This weekend, The Weekend Reader brings you The Body Economic: Why Austerity Kills by David Stuckler and Sanjay Basu. The Body Economic explains how the Republican approach to economics has and will continue to hit Americans’ wallets and cost lives. Stuckler and Basu analyze austerity and its effects on the health care system, and include moving personal stories of average people who have been affected by these harmful policies.
You can purchase the book here.
Diane was forty-seven years old when a splinter ruined her life.
She had been a teacher at a charter school in California. Because of $8.1 billion in education budget cuts the state enacted in 2009, she lost her job. Without her job, Diane lost her health insurance, so she had to purchase an individual coverage plan and pay the monthly premiums out of pocket. Diane signed up to the best plan she could afford, but that came with a high deductible: typically she would have to pay $5,000 before her insurance company covered any significant medical bills, making her think twice about whether she really had the money to seek medical help.
One afternoon, about a year after she lost her job and signed up for this high-deductible health insurance plan, Diane was walking on the floorboards of her old apartment and got a large splinter in her foot. Because Diane has diabetes, her minor wound became a large gash, then an ulcer that wouldn’t heal.
Diane felt that she couldn’t afford to pay the fee for a doctor’s office visit, nor for prescription antibiotics. So she tried to treat her leg herself—hoping that the redness creeping up her leg would go away if she strictly followed instructions she had found online: hot baths, soap, scrubbing, and over-the-counter antibiotic creams.
After a few weeks, Diana started to feel feverish and sweaty. Then she passed out. Luckily, a neighbor heard the shatter of glass when Diane’s head broke the coffee table. The neighbor called 911, and the police broke down Diane’s door and called an ambulance.
That’s when Sanjay met Diane—in the intensive care unit of the local hospital. Her leg was so badly infected it had to be amputated—something that could have been avoided if the infection had been treated earlier. Worse still, the infection had spread to her bloodstream. It was so overwhelming that it was causing her to become septic—causing her blood pressure to drop below 80 over 40. To stop it from dipping any lower and leading to a potentially fatal cardiac arrest, Sanjay inserted a catheter through her jugular vein and into the right side of her heart, so he could pump intravenous fluids into her system and give her medicines that increase her blood pressure. Her kidneys were failing because of the infection, so a dialysis port had to be sewn into her groin. But the dialysis machine created its own problems. Diane suffered a stroke when the dialysis caused a second precipitous drop in her blood pressure.
Diane now lives in a nursing home. At the age of forty-seven, she is unable to speak or walk or move the right side of her body. Like hundreds of uninsured or underinsured patients, she delayed medical care because of fear of the cost. But ironically, her one hospitalization cost over $300,000. Her stroke left her disabled, and she will cost the state of California tens of thousands of dollars a year for the rest of her life. She requires twenty-four-hour nursing care to turn her in bed, clean her when she soils herself, and spoon her food into the left side of her mouth so she won’t choke on it.
Diane’s story is an extreme, tragic example of an everyday occurrence in the United States: the deferral of essential medical care among Americans who simply can’t afford it.
Her case is particularly tragic because if she had encountered that splinter a few years later, Diane might have been covered under the new healthcare law, the Patient Protection and Affordable Care Act (PPACA), passed by Congress and signed into law by President Barack Obama on March 23, 2010. Before the law, about 20 percent of Americans with high-deductible healthcare insurance plans like Diane skipped preventive doctor’s visit because of the cost. The new legislation helps ensure that everyone has affordable healthcare coverage, even if they are unemployed. While it is impossible to say with certainty that Diane’s tragedy could have been avoided, had she been covered by an affordable plan, she probably wouldn’t have let cost come between her and her doctor. That meant she would have been able to go out and seek work again in an economy slowly recovering from the Great Recession.
While the United States under President Obama began taking urgently needed steps to help prevent the Great Recession from leading to more avoidable tragedies like Diane’s, the UK’s National Health Service (NHS) began doing the opposite. Initially its universal healthcare system had been a great protector of its people—and no one lost healthcare access due to the economic crash. But now, under the politics of austerity, the UK Tory government is trying to mimic the US model by introducing competition, markets, and private contractors into the NHS. To understand what these privatizing reforms are likely to mean for the UK, it’s first necessary to trace why the US healthcare system was in such dire straits during the recession.
Before the Great Recession, the US healthcare system failed to provide coverage for many of its people. Although two-thirds of Americans received health insurance through their employer, the rest—those whose employers wouldn’t cover them, part-time workers, and the self-employed—were on their own, if they couldn’t qualify for federal insurance programs. These American had to buy health insurance on the private market, but many could not afford the high monthly payments (premiums) and high deductibles. What’s more, before the passage of the PPACA, insurance companies were able to restrict coverage on the basis of pre-existing health conditions, like diabetes of high blood pressure—so many who could afford private insurance were nevertheless not fully covered. All in all the US system left about 40 million Americans—almost 13 percent of the population—without health insurance.
The Great Recession turned this bad healthcare situation into a full-blown crisis. When Americans lost their jobs in the recession, another 6 million people lost their health insurance. Losing healthcare coverage is extremely dangerous. A 2009 study found that people who lacked medical insurance were 40 percent more likely to die prematurely than those who had it. During the Great Recession, before the PPACA came into effect, there were approximately 35,000 avoidable deaths due to the lack of healthcare insurance.
Americans who lost insurance through their jobs had few options during the recession. Some tried to seek insurance on the private market, but about a third of them were refused coverage for a variety of reasons, including preexisting medical conditions. Others simply couldn’t afford the cost of a private healthcare insurance plan, which could be up to $25,000 per year for a two-person family. The recession exaggerated these costs further. Across America, on the pretext that the recession made it harder to operate, insurance companies were increasing their premiums—the monthly amounts people paid in to their insurance plans. Anthem Blue Cross in California, a subsidiary of WellPoint, raised its premiums by as much as 39 percent. The American Medical Association, the largest association of doctors in the country, officially condemned this practice (commonly known as purging), but they could do nothing to stop it.
Some people were eligible for public insurance (if they earned under about $23,050 household income for a family of four). These people could qualify for Medicaid, the US government health insurance program for the very poor. But as enrollment in the program jumped 8.3 percent every year since 2009, some politicians and officeholders, mostly Republican, grew increasingly vocal about “out-of-control” government spending on Medicaid.
All over the US, state officials began finding ways to cut Medicaid budgets. They introduced higher deductibles and co-payments (out-of-pocket fees) for prescriptions and doctor’s visits, cut benefits, levied new taxes on care providers, and instituted hiring freezes, furloughs, layoffs, and salary cuts to Medicaid workers. Since the peak of the recession in 2009, forty states have cut their Medicaid budgets in at least one fiscal year. Twenty-nine of these states subsequently cut their budgets a second time, and fifteen states did so a third time.
While it is too early to determine the full extent of the long-term impact of these cuts, there are already signs that people’s health is suffering. Among the Americans who switched to high-deductible plans to save money, many began forgoing medical care as Diane had done. Families on health insurance plans with high deductibles were 14 percent less likely to see a doctor when they needed to, compared with those who stayed on lower deductibles.
Reprinted from The Body Economic: Why Austerity Kills by David Stuckler, MPH, PhD and Sanjay Basu, MD, PhD. Available from Basic Books, a member of The Perseus Books Group. Copyright © 2013.