Barbara Eisenstein, 42, owns a small yellow townhome in the gently rolling hills of Lake Villa.
At first glance, her life seems fine. But looks can be deceiving. The reality is that she has been pushed to the edge financially and emotionally as a consequence of getting sick.
Eisenstein had no health insurance when she suffered a life-threatening condition requiring major heart surgery. In her tortuous journey through the health-care system, she says she has been treated like a pariah and often flatly refused medical care. Those physicians willing to see her have, at times, declined to perform the appropriate tests and treatment, she says, telling her they cost too much.
“I have felt like a nobody,” she says, “like I was garbage.”
Eisenstein is one of 45 million Americans with no medical insurance. Henry Brandt, of Chicago, belongs to a different group-those who thought they had good health coverage but who also have seen their finances destroyed by illness. They are among another 70 million who are considered underinsured, leaving them seriously exposed to catastrophic medical bills.
Together these 115 million people-roughly a third of the U.S. population-account for a preponderance of the nation’s bankruptcies. A startling 1 million of the 1.9 million Americans who declare personal bankruptcy each year do so because of medical debts, according to Dr. Steffi Woolhandler, of Harvard Medical School.
Eisenstein’s story is remarkable, not because her experience is so unusual-it is not-but because it was so easy for her to slip into penury.
A native of Morton Grove, she was hired in 1993 as a $25,000-a-year hostess at Jimmy’s Charhouse, a family-owned business in Libertyville. Jimmy’s does not offer health insurance to employees. The manager, Spiro Kokkinos, says the restaurant has sounded out employees about insurance but has never been able to get enough of them interested to make it viable.
Liability is a problem for most small enterprises, according to the National Federation for Independent Businesses. About 25 million of America’s 45 million uninsured either work for a small business, own one, or are dependents of those who do. And only 48 percent of the 600,000 small businesses the NFIB counts as members offer health insurance because premiums are so high. For these businesses, which average between 3 and 9 employees, “the average employer’s cost is $402 a month per employee for single coverage and $732 a month for family coverage,” says Amanda Austin, NFIB manager of legislative affairs. “If the costs keep rising as they have, sooner or later there will be a breaking point, and many of those 48 percent who offer insurance will have to stop.”
The high cost of health insurance is devastating to small businessesmen like Skip Trotter. A spokesperson for NFIB, he also owns Trotter Manufacturing in Rockford, which makes hydraulic valve spools. In October 2003, he had 53 employees and monthly premiums were $11,422. In December of 2004, he had 64 employees and paid $20,753 in monthly premiums, a 50 percent increase per employee.
“We employers have the same nightmare with health insurance costs that our employees have,” he says.
Without an employer to pick up part of the tab, employees seeking insurance on the open market face annual premiums in the many thousands of dollars.
“This is precisely the group that is most uninsured, working people who earn more than minimum wage but not much more,” says Dr. Ida Hellander, executive director of Physicians for National Health Insurance. “There is no way they can afford to buy health insurance on their own.”
Hellander points out that her own health insurance coverage at the physicians group-a small organization that insures only two employees-costs $542 a month from Blue Cross Blue Shield. “I am a healthy single person,” she says. “Blue Cross told me that if I had a family and everybody in it was healthy, the coverage would be $17,000 a year.”
When Eisenstein investigated insurance costs, she found that she couldn’t afford it on her salary after paying taxes, a $1,200 monthly mortgage and other basic expenses. “There were cheaper policies,” she says, “but they don’t cover much, so what good are they?”
Working 60 hours a week, she eventually became manager at Jimmy’s and her salary rose to $35,000 a year-still not enough, in her view, to afford the insurance premiums that she had been quoted. So, still in her 30s and healthy, she decided to do without health insurance and hope for the best.
For eight years, Eisenstein’s luck held. But in December 2001, she began experiencing pain, tingling and numbness in her hands and legs. She had trouble walking.
She tried a number of physicians. “The first question they ask is, ‘Do you have insurance?’ ” she says. “I would say ‘no’ and their tone would change. They’d say, ‘Well, it seems the doctor doesn’t have an appointment available for three months. Do you want it?’ But I couldn’t wait three months; I was in terrible pain.”
