the additional harms introduced for patients when additional stress is heaped onto medical treatment
Endless, draining worry is bad for your health. Stress makes everything worse. People are said to inherit the propensity to always fear the worst, traits like this are actually passed down generation to generation in the genes, apparently, as we now know from research in the relatively new field of epigenetics.  We undoubtedly inherit talents and disabilities from past generations: a good singing voice, physical strength, size, dexterity, courageousness, high blood pressure. We are also, apparently, born with a disposition to be cheerful or pessimistic. Whatever our given birth set-up is, it is greatly influenced by the environment we are exposed to as we develop. The old nature vs. nurture debate.
For our purposes today we are only looking at the environmental end of things, the conditions of the living world we are born into. Endless, draining worry is bad for your health, particularly if it starts with your first memories of life. If you are hungry as a baby, it leaves terrible scars on you (and changes your DNA) for life. If you run a real risk of being shot on your way home from school every day, have classmates die of gunshots from time to time, this will have a negative effect on your overall sense of security and happiness. If you are molested by an adult who tells you God loves you and that your special relationship is a secret between the three of you that must never be revealed, on pain of eternity in hell — it will affect everything about your life going forward. 
Adding the stress of unreasonable and unpredictable costs of healthcare, on top of the health concern itself, is a recipe for worse health outcomes every time. This is the only country in the world where virtually every citizen is subjected to this ever possible financial disaster on top of one’s very real medical problem. Unless, of course, the annual interest you earn on your inherited family fortune exceeds the amount of money most of your countrymen will see in their lifetimes.
When you see a doctor for a medical condition, you rely on their expertise in diagnosis and treatment, hopefully leading to a complete cure. If you cannot know the cost of going to the doctor beforehand (as under the current PPACA law), that introduces additional stress. If you can be billed virtually any additional amount after the visit (a practice not specifically proscribed by the PPACA), that introduces even more stress. That increased stress is universally known to negatively affect health outcomes is not acknowledged in the calculations of bottom-line, profit-driven corporate healthcare, the kind we have here in the greatest country upon which God has ever shed Her grace.
I give you a single illustration from my own recent experience. I had a painless symptom, blood in the urine and passing a soft clot the next day, that sent me to the urologist. Several tests were done (and the passive voice used), the final one being the introduction of a long scope into the urethra up to the bladder to give the urologist what he called a “peek into my bladder”. The scope was introduced through that little opening at the end of the penis . The peek into the bladder provided no cause for alarm, there was no sign of cancer there, nor any sign of cancer of the prostate, from what could be seen. These were the only two things I really had to worry about. No cause for the bloody urine was ever discovered, as is true in most cases where these tests are done, but there was no need for me to fear the worst. Late stage cancer of the bladder or prostate was ruled out, I was relieved.
Until, over the next few days, it burned more and more when I peed and the flow of urine became so constricted that it was painful to squeeze out any urine. I’d sometimes struggle to micturate three or four times an hour. At night I began waking hourly with an urgency to go, only to dribble out a few painful drops. I contacted the urologist, who told me I had a urinary tract infection, an extremely rare after-effect of the cystoscopy. He prescribed an antibiotic which quickly relieved the problem. For about a week. Then the symptoms returned.
“He didn’t do a culture?” asked my doctor friend. I was in distress, the urologist had told me the culture would take a few days to come back, so, with my agreement, he took his best guess. It seemed right, until his best guess turned out not to have been the correct guess. Apparently there are a million infections in the naked city. I went to his office in the hospital to piss in a cup and have a urine culture done.
I won’t mention the sickening brownish yellow color of that cup of urine, or the fact that I was forced to carry it around for well over ninety minutes, until I my number was finally called by the lab technician, who asked me to do part of his job for him, while I was there. I unscrewed the top of the stinking collection cup and held it steady as he pipetted the small amount needed. He told me to get rid of it. I should have just left it open on the table to freshen his day, and told him to have a nice day, but I was raised to be more pleasant than that. I waited for another patient to be done in the onesie bathroom and then flushed the disgusting sample and left the hospital, muttering to myself.
A few days later the lab results were in, I had a prescription for the correct antibiotic and the infection and its nasty symptoms were gone within a few days.
So, I had gone to the doctor with a vague medical problem. After tests that were not able to determine any cause, I developed an infection, as a result of one of the tests. The first antibiotic didn’t cure it, I had a further test and the second antibiotic did the trick. Then the fun started, because this is America and the paymasters of healthcare are corporate entities whose only mandate is maximum profit.
