Alex Cascio just suffered a devastating knee injury, and shares the price hikes and financial harm she's facing--compared to how she would fare in a country with universal healthcare
Thank you for sharing your story Alex. I have had a full ACL replacement due to a basketball injury that I later learned was due to a rare condition. Your story is so important to help folks understand how expensive it is for chronically ill/pain and disabled communities. Since I have rare conditions I have to see specialists A LOT so I spend a minimum of $1400 a month for care. No one should have to be in a position where they chose paying bills over their health. It's a lose lose situation and yet here we are. I hope you find a way to recover with softness. Keep being amazing!
While I certainly emphathize with the young woman who tore up her knee, Americans need more information than shouts of "we can do better." How can America do better on behalf of patients? I've been writing about this for years. Has anyone listened? No!
I worked for 30 years in the insurance industry mostly property casualty but also life and health. I worked in numerous positions such as sales, underwriting, ratemaking and finally as a compliance officer. It was as a compliance officer I saw how crooked insurance companies are. My Job was to create and file forms required by various state insurance departments to meet their laws.
Senior vice presidents wanted me to file language in direct violation of state law. They knew they could make millions before getting caught, would never be required to pay back people whose claims had been denied, and at best would be fined pennies on the dollar.
In the unlikely event it was serious enough to run into the millions and garner public attention, a head would have to roll----mine, not the bastard who ordered me to do it.
The last time that occurred before I left the industry, I took a copy of the law i had been told to violate into the VP's office and asked him to sign it. He told me to get the F out of his office and file it or quit.
I blew the whistle to the insurance department and quit a job making $100k per year. That was in the spring of 2000. Instead I took a job making $10.50 as a medical records clerk in a hospital. I was quick to learn that insurance cheating invades hospitals as well. My job was to pull insurance records and place them on patients' charts. It was 90% paper back then.
But about twice a month we would have nurses hired by insurance companies come into our office. My job was to pull patient records for nurses to review. They would then inform the hospital if, in their opinion, the patient needed to be released the next day. Even if a physician felt the patient should remain another day, the hospital would have to keep the patient on their own dime.
Not that hospitals were any better. I decided I wanted to be a coder so that i could make more money and took a coding class at a community college. They TEACH coders to find the highest code for any disease or injury that will result in the most money going to the hospital.
I'll never forget realizing that hospitals are equally crooked. Out instructor, a nurse and coder with 20 years experience told us that we should never code ANY pregnancy as normal. She said hospitals wouldn't stand for it, that there were so many possible conditions with a pregnancy we could find one in the medical records that a nurse, doctor or technician had recorded that would result in a higher rating.
The health care system in the U.S. is rotten to the core. And it all boils down to one word.
You don't know the half of it. Thirty years ago a group of actuaries proposed a method to provide all liability insurance by taxing gas and letting insurance companies bid on how many pumps within each state they would be willing to pay for. The "tax" would go to insurance companies to pay claims. Losses would be distributed among companies based on the number of pumps they insured. Insure 20% of the pumps, collect 20% of the revenue and absorb 20% of the losses.
Insurance companies were adamantly opposed as there could be no underwriting which allows them to select people they wish to insure and weed out those they don't. It's an inefficient model.
How would gas pump coverage help? In 2023, 15.4 percent of motorists, or more than one in seven drivers, were uninsured, according to a 2025 Study by the Insurance Research Council (IRC). From 2017 to 2023, most states saw increasing trends in UM (Uninsured Motorist) rates. The largest increases were in District of Columbia, New Jersey, and Missouri
That means you not only have to buy liability insurance to protect yourself from injuring others or damaging their property, but you should also buy uninsured/underinsured motorists coverage to protect yourself from all those drivers who refuse to buy or buy and cancel after getting their cars registered.
