The Problem With American Health Care Isn’t Just Insurance Costs

Everyone talks about the health insurance crisis in America, but rarely do we talk about the other crisis: people with decent insurance coverage who simply cannot access healthcare. There’s more to this than single payer versus private coverage. Health insurance is meaningless if patients cannot actually obtain timely medical care.

This week I helped a friend access healthcare in America. She has health insurance from a national provider. She is a recent legal immigrant (from a place with good national health care) but had little idea how getting a doctor here actually works. She had come down with a terrible case of shingles, which had spread across her face and back and was moving toward her eye. But she had no primary care physician. After three ER visits she still had no referral. The emergency room dispensed only minimal pain medication and told her to find a primary care physician on her own. None she called would accept new patients before a six-week wait. We finally, using a combination of sweet talk and some advanced begging, found a rare doctor willing to put the patient ahead of the paperwork. She recovered.

For many Americans, the challenge is no longer only paying for health care but finding a clinician who is available to provide it in a timely manner. According to the Centers for Disease Control, 10.6 percent of insured U.S. adults could not obtain an appointment when they needed medical care in the previous year, unrelated to cost or insurance. Some 4.6 percent could not reach providers during open hours because of work or caregiving. About 4.4 percent could not easily find a physician compatible with their insurance, while 2.4 percent said providers were too far away. The latter is a critical issue in rural America and across the bulk of America that has little to no public transportation. All those figures above exclude people who never seek care because they cannot afford the deductible their insurance requires.

Maybe it is time to move to Canada. Two acquaintances just immigrated there after a multi-year screening process that included producing original college and high school transcripts, taking a health exam, taking a French language test, interviews, and forms, lots of forms. They needed to hire lawyers to get them over a few humps, but ultimately made it. Their motivation resonates strongly: They want decent health care.