Eisenstein says she continued trying more doctors’ offices, getting the runaround from most of them. When a physician did agree to see her, she says, restrictions were imposed. “They’d tell me certain tests cost too much so they weren’t going to do them. I ‘d say, ‘Do I need this test?’ They would answer, ‘Yes, but you can’t afford it.’ “
Paying her own way, she was sent to Condell Hospital in Libertyville for $5,000 worth of CAT scans, MRIs, EMGs, mammograms, bloodwork and other tests. One physician said she had multiple sclerosis; another said it was lupus; a third said it was a disc that was acting up; a fourth said she had kidney problems and should be on dialysis.
She was put on nine medications, including an anti-depressant that cost her $180 a month-“and I wasn’t even depressed.” She was soon out of money.
Things seemed to be looking up, though, when she turned to Evanston Hospital. “They made a deal with me that I’d get 94 percent off the bill if I went through their clinic,” says Eisenstein.
But the clinic had her see a different doctor each time, she says, so there was no continuity of treatment. “They kept asking me the same questions about my history over and over.”
Then she started getting bills for the complete amount. “Collection agencies started phoning me. I’d call Evanston Hospital and tell them that charging me 100 percent of the bill wasn’t in our agreement. I called over and over, spending hours on the phone trying to correct mistakes. Collection agencies would call me at work and harass me, screaming profanities and threatening me. I was on the verge of a breakdown.”
The hospital says it can’t discuss the case. “I can’t speak to the particulars of this person’s situation,” says Mary Anne Lando, a spokesperson for Evanston Northwestern Healthcare. “We have a very generous charity-care policy and it is our interest to always provide the best care possible. I’m sorry if there were bureaucratic problems involved.”
In the fall of 2002, a new symptom appeared: Eisenstein’s heart began beating very rapidly, with spells of up to 250 beats per minute. A physician diagnosed it as supraventricular tachycardia-a form of accelerated heartbeat-and put her on Beta-pace, a drug designed to keep her cardiac rhythms under control. But after three more episodes-the last one with a heart rate of 250 beats per minute for more than two hours (“I thought I was dying,” says Eisenstein)-surgery was ordered.
The operation, called an ablation, was performed at Condell Hospital and succeeded in correcting the heart rhythm. Eisenstein’s bill came to $90,000.
She says Condell told her it would forgive half the bill if she could come up with $45,000. She couldn’t. So the bill remained at $90,000, but she was put on $100-a-month payment plan. The surgeon, meanwhile, took 50 percent off his bill of $13,000, and put her on a payment plan of $100 a month plus interest. There was a third bill of $75 a month for the cardiologist.
Cindy Cordell, director of marketing and public relations at Condell, says treatment there is never based on whether someone has insurance or not. “Ms. Eisenstein qualified for a 12 percent charity write-off based on federally published guidelines,” says Cordell. “She is currently paying a nominal monthly fee for her bill.”
Cordell says the hospital has seen a sharp increase in its charity costs. In 2002 Condell offered $14.6 million in charity write-offs to the uninsured while in 2003 the figure rose to $22.7 million.
Meanwhile, Eisenstein’s bills are piling up. Her savings have been drained, and there seems to be no end in sight. She has stopped taking Beta-pace, her heart drug, because it costs too much. “I figure I just have to take my chances,” she says.
“If I get sick again, no matter what, I’m not going to seek care. I can’t face the cruelty of this system again. I’ll treat myself the best I can. If I die, I die.”
Henry Brandt, who lives in a lakefront high-rise, had what he thought was excellent insurance. When he became seriously ill, he received superb medical care. But his treatment wiped out his entire life savings.
A 1969 graduate of Columbia College Chicago, Brandt began running the family business in wholesale hardware and building materials after his father died in the early 1970s. He earned good money, even after competition from hardware chains and giants like Menard’s and Home Depot began eating into his earnings in the 1980s.
In 1990, at the age of 44, he took out health insurance at a premium of $160 a month, but never needed to use it until the day in 1997 when he walked into a Northwestern Memorial Hospital outpatient facility with shortness of breath.
“When the doctor put the stethoscope on my heart, I could see the alarm on her face,” Brandt recalls.
He was taken immediately by ambulance to Northwestern, where it was determined that he had congestive heart failure brought on by two silent heart attacks. The percentage of blood being pushed in and out of his heart was 4.5, compared to the normal 55 percent. Under 10 percent usually causes death.
