In 2008 I started an art project I call Art As Social Inquiry. The idea for this project surfaced after decades of observing the hundreds of thousands of people (and I mean that literally) I encountered in 30 years of working in the restaurant business. You can imagine that, after so many conversations, I had heard many thousands of stories of people helping people. One day it struck me, “Why do so many people who support so many charitable causes withtheir time and money get absolutely livid and resolute in opposing real reform for creating a system in which all people can access healthcare in the United States?”
Surely, if these good people really knew what was happening to the “others,” the ones who had no or not enough health insurance, the ones not like them, they might feel differently. I wanted to create an honest dialog by connecting the issue of access to healthcare to real lives — lives affected by our opinions and the society shaped by those opinions .
Also at this time I was phasing myself out of the restaurant business and returning to art-making, something I had studied for a brief time in my twenties. I had the idea that I could paint portraits and tell every kind of healthcare story I could find. If I created an overview by lining up these portrait-stories side-by-side, and then invited people to look at was happening in real lives across the spectrum of healthcare access, would our opinions about how we get healthcare change?
Any doubts I might have had about this new venture were quickly scuttled when I felt a bit of a spiritual push. I recognized that I, in my small way, was responsible for creating this class of “others” who could not get health insurance. As a small business, our health insurance group was comprised of my husband, me and one other full time employee. When our one full time employee decided to leave after 3 years, I said to my co-owner/husband, “If we hire only part time employees, we won’t have to provide health benefits.” I felt nauseous. I had to either lie to myself about how I was planning to control costs in our system of employer-based coverage. Or, I had to admit that I would be contributing to this national epidemic of the uninsured like the hundreds of thousands of other small businesses looking to hire only part-time workers. I thought, “Is this any way to run a country?”
Fast forward to the present. I am 45 portraits into my social inquiry of how we access healthcare in the US. My goal is to paint at least 100 portraits and have an art show travel the country for many people to see the portraits and hear the stories.
The portraits I paint are large, expressionistic canvases, 40 x 30 inches. I have no interest in painting literal images of my subjects. First I listen listen listen then intuitively express in the painted faces what I’ve heard. The subjects of my paintings retell what is often the most harrowing emotional, financial and health nightmares of their lives. To paint their faces, I must feel as they do in the recounting of their stories. When the image I paint on the canvas stares back at me as the real live person did from across the table during the interview, I know I have succeeded.
These portraits stories and the people behind them have taught me a few things. For 2 ½ years I have listened to real people tell me how they accessed or tried to access healthcare. My conclusions reflect the lessons I have taken away from listening to the stories of my subjects, and so many others I have not painted. I encourage you to read the stories online (ArtAsSocialInquiry.org) and draw your own conclusions. And I would add that what I found is so disturbing that I must speak up as loudly and as often as I can.
But the one glaring finding from all my interviews: It is in all our best interests for all to access healthcare in the US.
Employer-based healthcare is very much a part of the economic/jobs crisis. Our current system incentivizes businesses to control healthcare premiums by eliminating them; that is, businesses hire part time employees wherever possible to avoid paying health benefits for full time workers. Employer-based healthcare is a contributing force, and a very powerful one, that keeps workers from getting full time work. More part-time workers ergo less benefits paid. (n.b. If an employer does not provide health benefits to anyone at all, however, then it doesn’t matter how many hours a person works. The company just doesn’t provide coverage. This is becoming more the case for small business employers. Some employers just don’t provide benefits to anyone. Period. These small business owners not offering insurance even to themselves sometimes get insurance by becoming dependents on their spouses’ group policies through the spouses’ employers. )
Unbeknownst to the American public, lack of access to healthcare is creating a public health risk. I recently interviewed a clinic director. She told me about a restaurant worker who delayed treatment for scabies, ahighly contagious skin disease, because he was uninsured. He was handling food. Think this is the only story of its kind? I don’t. When faced with spending $40-$50 out-of-pocket to see a doctor, and who knows how much for tests and a prescription, an uninsured low-income person typically puts off treatment for as long as possible.
