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  • By Jeremy L. Bevacqua

Why healthcare costs so damn much

We are told constantly while growing up that we when get sick or have a problem, to go to the doctor. "Go get it checked, or "Go take care of it before it gets worse," all words uttered by adults. "We just want you to get better." As children, we are not privy to all of the things that are needed when medical services are rendered. Just like most things in life at that age, the Bank of Mom and Dad seems to provide full coverage.

Fast forward in life when you become and adult and eventually a parent. You are a loving parent who just wants the best for his or her kids. Imagine an emergency, an unforeseen accident that happens to one of your kids. He or she needs care; it’s something that first aid cannot fix. You take them to the closest hospital, and get some work done. The child is seen and needs tended to; it is four to five stitches on an open wound. The patchwork is done in an hour; your child is in better shape.

You don't have insurance because your work does not offer a plan, so you have to pay out of pocket. It is for your child and the procedure is relatively small. It’s worth it, you think. Then you see your bill and it is $1500. You look at the bill and think, why does it cost so much?

It is a harsh reality that we live with on Guam. Paying out of pocket means paying whatever you have in the pocket and in the bank. If you have insurance, you are paying hefty premiums that continue to raise in price but provide less in coverage. If you are poor it means you qualify for Medicaid, but on Guam the program is limited compared to the mainland.

Veterans have great benefits in the medical area and rightly so, and of course the wealthy can pay for their health procedures and premiums. But for the majority of the working and middle class population, getting healthcare is not a right but a luxury. How can a society flourish when basic health needs are not met for the majority of the population? Bottom line, it cannot, and a society will flounder when basic health meets are not met.

Why is Healthcare so Expensive?

Ask the above question and to put in bluntly, Guam suffers the same problems as the United States by virtue of being a territory as opposed to a state. Guam has adopted many models of U.S. infrastructure, including a healthcare system that many consider totally inadequate. The system in place in both places is a private insurance cabal that is lightly supplemented and backed by a thin federal government safety net.

According to the Organization for Economic Co-operation and Development, the United States leads all other countries in the world in spending per capita for both public and private healthcare cost ($3,000 more than 2nd place Norway), but ranks low in actual quality of health categories such as life expectancy, doctor accessibility, and percent of population coverage. The rub here is that Guam, like the U.S., pays incredibly high costs while getting the least effective care.

Doctors and private insurance companies have devised a system that provides hefty profit margins to the people on top. The government cannot negotiate drug prices with pharmaceutical companies, and providers cannot import cheaper medicine because of the Jones Act. The “for profit model” that has powered the U.S. economic system gives no power to the consumer, who is forced to put up with the system, because being healthy is simply something we need and cannot ignore.

Since the 1980s, health care costs have skyrocketed while showing no signs of dropping and people cannot keep up. Guam Memorial Hospital is a case in point. “To address losses,” a recent audit stated, “GMH raised hospital fees by five percent in April 2017, and plans five percent increases annually.” This needed money will not much affect the top earners, but will disproportionately tap the pockets of the much larger bottom group.

Supporters of the present system cling on the notion that there are choices in coverage and that theoretically, more competition will drive the prices down. The key phrase is ‘in theory,’ because when applied in the real world, the prices rarely go down. We were all told that Guam Regional Medical Center would help reduce the costs of healthcare, but things are a little more complicated than that.

Hospitals are bound by federal law to treat all emergency care patients regardless of ability to pay and GRMC has been doing just that since opening in 2015, including patients with coverage from TakeCare, at a cost now running into the millions.

GRMC Director of Corporate Affairs Eric Plinske said in a news release that GRMC has continually sought to reach a network provider agreement with TakeCare, as well as to agree on a reasonable settlement of past due claims. “We have offered discounted rate packages similar to those accepted by Guam’s three other principal health insurance providers,” said Plinske. “However TakeCare has walked away from the negotiating table regarding historical claims settlement, and has not responded to GRMC’s latest network agreement proposal.”

TakeCare members who received such care got a rude awakening recently when the frustrated hospital sent them bills for the services they received.

Medical pricing isn’t much different from the cost of gasoline on island, in which consumers have no say in determining costs or how much they spend at the pump. New medical facilities might mean new specialists on island and equipment, something that GMH struggles to update due to an inconsistent lack of federal help for infrastructure, but at what price?

If something is too expensive, we generally seek another way. How are Guam residents reconciling their health issues?

Medical Tourism is a way that insurance providers and people outside the system attempt to deal with the high costs of certain procedures. Many Guamanians go and have gone to St. Luke’s Hospital in the Philippines to seek expertise or treatment for their ailments. A mini-vacation of well-being, it appeals to many as an escape and recovery. For the uninsured that need major operations done, places like Thailand, Singapore and now even India, are garnering attention as destinations for medical tourism. It speaks bound of the situation when the cost of a plane ticket across the world plus an operation in that country will save an uninsured American money compared to getting the work done in the U.S.

Alternative medicine (non-Western) is a growing trend all over the world, stemming from the rejection of huge pharmaceutical companies and their pills that have adverse effects on the body, or so we’re often told on the internet. In Guam, indigenous and native medicine has been carried out by Suruhånus and their Amot. Related to Chamorro Culture revitalization, it is idealistically thought that the prehistoric ancestors were healthy and lived for generations, and that the knowledge they had and the way they lived allowed them to flourish. While they were often touted as spiritual advisors, the knowledge of plants and diet Suruhånus possess has much real world application. While it may not cure all ailments or some major problems, it is a cost effective and practical way of treating health.



There Must Be Another Way

“Don’t Get Sick,” is a phrase I have heard many young people and couples maintain is their health care plan. It is Herbert Hoover’s ‘rugged individualism,’ but adapted for the 21st century. “What doesn’t kill you makes you stronger,” is another line, but the fallacy here is that a pre-existing condition can kill you if not cared for. Not getting care in the Emergency Room will likely end up costing you a lot of money when you are eventually hospitalized. If you make a decent salary, you are unable to get government assistance so you get to feel the full force of the costs down the line. The middle class gets punished the hardest in our system.

Countries like Cuba, which spend a quarter of the cost for healthcare when compared with the U.S. average, have higher life expectancy, lower infant mortality rates and an overall healthier population. They do this through preventive and proactive medical practice. Each family in Cuba is assigned a doctor. By contrast, the American motto has always been, “Our way or the highway,” but this stubbornness will likely lead to an eventual disastrous fall. Guam should learn from other nations.

Universal Health Care, or the more politically correct term, single payer coverage, is something that has been making headway on Guam and in the states. Guam Senator Dennis Rodriguez, for one, has been pushing efforts to create an all-encompassing healthcare plan and U.S. Democratic Presidential candidate Bernie Sanders made waves in 2016 for pushing a guaranteed healthcare right for all Americans, as is the case in many civilized countries. It’s hardly a revolutionary act or a new idea. Palau has a single-payer system that provides help to their citizens. And since the 1930s, the majority of Americans have overwhelmingly polled in favor of single payer coverage, but huge insurance companies and health care lobbyists have fiercely opposed this.

I was told once by a man in southern Guam that he is saddened by the fact that in many families, children have more teeth than their parents. It’s a sad comment on the state of Guam healthcare when heads of families sacrifice their own healthcare for that of their kids.

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