Callum Makkai | A not-so-clean bill of health

The doctor looked at me apologetically. "I'm sorry," he said.

No, it wasn't a bad prognosis. I wasn't about to die. The doctor was apologizing for the inadequacy of the medical system in America generally and at Penn specifically. "It's just not a good system," he added.

You see, I come from Canada, a land of exorbitant taxes and free health care. Growing up, I never imagined you'd have to pay for medical services. It only seemed natural and just that a sick person should receive care. What did money have to do with it?

It was as a teenager that I began to realize that not all people shared my perspective on health care.

I remember sitting in a restaurant in Nova Scotia, listening to a family of American tourists discussing the differences between America and Canada. "People are dying up here," said the mother to her children. "They're dying by the millions, because there aren't enough doctors to treat everybody."

Never mind that Canada's population isn't large enough for "millions" to be dying. I knew what the woman was saying wasn't true.

So when the doctor apologized to me, he was apologizing for what we both knew was the truth: Medical care in America is for the rich.

The doctor offered to give me a referral. "But it's going to cost you." Well, how much?

Being the naive Canadian that I am, I just thought that, since I was a Penn graduate student and since the University has one of the world's best hospitals, the University would take care of me when I got sick.

But what I've discovered since coming to Penn to pursue graduate studies is that one never knows how much the hospital will charge.

So it was with a mixture of fear and anxiety that I opened up a bill from the University of Pennsylvania Health System.

That's when I called the hospital. Could the amount due be correct? Surely, there must have been an error. "No," said the woman on the phone. "Everything is in order. You should call your insurance company."

And I did. But it wasn't long before my head was spinning as I tried to grasp words and concepts that were entirely foreign to me. Deductible, co-pay, what, what, what?

So I discovered - the hard way - that the University's insurance plan for graduate students is inadequate. How could I pay the hospital bills when my graduate stipend from the School of Arts and Sciences was barely enough to cover the basic necessities of daily living?

I felt angry, almost betrayed. But gradually I came to realize that I wasn't alone.

In a survey of more than 600 Ph.D. students conducted by SASgov in December 2007, respondents overwhelmingly ranked health care as a top concern. In its report, SASgov remarked that "the low stipend leads students to make unhealthy decisions such as not seeking medical treatment," a situation which "hit students with chronic medical conditions especially hard."

"I have had many medical bills that eat away all of my non-rent money," responded one student. "If there is any sort of medical crisis, or any other emergency, the stipend simply is not enough money. And I am not living in a manner outside of my means - no cable, only a studio apartment, no shopping for extravagant items, no travel."

Another student reported having to borrow money to pay for a medical condition because the stipend wasn't large enough. The same person lamented being "too busy by coursework and teaching commitments to earn any additional funding on the side."

So what's a sick graduate student to do? At the moment, the situation looks pretty dismal.

It just seems to me that at a University known throughout the world as a leading center for the medical sciences, students shouldn't have to go without medical treatment because they can't afford it.

In an ideal world, a Penn graduate student wouldn't have to pay the University's own hospital for health care.

Well, that's the way it would work if I were in charge.

But there I go again being a naive Canadian.

Callum Makkai is a 2nd year doctoral student in the School of Arts and Sciences, from Halifax, Canada. His email is makkai@dailypennsylvanian.com. Moment of Clarity appears on alternating Thursdays.

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