Your health or your wealth

By Lynn Bailey, Guest Columnist, The State

August 25, 2006

I applaud the health care experiment the South Carolina Small Business Chamber and the S.C. Primary Care Association helped facilitate for Mid-Carolina Steel and Recycling, profiled in the Aug. 13 Business section. It’s a positive step, but it doesn’t remove the terror South Carolina families, lacking health insurance, face everyday.

Who are the uninsured in South Carolina? Increasingly, middle-class families. Many of us work for small businesses that are dropping health insurance because it is too costly. Many are self-employed entrepreneurs following the dream of being “our own boss.” Many were formerly covered through an employer’s COBRA coverage, but it has expired, or was too expensive and we couldn’t find private coverage.

We are only a few degrees of separation from someone who is uninsured. Middle-class families hide the fact we are uninsured, perhaps because it is a painful or shameful indication that we aren’t really “middle class.” It terrifies us to think we are only one expensive medical event away from being destitute.

The recent experience of a good friend illustrates the meaning of uninsured. A few weeks ago, the neighbors of a good friend lost a young wife and mother because they didn’t have health insurance.

This young mother had a congenital heart condition; as a teenager she had had a heart valve replaced. This pre-existing condition makes her uninsurable in South Carolina’s private insurance market. Her husband’s employer didn’t offer insurance. Her employer did, but she hadn’t worked long enough to qualify for coverage.

In addition to her heart condition, she also suffered from migraines. Her migraines were severe enough that she often passed out. Without insurance, she couldn’t afford the prescription medications to prevent and treat her migraines. She also avoided regular visits to physicians for her heart condition.

It’s not that she didn’t know or care about her own health, but there were choices to make: groceries, the electric bill, car insurance, the mortgage, day care, work shoes for her husband’s job, and gas to get to work. There was never the extra $700 to $800 each month for the health insurance premium, had they been able to find a policy because of the pre-existing conditions.

So when the migraine hit, she didn’t go to the doctor or the hospital right away. They owed hospitals money, and collection agencies were calling. The migraine worsened; she was dehydrated and semi-conscious. Finally in desperation, her husband took her to the hospital across town — the one they didn’t yet owe.

At this hospital, nurses were unable to insert an IV to rehydrate and medicate her. She needed a surgical procedure to insert a central line in order to be treated. She was treated overnight and discharged. She wasn’t feeling well. Within a day, she began running a high fever. Again desperate, her husband took her the emergency department at the nearest hospital. There she was diagnosed with a raging blood infection.

She was then transferred to a tertiary care hospital because the infection attacked her replaced heart valve. She died from the infection before she could have surgery to replace her infected valve.

The terror isn’t over for her husband and baby. The hospital collections agencies are still calling. It looks like the family will end up filing for bankruptcy.

Your health or your life or your wealth — it is a terrifying choice every day for too many South Carolina families.

A dozen states across the country are making innovative private and public efforts to find ways to make health insurance more affordable and available. In South Carolina, the Department of Insurance studied the uninsured in 2003. This study concluded we could fix the problem of the uninsured by expanding and reforming Medicaid. This study didn’t recommend any actions to “fix” the small-group or private health insurance market.

We have yet to expand Medicaid.

South Carolina is a small state, certainly we can craft solutions to the problem of affordable and available health insurance if we choose to focus our energies. How many more families must face the choice of your health, your life or your wealth before we finally take action?

Ms. Bailey is a consulting health care economist based in Columbia.


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