Health Phil Ateto

Medicare for All Could Save My Life

My insurance says my cancer drugs aren’t “medically necessary.” No one should have to fight for care like this.
[Molly Adams / CC BY 2.0]

By Phil Ateto / OtherWords

I recently joined Reps. Pramila Jayapal (D-WA) and Debbie Dingell (D-MI) as they introduced the Medicare for All Act of 2021 in Congress. For me and millions of Americans, this bill’s passage would not only be life-changing — it could be life-saving.

In 2010, I was diagnosed with multiple myeloma, an incurable blood cancer that affects the bone marrow and makes it harder for my body to fight infections. Before I was diagnosed, I was an average 30-something guy who went to the gym and ate right. Today, after 11 years with this disease, I’m still fighting for my life.

I’m fortunate to have amazing doctors and nurses who are doing everything they can to make sure I live long enough to celebrate more anniversaries with my wife. Last year, my doctor found a drug that worked far better than expected on my cancer — sending it into remission for the first time ever.

However, my medical team had to go to great lengths to pressure my insurance company to approve coverage of this life-saving drug.

This year, when it came time to renew my prescription, the insurance company told me the drug that worked so well to fight my cancer isn’t “medically necessary.” After several rounds of appeals they finally approved it, but would not pay for it. I was looking at a bill of $23,000 a month to pay for my medication.

After more appeals, and almost two stressful months without the drug when my body went into a steep decline, we finally got Carefirst to do what it’s supposed to: pay for the medication I need to stay alive.

As I’ve taken on the physical toll of fighting cancer, I’ve also been forced to shoulder the emotional stress of fighting to get the care I need and not knowing if I’ll get it. Some days, it’s extremely difficult to bear.

And I’m one of the lucky ones. I have “good” insurance, which gives me more options than the millions of Americans who are uninsured or underinsured.

In 2019, nearly 30 million people didn’t have health insurance. Another 10.1 million people lost their employer-sponsored health insurance during the pandemic. In fact, one-third of the more than 500,000 deaths from COVID-19 are tied to a lack of insurance.

Meanwhile, some of the nation’s biggest health insurance companies doubled their earnings during the pandemic.

This pandemic has made it clearer than ever that we need Medicare for All.

Our nation must follow the lead of so many other nations around the world and create a single-payer health system. This would save almost 69,000 lives per year — and more than $450 billion, according to the Lancet medical journal.

And we would lower staggering prescription drug costs like mine.

As the single entity buying medications for millions of Americans, the U.S. government would have the purchasing power to force Big Pharma to agree to major cost concessions. This is already being done in the Pentagon, the Veterans Administration, and countries throughout the world.

How many more people will die before we decide to put people before insurance company profits? How many more people like me will have to fight their health insurance providers for the care they need to survive?

Today, I’m saying: Not one more.

As a member of Our Revolution and Healthcare is a Human Right Maryland, I’ll be urging every member of Congress to sign on to the Medicare for All Act of 2021. Join us and help secure health care as a human right for all of us — and for generations to come.

Phil Ateto

Phil Ateto

Phil Ateto is a member of Our Revolution Maryland. This op-ed was distributed by OtherWords.org.

12 comments

  1. I have been disabled since 1993. Medicare has been a major help to me. One of my conditions is skeletal and I get assistance with pain management, some what. I am in need of operations. Because my income is solely Social Security I cannot afford the co-pays and I make too much for Medicaid. Just like the author here, I am just one of thousands. I seem to remember that last year Congress approved something like $740 Billion Dollars for the military but I also understand that there have been cuts to medicare and a raise in premiums. How can we have a healthy, happy, productive country when everyone is sick or broke, or in debt or bankrupt from being sick? This past month was a hard one for me and at the end of the month I had to put Doctor visits and medications on my credit card. I am one of thousands. None of what the author wrote of or what I have expressed is sustainable. An adjustment must take place, it must.

  2. This story is a clear example of how the health insurance companies and big Pharma are ripping people off with their unending greed. We are the only country in westernized countries that treat people so poorly.

  3. Don’t expect a humane health care system any time soon….Most US politicians rather use our tax dollars on building frightful weapons to kill and torture human beings all over the planet….And support private insurance and big pharma to keep things just as they are.

  4. As an Australian citizen I live in a country with an excellent Medicare system providing high quality free medical care for all citizens that is paid from our taxes. It has always baffled me how Americans allowed your medical system to become privatised to such an extent only a small proportion of the population has easy access. We regard it as a right due to all citizens along with education and infrastructure.
    Despite your health challenges its so impressive how you’ve found the strength and passion to campaign for what should be one of the most foundational rights provided by nation states to its citizens – affordable/free access to medicine and health care.
    Wishing you health, stamina and success going forward.

  5. I have seen stories like this, and I am sure there many other like it.

    If I was in your situation I would move to a civilized country immediately, where the drug and other medical services could be provided for a reasonable fee.

    The American health insurance industry is simply a multi-billion dollar fraud.
    You pay outrageous monthly premiums, they take your money and DENY the services that you pay for. That a crime, isn’t it? $1000 a month, and you still have a “deductible”.
    It’s massive corporate run FRAUD. Let’s call it that.

    More immediate and easier than a national health insurance plan, the fraudulent health insurance industry should be REGULATED to force these criminal organizations to simply pay for the services that monthly premiums should guarantee.

    This won’t solve all the problems, of course, but it seems like it could be done without the congressional lies about “budget” and other nonsense. Maybe it could be a first step.

    1. “The American health insurance industry is simply a multi-billion dollar fraud.”

      I call the American healthcare system — very accurately, I think — an organized-crime syndicate that has succeeded in fully capturing both the government and the media. (Media capture may not be obvious to some people at first blush, but when you start paying attention to just how much advertising is from the for-profit health sector — over $14 billion a year from drug companies, insurance companies, hospitals, clinics, and even medical-equipment manufacturers) — it begins to dawn on you that Big Health is calling the piper’s tune when it comes to US healthcare news.

      And the Big-Health syndicate’s racket is *unbelievably lucrative*. We spend almost 18% of GDP on “healthcare,” and we provide care to the lowest percentage of our population and get the worst average outcomes of any “rich” country. The second most medically expensive tier of countries spend less than 12% of GDP on healthcare, they all provide care to virtually their entire populations, and they all get better average outcomes than we do. (Two of them, Switzerland and Japan, get the best average outcomes in the world.) Apply that 6% difference to US GDP, and that’s an “extortion surplus” of *over a trillion dollars a year*. (The surplus breaks down into administrative featherbedding and skimming, on the one hand, and provider price-gouging on the other. And for what it’s worth, the Affordable Care Act didn’t do anything to counter either. It merely institutionalized and subsidized them. That was actually the ACA’s primary goal…)

  6. When I read Phil’s account of how his insurance company at least temporarily decreed that his expensive life-saving prescription med was “medically unnecessary,” two things came to mind:

    (1) My mother was diagnosed with brain cancer (GBM4) in her 70s and she ultimately died of it two years later. During that time her major complaint was nausea and she was prescribed 60 pills a month of a patented anti-nausea med for it, at a pre-insurance cost of $1500 a month. Midway through her illness, her insurance company informed us that it would only cover 4 pills a month. I immediately filed an internal appeal, informing the insurance company at the same time that I was drafting a summons and complaint for … outrage, assault, and battery, I think. (My recollection is a little hazy. I chose torts that weren’t covered by mandatory arbitration or by most business legal-defense insurance policies.) The insurance company backed down within days.

    (2) French-American writer André Schiffrin was diagnosed with stage-4 pancreatic cancer while living in New York. He began his treatment at world-famous Memorial Sloan Kettering, in New York, and continued it at Cochin, a public hospital in Paris. When the chemo of first resort began failing in New York, his insurance company refuse to cover the fallback. In France, the fallback was already in the national insurance system’s formulary. André’s daughter, Anya, wrote an excellent article comparing and contrasting her father’s (and her family’s) treatment experience in the US and in France. It’s well worth the read:

    The French way of cancer treatment
    https://www.reuters.com/article/schiffrin-cancer/column-the-french-way-of-cancer-treatment-idINL2N0LI16620140213
    Anya Schiffrin, 13 February 2014

    NB: France’s healthcare system is technically still multi-payer but in practice it functions largely as a national single-payer system (like Medicare for All). Unfortunately, instead of giving physicians across-the-board fee-schedule bumps, successive governments (Giscard, Chirac, Hollande, Macron) have permitted an increasing number of physicians to balance-bill. This effectively offloads an increasing share of medical bills from the universal public system to private pockets, creating a two-tier system where patients who can afford increasingly costly medigap policies have priority access and patients who can’t are left to scramble. (As of five or six years ago, 90% of specialists in the Greater Paris Region balance-billed.)

    This is only one real-world cautionary tale about the hidden dangers of permitting private health insurance to subsist in any form. Two others are the UK and Italy, where the rich go private and get increasingly stingy when it comes to the public system. Think of private health insurance as a camel: if you let it keep its nose inside the tent, it will eventually find a way to muscle its way farther and farther in. (We’re seeing this in the US with Medicare Advantage and VA-care outsourcing.)

  7. I meant to include this as a sidebar to my previous comment:

    Insurance programs, private or public, wouldn’t be pressured into abusive denial-of-coverage attempts nearly as much if pharmaceutical companies (and pretty much every other “provider”) weren’t allowed to price-gouge. The way you do that is to have a single bargaining agent negotiate fair, sustainable, non-abusive prices on behalf of all patients (and taxpayers) and issue a mandatory uniform price schedule. This is called monopsonistic bargaining, and the US is the only developed country in the world that doesn’t employ it. (Thanks to Billy Tauzin and Tom Daschle, who both took deferred payoffs from Big Health as highly paid lobbyists, we don’t even use it for Medicare for Seniors.) Monopsonistic bargaining is baked into Medicare for All. Applied nationally (not state by state), it’s estimated that it will eliminate between $300 billion and $500 billion a year in gouged provider superprofits. (Savings from eliminating private-insurance-company-related administrative redundancy and waste are estimated to be *at least* that much.)

    1. The US, a “developed country” ?? With its horrific NON-health care system, huge poverty, homelessness, dangerous infrastructure and much more, it can hardly be called “developed”.

    2. Thanks very much for your detailed messages here, and for the link to the Anya Schiffrin article. The price gouging you mention is a massive part of the fraud.
      Yes, in the USA the healthcare “system” is simply one of greed, selfishness, and fraud, and middle-man profiteering.
      But we also have a large percentage of the populace who don’t have the simple courage, or maybe basic intelligence or perhaps the human decency, to criticize this dishonest and vile system. This is why it still exists.
      To fix something one must first admit that it is broken.

  8. Those who rule will not give you Medicare for all, or affordable medications, or anything else that would make your life better, easier, healthier, or more affordable. They want you working to make them money and if your not, they would appreciate it if you would die quickly and quietly so as to not damage their bottom line. To them, nothing else matters. You are a commodity, and a resource to be exploited. Nothing more. A bit harsh??? No I don’t think so. Capitalism is by it’s very nature very cold blooded. We didn’t choose this, at least no one ever gave me a choice. I don’t think you got a choice either. Time is coming when that will have to change….

    1. Interestingly, these days human beings who work for companies are known as “HUMAN RESOURCES”!

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