The urologist I’d seen the day I left the urine for the culture had not been “in network”, though he worked in the same office as my urologist. My doctor was at another site that day. A series of texts between me, my urologist, his receptionist, the second urologist, resulted in my visit being “under the radar” so I could avoid the $300 or more fee for a visit to an “out of network” urologist, a doctor who did not have a deal with my private health insurance company. Did you follow all of that?
The “out-of-network” doctor was good enough to spend a few leisurely minutes with me discussing my situation, but I was there as a grateful ghost. However, I was a ghost who had also left piss for a lab to find out more about. Who was going to pay for that? Did I really expect to escape paying even my $25 copay?
Ordinarily, the lab work would have been part of my doctor’s visit, since it was necessary to proper diagnosis and treatment. The hospital would have billed my insurance company $400 (or whatever their price is for the service) and my insurance company would have paid the contractually agreed rate of $37.50 (or less). Since this particular hospital (Columbia) is the most virile psychopath I’ve ever received medical services from, I would also, even after paying my copay for a regular visit, normally be sent a bill for the remaining $362.50.
This practice is called “balance billing.” It is not strictly permitted, but neither is it explicitly illegal. Since no law prevents it, and nobody regulates the practice (by design of the Patient Protection Act, in cooperation with NY State lawmakers) the corporation sends out perhaps a million of these improper bills a year. If even 25% of anxious patients pay, fearing for their credit scores, cowed by the letters from collection attorneys that always follow unpaid bills, well, that 25% is a pretty nice chunk of change. Especially since insurance companies are typically such cheap chiselers. My $88,000 treatment for kidney disease a few years back? The hospital who provided me that excellent drug was paid perhaps 20% of the sticker price.
Because I was necessarily identified as the ghost who had pissed in the cup, to determine what exact infection I had contracted at the hospital weeks earlier, my insurance was not involved in the negotiations over the lab fee. You get how this works? I hadn’t had an actual visit, paid my $25 copay and so the visit had nothing to do with my insurance company. The hospital was now legally entitled to collect the entire lab fee from me, you see, because my visit was not conducted under my insurance.
For this reason, I never open the bills from those fucks, they are on a large pile next to my kitchen table. Once in a while, after they call to pester me about paying an invalid bill, I contest one of their bills and my insurance company makes it go away, as the contract between private hospital and private insurance company requires, but I am generally too weary and disgusted to open the bills. They only aggravate me.
This mostly unregulated private for-profit healthcare system is responsible for the deaths of countless Americans every year and vastly increasing the stress on millions more. If the bills for medical care, even if you buy medical insurance, can put a major financial bite on you, or even, in cases of “high deductible” plans, bankrupt you, cause you to lose your home, your life savings — what kind of medical care is that?
It is corporate medical care, bitches, the best in the world, and you can all suck on its bottom line here in America the beautiful. Go to move France, Germany, Canada, Japan, England, Finland, Iraq (free universal health care under evil dictator Saddam, probably not that way today, under American tutelage ) and get all the uncomplicated healthcare you want, if you don’t want to live, in unlimited liberty and free from government coercion, in the greatest country the world has ever known.
Oh, by the way, shortly after my ghost visit to the urology department I got this letter, from Columbia Urology, which begins:
I would like to take this opportunity to thank you for recently entrusting Columbia Urology with your care. As the Chair of the Department, I want to assure you that our singular purpose is to provide the highest level of surgical care and the best clinical outcome possible.
Then he comes to his point:
We would not be able to achieve these goals without the generous support of the grateful patients whose lives we have touched.
 smell check will not let go of that word, which it claims is misspelled. It did not correct my misstatement, which I correct now:
Epigenetics is the study of heritable phenotype changes that do not involve alterations in the DNA sequence. The Greek prefix epi- in epigenetics implies features that are “on top of” or “in addition to” the traditional genetic basis for inheritance. Wikipedia
 I deleted this paragraph:
Now, clearly, I seem to be fixing to grind the same ax I often grind, take a few swings at the twin strawmen eradicable intergenerational poverty and the untouchable privilege of obscene hereditary wealth. I am coming at it from a specific angle today, and should probably have dispensed with the little intro above, (and even this little aside), because this piece is actually about the additional harms introduced for patients when additional stress is heaped onto medical treatment, but here we go.
 read all about it, countrymen, freedom on the march: