a National Health Program (click for some stimulating reading), which defines itself simply. They’re a non-profit research and education organization of 18,000 physicians, medical students, and health professionals who support single-payer national health insurance (yes, I’m a member).
As Mary and Billy face the twin challenges of cancer and financial meltdown, so too will some Frank, Catherine, Jose, Maria, and thousands and thousands of other poster faces across the country. I’m sure they’d all be grateful if you’d toss your change into that empty Country Crock container at checkout or splurge on a plate of cookies.
But I think we’ve got to consider doing something more.
David Edelberg, MD