“They told me that mine was the lowest percentage they’d ever seen for someone who survived,” he says.
Dr. David Fullerton, chief of cardiac surgery, operated on Brandt for 10 hours. Over the next six years, Brandt would undergo four more heart surgeries, twice having defibrillators sewn into his chest. The cost of these surgeries came to $250,000. Two years ago, an unidentified virus sent him into a coma that lasted 14 days. His hospital bill for that one episode totaled $200,000. His 20 percent share in the cost of prescriptions, required by his insurance company, was $15,000 a year.
Brandt says he had no choice but to dig into his $150,000 life savings to cover his medical costs as well as living expenses. With his health deteriorating and his savings vanishing, he became depressed and, seeking escape in food, saw his weight balloon to 360 pounds. His internist told him he would die if he didn’t seek help. The result was costly stomach-stapling surgery in 2003.
In an effort to bring down his drug costs, Brandt applied for the insurance of last-resort: the Illinois Comprehensive Insurance Health Plan. The yearly premium is $10,200, but the drug costs are only $1,700 a year. Nevertheless, Brandt has all but exhausted his savings.
“I have had the best medical treatment the world has to offer,” he says. “I estimate that my treatment since 1997 has cost over $1 million, and I would not be alive today if not for the incredible care I have received. But if I had been in a different health system, like the European or Canadian systems, I would not have suffered so much financially. It is sad that an illness and a health-care system can combine to completely decimate a lifetime’s assets.”
Hellander, of Physicians for National Health Insurance, says she is not surprised to hear that someone with good coverage became indigent. “Of the million middle-class Americans with mortgages and assets who go bankrupt each year because of medical debt, 75 percent had insurance at the time illness struck,” she says.
According to a Commonwealth Fund survey in 2003, 60 percent of uninsured adults and 35 percent of insured adults aged 19 to 64 had medical bill problems or were paying off medical debt. Among this group, 27 percent reported that they were unable to pay for basic necessities, including food, heat or rent because of medical bills. Forty-four percent had used all or most of their savings, while 20 percent said they had large credit card debt or had taken out loans against their homes to pay their bills.
“People in other countries view us as barbaric,” says Hellander, “They can’t believe that when people are most vulnerable and sick that we ruin them financially too. The consensus in the rest of the developed world is that being sick is hard enough. You shouldn’t also be pushed into bankruptcy.”
The problem is that even good insurance plans limit their coverage. A Commonwealth Fund study in 2002 showed that U.S. health insurers on average paid 63 percent of medical costs for people with independently obtained plans and 75 percent for those on group plans arranged through employers. However, those with cheaper insurance get very little coverage for their money. Lower priced plans cover as little as 30 percent of bills.
Dr. Quentin Young, chairman of Chicago’s Health and Medicine Policy Research Group, has long believed that a national single-payer health plan is the only way to create a health-insurance system that doesn’t bankrupt people like Eisenstein and Brandt.
“This is the plight looming for millions of Americans in the near future unless we adopt some type of universal health care like every other industrialized nation in the world has done,” he says.
But Mohit Ghose, director of public policy for America’s Health Insurance Plans, the association that represents most private health insurers, says the single-payer system is a one-size-fits-all approach that doesn’t get people what they want.
“Eighty percent of the 170 million who get insurance through their employers are satisfied with their coverage, according to a Harris poll,” he says. “We believe getting the 45 million uninsured access to coverage should be a concerted effort by health insurers, hospitals and government.”
Ghose contends the best solution is through public-private partnerships. “We need to improve federal funding for high-risk pools,” he says.
His association advocates making top-quality medicine the standard for health care. This will improve outcomes, eliminate errors and reduce costs, Ghose says. Efforts to extend access to the uninsured should build on the current employment-based system through tax incentives to the uninsured and small business owners. Also, he says, efforts need to be made to extend access to the 3 million adults and 6.5 million children who are eligible but not enrolled in Medicaid or the State Children’s Health Insurance program, as well as other public-private partnerships.
Young is unconvinced. He believes that these measures will not improve the plight of the uninsured and underinsured.
“The American health system does not have a problem with funding or staffing national health care,” he says. “It just has to confront the central ethical issue, that all Americans are entitled to it.”
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Lee Scheier writes frequently for the Magazine on health-related topics.