BUT, if you didn't have to buy insurance because it was a tax on gas you wouldn't need to buy uninsured motorist coverage either. And all those people not contributing to the total cost of insurance coverage in the U.S. would have to pay if they filled up their cars with gas. People driving in from Canada or Mexico would also contribute. Cross country lawsuits would disappear. There would be no need for hundreds of individual forms in each state because liability insurance would be federal. Coverage would be standard in every state, say 100/300/100 for every driver in the nation.
Having more people contribute lowers cost and using gas makes actuarial sense as vehicles driven more miles cause more accidents and bigger vehicles, using more gas, cause greater damage. This scheme would have lowered the total cost of insurance for the nation. It would also lower profit for insurance companies, so naturally they opposed it.
Technology has now changed and we have electric vehicles. A rating module would have to include a tax on electricity and/or charging stations, too.
But the rich and powerful cry TAXES TAXES, they will kill you. But STATISTCIS prroved back then that it would not. Because larger vehicles are more frequently in the purchase wheelhouse of wealthier individuals who would have to pay more to gas up their guzzlers naturally they complain about taxes.
But at that time, actuaries estimated that the total cost of liability insurance would average 10-20% less.
To make an allusion to a Bible verse, capitalists don't wish to kick against the pricks. No change is good change.
I can't believe that we are still dealing with this after all the information we have about how every other civilized nation provides complete health care. I watched Michael Moore's movie about healthcare in America years ago, and saw the logic of nationalized care. It makes so much sense, but GOP/maga continues to plug their ears and yell "Nah nah". I have high hopes that we have learned many lessons from existing in maga world for trump's 2 terms, and when we emerge from this national nightmare and have intelligent, caring people in Congress again healthcare will be one of the many, MANY wrongs we will be able to right.
I feel your pain. Our Healthcare premiums are going up 39% next year, to over $3,400 a month for a couple in their early '60s. It is beyond outrageous, but there's nothing we can do because you have to have Healthcare coverage. It is absolutely insane that we do not have universal Healthcare like 33 other major developed countries. The insurance company is out for profit and we desperately need to get rid of the middle man.
Hey Qasim! Thanks for sharing Alex’s story; a perfect example of our nation’s abysmal healthcare system. I’m intrigued by the principle of universal healthcare too, and would be interested to find out more about how it works if you’ve any recommendations on sources for good info. ☮️
Hey there! Universal healthcare is one of the policies that got me into politics! While all developed nations have it, (except the United States), there are a lot of variations on how to implement it. To me, this is a GOOD thing, it means we can learn from the successes and failures of other country to make the BEST healthcare system in the world.
There are some concerns (as Medicare already has issues, including administration by private insurers that inflate costs for profit), but it is a good place to start.
As an immigrant from Canada (came here to work 34 years ago and never left), I'm always amazed by the lack of awareness about what a crappy system we have here in the U.S. People seem to be convinced that any other system would be worse, when in fact almost any other system would be better!
1. "But government-run healthcare is so bureaucratic": Actually, it's way less bureaucratic than what we have. When I came to the U.S. and first encountered healthcare here, I was amazed at how much paperwork there was. In Canada, when you show up needing care, you hand them your provincial health insurance card and that's it for the insurance side of things.
2. But the taxes are so high to pay for it": yes, taxes are higher in order to pay for it. But Canadians still pay far less for healthcare because a) administration costs are far less, and b) the government uses their leverage to keep costs lower.
3. "But you have to wait forever to get care": Sometimes people do have to wait, just as we sometimes have to wait in the U.S. But for people who tell all kinds of tall tales about the horrors of socialized medicine in Canada, I like to tell this story about when my mother fell and broke her hip.
She was in her early 80's at the time, so this was serious. She was immediately admitted to hospital and they stabilized the hip. She was in hospital for over a week, and then in a rehab facility for several weeks. And it worked - she was mobile again afterwards. But a while later my parents got the bill and they were furious! They had been charged $10 for parking for when my father visited. That was the total bill.
