A Personal Story from Minnesota

You are so very right. We need fair national health insurance and a roll back in the high cost of medical treatment. We are both retired and disabled. Although we are both on Medicare, we also pay $693.00 a month (until July, 05, at least) for health insurance. My husband was a public school teacher for 34 years and I still keep up my RN license, but can not work, at this time. My husband had a kidney transplant eight years ago and must stay on several very costly meds. (Thank God, I was able to give him one of my kidneys.) I also have to take several meds.--Not due to the transplant. Anyway, I would rather pay more in taxes and not pay the insurance company, so everyone can get good health care in this country. My insurance company, at this time, is refusing to pay for several of my mental health appointments, although they had agreed to before, so I do not know what we will do if we have to pay several thousand dollars we never planned for. God bless you.

Sincerly, Gayle Heggem (in northern Minnesota}

P.S. I wish I had been born in Canada

Insurance should not be linked to Employment

Some thoughts from a reader in Los Angeles, CA:

Numerous of my friends and colleagues do not carry healthcare insurance, not because they don't want to, but because they cannot afford it.

Self-employed persons, such as myself (I'm also a healthcare researcher with an economics degree) are in danger of losing their insurance because our rates are raised as a result of our making us of it. In my case, I am preparing to see an immunologist for what might turn out to be a rare, inherited disorder, which has already cost me and my prior employer-paid insurance over $100k over a 25-year period, with no diagnosis or treatment for the expenditure. I am now in the unenviable position of deciding whether I should try to pay for this specialist's consultations, lab tests and potential treatment by myself so that my plan doesn't find out and further raise my rates (I'm already at the maximum deductible) or use my insurance and risk being unable to pay for future premium increases.

You are correct in that insurance - which I and my late physician father believed - should not be linked to employment. What if someone is disabled or otherwise unable to work (I can only run my consulting business from my home, my health would not allow commuting and working in an office) or they work for a small employer that either cannot afford to provide employee coverage or can legally avoid the expense. But none of us have devised a solution to this problem, i.e., how can coverage be provided to all Americans. Going to a completely government-based plan will not work; citizens of countries that have socialized medicine in general must wait a long time to see a doctor or receive treatment, which in itself can be hazardous to one's health.

Additionally, our government is doing its best to ignore this problem, esp. the current Administration, by creating diversions. I believe it is only when physicians and other providors begin to speak loudly about this problem that it will begin to be addressed.

Under our current system, the only parties that become wealthy are the HMOs and PPOs. It is certainly not the doctors anymore, or support staff, and patient care is degraded too.

Going elsewhere for care

From a reader:

I am lucky enough to have health insurance.

My wife of 6 years is originally from Honduras (in Central America).
We visit her family once a year.

Health care in Honduras in of high quality and only costs
about $20 US for a doctor's visit, and $400 US for a hospitalization
with surgery.

If I didn't have health insurance, I would consider going to Honduras
to have any major procedures done.

Also, the doctors there seem to spend alot of time with you answering
your questions (which is very different from the typical US doctor who
rushes out of your examination room after the 2nd minute).

Some thoughts on the Business Community

An observation from a radio listener in Wisconsin:

I heard you interviewed yesterday on Wisconsin Public Radio as I was driving back from Milwaukee. I thought you might be interested in another perspective on the disadvantages of employer-provided healthcare from Don Coxe, who is the chief investment strategist for Harris Investment Group. I listen to his weekly call because I follow commodities as an investment. However, Coxe frequently comments on the competitive disadvantage faced by American corporations because this is the only industrialised nation where the cost of healthcare (and pensions) is incorporated into the cost of goods. In other countries healthcare is provided through the government and is paid for by taxes. I recall that he said that all other things equal a car made in Canada was $1500 cheaper than than one made in the US because it did not include worker healthcare.

Although Coxe is coming from a completely different perspective his analysis is similar to yours in that the way the US provides healthcare is very inefficient. As you pointed out the US has the highest per capita health care costs, yet we do not have the best health by any objective measure (infant mortality, longevity). This fact alone tells us that the healthcare dollar is being inefficiently invested. My guess is that the business community is as interested in better healthcare as you, and I would think that your message might receive a sympathetic hearing from the likes of Coxe.

"What will we have left for our children?"

A comment from one of our readers:

I work for a company, which provides financial data and software solutions to the global financial services industry. Since 9/11, I have seen many of our customers' companies, as well as my own and competitors be downsized. Dozens of my colleagues and clients have been laid off over the years and many of them were out of work for months, if not more than a year. These are well-educated, talented people. Paying for their own health care for an extended period of time and running out of unemployment put a financial strain on many of them and their families.

As you state in your book, any of us are one pink slip or tragedy away from potential financial ruin due to the cost of healthcare. I have three small children and worry about this all the time. Some of friends found jobs, only to laid off again after those companies were bought and merged with another or had additional downsizing. Couple this with all of the white collar jobs being outsourced all over the globe, and I wonder what opportunities we will have left for our children.

In addition, health care costs are rising astronomically, and companies are passing more of these costs on to their employees. My company went with a more a la carte policy approach this year. I "chose" to have my costs rise by 20%, but it could have been as high as 80% if I purchased the best coverage available, which would still have been less coverage than last year's plan. With my 20% increase, I now have a $2,000 family deductible and $40 office co-payments. It's a disgrace.

Thank you for your efforts.

