Mired in the Health Care Morass:  An Alaskan Takes on America’s Dysfunctional Medical System for his Uninsured Daughter

Neil Davis

Ester, Alaska:  Ester Republic Press, 2007, 199pp. $18.00.

            Davis’s book is an important contribution to the literature on the American Health Care System since it is written by a consumer rather than a professional provider of medical services. Davis structured the book around the experiences that his family endured when his adult daughter, Patricia, was diagnosed with lung cancer. Davis’s story 

began in early November, 2004, when Patricia was diagnosed with Stage III non-small-cell lung cancer. Three months into her new job, Patricia started experiencing symptoms that should have sent her to the doctor. However, she chose to wait until her heath insurance would become effective. When her symptoms got worse, she finally went to the doctor and learned that there was a tumour in her lung. During the surgery, the medical team discovered that the cancerous tumour was too close to her aorta to be removed. Thus, chemotherapy and radiation treatments were necessary. By December, 2005, Patricia was treated by two hospitals and nine different doctors. Her bills kept escalating to the point that she found it very stressful to deal with the costs of medical care on her own. At this point, he took over the management of Patricia’s bills to save her from undue stress and financial hardship.

            Since Davis had no background in medicine, he found the terminology and billing to be difficult to comprehend. For one thing, he was wondering why there was such a major discrepancy between what some physicians charge for certain medications. For instance, one bill listed a charge of $1,224 for a 50 milligram injection of carboplatin while the same injection cost $1,428 on another bill.  Davis’s initial finding was difficult to comprehend. On the world market, he could buy 50 mg of carboplatin in bulk (2,000 doses) for $13.50 per dose. This drug obviously did not cost much to manufacture. 

A major pharmacy retailer in New York was selling it in small quantities for $61.36 per dose. Yet Patricia was being charged $1,224 in one case and $1,428 in another. After researching for some time, Davis found that because many uninsured patients could not pay for the drugs they received, they had to compensate that with charging insured 

patients much more. But Davis wondered why Patricia was compensating the system when she was now too sick to work enough to afford her own medical care. As Davis researched into the price of prescription drugs, he discovered that there was a major discrepancy between actual billings and customary, prevailing and reasonable reimbursements for prescription drugs.

            Davis found that American health care consumers can be divided into three major groups: those having public or private health insurance, those having insurance purchased by their employers, and those without insurance. Because the Alaskan population is younger, it has a smaller percentage of persons with Medicare than in the United States as a whole, and a somewhat higher percentage with Medicaid coverage. Well over half of health care consumers have coverage purchased from the insurance industry, and 25 to 30 percent are covered by public insurance. In both Alaska and the United States, an astounding one in six persons had no insurance. Three out of four underinsured American 

adults are low income. The underinsured tend to skip on health care by failing to fill prescriptions, skipping tests and follow up care, and forgoing treatment from specialists. Uninsured people suffer from poorer heath than insured persons and they die sooner. Except for the very rich, every member of the American public suffers from the deficiencies in their health care system. Its fragmentation creates unnecessarily high administrative costs.

            Every health care system has its deficiencies. However, the American heath care system is the most expensive and yet fails to provide the health care that the citizens of a modern nation should have. The health care system in other countries, such as New Zealand, Australia, the United Kingdom and Canada, believe that health care, like 

education is a human right that the government has a responsibility to provide. In America, health care is a privilege, not a right. The United States has a multi-payer system that does not provide health care to all citizens whereas Canada and the United Kingdom have single-payer universal systems that provide health care for all.

            Given all of Davis’ discoveries, he concluded that there are four criteria for an effective health care system. First, an effective health care system provides comprehensive health coverage for all citizens. If not, the poorest individuals will get inadequate health care. Second, a health care system ensures that health care is distributed to citizens according to their ability to pay. Otherwise, the poorest members of that society are penalized by paying a higher proportion of their financial resources for health care. Third, each health care system should provide uniform payment for necessary health care services. Fourth, prescription drug prices must be regulated, either by fixing drug prices or regulating pharmaceutical industry profits. For this to occur, the government must assume the primary role in operating the health care system.

            Thus, in conclusion, this book will be especially relevant to consumers of heath care and is an eye opener for those who may be seriously ill in the United States and are trying to understand why receiving health care creates serious financial difficulties for them.  We require a single-payer universal health care that takes care of rich and poor alike. The most economic form of health care is a fully socialistic system like the United Kingdom’s in which the government owns and operates the hospitals and hires the health care providers.  Such a system will ensure that everyone has medical care that they deserve without filing bankruptcy.

Irene Sonia Switankowsky, University of Wales, Lampeter