Yes, the anecdotal stories of waiting forever are mostly propaganda put out by our US insurance companies to scare us. I have been to Canada many times and have never found a Canadian who did not like their healthcare. Plus, the waiting times for specialists here in the US are often ridiculous. Try to get into see an endocrinologist in less than 6 months. And I live in DFW, a major metropolitan area with large and numerous healthcare practices. I only see my PCP, who is fabulous, for wellness checks because I make them a year in advance. I usually see her PA instead, who’s also fabulous so I don’t mind.
Painfully stark reminder of the true beneficiaries of the Health Exploitative Limited Liability (HELL) system of the US: The principals and investors. Thank you for this illuminating guest post by Alex Cascio.
Thanks for allowing Alex to use your platform to tell her story. "I should be figuring out what's best for recovering my health, walking again, instead of worrying how I'll pay for this. HOW LONG will repubs keep us from gov't health care? .... because it's socialism!!! If I didn't love my country so much, wasn't 80, want to restore her to our values, .... I would leave and find a reasonable country to live in. Wah.
I went on vacation to Italy back in 2013 and ended up contracting a urinary tract infection on the way over. In the US, you would have to have a doctor visit along with a required urine test that costs hundreds of dollars without insurance, and then more to get a simple antibiotic to get rid of it. There, the doctor did a simple exam, listened to my symptoms, just believed me as a grown woman that I know what a UTI feels like, and sent me off to the pharmacy with a prescription. The whole process took an hour and cost me 40 Euro.
Unfortunately as long as BOTH parties are taking money from the insurance & pharma lobbies, we'll never get universal healthcare here. There are some doctors offering direct-to-patient services now for a fairly low monthly subscription fee, which is very interesting and probably the way forward- make the current system obsolete.
I was born in a country that was half socialist and half communist, and here is what I think of that kind of healthcare (from my book).
"Socialized healthcare is the best healthcare you can have, so long
as you don’t have to use it, but if you do have to use it, please be
patient, and try not to die while waiting to use your socialized
healthcare. On the other hand, if you should die while waiting to use
your socialized healthcare, on behalf of a grateful nation, thank you
for your cost savings to the national socialized healthcare system."
That's why countries with socialized healthcare have supplemental insurances for those who can afford to pay for it, and for those who can't afford to pay, "on behalf of a grateful nation, thank you for your cost savings to the national socialized healthcare system."
Lebo Von Lo~Debar
Former/Always 82nd Airborne Infantryman, Disabled Veteran for Life, & Author of the book, "The Separation of Corporation and State" subtitled "Common Sense and the Two-Party Crisis" Available on Amazon.
Couldn't agree more! I am so sorry you're having to go through this, Alex. I know the National Health Service in the UK is in crisis thanks to the Tories, but at least you can't go bankrupt from medical bills there. Sending best wishes and hugs!
I do not know how many times i have read the phrase "It does not have to be like this"!
Of course not but as long as the US is addicted to "Free enterprise", so-called 'competitive advantage" and wildly unregulated kleptocratic capitalism; LEGAL extortion will remain the name of the game.
I feel your pain and your disgust. Truly it is time for universal healthcare and pharmacy to replace “triage for profit”. It will be cheaper if we deduct the multiple layers of overhead, G&A, and the profit and replace that with single payer negotiated and uniform rates. Just think. Insurance companies can take a hike. An entire layer deleted—FOR CAUSE! The conflict of interest these insurance companies have is beyond belief.
Doctors' offices and hospitals have entire departments designated for coordinating with patients' insurance - how much is that alone adding to our costs??
Thank you for sharing your story Alex. I have had a full ACL replacement due to a basketball injury that I later learned was due to a rare condition. Your story is so important to help folks understand how expensive it is for chronically ill/pain and disabled communities. Since I have rare conditions I have to see specialists A LOT so I spend a minimum of $1400 a month for care. No one should have to be in a position where they chose paying bills over their health. It's a lose lose situation and yet here we are. I hope you find a way to recover with softness. Keep being amazing!