The uninsured are most often working people who do not qualify or are not offered insurance through their employment. They are full time workers not working for corporations, people working two or three part time jobs, or people who have lost jobs and cannot afford to pay premiums for COBRA (a plan that allows them to stay on their former employer’s group plan for 18 months.) They are nannies, restaurant workers, pizza delivery guys, photographers, home health workers, bakers, landscapers, widows, students, jewelers, musicians, casino workers, acupuncturists, drapers, handymen, convenience store clerks, hairdressers, masseuses, contract workers and many more. They are those with pre-existing conditions and deemed uninsurable (read “unprofitable”); they are the very sick who become too sick to work, lose their jobs and along with it their health insurance; they are sole proprietors who cannot afford to buy health insurance on the individual market. (Insurance companies sell coverage directly to an individual rather than to an employer who has a “group” of people on a plan.)
Good people are finding ways to con the system. One woman I painted (anonymously) married her good friend just to get on his health insurance plan so she could get treatment for cancer. When a graduate student was required to carry the school’s insurance because she did not have her own, she devised a way to circumvent the requirement with a sleight-of-hand maneuver in the paperwork. She could not afford the out-of-pocket expense of the school’s policy. “I felt like I was uninsured anyway. So why have the school’s insurance that I was never going to be able to afford to use if I got sick?”
Our for-profit healthcare system is designed to cherry pick the healthiest among us who pay premiums. Healthy people use the system a lot less than sick people. Healthy people leave more of their premium dollars in the company’s hands. Conversely, selling health insurance to the sick eats up more of a company’s profits, and becomes something to be avoided in our current business model for accessing healthcare. We see this at work when companies set a premium price for more than it would cost for a sick person to pay out-of-pocket to get treatment. For example, a young woman, a college graduate and type I diabetic, found it was cheaper for her to buy her insulin than to buy health insurance.
Insurance companies know the cost of treating a type I diabetic and set rates accordingly i.e. price the insurance higher than the cost of her insulin. Why would a for-profit business take a financial loss by making the insurance premium less than the cost of paying for the needs of this type I diabetic? It would be against a corporation’s mission which is to produce profits and maintain share value for its shareholders.
In a free market we can decide to buy or not buy a product as was clearly seen in the recent Netflix debacle. Over 800,000 subscribers were unhappy with Netflix’s new pricing . The consumers expressed their dissatisfaction by cancelling their subscriptions as one can do in a free market. The market, in turn, saw plummeting sales and backtracked. Netflix reached out to the consumers in an effort to regain market share. Here’s the rub with health insurance in a free market. We can’t drop health insurance. If we could we would have expressed our displeasure long ago and walked away from health insurance premiums just as the Netflix subscribers walked with their dollars.
Every person is a cost/benefit analysis. The most fortunate sick people belong to group plans provided by their employers. The employer contracts with the insurance company for coverage for his employees. Small employers run the risk of having too many employees using the insurance (especially employees who have had medical catastrophes and need long-term care but still work). Small groups are subject to the same cost/benefit analyses as people buying insurance on the individual market. If the insurance company is not making enough profits from a particular group, the corporation will jack up the cost of premiums excessively high in the hopes that the employer will drop the insurance coverage. (I have heard of premium increases of as much as 40% in one year.) The insurance company wins because it has effectively dumped a profit-losing small group/business. This practice penalizes small employers for having unwell (but still productive)employees, and incentivizes them not to provide insurance at all.
Divestiture of the unwell has a face. The uninsured young woman, the type I diabetic, tried to save a few dollars by cutting down on her nighttime dosage of insulin. She thought she had the flu. She was actually falling into a diabetic coma. Courtney Leigh Huber, 23, died for want of a little insulin she was paying for out of her own pocket because the premium per month cost more than buying the actual medicine every month.
A cost/benefit analysis for a 23 year old, female, Type I diabetic would reveal how high a premium would have to be to cover the insulin AND make money. Logic says to price the premium to equal cost of medicine PLUS desired profit. Why would any self-respecting for-profit business sell a product on which it would take a loss? We see tangible consequences of this for-profit business model in our society: untimely deaths like Courtney’s (many thousands of them), citizens encumbered by medical debt (from being under-insured), medical bankruptcies, a stressed-out society afraid of getting sick for fear of what it will cost. The cost to a society far exceeds dollars and cents. The for-profit business model has brought the American people to its knees –uninsured and afraid of getting sick; afraid of losing a job and health insurance with it; afraid of actually using the insurance for fear of what it will cost out-of-pocket. Afraid, afraid, afraid. And we’re going to compete in a global world when fear is eating away at our workforce?
