Now with my internship going into its 8th week, I figured I should write something about what I’m doing. =p This really has nothing to do with MIT, so be forewarned. =D
Since the middle of June, I have been interning at a fairly large Asian public health clinic in Oakland, CA. During our stay, I shadowed doctors, attended healthcare lectures, designed surveys, debated in health discussions, helped the clinic to fundraise, interpreted for patients, and participated in community health outreaches and even one protest in front of the state Capitol in Sacramento.
Truthfully, despite being a premed, I knew very little about the current US healthcare reform debate prior to this summer (and I’m still learning). Growing up under Taiwan’s Universal Health Plan, I really had no sense of the great disparity of wealth and afforded healthcare in the American population. In Taiwan, seeing a doctor for ailments such as coughs and sneezes is commonplace, and I remember that my mom would whisk me off to the doctor for medicine at the slightest sign of a recurring cough or a stuffy nose that refused to go away. I remembered that in middle school, copayments for each outpatient visit to the local clinic was 50 NTD (less than $2 USD per visit, even with all the meds that the doctors give you). Since then, the price has increased to generally 150 NTD (about $5 USD), but this is still an extremely trivial amount to pay for a doctor’s visit and getting two week’s worth of medicine.
At MIT, I’m covered under the MIT Extended Student Insurance Plan, and except for a semesterly figure on my tuition bill, that’s the extent of understanding my own health insurance. (i haven’t been to MIT Medical much anyway – the only time when i actually felt bad enough to go to Medical was last fall? when i had severe diarrhea for like 3-4 days and i panicked once i started vomiting and having a light fever. the kind doctor gave me two ginger ales and chatted with me for about half an hour, then sent me home. i stopped vomiting that night.)
Then I come to this clinic in Oakland, and see that 95.2% of our patients are either uninsured, covered by federal/state/county aided health insurance (Medicare, Medi-Cal (California’s version of Medicaid), and Healthy Families (children lacking health insurance and fall under a certain income level; sponsored by the state California)).
Fully 97.9% of the patients fall below 200% of the federal poverty level (for those of you who are too lazy to click on the link, i’ll spell it out for you. FPI is $22,050 for a family of four (69.6% of the patients are below this income level) and 200% FPI is $44,100 for a family of four (another 28.3% of the patients are below that figure). if you consider the fact that MIT covers full tuition for families making less than $75,000, you’ll realize that $22,050 is very, very little money for a family).
Adding on to this is the fact that nearly 80% of the patients are “linguistically isolated” (defined as an individual that speaks an language other than English at home and does not speak English “well” or “very well”), it’s been an exceedingly powerful learning experience at times.
One patient held up a hospital bill for $11,000 USD, the cost of a 3-day inpatient stay at the county hospital for treatment. He was uninsured. He expressed to the doctor that if he knew that the bill was this steep, he would have refused to go, even through his condition warranted hospital stay. He was unemployed, and so was his wife. The only option now is to enroll him in Medi-Cal (state Medicaid) and see if the state will retroactively cover his bill.
Another patient waited nearly 18 months to get a routine colonoscopy since the only medical facility where he can get it done is the local county hospital due to insurance coverage. If you had private insurance and is decently well-off, you can get one scheduled for next week.
Yet another patient had a scheduled referral at the county hospital, where she sat in the emergency room for six hours, after unsuccessfully trying to flag down medical staff to obtain an interpreter. She could not speak English; none of the doctors nor the nurses knew what she wanted. She came back to the clinic asking for help. Knowing the overbooked schedules of the county hospital medical staff and the scarcity of interpretation services there (even though this is a federally-mandated law under Title VI of the Civil Rights Act, 1964 and Executive Order 13166 under President Clinton, 2000), the clinic sent one of their interpreters with her, and she was finally able to get seen – but not after waiting another six hours.
Such is the predicament of low-income and linguistically-isolated patients in our country.
Try this exercise: find a friend. Pick one to be the doctor, and the other will play the role of the patient. The doctor and the patient both have limited vocabulary; the doctor may only use words that begin with the first 13 letters of the alphabet (A-M) and the patient may only use words that begin with the last 13 letters of the alphabet (N-Z) (articles and pronouns included). Neither side may use vocabulary that obviously aren’t used in everyday speech.
Then, these are the objectives:
Patient: Diarrhea and vomiting for three days, feels slightly dizzy, tries to drink water but keeps on vomiting it up, fever of over 100 degrees, has no appetite, tried taking tylenol but it doesn’t really help.
