Monday, January 21, 2008
Barely making it but still undecided
Troy McCarty

By A. Chris Gajilan
Medical News Senior Producer

"I'm ashamed I have to go to the emergency room when I get sick, but there's no way I could afford health insurance…just no way. I'm barely making ends meet."

I met 35-year-old single mother and full-time waitress Troy McCarty on the campaign trail last week. She was our waitress as anchor John Roberts and chief medical correspondent Dr. Sanjay Gupta went live on CNN's "American Morning" from the Lizard's Thicket restaurant in Columbia, South Carolina.

I'm covering my third presidential election at CNN. I have to say that I've always loved the campaign trail. I feared being a medical producer would keep me away from the road, but no such thing. This election is blurring more than party lines. Put quite simply, medical has become political.

But sometimes, it's far too easy to get distracted by live shots, sound bites and stump speeches. Meeting Troy reminded me of one of the greatest things about the campaign trail: actually listening to people's stories.

Troy has lived in South Carolina for two years. Troy takes home between $800 and $1,000 a month from her job at the restaurant. Her expenses for the month total in the neighborhood of $1,200 per month. She decided not to contribute to her employer-sponsored health insurance because she couldn't afford it. About half of the waitresses pay into a plan that costs between $100 and $200 every week. What's worse is that Troy suffers from crippling migraines. When they strike, she turns to the emergency room where one visit ends up costing her more than $1,900. She ends up working out a payment plan for each bill. It doesn't take a mathematician to figure out that she's having a rough time.

Troy is just one of the 45 million uninsured people who are figuring out how to live without insurance. She's still an undecided voter, but she's hoping for a candidate who can give her some real solutions. Tonight, CNN will be airing a political debate with the Democratic presidential hopefuls live from Myrtle Beach, South Carolina. I can't wait to see whether any of them have anything to offer Troy or the millions of other people who are barely making ends meet.

What do you want to hear from the candidates when it comes to health care?

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As someone with 'pre-existing conditions', who can rarely find insurance coverage, and barely afford it when I do, I feel that insurance is often more of a gamble than actual insurance.

Just two of my prescriptions that I need cost over $2000 a month without insurance. That might make the $700 a month I'm paying seem like a bargain, but it's not since my condition required me to take some time from work. Then I was let go.

I'd let to see the cost of medication and other care come down. It seems like insurers are just middle men, making a lot of money. Why can't we eliminate them completely and let doctors and patients make informed, affordable choices without interference from a third party solely interested in profit???
Why doesn't she have a primary care doctor? She could probably see here PCP as a self-pay patient twenty times for what she's paying for a single visit to the ER. There are many generic medications for helping prevent migraines, and brand-name migraine treatments may be available at minimal or no cost through assistance programs sponsored by the pharmaceutical industry. The ER is not her only option.
Let me share with you an example of how health insurance should work. When I was about eight, my grandfather had an experimental heart procedure which saved his life. It was performed by the top heart surgeon at an ivy-league university. It cost $600,000, which in the mid 1980's was a lot of money. The surgery was a resounding success. My grandfather lived for another ten years and the procedure (they replaced his a major artery with artificial tubing) became standard.

Because my grandfather was insured, my family didn't have to pay anything. The insurance covered it all. The insurance didn't cost anything. My grandfather worked at the post office for 20 years.

What has happened to our healthcare system? It used to be the very best in the world. Maybe someday it will be again. But for that to happen, healthcare needs to be available AND affordable to everybody!
The issue seems not to be affordable health insurance but affordable medical care. Seven hundred dollars a month for two thousand dollars of drugs is a bargain! The issue is the two thousand dollars for the drugs.
There IS Help!!

Patient Assistance Programs are usually sponsored by pharmaceutical companies to provide free or discounted medicines to low-income, uninsured and under-insured people who meet the quidelines which are different for every program. Some have income guidelines are as high as $40,000

Programs called PAPs (Patient Assistance Programs) provide free or low cost medicine to low-income people who are uninsured or under-insured. This information site can help you save thousands. All of the medications applications(PAP) do require the assistance of your doctor.

A few of the programs will help those on Medicare D.
I make $10.37 HR. work 40 hrs per wk. I pay $253 biwkly for insurance. I still cannot afford to use it because each copay is $25 and specialist is $50. I have diabetes and HBP. I take 5 meds and have to choose which one to purchase each month along with strips/lancets. It is awful to be sick or have a disease. Our healthcare system is broken.
I have an 80/20plan, with a 2500.00 deductible. I earn 13.00 hour and work only 40 hours a week. I have not been to the doctor because I can't afford to pay the costs up front. And I have only worked on my job for one year, which means I still have about 90 days before my pre existing conditions are covered. ( migraines, torn ACL) I figured, the only reason I have this insurance, is if I happen to find another insurance plan that would cover more, then I wouldn't have the gap in coverage and have to wait the exclusionary period also.
I agree with the previous poster in that it is not just an insurance problem; it is an entire system problem. These are the questions I would like to have answered by the candidates:

1. What will they do about the high cost of medical schooling, which inhibits many people from entering the discipline and adds to our medical bills to help pay for the interest on our doctors’ school loans?