Profits are also maximized when consumers are confused and make mistakes. An insurance company will find every way it can to deny claims because denying claims means more profits.(Sounds harsh, but I must refer the reader back to the portrait-stories.) Denied claims thrust under-insured patients into this labyrinth of twists and turns of procedures being coded incorrectly, hospitals in network but the doctors aren’t, etc. One wrong move in how care is sought by the patient, and he or she could be on the hook for thousands of dollars. The onus is on the patient (and medical professionals) to be the expert in not making mistakes that the insurance company can then dangle in front of them as reasons to deny coverage. Imagine the distress we feel just trying to straighten out one mobile phone bill with a customer rep. If a person with a serious illness has a pile of bills five inches thick — “explanations,” denials frominsurance companies, etc. — just imagine how much fear, tears and stress are caused by countless calls to the insurance companies. And imagine how stressed this person would be if she were fighting for her life AND facing financial ruin because of unpaid medical bills. For those who are sick and under-insured (and there are many millions), this is real. One of my insured subjects who suffered a stroke actually hyper-ventilated on the phone with an insurance company representative as she was fighting to get some of her claims covered.
Clinics, emergency rooms and Medicaid are often proffered as ways to deliver healthcare to the uninsured. Medicaid is for the very poor. Even an uninsured man who took a job making $12,000/year could not qualify for Medicaid. He ended up dying for want of a defibrillator. Emergency rooms are required to “stabilize” which means if they patch you up, they need go no further. The man needing a defibrillator could get the “paddles” to get his heart started, but he could not get a new device that would keep him out of the emergency room for good. And emergency rooms are not free. Poor or struggling middle-income patients get billed which further pushes them underwater financially.
Yes, some hospitals have generous charity care, but if this were the norm, why do so many thousands of uninsured people go untreated and die? Some clinics are propped up by hospitals which keep them solvent, but many are stand-alone operations that do beg-a-thons to stay in business to serve the uninsured.
If politicians point to Medicaid and clinics as solutions giving the uninsured access healthcare (as my representative often does), why don’t these same politicians support generous funding for the clinics hobbling along trying to serve the 50 million uninsured? Why do these same politicians support cuts to Medicaid?
This hodge-podge way of delivering care to the uninsured is inefficient and costly. And, in the end, inefficiency and wasteful spending end up costing the consumers who are paying health insurance premiums. Our current system is not sustainable for those actually paying the premiums. The sick people are uninsurable. They go to emergency rooms for care. They get billed by the hospitals but cannot pay. The hospitals can only eat so much bad debt until they needs to recoup losses. So the hospitals raise their fees. Now the hospitals want more money from the insurance companies, and the insurance companies want more money from people paying the premiums. Those paying for insurance end up paying for the uninsured in the form of higher premiums.
The ultimate lie is that uninsured and under-insured people are, at best, just short of deserving access to healthcare and not clever enough to figure out how to get care from clinics, charity care or Medicaid. At worst, the uninsured and under-insured are slackers, dregs of society and deserve their fate. We are beating up a class of working people by not creating a system where all can access healthcare when they get sick. And we expect these very same people to be the backbone of this nation and make us the best in the world. Our psyches are hammered with pat slogans about what it means to be patriotic –pull yourself up by your bootstraps. Work harder. You’re not ingenious enough. The message is that an uninsured person in this country has done something wrong. Shame on our representatives for rigging the system with favors bought by corporate money and influence; and then blaming the consumers for not being able to access the healthcare system – a corporate system that has successfully exploited democracy by buying politicians. For those unable to get care when they are ill, it is much like those games where you put in your 50 cents and try to grab the toy with the hook. Somehow the hook never gets the toy. It’s rigged. It’s not profitable to insure sick people. For-profit corporations must tend to their profits first. The American workers are made to believe they aren’t good enough. Nobody is talking about the toll these lies about the American people are taking on our national soul.
