Important Health Warning

Dushyant Kumar, a student at the University of Illinois in the U.S., was having bouts of intermittent spasms in his stomach but a visit to the university hospital made him double up in pain on learning about staggering amount of money he would have to spend on medical tests. As an international student, Kumar said, “Despite having student health insurance cover, I was supposed to shell out $600 (Rs 36,000) for only an ultrasound.” 

Healthcare remains a concern for Indian students as well as citizens of the U.S. While U.S. citizens have health insurance cover that would pay a substantial portion of their medical bills, as many as 8 lakh international students, including about 96,000 Indian students, are at a huge disadvantage for no health insurance will pay more than 80 percent of their medical bills—that too after a one-time deductible of $500 (Rs 30,000) on first visit to a clinic. 

Procedures such as an ultrasound or a CT scan cost upward of $1000 (Rs 60,000) in the U.S, which essentially means an international student first pays $500 (Rs 30,000) one-time deductible and another $100 (Rs 6,000) as 20 percent of the total cost he is supposed to shoulder. All this after he pays a huge sum for being insured for the year.

Mounting healthcare cost is a bane on a society that has over 5,500 hospitals and 8 lakh doctors to cater to a population of about 31 crore. Sample this—a woman delivering a kid, and that too without complications, will pay about $30,000 (Rs 18 lakh). 

Unlike in India, where purchasing medical insurance is still not in vogue due to a variety of reasons, few in the U.S. can afford the spiralling costs of healthcare without medical insurance whose monthly premium jacks up the expenditure for a family of four by several hundred dollars each month, with a sizeable chunk of the population—totalling over 2 crore—remaining uninsured. This is in sharp contrast to the fact that the U.S. spends over 10 percent of its Gross Domestic Produce (GDP) on healthcare, making it one of the few nations to do so, according to the World Health Organization (WHO).

The recently instituted Patient Protection and the Affordable Care Act (PPACA), better known as Obama Care—a derisive reference by President Barak Obama’s trenchant opponents—aims at lowering the uninsured rate and making insurance more affordable for all. However, its real achievement lies in having insurance providers include pre-existing conditions of those seeking insurance cover—a feature that was, until recently, non-existent. Also, the Act makes it mandatory for companies having more than 100 employees to provide them with insurance cover, irrespective of their race, gender and orientation. 

However, it does not change the ground realities for international students, who will still pay 20 percent of their medical bills, and the over 80 lakh illegal immigrants in the country for whom there will be no insurance cover. They would have to fend for themselves, their only solace being their inclusion in emergency care. Vocal support for this Act pales into insignificance in Republican bastions such as Tennessee and Mississippi, where its mere mention triggers angry rebuttals and baleful predictions. “It would make the monthly premium significantly go up,” said Paul Sanderson, a Tennessee-based insurance agent. Also, the one-time deductible that a person pays on first visit to a doctor would increase, he warned. 

But those are not the only issues plaguing the healthcare industry. Getting to see a doctor on time and paying medical bills are hurdles most people face, bringing to the fore broader issues of healthcare and its reform for a country that boasts of cutting-edge technology and state-of-the-art research. Li Chang (name changed), a teacher of library science, landed at the JFK Airport in New York, USA, ill at ease with the weather after visiting her sister in Canada. Suffering acute lung infection, she rang up a doctor for an early appointment to control the bouts of coughing and fits of wheezing as she doubled in distress. “The doctor gave me a date one month down the line, forcing me to fight on—unaided and alone,” Chang said.

Buying a medical insurance is not a guarantee that all will be well. Doctors refusing to treat patients having insurance policies of certain companies, a variety of alternative forms of medicine, including Ayurveda and Homoeopathy, not being included despite recognition from the federal government, many emergency-room doctors not under the ambit of insurance companies and being termed “out-of-network” doctors, and thus having to be paid by patients over and above the hospital bill, have left many with no option but to mortgage their property. Oftentimes, and funnily, though, a person will have to enquire about both the hospital and the doctor he will most likely seek an appointment with being on the right side of his insurance provider. There have been incidents of a doctor not being registered by an insurance provider despite the hospital he was working with being registered with it.

Adding to the woes of the sick is “drive-by doctoring” where patients have had to pay consultants and assistants to doctors, too, at times out of their own pockets after their insurers refused to pay them. These assistants are called in at the discretion of the doctor, often with questionable motives in doing so. This translates into specialists being called in—and increasing the medical bills—when even a resident or a nurse can handle the situation in the emergency room. Sometimes doctors split the profit with such assistants or consultants, experts said.

The politics of the system too has a role to play in the way things are moving in the healthcare industry. With upbeat Republicans gaining control of the Senate, Obama supporters fear that the government-initiated reforms in the health sector may be halted by the Republicans who do not support the health policies of the U.S. government.

Abhijit Mazumdar is a U.S.-based journalist and researcher