A Cautionary Tale About American Health Services

I know little about how the American health service works. I have vaguely assumed that people get themselves ‘medical insurance’. If they don’t, then they will permitted to drop dead in the street or just rot at home in pain and agony.

But, surely, The State could not possibly be so cruel?

Well …. It is….. Although convolutely so. Let me tell the tale.

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My grandson, C…, got friendly with this American lady, M…., via the internet. He went over to the USA to visit and stay for a while. They hit it off and married within three months. For some strange reason, the United States of America Government tried its best to throw C out of its territory, but failed. Convoluted processes were involved, but, in the end, as I recall, it was accepted that there was no ‘cheating’ going on and that his marriage was genuine. He was allowed to stay. He got a’green card’, and got a job, all-be-it part time. Unfortunately, somehow or other, he suffered a quite serious infection and had to be rushed to hospital. Since he had no insurance, he owes the hospital thousands of dollars. I suppose that he will have to become bankrupt at some point, since he has no money.

—–

That is background info. What has happened recently is incredible.

His wife, M, has certain ailments, one of which is that her bones tend to ‘fuse’. That is, vertebrae in the neck, for example, ‘fuse’ together and become solid blocks. Recently, she had to have two operations, one on the front of her neck and one on the back, to ‘free’ the vertebrae. But, she needs medication to reduce the likelihood of these ‘fusings’ – also, she has other medical problems. Clearly, with these problems, she would have difficulty holding down a job, and so she is dependent upon ‘Medicare’ (whatever that may be).

—-

Now here is the most amazing thing. [I cannot vouch for the accuracy of what follows. I have it at third hand – grandson, daughter, me] M had a prescription from her doctor. When she took that to the chemists, she was told that her Medicare ‘provision’ had been withdrawn and that she could not have her medication. The stated reason for the withdrawal was that she had married.

let us disregard that for now.

Conversations with my daughter reveal that the UNITED STATES OF AMERICA GOVERNMENT offered two alternative solutions; C could return to the UK, in which case M’s Medicare would be restored, OR, C and M could divorce, in which case M’s Medicare would be restored. [However, if they divorced, C would be thrown out of the USA]

——-

To make things worse (and this part is very uncertain), it seems that C ‘had a chat’ with his employer, and told his employer about the problem. It seems that his employer was very understanding and sympathetic – but sacked him! I have doubts about that part of the story – surely there must be more to it. But never mind, because that bit is not important.

——-

Weird things are coming out of these events. For example, M, despite her ongoing health problems, is not given a repeat prescription. Every month, she has to visit her doctor to get her prescription. Every visit to the doctor costs Medicare $400. Further, the medicaments cost $2,000 per prescription. I find that hard to believe.

It is very sad that a happy couple can be broken up in this way, but all is not lost, I’m sure. Fight and fight against the dying of the light. It might be possible to source M’s medicaments via the net. We shall see.

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6 Responses to “A Cautionary Tale About American Health Services”

  1. cherie79 Says:

    I don’t pretend to understand all the ins and outs of the American Heath system but from the lung cancer forum, mostly American, I hear a lot of stories. Not a great deal about people having problems though. Certainly one friend on Medicare was able to choose a top cancer surgeon at a major cancer centre for surgery that her local hospital would not do. She also gets her prescriptions at a fraction of their costs. It is true they don’t seem to do repeat prescriptions. I think unless you have good employer insurance it is quite difficult to navigate but there seems to be a lot of charities and drug companies who will help so perhaps thats where to look. Incidentally as I have posted on other sites we all read my four year scan was fine. Perhaps one of your American readers can explain more.

    • Junican Says:

      Glad to hear about your scan, cherie79.
      We shall have to see how matters develop re C and M.

