U.S. health care system based on income, not need

By Tom Walsh

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The sad-but-true reality is that health care in America is rationed not by medical needs, but by income.

Those with means have access to care at a minimal cost, because of their eligibility for or ability to afford health insurance, while those who subsist on minimum wages with no health insurance fend for themselves, often forsaking preventive care due to the substantial costs involved.

There is a young

woman who cleans my house one afternoon, every two weeks. In the early mornings, she works as a “stern man” on a lobster boat, removing lobsters from traps and re-baiting the traps for re-setting.

It's a strenuous job for anyone, much less a woman who weighs about 100 pounds soaking wet. Betty (not her real name) has a live-in boyfriend. He is a carpenter and finds work sporadically. Both earn minimum wage, and neither has health insurance.

Betty discovered a few months ago that she was pregnant in an unplanned sort of way.

Without health insurance, having the baby, given prenatal care and delivery costs, would cost at least $20,000, assuming there are no complications. A premature baby might run $40,000, maybe even more, depending on the complications involved.

Betty's other option was an abortion that would cost $600. She's decided to have the baby.

“I know I'll be paying the hospital $100 a month, or whatever I can afford, for the rest of my life, but that's OK. I want this baby,” she says.

It's regrettable that America has such a dysfunctional health care delivery system that women without means are put in this position.

Ironically, if Betty lived 100 miles up the road, in New Brunswick, Canada, the cost of having a baby, premature or not, would be $0. That would also be the cost of an abortion.

Clearly, she would be paying higher income taxes for that medical care entitlement, but she wouldn't find herself in debt for years.

Every health care delivery system rations care. In the United States, it's rationed by income.

In Canada, it's rationed by waiting times, although those with life-threatening needs go to the front of the medical care queue.

Meanwhile, even Americans of means are forced to endure a health care delivery system that reflects dismal results in terms of outcome, including infant mortality.

Compared with five other developed nations - Australia, Canada, Germany, New Zealand, the United Kingdom - the U.S. health care system ranks last or next-to-last on five dimensions of a high-performance health system: quality, access, efficiency, equity, and healthy lives.

The United States is the only country among these six nations without universal health insurance coverage.

It seems clear that the only way to survive the American health care system, both physically and financially, is to do everything you can to stay out of it.

Tom Walsh of Gouldsboro, Maine, is a former Gazette reporter who has been a medical and science writer for nearly 40 years. He produced a 10-part series on the Canadian health care system that won national and state awards. Comments: tom.walsh@jax.org