When it comes to access to health care, I’m up in the privileged tier, but the ground still feels a little shaky.
Arriving in the United States in the mid-1960s from England, I was put on the fast track to get my green card. So, unlike the eleven million immigrants without legal status in the United States, I didn’t have to choose between getting health care versus risking deportation.
During my professional career, my family was well covered. I was lucky to enter academia in the 1960s during the short-lived era when there were mostly full-time positions, solid benefits, and a decent pension plan.
My children, Daniel and Rebecca, born in 1966 and 1968, received their first regular check-ups in their mother’s womb. I didn’t have to worry about them getting enough nutrition in their early years, as is the case with some 100 million children worldwide whose growth is stunted or worse by the age of two.
Until now I’ve been fully covered by my HMO plan, though co-pays are on the increase. I’m one of the six out of ten folks who get their medical care through employer-insurance programs. You can count me among the gluttons – the twenty percent of the population who use eighty percent of the country’s medical resources. I’ve been loyal to Kaiser since they shelled out a few million dollars to get my teenage son through his first and second rounds of a brain tumor.
I’m not one of the 47 million folks in this country that try to get by without health insurance. I don’t have to wait until I really need care, then head to an emergency room and engage competitively with other sickies for attention in a system that, officially, is “on the verge of collapse” and “dangerously overcrowded.”
If you’re unlucky to head to a metropolitan ER at night, be prepared to first meet a couple of poorly paid, chunky security guards who ask you, “What do you want?” And if you get past them, you’ll eventually get to see a triage nurse, or at least her head as she pokes through an opening in the wall and tries to find out if you’re sick enough to be there, that you’re not a malingerer who gets your kicks hanging out in a claustrophobic, over-lit, over-heated room, surrounded by coughers and bleeders, watching Jerry Springer turned up loud enough to wake the comatose.
I’m not just better off than the uninsured, I’m also better off than most people in my position. We own our home – in realty-rich Berkeley, no less – have no debts, and pay off our credit cards every month. We own two new, albeit modest cars and a share in a cabin up the California coast where redwoods meet ocean.
Cecilia has a secure, full-time teaching job at a local state college where she has a pension plan and enough health insurance to pay for most of the extravagant costs of her illness. And given her diagnosis, it helps that we live in the San Francisco Bay Area where, thanks to a large middle class and feisty feminist movement, she has access to a female surgeon, a collaborative health care team, drugs and herbs, and yoga for breast cancer survivors.
We’ve also amassed a sizable chunk of cultural capital that enables us to find our way through the medical labyrinth and access the latest information about treatment options. “If only more of our patients had people like you to support them,” the Lung Transplant and Advanced Lung Disease Coordinator at a local university hospital e-mailed me during Daniel’s last year.
But most patients and their families, even solidly middle class ones, don’t have our resources: a brains trust of medical friends for third and fourth opinions, and the confidence to assert our rights against stubborn bureaucrats. We could be the poster family for “patient-centered care” – we know how to demystify esoteric information, how to network, and call in our chips.
We also know how to plan ahead. Anticipating retirement a few years ago, I invested in supplemental health coverage that promises me $205 per day in a nursing home. If I prefer to receive care at home, my plan allows for $3,079 per month (after I’ve paid off the first three months’ deductions). On paper I felt reassured by this coverage until I read that it costs about $75,000 a year for nursing home care and a whopping $166,000 if I want to pay a health aide to take care of me at home (at $19 per hour). I’m a little short.
It would only take a major disability or an expensively chronic illness to take us quickly from the crème de la middle class crème to social insecurity. “Unless you’re Bill Gates,” says a Harvard researcher, “you’re just one serious illness away from bankruptcy.”