Doctor: Recommends plenty of rest, don’t eat anything too heavy, try to replace fluids lost, if cannot keep water down by tomorrow, come back for an IV, will prescribe tylenol with codeine and see if it works better than regular tylenol. Call if doesn’t feel better by tomorrow noon.
When I tried it with a friend, this is what it ended up sounding like:
Patient: Poop water poop water poop. Vomit yesterday yesterday, yesterday, today. No sense of straight. Walls slanted. Once water take, vomit soon. No want yummy things. Tylenol take, no work.
Doctor: Be in bed much. Eat light foods. Drink juice, cola, flow from faucet. Day after, feel bad come back for drip-drop in arm. Me give extra good medicine. Call me if feel bad day after.
This sounds funny, but at least we’re speaking the same language. Many times, with linguistically isolated patients, doctor consultation visits turn into wild games of charades, adding pressure on top of the doctor’s already overbooked appointment schedules.
And these patients are never too far away from you – they share a seat with you on the BART (the SF equivalent of the Commuter Rail in Boston), they made the egg tarts that you’ve just delightfully bought at Chinatown, and they probably pressed the laundry you brought in yesterday to dry-clean.
This is who the fight is about; this is the population who are on the cutting board of health care reform.
On July first of this year, the State of California caved in to Medi-Cal budget cuts, eliminating many areas termed “optional care” for low-income individuals. Patients solely on Medi-Cal will no longer be eligible for dental, podiatric, and optometric services. This means no more dental check-ups, no more feet check-ups for chronic diabetics, and quite literally, no more eyeglasses. Now, these measures were passed as a response to the California budget crisis, and I understand that the government’s hands are tied somewhat, but it’s important to realize that there’s often a personal side to all of this.
Next time you read about health care reform on the news or follow HR 3200 through Congress, remember these people. Remember the elderly dishwater couple who survive on a salary of $400 a month, hoping fervently that neither gets sick because there’s just no more money to spare. Remember the new immigrant borrowing English cassette tapes from her friends after her 15-hour shift just so she can hopefully pick up enough phrases to find a job outside of the factory. Remember the $11,000 medical bill.
Pick up the phone. Get a postcard. Write to your legislators. Follow the news. Become involved.
This is their fight, but it is ours too.
Hey Anon E Moose, you are obviously well above said poverty line, by your sense of arrogance of the subject. Outside of simply people that go to health clinics, current government coverage sucks. Remember, this is a small clinic in california. Multiply by all such clinics nationwide, then add in the people who simply pray they don’t get sick. I know personally family members who have to beg the rest of the family to help pay medical bills. When you say “it’s not as bad as you are led to believe”, you obviously aren’t living it. Just saying.
Nice article! But you know what? I gonna be admitted for CLASS OF 2014!!! gwhahahh!!!
I was flipping through the blog and I saw “Poop water poop water poop. Vomit yesterday yesterday, yesterday, today. “
You just made my day.
@ Su –
So it’s actually kind of random. I came upon this internship by accident through an internship database that MIT shares with a bunch of other colleges during my summer work search back in early March. Part of the reason why I pursued this internship was because I wanted to spend time living in California (I’m totally brainwashed by the Bay Area now – will blog about it next), but I think in retrospect I got way much more out of this experience than I bargained for.
@ Banerjee –
Sorry, no idea =/
@ Anon E Moose –
Yes, the public plans are not necessarily the same as uninsured, but I grouped them in the same category because with the current limited funds that the government of California is working with, a lot of these plans have significantly reduced benefits compared to private insurance. Clinicians here are constantly looking for cheap drugs to prescribe since Medi-Cal only covers a narrow range of medicine. California just cut $178 million towards Healthy Families and $1.4 billion towards Medi-Cal (source: http://www.kaiserhealthnews.org/Daily-Reports/2009/August/03/States-Mon.aspx). I think it would be hard pressed to say that these people are enjoying the same level of healthcare as employer-provided private health insurance. Yes, it’s better than nothing, but the mere fact of being covered by health insurance != adequate health care.
Again, you can’t defer everything to government programs. With the exception of Medicare, which provides better reimbursements, many private specialists are no longer accepting Medi-Cal patients because of the extremely low reimbursement rate. A clinician that I spoke to who works at Alta Bates Medical Center compared specialists taking on patients strictly on Medi-Cal as “community service” work for these clinicians. A big factor of such low reimbursements is simply because the state of California has no money right now. You can blame it on the gridlock in Sacramento, but the fact still stands that government programs aren’t the solution to everything.
