Inadequate health insurance is an issue that is close to my heart. In 2005 I was a self employed musician or “starving artist” living in Nashville, Tennessee. I had decided I wanted to be a professional musician when I was in high school – at an age when 401k plans and healthcare packages don’t really factor into life plans. As a junior in college, I had a sudden medical emergency: my right retina detached during a flight to London, England, where I was headed with some of my classmates for spring break. I noticed a “black curtain” coming over the field of vision in my right eye. But since retinal detachments themselves are not painful, initially I wasn’t too concerned. However, it turns out they are very serious; blindness occurs if the retina is not repaired within 24 hours. The phenomenon of retinal detachment usually occurs in either geriatric patients (due to severe nearsightedness), or from a head trauma, neither of which pertained to me.

My treatment at the London Eye Hospital was my first experience with socialized medicine. I sat in a hallway adjacent to the big main room that was lined with beds and a nurse’s station in the middle. Next to me sat two men with bandages wrapped around their heads, groaning. I was petrified and feeling very far from home. When the doctor finally saw me I said, “I don’t think you understand. I am an American. I need to go back to the US.”

Though not the most culturally sensitive remark I could have made, I was young and scared and the thought of being left alone in a bed in that big open room was more than I could handle. Since I was an American though, I received private healthcare. I called my parents at three in the morning and asked for their credit card number so I could have the needed surgery. Once the payment went through, I was wheeled into the operating room.

The surgery itself is horribly painful -- I’m glad they didn’t tell me just how painful it would be before they wheeled me in, or I might have chosen blindness! The doctors wrapped a band of plastic around my eyeball to hold the retina (which is on the back of the eye) in place, which meant that every time my eye moved, so did this new band of plastic in my eye socket. I also had stitches in my eye. I don’t know how I managed the rest of the week in London, but I was determined to sightsee with my classmates despite my puffy, purple eye.

Then after graduating from college, I found health insurance that I considered adequate -- until three years after graduation when both my retinas detached! Too late, I learned that my insurance company had added a rider excluding eye problems, due to my previous retina surgery. Much to my dismay, I was told that my insurance wouldn’t cover the surgery I was now facing: the doctors told me they would need to operate first on my right eye. I would need to present a check for $15,000 the next morning if I was to have the surgery. Panic set in as I realized that if I didn’t “cough up the dough” I would go blind.

The next day, when I did the paperwork, I submitted my insurance card as if I had coverage, hoping they wouldn’t discover the error until the surgery was over. Surely they couldn’t repossess my eyes? The second surgery was to be done at a different hospital as soon as I healed from the first surgery (which took about four weeks); there I did the same thing, submitting my insurance card and keeping my fingers crossed.

The first surgery in Tennessee on my right eye wasn’t as painful as it had been in England, perhaps because they couldn't wrap plastic around my right eyeball again. Plastic was already in my eye socket from the operation in England. So they fixed it internally with a “gas bubble” that was inserted in my eye to push the retina back into place. The uncomfortable part of that recovery was that I then had to lay on my side for two weeks. I could only get up for 10 minutes every hour at the most. So I stayed on my friends’ couch where they could feed me and help me to bed.

The second surgery was very similar to the one in England – they would wrap a band of plastic, called a “schleral buckle,” around my left eye. My surgeon told me that this procedure is considered the most painful next to open-heart surgery. And he was right: it was horribly painful (just as it was in England). Afterward I had stabs of pain in my eye from the huge stitches and pain that occurred whenever my eye moved. For two weeks I had to do Lamaze breathing just to help manage the pain. I also had to keep my eyes dilated for six weeks as I had had to do after the previous surgery. This meant I couldn’t drive or leave my house because the sunlight hurt my eyes so much. My mom came and stayed with me for two weeks, which was wonderful, but due to the poor health of my dad and younger brother, she couldn’t stay longer. When she left I was so still visually impaired I could not see the numbers on my cell phone or remote control, but she had to get back to take care of them. The ultimate recovery from that second operation took a very long time.

Soon the daunting medical bills began arriving in the mail. Before applying for financial aid from hospitals, I was instructed to apply for TennCare, Tennessee’s version of Medicaid. I went to the Department of Human Services, took a number and waited six hours before I saw a caseworker who only told me the state couldn’t help me. “We can only help you if you are pregnant,” he said.