2. What will they do about the high rate of misdiagnoses and medical errors, both of which are not only a physical burden on the patients, but also a financial burden on the system?

3. What will they do about the high cost of hospital and diagnostic clinic care?

4. What will they do about increasing the number of nurses and reducing the burden on an overworked nursing corps?

5. What will they do about making our medical licensing boards more accountable to ensuring more doctors and higher quality doctors are licensed?

6. What will they do about watching for price fixing within the medical and insurance community?

7. What are they going to do about practices that limit patient choice, such as insurance companies establishing preferred provider networks (a form of surreptitious, tertiary medical licensing) and doctors refusing to take some insurance?

8. What are they going to do about the reach of pharmaceutical companies into the doctor office to provide implied-quid-pro-quo benefits and incentives to doctors, creating a conflict of interest?

9. What are they going to do about pharmaceutical companies that bury negative research findings? To be fair, Congress just recently passed a bill requiring companies to post ALL research results for drugs going through FDA approval. Could more be done?
My sister sounds very similar to the main character in your story. Unfortunately, and I hate to say this, but she also chooses not to pay for her insurance and goes to the emergency room when she is sick. However, she spends her money on cigarettes and alcohol as well as playstation 3 and a big screen TV and her family eats out to dinner almost every night. I am sorry to say this, but if you are working as a waitress and have 3 children, maybe you should spend your money on health insurance instead of things that are uneccessary and might even make you sick. Also, she has government assistance for insurance for her children when I know very well she could afford to pay for the coverage. For example, if her and her husband smoke a pack of cigarettes a day, that is 70 dollars per week, which is 280 per month. I know people who make 60,000 - 100,000 per year who would not spend money on those things. I am not saying that everyone who has no insurance is irrepsonsible, but many people are and we should try to keep that in mind.
What I don't get is how can middle and lower middle class American accept this travesty, having to worry about deductibles and pre-existing conditions, what do you people pay taxes for? What do you get for your taxes?
In all the Western Countries (every single one) their governments have removed that concern from the citizens. They must laugh at us boasting how wealthy we are.

Why haven't we demanded universal health care for adults and children, and for those who can afford it there will always be private medical care, like in The UK.
When I did have insurance through my job, I was not able to use it but twice during the many years I paid to have it. Neither time was it worth what it cost me for the visit, let alone what it cost me every week for all those years. I don't even want to know how much more the company spent for it. I would like to hear what they plan to do about that sort of thing. Many of us pay and pay and get nothing in return, even for simple routine care. Why are we paying so very much of our gross wages to be told that we needed to make an appointment 2 years ago for a physical and 3 for an urgent visit? Only to discover that had we had an appointment we would likely not even see any doctor and none of our issues would be addressed? There's only so much the nurse is allowed to do.

I would like to hear them speak about PCPs unwilling to take self-pay patients and ERs that refuse to treat the uninsured. As I personally have witnessed both of these. While I can understand that it might be a risk to the Dr that someone will not pay, this is why people end up using the ER as a PCP. (For the moment, disregarding the Presidents statment suggesting they should do just that.) I have been looking for 2 years for a PCP who will take self-pay and still have not found not one single PCP who will take anyone without insurance (government or otherwise). Personally, the way the ER treats me now that I do not have insurance is completely different than the way the very same hospital and doctors did when I had it. Also, I have seen others sent to what I hear them call "welfare hospital" because they outright refuse to treat them.

I would like to hear their resolution to pre-existing condition and high-risk pool issues. Many people with pre-existing conditions cannot afford to buy into the only people who will offer them coverage and depending on the condition not many will offer coverage nor cover most of what they will need. What is the point in having any then? When I inquired, my state insurance commissioners office responded that neither are available in our state and referred me to social security and medicaid. Now, while I would gladly pay into medicaid to use it (like insurance), I do not wish to take advantage of the system. I would like to hear a resolution to abuse in the insurance industry and medicaid.

I would like to hear what exactly we are paying for when so many complain about the system? Where is all that money going? And - What do they think about how I could have paid for every ER and otherwise visit I've had in the last 7 years, in cash, if I hadn't spent all that money on insurance I never got to use?
I want a plan that will cover everyone. Why can't we expand and fund Medicare to cover everyone - plenty of older folks get health care from Medicare and quite a bit of it. Yes it will raise taxes but the cost of uninsured not paying their medical bills will offset that as well as people not getting care until their illness becomes serious since they can't afford prevention/early care which is much cheaper than surgery.
No system will be perfect but our's is broke. You either have to have a job that has good pay, a large enough group to lower premiums...or you have to be poor to get free health care. Nothing for the lower-middle class that works just as hard as the folks with good jobs.
Insurance companies are in control of our health system now and doing a lousy job while making record profits.
I am verrryy.... glad that I am Native American. Health care and medication is free, as long as we are seen at an IHS facility.
So yes, it is possible. Look to the government for Universal Healthcare, not cheaper/affordable healthcare, it should be free for all.
there was an interview with an American professor about why the Swedes/Norwegians were able to have universal health care for all from cradle to grave and he stated that it couldn't happen back in American because the European were of one type (race) so they are more willing to ensure that everybody gets the same level of care, than in a multi-glot population like in the USA.
I really hope he isn't right that we would spite ourselves and or children in order to deny another American equal benefits.