Yes, he probably will not have to pay the $11,000, as it will be absorbed into the system one way or the other. But I think more importantly, this illustrates the stark disparity between the insured and the uninsured. If we get sick, we can rely on the insurance companies to take care of most of the bill for us. Often, we forget that the alternative is getting slapped with a 10k bill. I don’t think the take-away message in this case is the patient’s ability to pay. It’s the situation that a lot of these patients face without adequate insurance information (at the time of coming in for the visit, he still doesn’t know that he needs to enroll in insurance ASAP – I mean, he also doesn’t speak English – if the clinic has not arranged for him to see social services soon, collection agencies are going to be sent after him from the hospital).
Finally, re: diabetes. Believe it or not, diabetic foot care has been at the forefront of the protest against cutting podiatry. The average clinical visit time for an internal medicine appointment is 15-30 minutes. Given the limited time and the often complicated nature of advanced diabetes, there simply isn’t enough time and resources to defer everything to the GPs. At a presentation given by the California Podiatric Medical Association, the organization actually presented data that the number of amputations due to diabetes complications decreased significantly after podiatry began being covered by the state under Medi-Cal.
No offense intended, but I’m hardly being “naive.” The situation here is more serious than what the media portrays; and yes, the same scene is being played out in community clinics treating the underserved across the nation. I just feel like with all I’ve seen and participated in this summer, I for sure can no longer say with a good conscience, “the government will take care of everything,” because it simply won’t. The challenge that we are also facing now is that the legislators on Capitol Hill are not the people who are on the falling axe of public health care. It’s one thing to vote on a bill proposing 1.5 billion of cuts to medical care for the poor, but it’s another to sit in at the waiting room of the county hospital, crammed with patients waiting for treament and procedures – since the county hospital is the only place that these people can go to for health care anymore.
Thank you for this entry, Chris.
My family (my mom, grandma, and myself) has been on Medicaid/Medicare/+random HMOs here my whole life.. going to a doctor is always bundles of waiting fun, and we can speak English!
Try showing up to a scheduled doctor’s appointment and THEN being told “oh, sorry, we don’t accept this specific HMO some other division made you get”, you just wasted money and time getting here so find another doctor!
Pain. In. The. ___.
The system is just all sorts of broken.
My grandma’s mother died while they were waiting in an emergency room for the mother to get treated for her heart attack. I don’t think my grandma especially likes hospitals
Both my mom and grandma see lots of doctors for their various issues. My mom’s longtime most trusted doctor jumped off a building. :( My grandma’s doctor pretty much prescribes my grandma every pill under the sun.
My Medicaid expired by the time I came to MIT so for now MIT’s insurance is the only kind I’m covered under (it’s been great so far!). But am I looking forward to graduating and having to find my own insurance? Ummmmm..
I’m not looking to start a debate – just hoping to shed some light on the other side of the spectrum. Yes, you brought up flaws in the system. This shows that the system already doesn’t work. Now, the government wants to expand this broken system. Under the proposed system, not only will these people have to wait for hours for help, but so will the rest of the nation. Just look at how well socialized medicine has worked in Canada.
the stories in this trend of using personal experiences to justify the problems of the system are definitely very sad, but a universal health plan (like the one mentioned, Taiwan’s) would still be unable to improve many outcomes
“The system is just all sorts of broken.
My grandma’s mother died while they were waiting in an emergency room for the mother to get treated for her heart attack. I don’t think my grandma especially likes hospitals”
the UK has a national health system, but still:
-One in three people who have a heart attack die before even reaching hospital (Fatality outside hospital from acute coronary events in three British health districts, 1994-5. BMJ, 1998; 316: 1065-1070.)
-Heart and circulatory disease claims around 200,000 lives in the UK each year (Table 1.2, British Heart Foundation Statistics 2008)
So heart attacks are a really fast/serious occurrence, with or without a broken system
I think you brought up a lot of good points. Healthcare in America definitely needs to be completely re-worked. However, I don’t think universal healthcare is the solution (you haven’t, to my knowledge, come out for or against it, so would you mind clearing up your stance on this issue for me?).
One of the biggest problems, imho, is the insurance companies themselves. Over the years, the cost of health care has dramatically increased because of negotiations between doctors and companies – namely, the insurance companies only agree to pay so much of the bill, so the doctors charge more in order to make more money from it. It’s really just an inflation of charges. If this hadn’t happened, that 11 grand bill would probably be a lot less.
