As Elizabeth Trujillo and I spoke late last year, I wondered how many more Americans would end up like her — unable to receive needed medical care until it was basically too late.
Yes, even with the Affordable Care Act coming of age this year, millions still won’t have insurance. Like Trujillo, a 29-year-old mother of three who had to let her breast cancer go untreated for months because she wasn’t insured, they will largely have to rely on the power of prayer to keep themselves healthy and alive.
The complex health care legislation originally had two solutions for people who didn’t have health coverage through their work. Middle-income earners could shop for plans in an online marketplace, with some able to receive a federal subsidy to help pay for it.
For the most down and out, states would expand Medicaid — as Nevada has — to cover them.
But the U.S. Supreme Court made that optional, so 25 states are not expanding Medicaid, even though the federal government will pay 100 percent of the expansion for the first three years (gradually reducing it to 90 percent by 2020).
Although several studies have shown that the financial benefits of the program outweigh additional financial burdens on states, several governors either believe there are additional costs they can’t afford or are ideologically opposed to more reliance on the federal government.
“I can’t believe there are other women who will have to go through what I have,” Trujillo said.
Oh, but they will. A recent study by the Kaiser Family Foundation found that at least 5 million people nationwide, the vast majority of them either African-American or Hispanic, will be left without coverage because states aren’t expanding Medicaid.
(Other studies have shown that the number of uninsured in the country could remain as high as 30 million when you consider growing numbers of undocumented immigrants and those who fall through the cracks created by inconsistencies between state and federal guidelines for who qualifies for assistance.)
All but three of the world’s 30 developed nations that are members of the influential Organization for Economic Cooperation and Development have universal health coverage — Australia, Austria, Belgium, Canada, the Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, South Korea, Luxembourg, the Netherlands, New Zealand, Norway, Poland, Portugal, the Slovak Republic, Spain, Sweden, Switzerland and the United Kingdom. The only three lacking universal health coverage: Mexico, Turkey and the U.S.
Mexico and Turkey have long had the excuse of poor economies. The U.S., however, has always come with a variety of excuses, including the threats of “socialism” and “the death of the physician-patient relationship,” but the truth is that intertwined political and commercial interests have killed universal health care.
The U.S. spends twice the amount on health care per capita than any other country — more than the next 10 countries combined, and ranks dead last in the quality of health care among industrialized countries, according to studies by the consulting firm McKinsey &Co.
Even President Barack Obama, whose Affordable Care Act tries to navigate the special interest lobbies that keep politicians in office with their contributions, recognizes his legislation isn’t universal health care.
“I want to cover everybody,” he said in 2009. “Now the truth is unless you have what’s called a single-payer system in which everyone’s automatically covered, you’re probably not going to reach every single individual.”
How Trujillo wishes all Americans could be covered, so they could be spared her ordeal.
In July 2012 Trujillo was exercising at home when she discovered that she had two lumps in her right breast, each the size of a quarter.
Laid off from a job without health benefits — husband Jorge Guevara’s construction job also didn’t offer them — Trujillo didn’t have insurance coverage or money to pay for care.
Unable to get Medicaid — workers there told her she would get that insurance if she became pregnant again — Trujillo prayed she could find a job with insurance. She did, but it wasn’t until five months after she discovered her lumps — by that time one was as large as an orange — that she received the surgical, drug and radiation treatment necessary.
She was stage 4 when she presented herself to doctors. She has gotten insurance through the state exchange, but the cancer has spread to her bones. Doctors don’t know how much time she has left.
Trujillo and her family pray for a miracle.
I agree with Trujillo — it is time, actually well past time, for universal health coverage in the U.S. No one should have to go through what she is going through.
During a December event for prostate cancer survivors in Seattle, Colin Powell, a retired general, prostate cancer survivor and the former secretary of state under George W. Bush, pointed out that other developed nations, including Canada and countries in Europe, make government-funded health coverage available to all their citizens through a single-payer system (basically an expanded and better version of Medicare).
“We are a wealthy enough country with the capacity to make sure that every one of our fellow citizens has access to quality health care,” Powell said. “(Let’s show) the rest of the world what our democratic system is all about and how we take care of our citizens.”
Paul Harasim is the medical writer for the Las Vegas Review-Journal. His column appears Mondays. Harasim can be reached at firstname.lastname@example.org or 702-387-2908.