  2. J Brown Says:

    Sprry to say this, but I think that a bit of ‘research’ is needed here. The above is a bit of a mish mash of different health situations, thrown together. First, the investigation of the reason for a marriage after 3 months is pretty common – this is a common way for people to gain entry to the US – marriages of convenience, where once a green card is obtained, divorce ensues. This is an immigration (illegal or otherwise) issue.
    One of the reasons for ‘Obamacare’ is to ensure that all working people have health care. In the past, you would have been responsible for your own health care if your employer did not provide it – as with your grandson. He worked part time, he had an income, he had no health care. So, the hospital will charge him for their services. As an American, I ask, whose fault is this? The hospital which is a business and has employees, expenses, etc. to pay for? Or a young person who decides that he is young, won’t get ill, that health care is a bit of a crapshoot, that would rather not pay for even minimal hospitalization care, etc., and then gets caught out??
    The wife is a different issue – she has been legally labeled ‘disabled’ apparently, and as such will have a portion of Medicare that provides for her health care, but the ‘family’ income is not low enough to provide for the entirety of Medicare to kick in (hospital, doctor, prescriptions).
    The attitude in the US is a bit more ‘libertarian’. There is some dissention about a ‘nanny state’, where the state takes care of these issues. The underlying attitude there is that we are adults, and responsible for our lives, decisions, care, bills, etc. On the one hand, I read in this forum some dissatisfaction with government intervention in our personal lives. Yet, when the government doesn’t intervene (like in health care) we are looking for their intervention. Can you have it both ways?
    The reasoning for the ‘divorce’ situation is that the income that this couple produces together is greater than the level that is needed for government intervention. The fact that they decide that health care should not be one of their expenses is, perhaps, a personal choice – if they had remained ‘healthy’ it would have been a ‘good’ choice. Sadly, however, this is not the case.
    In any event, this is the exact situation that Obama care attempts to alleviate – working people who do not, or cannot, afford health care will now be able to get it – and their employers must contribute to the cost.

    • Junican Says:

      The stuff about C’s visit to the USA and marriage were just background information. I accept the need for care re arranged marriages. As I said, that difficulty was surmounted. And I agree fully that C should have investigated the need for health insurance. Again, that was more for background info. What was most important was M’s position. It seems obvious to me that she and the rest of her family were not aware that simply marrying C would invalidate her personal health care situation. Why should his simply leaving the USA change the situation back to what it was? They would still be married. I understand why his earnings would need to be taken into consideration by medicare, but, according to my daughter, his part-time job paid very little. In any case, he has now been sacked and is unemployed again.
      There seems to be a callousness, even in what you say about ‘it’s your own fault’ (and I know full well that you are not a callous person!) – it’s a little like the Healthists’ propaganda.

  3. J Brown Says:

    No, I’m certainly not callous to the situation, but I think that there is the possibility of anecdotal misunderstandings in the conveyance of the above information. First of all, it would appear that M is actually on Social Security Disability. This provides her with an monthly income, as well as medical coverage, and dependant on that income, along with her husband’s (ie, ‘household income’) she is entitled to certain levels of Medicare. If their combined income is low enough, they are also eligible for rent assistance, reduction in phone, utilities, etc. However, it would seem that their combined income is too great; high enough where only doctors and hospitalization is covered – the Medicare Part for prescriptions is not, as the combined income is not low enough. Hence, the somewhat convoluted ‘solution’ of reducing that income by separating, divorcing, etc. Note that there is also ‘wrap around insurance’ that they can purchase, which picks up the difference between what is and isn’t covered by Medicare. Of course, you must privately pay for this insurance yourself.
    If their combined income drops below a certain level, they are then entitled to Medicaid, which covers everything, including income assistance, somewhat like our dole. This is all income dependent. And as Cherie advises, there are also other avenues such as drug companies and charities, that assist in such situations. My point is that there is a lot more involved in this scenario – details, means testing, etc., than just a black and white situation. By the way, Obamacare does not cover people who are already insured through Medicare or Social Security Disability…..

    • Junican Says:

      That is very helpful, JB. Perhaps the picture is becoming clearer. You see, C and M live with her parents, so ‘household income’ might well include the parents. I have no idea what that combined income might be, except that they seem to have a decent sized home. There again, it is hard to see how the marriage, in itself, is involved. The parents’ situation existed before the marriage.
      Better leave it, but thanks for the info.

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