Another reason why health care is so expensive is that there are so many people being treated who can’t afford to pay. If hospitals have to pick up the tab, they have to make up the money somehow. The most logical solution is to charge more, thereby forcing those who can pay for health care to cover the costs of those who don’t (and this is exacerbated by illegal immigration – but that’s a debate for another day, I suppose). This, of course, makes it even harder for those at or under the poverty level to pay, leading to even fewer people who are able to pay. Sometimes costs are so exorbitant that even those with insurance can’t pay! It seems like health care is a catch-22.
Hence, some have presented the solution of universal healthcare. However, this just passes on the cost to the government, which then taxes the people in order to pay for it, and the same people are stuck picking up the tab. Then there’s also the problem of the government having to regulate everything, and don’t get me started on that…
So, another solution is desprately needed. I’m curious – what do you think should be done?
Your internship sounds awesome by the way!
Did you find out about it through MIT?
I forgot to mention: kudos for blogging on such a politically charged topic – it definitely takes guts to do so!
@ anonymous –
First off, I’m just trying to describe some of the experiences that I ran into, and connect it to a larger, global problem. This is a blog, not a research paper, and I’m entitled to write about my experiences – that’s what I strive to do here, just like any newspaper reporter. I can also throw out figures instead, but I feel like you can easily obtain that through Google and government documents. Congress went through thousands of pages of data to draft/debate HR 3200, and I think if you’re more interested in that, just go look it up.
More than anything else, medicine is about human beings. Too often, I feel like the sentiment of the media and the general populace is “the government will take care of everything” and “no system works well so let’s just give up.” I know, because I’ve been there too. It’s just that every day you resign yourself to let the winds of fate take control, it’s another day that the millions of people lacking adequate health care go through.
Concrete facts is evidence, like my science classes taught me, but if I think compassion also goes a long way. Behind every fact and figure, there is a personal story. Have some heart for these people.
@ Olive –
You’re right, I don’t think universal health system is the perfect solution. I’ve done research on the Taiwanese system and studied many of the problems associated with the framework. For one, the Taiwanese system is currently under patient abuse, with a large percentage of the patients going to the doctor’s and getting meds way more than they need, just because the copayment is so cheap and health care access easy. This is leading to a very possible health care insurance bankruptcy in the future (the Legislature is trying very hard to avert that).
It has been proven that the Taiwanese system did help increase life expectancy and lower infant mortality, as well as raising health care coverage to 99%+, which means that there are still benefits. I think this shows that health care reform though, will always have to be a pro/con tradeoff. There’s no “perfect” system.
I think you pointed out many, many valid points. I think one key factor is that American medicine is literally a “business.” It’s a flourishing trade between the allied health care stakeholders (pharmaceutical companies, manufacturers…etc.), insurance companies, the doctors, and the government. I agree that until all parties involved agree to concede to change the current policies, nothing drastic will ever change, regardless of how you reform health care.
I think you bring up a good point about the number of patients who cannot afford to pay for health care. In fact, this has been one of the strongest points in the Congressional lobby against universal health care – the fact that the poor people will “undermine” the integrity of the cost system of universal health care. I personally think that this issue is intricately linked to immigration reform and the US needs some way of addressing this issue before anything drastic can change – undocumented immigrants is a hot potato topic in the health care decisions of almost any state in the US. (this is also why Taiwan universal health care has been able to work relatively much better – the wealthy/poor gap is not as pronounced as the American one, and there is a small number of unregistered immigrants – same with most other industrialized nations with national health care).
I must admit that personally, I don’t understand enough about health care to propose any kind of viable solution. It may make me seem like a hypocrite for writing that, but I think this is the truth – some scientists and policymakers have spent their entire careers analyzing this problem and are still struggling with it. I do think, however, that the branch will have to bend somewhere – we will all have to make concessions to make this work, whether it be regulations on pharmaceutical and insurance companies, higher taxes, or political compromise.
Here’s my own view, since you asked. I don’t want to tack this on to the entry above because this is only my personal opinion.
Actually, I am for government regulation and stricter government control. I humbly believe that one of the problems (yet also one of the gifts) of the United States is individual freedom. This is a great concept and the cornerstone of the American spirit, but I feel like too much individual freedom will only cause chaos and disarray. This is precisely what is happening now with all of the companies, the politicians, and the stakeholders in this debate doing anything they please. I’m personally willing to concede more of my rights and freedoms over to the government with the government having a bigger control of the system. No government is free from corruption, but I feel like at times like this, we should all make sacrifices to reach a solution.
