When the cost of living is bankruptcy

DonnaIn the American documentary Sicko, by renowned filmmaker Michael Moore, Donna Smith told her incredible story of bankruptcy brought on by a family medical crisis. At the NSWNMA Annual Conference Donna warned of the perils of following the US model of privatised healthcare.

A few hours after Donna Smith arrived in Sydney, and only 15 minutes after leaving her hotel, she had a terrible fall and suffered extensive bruising.

When “two, lovely, Australian women” came to her aid and wanted to call an ambulance, her first instinct was to say no, so fearful was she of the cost of medical treatment.

“That’s because I’m an American. How sad is that and what a commentary on the American healthcare system,” she said.

“Later I went to the doctor. The entire cost of everything – doctors, x-ray, medications and an ice pack ­– was less than $200. In the US you would be talking $1000-2000.”

When the cost of living is bankruptcy
Donna’s story is one of a mainstream, middle-class American family financially devastated by a broken healthcare system.

“My husband Larry and I have been married for 38 years. We have six children and 15 grandchildren. We had worked very hard all our lives, owned our own home, put our kids through college and we always had health insurance.

“My husband is a tall, slender man who developed a really serious artery disease – his family had a history of that – and had three open heart surgeries. He had a hard time.

“He had long-term chronic health issues, which were a strain, but we did what most middle class families do – we found a way to get by. We went out a little less, we bought fewer things for the grandkids. We did what we could do to be responsible but it wasn’t enough. I was diagnosed with cancer and we were hit with this double whammy.”

Donna and Larry wracked up an enormous amount of debt for medical expenses that they just couldn’t pay.

“We ended up being a part of Michael Moore’s film not because we were unique – just the opposite. We represented so many Americans who, when they get sick or hurt, eventually end up declaring bankruptcy and that’s what happened to us.

“It hurt and it was a shameful thing. I’ll never forget the day when we declared bankruptcy in South Dakota, a bankruptcy trustee looked at my husband and said ‘how did you get yourself into such a mess’.

“I saw this hard-working man, shoulders slumped, take the weight of what someone said to him, accusing him of failure when actually it wasn’t his failure it was the failure of the system.”

Dysfunctional and broken
According to a Harvard University study, so far this year 410,434 people in the United States have gone bankrupt due to a medical crisis, even though the majority of them had insurance at the time their illness or injury occurred.

A 2013 study in the Journal of Internal Medicine found that about 25% of all American senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence.

The US spends $2.8 trillion on healthcare, nearly $US8000 per person, or 17.4% of GDP, compared with $3445 per person or 8.7% of GDP in Australia.

These numbers are enormous and numbing, but there is one number that worries Donna the most: 123.

“In the United States 123 people die per day because they can’t access healthcare. That is 45,000 people every year. It’s like a jet liner going down every day and no one’s talking about it. It’s tragic,” she says.

“The US is spending a staggering amount on healthcare – almost twice that of any other industrialised nation. Yet our outcomes are poor. We should throw out what we are doing, study what others are doing and emulate it.”

The scourge of privatisation
Donna says that at the heart of the US healthcare crisis is a fragmented and privatised system that lets enormous numbers of people fall through the cracks.

“Forty million people in the US are uninsured or underinsured – that is twice the population of Australia. If you privatise more and more of your healthcare, money will drive it more and more. They cut back on nurses and ancillary staff but they never cut back on profits.”

The costs to families and the economy, whether you are sick or not, are enormous, Donna says.

“My insurance cover now costs over $800 a month. I have a friend who pays $2100 a month for her family.

“The ripple out into the economy is huge. Bankruptcy due to medical crisis and debt doesn’t just impact access to health services. It also makes it difficult for those who have gone bankrupt to fully participate in the economic activity of their communities and nation.

“Buying homes or cars, securing housing and even getting a new job with good health insurance benefits can be made much more difficult. Those losses are felt by everyone in the wider community.”

Lobbyists for the people
Donna says nurses have a pivotal role to play in defending public health from privatisation.

“Private operators have their tentacles so deep into government. Nurses have to counter that and be lobbyists for the people. It is important to be heard above the clinking of the money. The pushback has to be mighty and it has to come from you – nurses and midwives.

“People trust nurses because they believe nursing is a helping, human profession. People listen when you say it is not the way to go. You’ll be trusted more than a politician.”

She says, for all its faults, the Australian public health system is a good system, worth fighting for.

“You do not allow 123 of your people to die daily simply because it wouldn’t be profitable to care for them. [Your health system] is not forcing people into bankruptcy.

“Your system is superior to ours. Protect that. Teach us. Do not import the things we do less well than you do. Export to us the compassion and common sense that first drove you to create something better.”