by Luigi Ripamonti
An instructive story from abroad to stimulate collective awareness
We report the story of an acquaintance who currently lives and works in California for one of the largest companies in Silicon Valley, and therefore enjoys respectable health insurance coverage. «I arrived at the ER (Emergency Room) after 17 days in which my son was vomiting and after several medical visits during which they told me that he probably just had a virus. But after losing three kilos I wasn’t very convinced anymore. At the ER they did some tests, an IV and a visit. It then happened that at the same time, it was now 2 in the morning, the second son was also ill. And so they had to visit him too. The whole thing cost me $5,912 (the insurance covered the other $55,000 of the fee). Things went worse for people who, on another occasion, I saw crying because they couldn’t afford a transfusion ($5,000) that their insurance didn’t cover. Mine, however, did, and so I was able to get it for $390. Even worse was the situation with a manager of a big tech company (big tech company) who had to do crowdfunding to cure his son’s cancer.” Crowdfunding, that is, a collection.
Those who are part of the boomer generation will remember that there was a time when it wasn’t so strange to read about appeals to raise money for treatment or operations abroad. It still happens, but it is perceived as less “normal”. This is because we have “got used to it well” since 1978, the year in which the reform was launched which made a universalistic National Health Service available to us. Just as, for now, it is not yet common to hear about “medical debt” in Italy, which is instead a common problem in the United States. According to the Healty System Tracker website, an analysis conducted in 2021 found that 23% of adults in the US had medical debt. This data is similar to that obtained from the KFF Health Care Debt Survey which found that 24% of adults had one or more medical or dental bills that were overdue or that they were unable to pay.
The KFF survey also found that 41% of adults have medical-related debt. The 41% figure refers to a broader definition, which includes medical debt on credit cards or towards family members. Even if those without health insurance are more inclined to have medical debt – the same site reports -, financial vulnerability persists even among the insured: more than 1 in 5 insured adults have medical debt.
We can react to the story and these data in different ways. The first is to raise eyebrows by stigmatizing the American healthcare situation as unfair and insensitive and to highlight the cynicism of insurance companies. That would be superficial and naive. Superficial because it is easy to express judgments on US healthcare because, at least, the news comes from there and the care when provided is of a high level (and for completeness we should also talk about the Medicare service), while little or nothing is known about other countries and in comparison of social injustices, the service is also poor: Corriere Salute some time ago published a series of articles in which the healthcare systems of various nations were analyzed and each had its pros and cons but there were few cases that could arouse envy in us. And naive because we cannot expect for-profit companies, such as insurance companies, not to have the objective of maximizing profits. If anything, one should think that it is necessary to establish certain and fair rules to govern this type of business. A second possible reaction is to think that this type of story is obvious: these are things that are known.
True, but it’s worth reporting them because, even if they are known, when they are reported to us (invoices in hand) by someone we know they take on a concreteness that makes us feel involved and leads us to ask ourselves, with a shiver: what if it happened to me ? A question that we would do well to really ask ourselves, because at the end of the tunnel of a health service in trouble there is precisely this, or something similar. The signs are already there, starting with the three-speed waiting list: SSN “right lane”, insurance “center lane”, paying immediately out of pocket for “left lane”. And when your life is at stake, if you have the money you pull it out just to “get off the gas”. Health, as Guido Bosticco writes in Corriere Salute on 25 February, is a common good, like information, but not guaranteed. For this to be the case, it is necessary to always remind those who hold the reins of politics and the economy that the universalism of the NHS must be the priority among the priorities, but each of us must also be reminded to do our part, both by trying to use well the resources available and by becoming a critical mass of opinion that makes its weight felt for this purpose. Otherwise, as Alberto Scanni recalled in Corriere Salute, we risk ending up like Noam Chomsky’s frog, which when he realized it was being boiled was too tired to jump out of the pot.
February 24, 2024
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