Tuesday 23 January 2018

I prayed my pregnancy in the US would be OK: I didn't have insurance

Barack Obama was forced to backtrack this week on his healthcare plans. Caitriona Palmer reports on what it is like to live in America without health cover

There are over 47 million people in America without health insurance and five years ago -- for a brief and unpleasant time -- I became one of them.

Five months pregnant, I arrived in Washington in the summer of 2004, following my husband's sudden expulsion from Iran as a foreign correspondent for The Guardian newspaper.

Our speedy departure from the Islamic Republic had happily solved my mounting anxiety about the prospect of giving birth in Iran -- an experience I was gearing up to face alone as my husband, thanks to the ruling clerics, would most likely be banned from the labour room.

But being pregnant in the Axis of Evil, I soon discovered, was a cakewalk in comparison to being pregnant -- and uninsured -- in the Great Satan.

In America, the majority of those with medical insurance receive it through their employers. But as freelance journalists employed by foreign newspapers, we had no such coverage. No to worry, we thought, let's just pay for it ourselves.

We made some calls. A representative at America's premier health insurance company told us that they would happily take us on for a monthly premium of $750. We gulped a little, filled out the necessary forms and put them in the post.

A week later came a reply. Dan would be covered but I was rejected. "Denied due to a pre-existing condition: pregnancy," the letter read.

We moved on to another company, and then another, and another. The rejection letters continued to arrive. One company denied me not only for my pregnancy but also for a previous spinal injury caused when a careless driver ran a red light some years back and slammed into my bike.

Being pregnant was bad enough, it seemed. Pregnant with a bad back? Forget it.

Another month passed -- I was now six months along -- and becoming desperate. We hired an insurance broker, an expert who knew the system, to help us find coverage.

He tried admirably but failed. "Pre-existing condition," he told us apologetically over the phone.

I began to research the prospect of giving birth in America without insurance. It didn't look pretty. Owing to America's litigious society, the birthing experience had become heavily medicalised with scalpel-yielding obstetricians and sky-rocketing C-section rates.

A normal vaginal birth in American costs, on average, $7,500. A C-Section comes in at around $14,000 although I was warned that it could be as high as $40,000. The choice seemed like a no-brainer.

And so, with a deep breath, I decided to give birth naturally -- without drugs -- the best odds to avoiding the C-section route. It was something I had always expressed interest in but now seemed the only option in a quest to keep our costs below $10,000 -- providing everything went well.

I found a midwife who offered to deliver my son for just $2,500. Her practice took pity on the uninsured and charged just $100 for office visits. They offered discounts for my pre-natal scans and blood-work and gave us hints on how to navigate the system.

"Negotiate a deal with the hospital before you deliver," they told us. And so with our financial records in hand we met with the board, explained our predicament and hashed out a deal.

"Even if things do go wrong with you and the baby," the kindly financial officer at the hospital told me, "we won't charge you more than $20,000 total."

In the end, everything went just right. I gave birth to a beautiful healthy baby boy with no complications. The $8,000 bill did not send us into the bankruptcy courts. And in a few months, my husband's new job with excellent health benefits meant we could leave the ranks of the uninsured.

But my story illustrates the complexities and cruelty of the American healthcare system. One that President Barack Obama is desperately trying to reform despite increasing scepticism and hostility across the country that he is trying to institutionalise "socialised medicine".

This week the president was forced to backtrack on his plans to create a public insurance plan to compete with America's powerful private insurance companies.

Those on the right say Obama is planning a "government takeover" of healthcare that will usher in a system akin to the NHS -- a system that is often portrayed in the US as something out of a Soviet nightmare.

Supporters of the plan say that the healthcare system in the US is sick and that a public option is the only chance of saving it. "You can't have reform without a public option," said Howard Dean, a former presidential candidate and physician. "If you really want to fix the healthcare system, you've got to give the public the choice of having such an option."

With no public healthcare available -- except for those over 65 and the impoverished -- Americans without health insurance are forced to pay out of pocket for their treatment or avoid the doctor altogether.

With the country's emergency rooms obliged to treat anyone who walks in -- no matter how small the complaint -- the ERs are stuffed with people without insurance suffering from minor complaints like sore throats and colds.

And with exorbitant health costs rising higher and higher, the uninsured with chronic or life-threatening conditions like cancer often face an unenviable choice: bankruptcy or death.

Take a man depicted in the Michael Moore documentary, Sicko, who sliced off two finger tips in an accident. He was told at the emergency room that an operation to sew his middle finger back on would cost $60,000 but that the index finger would cost only $12,000. He chose to live life without his middle finger and parted with $12,000.

Even those lucky enough to own health insurance face problems. Some who have been paying high premiums for years are often denied a medical procedure they desperately need.

Others who lose their jobs -- and therefore their health insurance -- are often denied coverage when they try to find it elsewhere owing to some previous "pre-existing condition" like a brush with cancer or a bad back.

Others fall prey to the hidden small print: such as the little-known fact that insurance usually begins two weeks after a new job begins.

That happened to Jim Howe from Indiana whose family had gone without insurance during short periods of unemployment. Days after Howe began a new job his 21-year-old daughter nearly died in a car crash, a trauma that cost her 13 surgeries, nearly $300,000 in medical fees and a possible date thereafter in the bankruptcy courts.

With billions of dollars in profits at stake for the insurance companies, there is a lot riding on the president's plans to overhaul the healthcare system.

In past weeks the president and his aides have emerged battered from town-hall meetings held across the country to promote his health reform, and now even some Democrats in the Senate are opposing the public option plan.

It seems more and more likely that Obama will be forced to capitulate and abandon his plans and instead advocate a more watered down version through non-profit co-operatives.

But with 14,000 Americans losing healthcare coverage every day owing to the effects of the recession, the situation for many middle- and lower-class Americans has become critical, said Obama this week.

"The cynics and the naysayers will continue to exploit fear and concerns for political gain, but for all the scare tactics out there, what's truly scary -- truly risky -- is the prospect of doing nothing," he said.

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