But I don’t want to start another debate. Like I said, I’m still learning, reading, and experiencing. Perhaps health care reform will not even be something that we’ll see work in our lifetime, but at least I feel like by spreading the word and sharing knowledge, we’re slowly effecting a change, step by step. That’s really all I want to do. To me, I feel like that’s more important than criticizing ideas for the sake of shooting them down, and wasting breath arguing.
Ahahah, I had actually completely forgotten what you were doing in California =P But it sounds like fun ^_^
I know this is slightly beside the point, Cris, but do you know when the online/pdf version of the MIT application for 2010 will be available?
Well intended, but somewhat naive post.
“95.2% of our patients are either uninsured, covered by federal/state/county aided health insurance (Medicare, Medi-Cal (California’s version of Medicaid), and Healthy Families (children lacking health insurance and fall under a certain income level; sponsored by the state California)).”
The others listed are not the same as uninsured.
“Fully 97.9% of the patients fall below 200% of the federal poverty level”
Then vast majority are or should be enrolled in one of the government programs.
“One patient held up a hospital bill for $11,000 USD, He was uninsured. … He was unemployed,”
He was treated, regardless of the lack of insurance or money to pay. The bill will be covered by a public plan or written off to a free bed fund.
“Patients solely on Medi-Cal will no longer be eligible for podiatric optometric services. This means no more no more feet check-ups for chronic diabetics”
Wanna bet foot and lower leg problems associated with diabetes are treated as part of the diabetes. No bunion treatment =/= no diabetes treatment.
It’s more complicated and not as bad as you are led to believe.
This blog post and all the comment responses bear imprints of the fact that you debate. It’s amazing how a single activity can totally change the way you present your ideas.
As for healthcare. it’s been a long time, almost 10 years, since I’ve been treated in the US, but I’ve been following this issue ever since the President campaigned about this in the election, and I am also willing to give up a certain amount of freedom in exchange for a better healthcare system, but the single most important thing for all of us to accept is that we will always have to give up something or the other in healthcare reform. The problem is that we just can’t decide what exactly to give up.
that’s a really thoughtful reply
i basically agreed with everything you said in it & the original post, but just wanted to point out that nothing is really a panacea, and there are always going to be limits in medicine
that something may not be preventable doesn’t make it any less of a tragedy, and i didn’t mean to imply otherwise
you’re right though,there’s no excuse for us to stop trying to make things better
Thanks for the wonderful response! I definitely agree with you, and I don’t think it’s hypocritical to say you don’t know enough about it to propose a viable solution. Really, it would be hypocritical to propose a solution without thoroughly knowing the problem! I think we need more people like you working on the problem
One thing though is that I want to mention that I’m not trying to “shout down” anyone. I realize that my opinions tend to be rather long-winded, so I apologize if I seem to just “flood out” other people’s ideas. I encourage discussion and various viewpoints – please don’t feel like I’m offended or getting hyper-defensive about my ideas. I’m open to discussion and would be happy to respond to your comments as long as you remain civil.
Chris, you should check out STS.005. It’s got a lot of good reading on health and history with a lot on the causes of disparities. The only downside is its HASS-D and CI-H so you have to do the lottery and weekly writing plus papers.
I’m all for universal insurance but not necessarily all this translation stuff. If the hospitals don’t do it and no one is suing them and winning then it’s probably not illegal despite some people’s interpretation the Civil Rights Act. The untold side of the story is that the immigrants are still better off–that’s why they moved here. It’s like blaming Wal-Mart because its employees often use Medicaid, when if Wal-Mart didn’t employ them they’d be even worse off.
I’m also not convinced insurance is that important for your health. They say about 20,000 people die each year from not having insurance which is not necessarily that many compared to say, car crashes that might be preventable, or morbid obesity we could reduce.
It is irrefutable that healthcare is about human beings first, and providing care for those who may not necessarily be able to do so for themselves. But, as you mentioned, there is too much abuse of the system that does not seem to come under scrutiny when discussing healthcare reform. For example, what solution is proposed to address the illegal immigrants who pay nothing into the system and thus cannot receive healthcare? Give them the option of public insurance as well. What solution is proposed to address tort reform, to stem frivolous lawsuits from which doctors must protect themselves with expensive malpractice insurance? None so far.
