Robert Cohen, 57, is like most entrepreneurs. He eats, sleeps, and breathes his business—a limousine service, with three cars and three drivers—and visualizes the day when his hard work pays off in profits. For now, though, everything he makes goes back into the business, so he has little take-home pay—certainly not enough to afford an individual health insurance policy, even if he were in perfect health.
But he’s not in perfect health. He has a history of heart disease and diabetes. He can get insurance for his business, his home, his car, just not his health. Yet he knows that’s where he needs coverage most.
In August, Cohen had a heart attack and was rushed to a private hospital downtown. “I was very sick,” he says. “The whole left side of my heart shut down. I think I surprised everyone by living.”
He had two stents placed and spent eight days recovering. Then, two hours after he was discharged, he had another heart attack and was back in the hospital for another eight days.
Seeing that Cohen needed regular follow-up for his heart condition and management of his diabetes, his cardiologist told him about Venice Family Clinic. Cohen had never heard of a free clinic; he had assumed no one would treat him if he couldn’t pay.
“Before I went to Venice Family Clinic, I just kept thinking, ‘I hope it doesn’t hurt too badly to die like this,’” he says.
Right away, his doctor diagnosed him with congestive heart failure and sent him back to the hospital (operated by L.A. County, so it was free of charge). He has been in and out several times since, but still, he’s relatively fortunate—many uninsured wait so long to seek care that they never recover.
“As long as you don’t get sick,” he points out, “no big deal.”
Therein lies the problem. Everyone gets sick. Plus, as everyone knows, the health care system needs to do much more than just treat illnesses—it needs to prevent them. And that means seeing patients even when they are well.
This issue is growing in urgency as, in addition to the more than 46 million uninsured in America in 2008,1 an additional 14,000 people lose their health coverage each day. 2 Not all lose it along with their jobs. Some lose it because their employers can no longer afford to provide group plans; others because their individual policy premiums have surpassed their rent or mortgage payments.
Then there are people like Cohen, whom no insurer will touch, no matter how much they are able to pay. It’s a reality Cohen knows all too well—he’s also a registered insurance broker.
“The one time someone said they would insure me, it made me nervous,” he recalls.
But you don’t have to have an immediately life-threatening condition like heart disease to be uninsurable individually. A Venice Family Clinic employee, who asked not to be identified, recently discovered this when he enrolled in an alcohol recovery program offered by his group health plan.
“I was an extremely high-functioning alcoholic—I drank with dinner,” the employee explains. “But one day I had something of a revelation. I realized I needed help, so I brought it up at one of my doctor’s appointments. Then came this horrible, sinking feeling.”
He realized his confession was going to follow him the rest of his life by way of his medical record. As soon as he got home from his appointment, he did an Internet search and quickly found insurance application forms that confirmed this.
One of them read, “If you have a condition, illness, or injury that is listed on the Medical Condition Rejection List below, you will most likely be declined for individual coverage.”
Second on the rejection list: “Alcoholism (within five years).” Other forms said seven years. Others, ten years.
“This is one of the perverted things about the health care system today,” the employee says. “Too often, there’s a disincentive to accessing the care you need, because anything you say can and will be used against you.”
He knows he could be—probably will be—in Cohen’s situation someday, unless the insurance system is overhauled. In fact, everyone at Venice Family Clinic takes the health insurance crisis personally. They are reminded on a daily basis that their coverage is simply an accident of employment.
And even those who succeed in getting individual coverage will note that almost no private policy covers pre-existing conditions. Yet almost everyone has some kind of pre-existing condition—allergies, injuries, surgeries, infections, headaches, insomnia, the list goes on—that could be used as the basis for refusal of a claim. Without group plans, the number of uninsured, or effectively uninsured, might be double, triple, or quadruple the current number.
It is this shared crisis—not the crisis of any one segment of the population—that is at the heart of the major health care reform bills making their way through Congress. The system is broken for everyone; some just have better luck in it than others.
Meanwhile, Cohen easily could be angry and dispirited over having more than $50,000 in medical bills from his first two hospital stays, but he’s not. He’s focused on getting back to work, on adding to his fleet.
“I know I’m not the only one in this situation,” he says. “I got lucky.”
This story appeared in the Fall 2009 issue of Encounters. Click here to download the entire newsletter as a PDF.