Let’s Talk About Healthcare Costs — And Privilege

Healthcare costs have been on the rise for decades and even with insurance, it can be tough to get access to the care needed.

A few days ago, I went to the eye doctor for an exam. One of the options I was given was to have a really cool camera get pictures of the inside of my eyes. These pictures would be pictures of everything in there — with the same impact as dilation but without going through the process.

“Insurance doesn't cover it,” the assistant told me, apologetically. “And it costs $30.”

I don't have vision insurance, so I knew I had to pay out of pocket for everything. And $30 for the eye doctor to see everything without dilation? SOLD.

As I sat there, waiting for the camera to do its magic, I thought about the following:

1. For some people, $30 is outside the budget of what they can afford for something that could catch glaucoma early and see small tears in the retina before they become big tears.
2. I'm lucky that I can afford things like eye exams and fancy cameras even though I don't have vision insurance.
3. There are a lot of folks who don't get access to what they need to remain healthy because they can't afford it.

By the time I left the eye doctor, I'd spent a little more than $1,000 for the exam and its trappings, new glasses (I'm due), and a year's worth of contact lenses. While that wasn't exactly fun for me, it was doable without causing me a lot of budgetary pain. I didn't even have to use the money in my HSA.

Today, Healthcare is Very Much a Privilege

There's a lot of privilege surrounding my situation and my ability to pay my healthcare costs. Here are some of the realities of my situation, thanks to my privilege.

• A career and income that provides me with ample time to understand my healthcare options and compare them.
• Internet access (Idaho's broadband coverage isn't great), allowing me to research and sign up for health insurance online and according to my schedule.
• Adequate income for paying high deductibles (so I can get a lower-cost plan).
• Being able to afford higher deductibles provides the ability to contribute to an HSA.
• A convenient career that allows me the luxury of time to see healthcare providers when I need to.

In general, access to healthcare in the U.S. is all about how much money you have.

If you can afford to buy insulin, you can manage your diabetes (whatever its type). Not toiling away at a minimum wage job that isn't enough to provide the basics of life? Congratulations! You deserve to be able to pay $30 to have your eyes checked by a great camera.

I'm lucky. I have the means to pay for health insurance through a state exchange, contribute to an HSA and then pay out of pocket for things like therapy and having my tubes tied. I can afford to enforce my bodily autonomy, and if my son needs medication, I don't have to decide between helping him get well and paying the electric bill.

Not Everyone Can Afford Healthcare Costs

To me, it seems strange that something as basic as making sure that you can see problems in your eyes early enough to do something about it is out of reach for many people.

If your work doesn't offer vision insurance, maybe you can't afford to even go to the eye doctor. And if your vision insurance doesn't cover the cost of the camera, maybe you discover the tear in your retina only after it's gotten big enough to be a real issue — because you couldn't afford the extra cost.

This type of scenario can be applied to other types of healthcare.

What about dental?

Can you afford to have your teeth checked? My ex and I had been married for more than five years before we could afford to go to the dentist because we didn't have dental coverage. When we finally made it in, we had to save up for three months to be able to afford the work that needed doing.

That doesn't even account for preventative care, seeing a doctor when you need one or paying for prescriptions.

In 2018, the average “consumer unit” spent 8.1% of their income on healthcare costs. I shudder to think what it might be if people were paying for the things they actually need — but didn't spend money on because they couldn't afford it.

Insurance Companies in Control

In addition to being a great deal about the money, healthcare is also about insurance control. Before I went in for my surgery earlier this year, we had a bit of a scare when we realized that the hospital of choice isn't on my insurance plan. I was able to go to another hospital in town, so it turned out ok.

But that experience got me thinking. I ended up having my surgery at a hospital without an emergency room. The hospital with the emergency room isn't in my provider network. So, I make sure that my son is very aware that if he has to call an ambulance to get me, he's to insist that I be taken to the hospital in another town — 30 minutes away — to avoid the astronomical out-of-network cost that would come with being taken to a closer emergency room.

You can't get care where it's most convenient or accessible. You have to go where the insurance company says you can go.

We've all seen the numbers. We know that having insurance doesn't keep you from being devastated by medical bills. It's also true that many people can't even rely on healthy habits to keep them from injury, accident and terminal or chronic conditions.

But, even though lives are on the line, the insurance companies aren't beholden to the people they cover. No, insurance companies are, by and large, for-profit entities. They're beholden to their shareholders.

And now, with our “leaders” working toward rolling back protections granted under the ACA, there's a very real threat that insurance companies could go back to having carte blanche over pre-existing conditions and charging extra to cover women.

You Only Deserve Healthcare if You Can Afford It

We spend a lot of time in our society trying to decide who “deserves” what. Can't get a job that offers health insurance? Well, you must not be working hard or smart or right or whatever. Too bad! You don't deserve healthcare.

You have insurance but you're still struggling to pay the out-of-pocket medical costs? Obviously, there's something lacking there morally. Are you not working hard enough? Were you just too stupid to pick the right plan? Clearly, you don't deserve healthcare.

For some unfathomable reason, we've decided that money is the measure of whether someone should see the doctor or get medicine for their kids.

Sure, you can go to the emergency room in a dire situation, and they have to treat you and keeping you from dying, but if you don't have insurance or money (or both!) they can kick you to the curb as soon as you're stable. Even if it means you're right back in there.

It's inefficient and it doesn't result in better outcomes for our population. We pay twice as much as other high-income countries for our healthcare — and have poorer outcomes.

At some point, we'll have to decide, collectively, whether we want to keep healthcare as a privilege. The current state of things doesn't seem to be working out well for a large swath of the population.

I'm lucky. I can afford my healthcare costs. The result of being able to afford good care (on top of my genetics, apparently) is that I am generally healthier, reducing my need for costly care.

But not everyone is in that boat. And I think they deserve access to affordable healthcare, too.