Portraits of Health: Four stories from the health-care front

Five-year-old Erick Winston Jr. was born with a pre-existing health condition that makes him uninsurable.

Dr. Mario Bartoletti waited two months for treatment in Canada, but he also waited nearly two months for treatment in the U.S.

Jim Harrell wonders if a government-run health care system would pay for more of his lung-transplant costs, but he also wonders, given he's of retirement age, if universal health care would have even approved a transplant for him.

Andrew Wardle has experienced both the health-care system of his native Britain and his adopted home in the U.S. He's seen the advantages and disadvantages of both government-run health care and private insurance.

Health-care is a hot button of debate because it is a universal issue. It touches everyone's lives. If not personally in the present or the past, likely in the future. And more than likely, it has touched a member of each person's family or a friend.

The Valdosta Daily Times contacted four people with diverse stories concerning health care. Two people and their families have faced adverse conditions. Two others have experienced both the American health-care system as well as the systems of nations where government pays for health care.

These are their stories.

PRENATAL PRE-EXISTING CONDITION

Within the first month of being pregnant with her second child, Shaneka Winston experienced contractions. At three months, physicians discovered the baby had an enlarged bladder. After five months, doctors said things did not look good for the baby. Physicians suggested inducing labor. The baby would likely be lost.

The Winstons told the doctors no. They would not induce labor.

"It would be up to God what happened to this child," Shaneka said in a past interview. "This baby would be in God's hands."

Erick Winston Jr. was born early with three holes in his lungs. He could not urinate at first. By May 2008, the Winstons learned Erick Jr.'s bladder had shut down. His kidneys were failing. The little boy needed a kidney transplant.

Erick Sr. proved a match for his son. Several weeks ago, Atlanta surgeons performed a successful kidney transplant from father to son.

Erick Jr. has been home since Oct. 2. He hasn't been able to return to S.L. Mason Elementary School yet, but he has been active, playing with older sister Alexis and younger brother J-Shawn.

Erick Sr. and Shaneka are covered by insurance from his work, while the children are covered through Medicaid. Placing the children on his insurance is more than the Winstons can afford. If necessary, Alexis and J-Shawn can eventually be covered by Erick Sr.'s insurance. Erick Jr. will likely never be eligible for his father's insurance or any other medical insurance policy.

Before his birth, Erick Jr. had a pre-existing condition, meaning no insurance company will likely ever cover him, Shaneka Winston says. For the rest of his life, he will require expensive medication to ensure his body does not reject the transplanted kidney. Erick Jr. is 5. His Medicaid coverage for these medications will last another three years, Shaneka says.

She mentions meeting a patient who received a transplant as a child. Now 18, this patient is uninsured and cannot afford his medications. His body began rejecting the transplanted organ. Now, he needs another transplant.

Shaneka Winston does not want her son facing a similar experience. She would like to see a health-care policy ensuring transplant patients affordable access to the medications they will need for the rest of their lives.

Local fund-raisers and benefits have helped the family cope with the travel expenses and other costs incurred by Erick Jr.'s transplant. But it would take a lifetime of bake sales and church benefits to help offset the costs of Erick Jr.'s medication without insurance.

CANADIAN CARE

An American citizen, Dr. Mario Bartoletti worked in Canada as a landed immigrant from 1962 to 1995. After serving in the U.S. Navy, he resided in Canada for 20-some years. He and his wife, Lili, raised three daughters in Canada. He traveled back and forth between Canada and business in Miami the last 10 years there. Several years ago, Mario and Lili moved to Valdosta.

During their years in Canada, the Bartolettis paid taxes into Canada's universal health-care system. He does not recognize the American arguments that use the Canadian system as an example of a failed attempt at government-run health care.

"The Canadian health-care system has been distorted very badly in the press and by opponents of universal health care," Bartoletti said.

As he noted in a letter to The Valdosta Daily Times: "Speaking of Canada's national health care, my wife and I lived there for over 20 years and were impressed that we and our three children received wonderful care from any physician we chose. To cover costs, we had health insurance deductions from our pay every month, as do all residents of Canada. Their program covers all medical and hospital costs, and delays for appointments were never excessive."

In an interview, Bartoletti says the waiting period in Canada for non-emergency procedures and regular doctor's visits is comparable to the U.S. He cites two personal examples, having to wait an average of two months to see certain specialists or for non-emergency treatments in both Canada and the U.S.

"It's similar in Canada as it is here," he says. "If you need a specialist, you may have to wait to see that specialist. If it's a non-emergency, you may have to wait for surgery. If there is an urgent need, however, they are the same in the U.S. and Canada. You will be taken care of right away."

The only problem he can recall with the Canadian health-care system was an occasion when his wife needed a treatment. Officials required his signature, along with hers, to approve his wife's treatment. He felt his wife shouldn't require his consent.

He had many experiences where he and his family received good care through the Canadian system without the worry of being bankrupted by medical bills later.

