The second in a three-part series on Bush's America looks at the inflated hospital bills facing the uninsured poor
4 November 2003, Julian Borger, The Guardian
Rose Shaffer's heart attack taught her a lot of things that, as a nurse, she should have known. She learnt it pays to eat carefully and exercise regularly. And she learnt the hard way that if you cannot afford medical insurance in America, you better hope you don't get sick.
A Chicago hospital saved Mrs Shaffer's life but she feels it is now trying to take it back. Since that frantic October night three years ago, the hospital owners, a Christian, non-profit foundation, have hounded her for crushing bills she could not afford, partly because as an uninsured patient she had been charged double. The hospital sent debt collectors after her who called her all hours of the night, at home and work, until she gave in and was forced into bankruptcy. Now, at the age most people are thinking of retiring, she has to work long hours seven days a week at a nursing agency for the next three years to have any hope of holding on to her last asset, a suburban bungalow. "When I was young I thought that, when you reach 60, if you don't have anything, then you're nothing. Well, I'm 63 and I don't have nothing, and I'm not going to get anything," Mrs Shaffer said, sitting at her kitchen table sifting through some of her latest bills. "The whole system is messed up. In this country the rich get richer and the poor get poorer, and no matter how much you work, you're going to get poorer."
In the US today, there are nearly 44 million people in her position - without medical insurance in a country that does not guarantee basic healthcare - and the crisis is deepening. In the three years since George Bush took office, the ranks of the uninsured have risen by 10%, or four million people. The government will pay if you are destitute but not if you earn enough to keep above the poverty line - about $18,000 (£10,600) for a family of four. In theory, employers are supposed to provide health insurance but more opt not to, and buying cover individually is either very expensive or impossible if you have a "pre-existing condition." Consequently, 15% of the population, most of them the working poor, live in the fear that an accident or sudden illness could plunge them into debt. The uninsured will typically put off going to see a doctor in the hope that their medical problems will pass. They tend to seek treatment only when their condition is critical.
The crisis has become an issue in the presidential campaign. Remedies vary in cost and ambition, from schemes to expand Medicaid and Medicare (the government-funded schemes for the destitute and elderly) to cover the rest of the uninsured, financed by repealing the Bush administration's tax cuts, to the far more modest market-oriented proposals put forward by the White House itself, based on tax breaks for the self-insured. History suggests that, whoever is elected, little will change. The hospital business and the $400bn insurance industry have too much to lose, as do corporate employers who would be asked to foot much of the bill. Much like an uninsured patient, the US knows there is something wrong, but it is unable so far to face the cost of the cure.
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