I should NOT have to think through a maze of health coverage in order to get medical attention, my parents should NOT have to travel to Canada to get AFFORDABLE drugs, is the USA so much poorer than other western countries?
I am a 22 year old, 70% disabled veteran. Although my health care is free, and I get a disability check, it still isn't enough. Part of the biggest problem with our health care, also comes from our employeers and their ability to understand people with a pre-existing injury. Since I became injured I have hopped from job to job. I have been unable to stay at any one employeer for much beyond 6-9 months. Why is this? Not because I'm not a hard worker. Not because I have done anything wrong. Simply because my injuries force me to take quite a bit of time off work. My injuries force me to spend several days each month at my doctor's office. I tell my employeers this, and they claim they will work with me. But, when they realize I was serious, I end up getting let go, or forced into quitting. So although I am getting fair health coverage, I am still getting the short end of the stick.
What I would like to hear from the candidates on health care is that they won't tolerate people with pre-existing conditions being denied insurance or charged more than their income. The only insurance I could afford covers hospitalization only -- and I haven't been hospitalized since 1969.

The policies that would pay for what I need cost more than I earn. If I work more hours so I can pay more, then I wind up sicker and can't work at all.

I would actually be better off to stop working so I could get Medicaid. But if I stopped working to get the healthcare I need, people would call me lazy for not working. Can't win.
I've been without health care and ended up impacted for 18 days, bedridden ill for months and no income coming in.

They still don't know what happened because I didn't have insurance to see a doctor.

I ended up in the ER atleast 4 times. They put me on numerous antibiotics and laxatives to get the system running again.

I didn't have money for health insurance let alone the ER bills.
There isn't a way to cover health insurance on the small salaries that a lot of us make.

We need a health insurance plan for everyone and hospitals have to stop dumping patients who can't afford care on Skid Row or giving up on them. An ounce of prevention is worth a pound of cure.
I think if a politician had to live in our shoes for one month...
they would DO something..

but even after all we've been thru.. I don't believe the answer is socialized medicine.
My husband has an idea... but we feel healthcare is too big of a business and nothing will ever get done about it.

When I asked a NICU doctor how he justified getting paid $1692 a day
(we were in a local hospital for 2 1/2 months)

after a long discussion, he basically ended up saying that we're paying for those that don't pay...

how else can you explain a hospital bed at Stanford costing $26,000 a day for one person.
Oh yes,

I just heard on the radio the other day that CVS or Walgreens will have little clinics in the store? I would think that should help to relief the ER's...??
I have been been without health insurance for 3 years since being laid off in my field and my new field is part-time without insurance, so after a a number of ER visits for a pre-existing problem which had caused me to be denied insurance, I decided to do whatever is necessary for survival.
I was able to find a loophole in the Canadian health care coverage for foreigners even though I had never been to Canada I was able to gain full Canadian coverage.
I am pretty happy with the level of care, I have had both eyes fixed and my colonoscopy all for free.
Question is: why do I have to travel across the border whenever I need to see a doctor? In Canada I show a card and my Health care is guaranteed, What's wrong with this country?
I saw the program on TV. I work for Aflac and I think one of the reasons why we are growing so quickly is because health insurance is no longer enough. Does anyone think that supplemental insurance can be a solution?
Bravo to you for addressing our critical condition. As a healthcare professional with 24+ years experience I can say that this system is and has been broken for some time. It is unfortunate that people outside of the system and most elected officials who have excellent healthcare insurance compliments of the US taxpayers,lack an understanding of how bad it really is. The republicans are in total denial and I do believe that Hillary Clinton understands the problem in great detail and the hurdles necessary to effect change.
Because of the way it was set up, any changes in the system will threaten stock markets and jobs.
Because of the way ot was set up (I am a medical sales manager)prices keep going up. Healthcare is an INDUSTRY, a big employer, a big abuser of Medicare. Drug companies lobby and they get richer. Alot of money is made at the expense of the sick. Where are our values? The democrats are finally addressing this again. The republicans use the usual fear tactics: they misrepresent the democrats framing it as socialized medicine, they'll be rationing, we have teh BEST helathcare in teh world. My gosh, how do they sleep at night?
I am an American living in Canada , I have also lived in the UK.

I am sad to say that I would never move back to the USA after experiencing the Universal health care here in Canada and the UK.

I pay $44 per month for health premiums.

For that price I get excellent care for much less than Americans.

BTW our taxes are only 5% here in ALBERTA . We have no sales tax.
Regarding Walker Canadian health care for foreigners, how do I signup? this is one American not too proud to beg for my health.
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