There is so much demagoguery and misinformation about ‘Obamacare.’ The rhetoric has convinced a huge chunk of middle-class America to vote against their own best interests in the name of “patriotism”. Too many distortions to list here. The biggest one, however — Obamacare is socialized medicine. The Affordable Care Act (‘Obamacare’) calls for competitive marketplaces where for-profit health insurance companies sell their products. I repeat, for-profit companies selling their products. The Affordable Care Act imposes consumer protections on those products, things like rate review, medical loss ratio, no pre-existing condition clause, no rescission, basic benefits packages and more. Most of the reforms don’t start until 2014, so this hysteria about reform driving up current rates is unfounded and meant to scare people and influence them politically.
The definition of patriotism has been co-opted by the corporations and their lobbyists whose campaign contributions give them privileged access to our representatives in Congress.
Somehow it has become unpatriotic to set regulations in the health insurance industry to protect the health and welfare of the citizenry. We won’t accept lead-tainted toys from China or listeria-ridden cantaloupe. Without regulations, the tobacco industry would be selling cigarettes to minors. But somehow telling an insurance company it needs to spend 80-85 cents of every dollar it takes in on actual claims (as per the Affordable Care Act) and not on executive pay and administrative costs is unpatriotic. If this regulation were in place a year ago, an insured woman who needed a PET scan might be alive today. Her cardiologist needed the scan to determine whether a tumor was pressing on the woman’s heart. The insurance company refused to pay for it. By the time the family was able to raise the $7,000 for the PET scan, the cardiologist said it was too late. The patient was too weak to operate on. Death panels are alive and well and they are housed in insurance companies.
Millions of Americans are rallying under a corporate banner bolstered by bought politicians who say it is unpatriotic to regulate a product. Yet that product affects the health and welfare of an entire country. This PR assault on reform is so effective that many people don’t even know that Obamacare IS the Patient Protection and Affordable Care Act (commonly referred to as The Affordable Care Act). People dismiss the consumer protections of The Affordable Care Act by calling it, derisively, “Obamacare,” as if they were rejecting communism. How clever and successful of the market-teers to link corporate profits to patriotism thereby making foot soldiers of hard-working Americans who think they are saving our country from socialism by rejecting healthcare reforms that would benefit them. The corporations through our representatives in Congress have sold the American public a bill of goods: health care reform is socialism.
This for-profit system has become so complicated that to even just talk about it or try to pick an insurance policy, one has to be an expert. Average Americans are flying blind and only realize how lacking their coverage is when they get sick and need insurance. And the insurance companies want to keep it that way. If we are confused about their dealings, we won’t want to speak up and risk looking stupid, or being shot down by some smooth-talking politician who will infer we’re not patriotic. If an insurance company can’t profit on the free market by selling products that don’t bankrupt or under-insure the person buying that product, then maybe they don’t belong in the marketplace. If insurance companies can’t produce products that do well in the marketplace without currying favor with bought politicians, then they don’t belong in the marketplace.
Regulations are a counterpoint to the money the lobbyists throw at our representatives. Politicians who are financed by corporations are paying back their financiers by trying to weaken the Affordable Care Act. The Affordable Care Act sets a ceiling and floor in which the for-profit corporations must operate if they are going to sell products that affect the health and well-being of the American public. (After all the interviews and research, I, personally, would opt for a single-payer system. I didn’t start with that idea. I arrived at it after many hours of listening to the horror stories of people trying to access healthcare.)
Some of the solutions put forth by those who oppose “Obamacare” are specious at best. For example, health savings accounts (HSA) are often touted as a big part of the solution to our healthcare crisis. Health savings accounts sold on the individual market (not a group plan) are a disaster for people who maybe can afford the monthly premium paid to the insurance company, but then might not understand that on top of the monthly premiums they must fund a special savings account from which they are supposed to pay their medical bills up to $5,000/year(or depending on what kind of HSA they choose.) Confused yet? HSAs may be a viable option for an employer group plan IF the employer pays both its portion of the premium AND fully funds the health savings account (or close to it) for the employee to use. Yeah, it’s a lot to sort out. Health savings accounts will solve our healthcare crisis as much as single hammer will build a skyscraper. There are those who say “I want reform just not Obamacare.” For those in the know, the collective eye-rolling could cause a mushroom cloud. Politics– while people go bankrupt, are maimed trying to find care, or die.
I am one person who learned a lot from listening to people. Real life stories and not political ideologies. The jig is up. O sweet country of mine, I have listened and understood. It is in all our best interests for all to access healthcare in the US.