Blood poisoning nearly took his arm. He spent five days in the hospital. He received follow-up care at home. It was all covered under universal health care.

The Bartolettis nearly lost their youngest daughter at 6 months. She required exotic treatment, was even placed in what he referred to as a "plastic bubble" for some time.

"They saved her life and, this is the amazing part," Bartoletti says, "we didn't receive a single bill. ... Down here, I'd hate to think what it would have cost."

In Canada, specialists could charge patients a co-pay of 10 to 15 percent for treatment in addition to what they would receive from universal health care. Yet, in Bartoletti's experience, no specialists charged his family this additional co-pay, leading him to guess they were well compensated through universal health care.

Payment came out of Canadians' paychecks, similar to how many American employees have insurance premiums taken out of their paychecks.

"It was something that you paid but nothing horrendous," Bartoletti says. "But Canada doesn't have a huge military-industrial complex like the U.S. has to sustain through taxes."

A TALE OF TWO NATIONS

Andrew Wardle is a native of Britain. He's spent the past decade in the U.S. He has experienced both nation's health-care systems. He has found them both wanting.

"It's a balancing act, really," he says.

He lists some of the disadvantages of the British health-care system: Yes, there's a waiting period. Yes, there's a feeling of age, the feeling that facilities and equipment haven't been updated in 30 years. Yes, the British system screwed up a treatment Wardle received as a 16-year-old, leading to an adverse reaction.

Plenty wrong with the government-operated British health-care system, Wardle says.

"On the other hand, there was not a fear of bankruptcy or my medical care being decided by an insurance underwriter," he says referring to his concerns with the American health-care system.

In England, a concerned parent can call about a sick child in the middle of the night and be assured that medical personnel will visit the family's home that same night. And the family won't be charged for the visit.

A British patient can be billed for calling an ambulance for the wrong reason, but the bill isn't so much that a person is afraid to call an ambulance.

There are also options in Britain. Citizens can opt out of the universal health coverage. They can purchase private medical insurance and visit private medical insurance hospitals.

"My experience of the American system is insurance seems expensive considering what you get," Wardle says. "If a person suffers a major illness, they can be insured and still receive a $15,000 bill."

In America, doctors often test patients for every conceivable possibility, driving up the patient's bill. Yet, U.S. doctors must do this not so much to ensure a patient's health, Wardle says, but to ensure a patient won't sue if something is missed during the diagnosis phase.

Waiting is comparable in the U.S. and the U.K. (United Kingdom). "There's no real difference. If you are having a heart attack, you are going to be treated. In both places, it depends on the nature of the injury or condition. Doctors arrange to see patients by the urgency of care needed and depending on how busy they are. You wait anywhere."

In America, Wardle says he sees people ignoring early symptoms of health problems for fear of what the medical care may cost. "You receive very good care here," Wardle says, "but that fear of bankruptcy remains even if you are insured."

Fear also seems to be driving America's health-care debate. He says there are government officials over health-care in Britain, but adds, that accountants and insurance underwriters determine care in America.

Misinformation on government-run systems and lack of information of what a reformed American system might look like fuel the anger, frustration and fear in the current health-care debate.

"We, in the U.S., need a two-page document that gives the relative facts," Wardle says. "No one seems to really know what is being proposed."

TRANSPLANTED QUESTIONS

Shortness of breath warned Jim Harrell of Lake Park. Something was wrong. He knew. He'd been here before. A couple of years ago, Harrell needed a lung transplant.

He waited. He received the call. He received a new lung. He persevered. He survived. He paid the bills his insurance didn't cover. A year after transplant surgery, he still paid $26,000 in medical bills, co-pays and pharmacy costs just in 2008.

Now, Harrell waits again. His body is rejecting the transplanted lung. He is on a waiting list for a second transplant.

He has mixed emotions about the national health-care debate. "Will we be treated when we needed to be treated? I don't know how much of that stuff is true. Or you take someone like me. I'm at retirement age. If I get down to where I could not work, there's nothing coming in to help pay for my medications."

In his 60s, Harrell wonders if a government-run health-care system would make him a candidate for a first transplant, much less a second one.

Comparably, as it is, Harrell must get his insurance provider to commit to paying for a transplant. Without the insurance provider's approval, the operation would not proceed.

"But I don't care for the scenario of going to the federal government," he says, "and telling them I need a new lung."

Even with coverage, the Harrells have paid tens of thousands of dollars in medical bills. Much of this money has come from he and wife Sandy's earnings and savings. Local fund-raisers and benefits have supplemented additional payments.

Waiting for a second transplant, Jim Harrell knows these costs aren't going away and more bills will be coming. Thinking of his situation, Harrell is confronted with the circumstances of a man he knows.

"I know this guy, about my age, dying of the same thing I have," Harrell says. "He can't afford a transplant. He's on Social Security. ... He can't get insurance because of his condition, and he can't afford it even if he could get it."