Nice to read a concrete example and see some data about lobbying money. Someday, I hope common sense will prevail. Thanks for sharing.
While I certainly emphathize with the young woman who tore up her knee, Americans need more information than shouts of "we can do better." How can America do better on behalf of patients? I've been writing about this for years. Has anyone listened? No!
I worked for 30 years in the insurance industry mostly property casualty but also life and health. I worked in numerous positions such as sales, underwriting, ratemaking and finally as a compliance officer. It was as a compliance officer I saw how crooked insurance companies are. My Job was to create and file forms required by various state insurance departments to meet their laws.
Senior vice presidents wanted me to file language in direct violation of state law. They knew they could make millions before getting caught, would never be required to pay back people whose claims had been denied, and at best would be fined pennies on the dollar.
In the unlikely event it was serious enough to run into the millions and garner public attention, a head would have to roll----mine, not the bastard who ordered me to do it.
The last time that occurred before I left the industry, I took a copy of the law i had been told to violate into the VP's office and asked him to sign it. He told me to get the F out of his office and file it or quit.
I blew the whistle to the insurance department and quit a job making $100k per year. That was in the spring of 2000. Instead I took a job making $10.50 as a medical records clerk in a hospital. I was quick to learn that insurance cheating invades hospitals as well. My job was to pull insurance records and place them on patients' charts. It was 90% paper back then.
But about twice a month we would have nurses hired by insurance companies come into our office. My job was to pull patient records for nurses to review. They would then inform the hospital if, in their opinion, the patient needed to be released the next day. Even if a physician felt the patient should remain another day, the hospital would have to keep the patient on their own dime.
Not that hospitals were any better. I decided I wanted to be a coder so that i could make more money and took a coding class at a community college. They TEACH coders to find the highest code for any disease or injury that will result in the most money going to the hospital.
I'll never forget realizing that hospitals are equally crooked. Out instructor, a nurse and coder with 20 years experience told us that we should never code ANY pregnancy as normal. She said hospitals wouldn't stand for it, that there were so many possible conditions with a pregnancy we could find one in the medical records that a nurse, doctor or technician had recorded that would result in a higher rating.
The health care system in the U.S. is rotten to the core. And it all boils down to one word.
PROFIT.
Wow! I knew it was a mess but did not realize just how intentionally corrupt. You could write a fabulous whistleblower book!
You don't know the half of it. Thirty years ago a group of actuaries proposed a method to provide all liability insurance by taxing gas and letting insurance companies bid on how many pumps within each state they would be willing to pay for. The "tax" would go to insurance companies to pay claims. Losses would be distributed among companies based on the number of pumps they insured. Insure 20% of the pumps, collect 20% of the revenue and absorb 20% of the losses.
Insurance companies were adamantly opposed as there could be no underwriting which allows them to select people they wish to insure and weed out those they don't. It's an inefficient model.
How would gas pump coverage help? In 2023, 15.4 percent of motorists, or more than one in seven drivers, were uninsured, according to a 2025 Study by the Insurance Research Council (IRC). From 2017 to 2023, most states saw increasing trends in UM (Uninsured Motorist) rates. The largest increases were in District of Columbia, New Jersey, and Missouri
That means you not only have to buy liability insurance to protect yourself from injuring others or damaging their property, but you should also buy uninsured/underinsured motorists coverage to protect yourself from all those drivers who refuse to buy or buy and cancel after getting their cars registered.
BUT, if you didn't have to buy insurance because it was a tax on gas you wouldn't need to buy uninsured motorist coverage either. And all those people not contributing to the total cost of insurance coverage in the U.S. would have to pay if they filled up their cars with gas. People driving in from Canada or Mexico would also contribute. Cross country lawsuits would disappear. There would be no need for hundreds of individual forms in each state because liability insurance would be federal. Coverage would be standard in every state, say 100/300/100 for every driver in the nation.
Having more people contribute lowers cost and using gas makes actuarial sense as vehicles driven more miles cause more accidents and bigger vehicles, using more gas, cause greater damage. This scheme would have lowered the total cost of insurance for the nation. It would also lower profit for insurance companies, so naturally they opposed it.
Technology has now changed and we have electric vehicles. A rating module would have to include a tax on electricity and/or charging stations, too.
But the rich and powerful cry TAXES TAXES, they will kill you. But STATISTCIS prroved back then that it would not. Because larger vehicles are more frequently in the purchase wheelhouse of wealthier individuals who would have to pay more to gas up their guzzlers naturally they complain about taxes.
But at that time, actuaries estimated that the total cost of liability insurance would average 10-20% less.
To make an allusion to a Bible verse, capitalists don't wish to kick against the pricks. No change is good change.
Ah, logic! That will get you nowhere in this country!
The greed has infected EVERY level of healthcare - it will only get worse so long as we put profits over patients
I can't believe that we are still dealing with this after all the information we have about how every other civilized nation provides complete health care. I watched Michael Moore's movie about healthcare in America years ago, and saw the logic of nationalized care. It makes so much sense, but GOP/maga continues to plug their ears and yell "Nah nah". I have high hopes that we have learned many lessons from existing in maga world for trump's 2 terms, and when we emerge from this national nightmare and have intelligent, caring people in Congress again healthcare will be one of the many, MANY wrongs we will be able to right.
I feel your pain. Our Healthcare premiums are going up 39% next year, to over $3,400 a month for a couple in their early '60s. It is beyond outrageous, but there's nothing we can do because you have to have Healthcare coverage. It is absolutely insane that we do not have universal Healthcare like 33 other major developed countries. The insurance company is out for profit and we desperately need to get rid of the middle man.
$3,400 per month is almost twice the average cost of rent for a 1bdr apartment!!! That's insane!
Hey Qasim! Thanks for sharing Alex’s story; a perfect example of our nation’s abysmal healthcare system. I’m intrigued by the principle of universal healthcare too, and would be interested to find out more about how it works if you’ve any recommendations on sources for good info. ☮️
Hey there! Universal healthcare is one of the policies that got me into politics! While all developed nations have it, (except the United States), there are a lot of variations on how to implement it. To me, this is a GOOD thing, it means we can learn from the successes and failures of other country to make the BEST healthcare system in the world.
Currently, the most popular proposal is Medicare for All, which you can find more info about here: https://www.nationalnursesunited.org/medicare-for-all
There are some concerns (as Medicare already has issues, including administration by private insurers that inflate costs for profit), but it is a good place to start.
Thanks Alex! ☮️
As an immigrant from Canada (came here to work 34 years ago and never left), I'm always amazed by the lack of awareness about what a crappy system we have here in the U.S. People seem to be convinced that any other system would be worse, when in fact almost any other system would be better!
1. "But government-run healthcare is so bureaucratic": Actually, it's way less bureaucratic than what we have. When I came to the U.S. and first encountered healthcare here, I was amazed at how much paperwork there was. In Canada, when you show up needing care, you hand them your provincial health insurance card and that's it for the insurance side of things.
2. But the taxes are so high to pay for it": yes, taxes are higher in order to pay for it. But Canadians still pay far less for healthcare because a) administration costs are far less, and b) the government uses their leverage to keep costs lower.
3. "But you have to wait forever to get care": Sometimes people do have to wait, just as we sometimes have to wait in the U.S. But for people who tell all kinds of tall tales about the horrors of socialized medicine in Canada, I like to tell this story about when my mother fell and broke her hip.
She was in her early 80's at the time, so this was serious. She was immediately admitted to hospital and they stabilized the hip. She was in hospital for over a week, and then in a rehab facility for several weeks. And it worked - she was mobile again afterwards. But a while later my parents got the bill and they were furious! They had been charged $10 for parking for when my father visited. That was the total bill.
Yes, the anecdotal stories of waiting forever are mostly propaganda put out by our US insurance companies to scare us. I have been to Canada many times and have never found a Canadian who did not like their healthcare. Plus, the waiting times for specialists here in the US are often ridiculous. Try to get into see an endocrinologist in less than 6 months. And I live in DFW, a major metropolitan area with large and numerous healthcare practices. I only see my PCP, who is fabulous, for wellness checks because I make them a year in advance. I usually see her PA instead, who’s also fabulous so I don’t mind.
I've NEVER met a Canadian that wants to pay what we do for healthcare!
Painfully stark reminder of the true beneficiaries of the Health Exploitative Limited Liability (HELL) system of the US: The principals and investors. Thank you for this illuminating guest post by Alex Cascio.
Thanks for allowing Alex to use your platform to tell her story. "I should be figuring out what's best for recovering my health, walking again, instead of worrying how I'll pay for this. HOW LONG will repubs keep us from gov't health care? .... because it's socialism!!! If I didn't love my country so much, wasn't 80, want to restore her to our values, .... I would leave and find a reasonable country to live in. Wah.
Me too!
Awee Martha this is so sweet!
This is why we keep fighting - the midterms are around the corner. Its time for a progressive wave that demands universal healthcare!
I went on vacation to Italy back in 2013 and ended up contracting a urinary tract infection on the way over. In the US, you would have to have a doctor visit along with a required urine test that costs hundreds of dollars without insurance, and then more to get a simple antibiotic to get rid of it. There, the doctor did a simple exam, listened to my symptoms, just believed me as a grown woman that I know what a UTI feels like, and sent me off to the pharmacy with a prescription. The whole process took an hour and cost me 40 Euro.
Unfortunately as long as BOTH parties are taking money from the insurance & pharma lobbies, we'll never get universal healthcare here. There are some doctors offering direct-to-patient services now for a fairly low monthly subscription fee, which is very interesting and probably the way forward- make the current system obsolete.
Pay attention during the midterm primaries especially - vote for candidates who refuse to take corporate money AND support universal healthcare
I was born in a country that was half socialist and half communist, and here is what I think of that kind of healthcare (from my book).
"Socialized healthcare is the best healthcare you can have, so long
as you don’t have to use it, but if you do have to use it, please be
patient, and try not to die while waiting to use your socialized
healthcare. On the other hand, if you should die while waiting to use
your socialized healthcare, on behalf of a grateful nation, thank you
for your cost savings to the national socialized healthcare system."
That's why countries with socialized healthcare have supplemental insurances for those who can afford to pay for it, and for those who can't afford to pay, "on behalf of a grateful nation, thank you for your cost savings to the national socialized healthcare system."
Lebo Von Lo~Debar
Former/Always 82nd Airborne Infantryman, Disabled Veteran for Life, & Author of the book, "The Separation of Corporation and State" subtitled "Common Sense and the Two-Party Crisis" Available on Amazon.
https://a.co/d/fy5rSdW
Hope you get back on your feet real soon Alex.
Thank you! The recovery is slow but I'm definitely improving! I am very fortunate.
Couldn't agree more! I am so sorry you're having to go through this, Alex. I know the National Health Service in the UK is in crisis thanks to the Tories, but at least you can't go bankrupt from medical bills there. Sending best wishes and hugs!
I do not know how many times i have read the phrase "It does not have to be like this"!
Of course not but as long as the US is addicted to "Free enterprise", so-called 'competitive advantage" and wildly unregulated kleptocratic capitalism; LEGAL extortion will remain the name of the game.
I feel your pain and your disgust. Truly it is time for universal healthcare and pharmacy to replace “triage for profit”. It will be cheaper if we deduct the multiple layers of overhead, G&A, and the profit and replace that with single payer negotiated and uniform rates. Just think. Insurance companies can take a hike. An entire layer deleted—FOR CAUSE! The conflict of interest these insurance companies have is beyond belief.
Doctors' offices and hospitals have entire departments designated for coordinating with patients' insurance - how much is that alone adding to our costs??