As a health care vote in Congress looms on the horizon, it has become increasingly clear that the search for affordable and effective medical coverage has had effects that extend far beyond the wallets -- and even the waiting rooms -- of middle class America. From job choices to marriage prospects, food options to travel destinations, it seems that there are few parts of American life that the health care system has not touched.
It's hard to measure the popularity of some of the more outrageous schemes, such as starting a small business in order to qualify for reasonably priced insurance. But many health care trends, like the three we explore below, have had a significant effect, not only on their practitioners, but on the economy as a whole. While some of these trends may disappear if health care reform passes, it seems likely that others will remain a permanent part of the American cultural terrain.
In 1992, Ronald Pollack, a health care lobbyist, commented on the growing Mexican health care market, asking "What greater embarrassment could we have than the spectacle of tens of thousands of Americans leaving our country to get affordable health care? If you want to know why comprehensive health reform is certain to pass in 1993, this disgrace at the border gives you part of the answer."
Health care didn't pass in 1993, and the next seventeen years brought a boom for Mexico as cheap dentistry and more attentive medical care tempted thousands of American residents to cross the border. In towns like Los Algodones and Tijuana, dental surgery and basic medical care cost about a quarter of their stateside price and, despite dire warnings of infection and poorly-regulated doctors, the ranks of medical tourists swelled.
In 2005, American caregivers shifted perspective as some California HMOs began sending their customers to Mexico for routine medical care. Today, the Mexican tourism secretariat remains optimistic about medical tourism: it anticipates a flow of about 650,000 medical tourists spending $50 million a year by 2020.
Mexico is only one of dozens of countries that provide a low-cost medical alternative for cash-strapped Americans. The most famous is probably India, where dozens of hospitals cater to Western tourists, offering many procedures for a fraction of the stateside price. According to Research and Markets, India is poised to be the worldwide leader in medical tourism, gathering 2.4% of the worldwide market, which generates over $1 billion per year.
Marrying for Health Care
While many Americans have taken trips out of the country for health care, some simply take a trip down the aisle. In January 2010, this issue flew into the headlines when San Diego resident Terri Carlson announced her plan to marry for insurance. Carlson, who has a lupus-like immune system disorder, was covered by her husband's insurance until the two divorced. Her national COBRA coverage has already expired, and her California COBRA coverage will expire in 2011, after which she will be effectively uninsurable because of her pre-existing condition. When describing her preferences for a potential mate, Carlson chirped "The lower the copay, the sexier you are to me."
Carlson is an extreme example, but her problem -- and her response -- are not uncommon. In a 2008 poll, the Kaiser Family Foundation determined that, in the prior year, 7% of respondents had either married for health insurance or knew someone who had. Meanwhile, because of the vagaries of state-sponsored medical programs, other couples considered divorce so that a sick spouse could receive larger benefits.
Although it is impossible to determine the exact numbers of people for whom health insurance has dictated marital status, extensive anecdotal evidence suggests that high-priced insurance has done what religion and social convention could not: it has helped reinvigorate the institution of marriage. Of course, it remains to be seen if medical marriages will survive the arrival of health care reform.
Supplements: Taking Pills to Stay Out of the Doctor's Office
Although multivitamins have been commercially available since the 1930's, they seem to be entering a sort of renaissance, with their popularity skyrocketing over the last decade. Between 2000 and 2008, retail sales of nutritional supplements more than doubled, reaching an astronomical $25 billion. While this includes everything from weight-loss pills to children's vitamins, Nutrition Business Journal suggests that one of the strongest market segments is self-medication for medical problems: "Much of this growth was fueled by the sale of new specialty products, such as omega-3 supplements targeted to specific health conditions."
The idea of using supplements to ameliorate health problems is hardly new: in 1983, Phyllis Balch's Prescription for Nutritional Healing hit the market, offering an encyclopedic compendium of diseases and the supplements that could help treat them. In the last ten years, however, Balch's book (now in its fourth edition, with more than 6 million copies in print) has been joined by an army of similar tomes, prescribing an array of supplements and diet changes to heal an endless list of diseases.
And That's Not All
Of course, these are only a few of the numerous methods that desperate consumers have used to get health care. CNN, for example, produces a yearly list of the best employer-based health care programs, suggesting that, for many, employment choices have a lot to do with medical coverage. For others, Canada's free health care system presents a compelling argument for emigrating to the Great White North.
As part of an upcoming feature, we're compiling the strangest health care stories we can find. If you're interested in contributing, drop us a line!
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