It was my understanding that HR3200 and the two other senate bills under consideration are intended to provide a public option…a government-run option, let me repeat, option, for individuals who do not currently have any health insurance. But the wholly unexpected response from many uninsured individuals is a demand that everyone else also go on the same plan they are being offered. If individuals like doctors, business-owners, professors, etc. have worked hard and accumulated sufficient income to provide adequate insurance and healthcare for themselves and their families, what right do others have to demand that they give up their insurance and take the public option? This just appears to be another abuse of the system, another demand for equality between everyone, a stifling of entrepreneurial spirit and the promise of reward for hard work. While I agree with comments that urge for action against the plight of many uninsured Americans, it is not fair for the currently uninsured to demand others take the same plan as that which they may be offered.
And while reform sounds great to everyone, we must realize that our generation will be saddled with the bill. It is easy to say that no price tag can be put on human health. But nothing comes freely. Someone will have to pay for drastic changes, and no one sector of the public, including our heavily-indebted government, can bear too much of that burden alone.
I don’t think it is “irrefutable” that health care is about “providing care for those who may not necessarily be able to do so for themselves.” Yes, health care is first and foremost about humans, but at the same time, health care isn’t a right. Believe me, I think it’s important to help as many people as we can, and hopefully one day everyone in America will have coverage, but this isn’t because it’s a right: it’s because we care about our fellow human beings and want them to have a good chance at living life. Also, healthy people = healthy society. However, throughout history, health care has been provided as a service for which money is expected in return (or individuals took it upon themselves to help the less fortunate). The fact that governemnts these days are providing universal healthcare, and that many people expect it as a right, is unprecedented.
However, I agree with the rest of your post I have to say though, I think at this point, no matter what we do will require extensive government involvement. I would like to see that involvement be one of two things:
1) The entire system is scrapped and completely reworked.
2) The government mainly acts as a mediator for the people, the doctors, and the insurance companies while tightening some regulations and loosening others.
I don’t think any more “reform”, especially that which is planned now, will be of any use. But aside from disapproving of certain measures being taken, I still believe we don’t have enough money for it anyway. Also, health care isn’t going to be fixed if it’s treated as an isolated problem; there are too many factors involved (our country’s insane amount of debt, the immagration dispute, obesity, etc.). If these are not treated either before the ‘reform’ or simultaneously, said ‘reform’ simply isn’t going to work. It’s just going to make things worse, imho.
Oh, and I suppose I should explain my earlier post: fyi, Chris, I said we need more people like you working on the health care problem because you understand that there will have to be compromises and you are willing to look at the problem from all sides, which is more than the folks over in D.C. seem to be capable of doing…
hehe, I would have gotten back in this discussion sooner if I hadn’t started school this week (one more year…then MIT ’14?)
Chris, thanks for posting and sharing your thoughts. I now live in Taiwan and am very appreciative of Taiwan’s single-payer universal insurance scheme (different from the models in Canada and UK, which a lot of people seem to confuse).
@Olive – the basic fact of healthcare is one is most likely to need it when one is least able to afford it, i.e. when you are very young, very old, or pregnant. The point of insurance is to pool and spread risk. By default, the healthier and wealthier subsidize those who aren’t (and the same could be said of unemployment insurance, homeowner’s insurance, auto insurance, etc.)
And why shouldn’t access to quality and affordable health care be a right as much as a right to bear arms or freedom of speech? Wouldn’t access to healthcare fall under the “right to life, liberty, and pursuit of happiness”?
The way the current system is set up, some people are over-insured while millions of others are uninsured. I believe a lot more of medical costs fall under that category than can be blamed on illegal immigrants. MIT World has a recording of an excellent talk given by Jonathan Gruber, where he mentions that under MIT’s health plan (excellent, and what he considers “over-insurance”), his son can, for example, choose to change the color of his braces every 6 months – a benefit that doesn’t have any significant life extending benefits, but certainly raises costs.
The U.S. also has incredibly high administrative costs in health care (~20% to Taiwan’s less than 2%).
For what it’s worth, I found the medical care while I was at MIT to be excellent. It wasn’t something I appreciated until I graduated and moved out to the “real world.” It is frightening to be between jobs without health insurance and knowing that an accident could have catastrophic consequences. I have a friend who, between finishing law school and starting her job, had to pay over $1,500 a month in premiums for COBRA (this is the supposedly the more affordable option mandated by government for people between jobs) because she had two young daughters. These are not insignificant costs that add up and weigh heavily on not just the poor, but the middle class as well.