An interesting historical anecdote from a Canadian Reader

From Todd Gorman, M.D., a reader from Canada:

A brief anecdote you may appreciate... About a year ago, I took my kids to the Montreal firefighters museum. There was a display there of a door placard from about 1900. At that time, homeowners would pay "fire insurance" if they could afford it) and would then receive the placard to place upon their front doors. For any fire, the fire department was summoned. If they arrived and found the placard upon your door, they would put out the fire. If, however, you had not paid for fire insurance and had no placard, they would kick back and watch as the house went up in flames.

Eventually, everyone realized that fires simply happen and that taxpayers should pay for universal coverage against fires, which is where today's system came from. The parallel was so striking to me.

The system here in Canada is far from perfect, but much closer than the US. I hope your book helps with progress.

A message to our President

From Betty Thurman, one of our readers:
"Thank-you so much for this wonderful work and the attention that you are drawing to this growing problem of inadequate health care. Most Americans are only a few paychecks away or even a misfortune away from being in the same situation as the people you have highlighted in your study. I personally am horrified that a country of our great wealth stands by and allows this to happen to our citizens. I am hoping that our president will read this and will truly see that we must make equal access to healthcare a priority for all. Afterall, he and his family and the members of congress are the fortunate recipients of the best healthcare in the world -courtesy of the taxpayers of this great nation. How dare George W. Bush say, We can't afford health care for the 45 million uninsured ( a low figure). We can't afford not to! Those are the very same hard working folks who have been paying the way for him and others. Shame, double shame on those who dare to create a social strata where one group is considered more worthy than another to have affordable housing, health care, food, etc.. It angers me that those in power now pitch " rugged individualism" when they have millions of dollars in the bank, power, position and influence and still have used the system for their own selfish means (Pigs at the Trough, Arianna Huffington). Keep up the good work.

As with all our posts, these comments reflect the individual opinion of their author and not of any organization they may be associated with.

Rushika Fernandopulle's bio

Rushika Fernandopulle, M.D., M.P.P. has spent much of the last ten years involved in a variety of efforts to improve the quality of healthcare delivered to patients. He was the first Executive Director of the Harvard Interfaculty Program for Health Systems Improvement (PHSI), an effort to leverage top faculty from across Harvard University and senior leaders in health care organizations to tackle the largest, most difficult problems facing the health system. As part of this role he has been involved in research on many aspects of the U.S. health care system including racial disparities in care, clinical information systems, pay for performance, and the uninsured.

His current primary interest is in redesigning the model of how we deliver care, and he is a founder of Renaissance Health, a prototype medical practice and innovation lab in the Boston area featuring a radically different model of how to engage patients in their own care, innovative staffing models, improved physical design of the space, and leveraged use of information technology.

Prior to these positions, Dr. Fernandopulle served in several senior capacities at the Advisory Board Company, a membership based health care research firm located in Washington DC. He was Managing Director and Chief Medical Officer of the Consumer Health Initiative, which developed clinical content for consumers which could be customized for a particular patient’s needs and integrated into the process of care, and also served as Managing Director for the Clinical Initiatives Center which researched and shared best practices for clinical practice improvement for hospitals.

Dr. Fernandopulle is the co-author or editor of several publications including Health Care Policy, a textbook for physicians and medical students; Uninsured in America: Life and Death in the Land of Opportunity, a book describing what it means to be uninsured in America; and several articles on improving the quality of care in both inpatient and outpatient settings.

Dr. Fernandopulle earned his A.B., M.D., and M.P.P. (Masters in Public Policy) from Harvard University, completed his clinical training at the University of Pennsylvania and the Massachusetts General Hospital, is board certified in internal medicine, and currently serves on the clinical staff at the Massachusetts General Hospital and the faculty of Harvard Medical School.

Susan Starr Sered's bio

Susan Starr Sered’s work spans the fields of health policy, religious studies, and gender studies. As an anthropologist, she has conducted research in Israel, Okinawa (Japan), and the United States, researching topics including women’s experiences of breast cancer treatment, Israeli childbirth rituals, the role of Okinawan priestesses, and the renaissance of religious and spiritual healing in the United States.

Sered currently serves as Senior Research Associate at Suffolk University’s Center for Women’s Health and Human Rights. In that capacity, she is helping create a Master’s Degree program in Women’s Health, and carrying out research useful for women’s health advocacy at the municipal, state and federal levels.

Before coming to Suffolk, Sered founded and directed the ‘Religion, Health and Healing Initiative’ (RHHI) at Harvard University’s Center for the Study of World Religions. The RHHI, the first research program of its kind in the United States, spearheaded the study of religious healing in diverse communities in the US and the world.

A former Associate Professor of Anthropology at Bar Ilan University (Israel), Sered continues to advise the Gender Studies Program at that institution.

Combining academic work with advocacy and organizing for social change, Sered was one of the founders of the Israel Association for the Advancement of Women’s Health. She also co-founded ‘Women Healing Women’ – a project bringing together women clinicians and clergy in order to develop new models for addressing women’s health and spiritual needs in the Boston area.


Sered’s publications include:

Uninsured in America: Life and Death in the Land of Opportunity (with Rushika Fernandopulle)

Religion and Healing in America (with Linda Barnes)

Priestess, Mother, Sacred Sister: Religions Dominated by Women

What Makes Women Sick?: Militarism, Maternity and Modesty in Israeli Society

Women as Ritual Experts: The Religious Lives of Elderly Jewish Women in Jerusalem

Women of the Sacred Groves: Divine Priestesses of Okinawa

Healing and Religion: A Jewish Perspective

Welcome to the blog

Over the past year, we have travelled across the United States speaking with dozens of Americans who do not have health insurance. In this blog we will share our observations as we continue our work to try to understand the impact of being uninsured both on individuals as well as on our society as a whole. Please feel free to comment on any of the entries, or send us your own stories or observations to post.