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  • Writer's pictureSociety of Bioethics and Medicine

An Illness Away From Bankruptcy

Written by Christine Kuang

Edited by Jacquelyn Tang

Give me a moment as I grapple with the fact that I am one serious illness away from bankruptcy. The cost of healthcare is unregulated and steadily increasing, leading me to wonder about the repercussions. The United States healthcare system became a corporate business with an irrational marketplace and outrageous pricing.

According to National Health Expenditure Data, the United States spends 17.7% of its GDP on healthcare per person, significantly more than other wealthy nations, including nations that offer free publicly funded healthcare systems (Martin, A. B. et al., 2019). Yet, United States citizens face complications and dissatisfaction with the healthcare system, and some even declare medical bankruptcy. Medical bankruptcy is defined as the cost of healthcare procedures to exceed the individual’s ability to pay. A clinical research study found that “62.1% of all bankruptcies have a medical-related expense and the average medical debtors are educated, middle class American folks with medical insurance” (Himmelstein et al., 2007).

Polar opposite to the United States healthcare system, Canada serves as a progressive’s gold standard for equitable healthcare. Canada’s universal Medicare system emphasizes patient welfare as essential, a given right to its citizens regardless of one’s ability to pay. According to the World Health Organization, Canada’s administration costs are maintained at a low price, spending only 10% of its GDP on its healthcare system at $4,553 per person, whereas the U.S. spends $10,209 per person. Although the Canadian system is not bulletproof, Canada declared fewer infant mortality and medical errors, in addition to an overall higher life expectancy rate. The Canadian healthcare system astoundingly achieved lower costs, more services, and universal access to healthcare without compromising patient health.

What about the United States medical insurance? Doctor David Himmelstein states that today, 91% of the United States civilians have medical insurance coverage. However, people with chronic illnesses are obligated to higher premium insurance prices. Your chronic medical conditions may even lead you to not qualify for medical insurance as the United States healthcare operates on a “for-profit insurance system.” Insurances do not protect patients; instead, they answer their shareholders, creating today’s medical-industrial complex. Healthcare expenses that lead to medical bankruptcy fall into “out-of-pocket medical costs and lost labor income” (Dobkin et al., 2018). An act of desperation forces debtors to pay through credit and consequently embody interest.

The United States insurance system is primarily a private corporation that can determine what procedures and drug costs are covered. Insurance companies set prices in favor of their profits, ignoring the cries and upshot of the insured and uninsured. An average out-of-pocket procedure cost in Canada is $600 compared to America’s $1000.

Medical insurance premiums have been steadily increasing. Without insurance, the price of an EpiPen went up from $94 to $609 (Rapaport, 2017). Up 535% from 2007 to 2014. Another instance is a 70-year-old Seattle man with a 62-day stay at the hospital with COVID-19 resulted in a total cost of $1,122,501.04 (Stump, 2020). Below are some of his medical cost breakdowns:

$408,917 for a 42-day stay in an isolation room in the Intensive Care Unit

$82,215 for 29-day ventilator usage

$100,000 for lab tests and drugs for heart, kidneys, and lung failure

The federal government pledged $100 billion to cover all COVID-19 uninsured patients. Other illnesses are not so lucky.

Our healthcare system’s hefty price tag is fragmented and contingent on care delivery, administration costs, procedures and tests, medicines, supplies, and room fees. Wealth and affordability to purchase top physicians and procedures are prevalent in the United States healthcare system. This is the financial consequence of our capitalistic country. Corporate involvement in healthcare endangers a patient’s life. Hospital businesses have a responsibility to shareholders but not to patients, distorting the priorities of patient care. As Doctor David Himmelstein emphasizes, “Inequality has no place in medicine.” Government provision and oversight should modulate the cost and allow hospitals to recommit to the quality and ethics of patient care.

Is it ethical for our nation to put a price tag on our mortality? Do we forfeit our lives for the marketplace?

Special thanks to David Himmelstein, M.D., for his contributions to this article.

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