The Crippling Fear of Medical Poverty

This isn’t my bill, but it’s close.

I wrote this as a personal blog entry in 2012. I’m republishing it today because it’s obviously still relevant.

Here are some facts:

• Appendicitis can happen at any time to anyone and is incredibly deadly if untreated.
• It’s the most common cause for emergency abdominal surgery in America.
• The median cost for an appendectomy in the state of California is $33,611.
• The minimum wage in California in 2011 was $8.00 an hour. Working full-time at minimum wage, you’d earn $16,640 a year.
• If you were uninsured and struck by appendicitis, chances are you would not be able to afford your surgery even working two full-time minimum wage jobs in a year.

A lot of people don’t put American poverty into context. If you grew up moderately well off and have sunk into a relatively stable career post-college, it’s hard to understand what it’s actually like to be poor. The media obfuscate the experience for most Americans by racializing it (most poor Americans are white, not black), isolating it (most poor Americans live in rural or suburban areas, not cities), and minimizing it (1 in 5 American children are poor). Much of my own research grapples with urban poverty, which I often have to stress is only a small slice of the American landscape. But I know this image of poverty resonates most strongly with what most people think of when they think about the American poor.

This is one of the reasons why so many poor Americans will never say they are poor. They look at these portrayals of urban black poverty and say, “Well, that’s not me, so I guess I’m not poor after all.”

Growing up, my mom was like that. My mom spent most of her working life as a waitress. A single mother, she took great pride in being able to say, “I work. I put food on the table. We don’t need help.” So she never sought out welfare. But we were incredibly fortunate to be poor enough to qualify for Pennsylvania Medical Assistance (Medicaid). It saved us from medical poverty.

When I was 14, I was diagnosed with Anorexia Nervosa. I spent a month in a residential hospital in Philadelphia (one of the only facilities in the state that could treat me at the time), which cost over $2,000 a night or a whopping total of $60,000 for the month of mandatory treatment. When I was 15, I required an emergency gallbladder removal which I remember would have cost us $17,000. The week of my high school graduation, my appendix ruptured, costing another $20,000. All told, within five years, my teenage medical expenses would have cost my family over $100,000 — or the entirety of what my mother earned for 10 years.

Working in food service, my mother never earned more than $15,000 a year. There’s no way on earth we could have paid for those bills. No way.

But man, in college, I was fucking terrified. All the time. I became a member of uninsured America living off a student stipend of $3,000 a year. Knowing how much a trip to the emergency room “just to make sure” costs, how much a basic procedure costs, I could never explain to my ex-boyfriend at the time how lucky he was to get to see a doctor whenever he wanted or needed — and likely the best doctors his parents could find in the state of New York. He never quite understood the panic I felt at every malady. Why I didn’t participate in the sports I had loved in high school for fear of blowing out my knee or my elbow. Why my ongoing fits with abdominal and neck pain weighed over my head like a black cloud. How I could go so long without seeing a dentist. Even why I couldn’t afford birth control pills.

And yes, I would later learn I suffered from conditions I had to let go completely untreated for four years.

Almost no one at Wesleyan understood what it was like to be uninsured. A lot of freshmen get taken to the hospital to get their stomach pumped after their first bout of alcoholic excess. Not me. I knew what the $500 ambulance ride down the street would have meant.

Now as a graduate student at Harvard, I have amazing health insurance. Amazing. I am so incredibly fortunate to have access to world-class doctors at very little cost. I love going to my yearly physicals and eye exams and dental checkups because I know how much of a privilege they are. I make sure my bloodtests, cholesterol and weight are perfectly in line with every medical standard. I floss. And every month, when I pick up my prescriptions, I am relieved to know I pay a $62 co-pay for drugs that would cost me without insurance over $500 a month.

Now, I still live in fear of medical poverty. Since Borders went bankrupt, my mother has struggled to find a new job, despite applying for over 100 of them. She is right now among the 50 million uninsured Americans, just an appendectomy away from medical poverty. Every murmur of chest pain fills me with dread. She’s 6 years away from Medicare eligibility. The costs of insuring a woman her age, with her conditions would guarantee medical poverty. The incredibly high costs of health insurance versus the incredibly high costs of medicine. There is no choice but to risk.

Medical poverty is a uniquely American problem. There are a host of reasons why healthcare costs are so high, but that’s besides the point. The point is that for 50 million Americans, there is no choice but risk your health and often your life. You can’t do otherwise. There is no other choice.