“I can get pregnant,” I replied, “but that will only add to my problems!”

I had picked an unfortunate time to apply for state assisted healthcare. In 2005, Tennessee had started making drastic and much needed cuts to their healthcare program; a whirlpool of medical costs that had piled up by that time threatened to bankrupt the state’s resources. Begun in the mid-nineties, the TennCare program was already facing financial difficulty by 2000, as a result of having attempted to offer healthcare to all uninsured residents. The cost of that initiative proved to be so high that it monopolized the state’s budget. By 2004 Governor Bredesen announced that cuts and changes would have to be made to the program: “Over the past year, we've made every possible effort to preserve the program. But persistent lawsuits have tied our hands. The sad reality is, we can't afford TennCare in its current form. It pains me to set this process in motion, but I won't let TennCare bankrupt our State.”

Patrick Poole, a former analyst for the Tennessee Institute for Public Policy, stated in his article about the TennCare dilemma that many employers who had previously offered health insurance had contributed to the problem, as they took advantage of a newly created loophole. “Many employers gladly dumped their healthcare plans and transferred their employees to the public dole and added that money to their bottom line.” That of course helped drain the resources further.

If the TennCare program really offered healthcare to all uninsured residents, one had to ask, why buy Advil from Walgreens, when you could go to the emergency room and get it free under the state plan? This kind of collective thinking further damaged an already endangered program.

My heart goes out to those in need of medical help who cannot afford it and have no one to help them. I understand their predicament; I’ve experienced their fear. And even though I was unable to work for several months after each surgery, I was denied disability pay. Being self-employed, I had no paycheck coming in. Fortunately my church provided for me where the state had failed. My fellow parishioners paid my rent, brought me food and groceries and gave donations to help pay my medical bills. I often wondered what I would have done had I not had a compassionate church to rely on.

After watching the failure of a state plan guaranteeing to insure all the uninsured and observing its massive capital cost along with the resulting restrictions on treatment that came with it, I cannot not endorse a national plan. Based on my Tennessee experience, I would say there would be too many hands in the honey pot and not enough to go around.

That doesn’t mean however, that I don’t think there should be reforms. One of the reasons that medical care in the US is so expensive is the exorbitant cost of liability insurance for doctors. We have become too eager to sue and the resulting costs rebound right back on us. Lawsuits need to be minimized -- that alone would reduce healthcare costs and health insurance premiums.

Another major problem is that healthcare is not part of a free market economy. When we or someone we love is seriously ill or in pain, we will do anything and pay any amount to get well. Healthcare professionals know that. Ask them what a procedure costs beforehand and they can rarely tell you. There need to be caps on what can be charged for services, or at least, like any other service, we should be able to get accurate estimates ahead of time.

I think that doctors’ offices should work with patients who do not have health insurance to explore payment plans and financial options. Even now when I call for an eye appointment, I am told to “just go to the emergency room” because I am not covered. I would much rather owe a doctor $100 for a visit than add another thousand to my list of hospital bills! However, for many who can’t afford healthcare, the emergency room is both the only option and, ironically, the most expensive.

I was fortunate enough to get the medical help I needed, but I also accrued a medical debt that now exceeds my student loans. Consequently, my need to get full healthcare coverage spurred me to make a radical career change. Now two months away from a graduate degree in International Policy, I am confident that this former classical flute player will find a job that will not only provide the health coverage I need, but will also help me pay the medical bills.

While healthcare for the uninsured is definitely a problem needing attention and research, a government healthcare plan is not the solution. Hospitals, insurance companies, businesses, and lawmakers -- working together -- can and must explore options that would avoid the massive tax increases and the restrictions on treatments that accompany bureaucratic solutions.

All of us in the US feel reassured in thinking that no one in a life-threatening situation here will be turned away from a hospital. Yet millions worldwide don’t have that luxury. So we must realize that we are indeed very blessed, even if we are uninsured.



About the Author
Katie Thompson is completing her Master's at the Monterey Institute of International Studies in International Policy with a specialization in Terrorism. Her research has focused on counter-terrorism finance and anti-money laundering policies. Katie interned at the Department of Treasury’s Financial Crimes Enforcement Network in Washington D.C. and currently works at the Naval Postgraduate School for the Center for Homeland Defense and Security on the Homeland Security Digital Library Project.