Thursday, June 23, 2011

Time to change the world, pt 1

A while back I posed this question for my readers in the United States:

Is health care a Right or a Privilege?

In all honesty, I was very surprised by some of the responses.  As I tried to objectively read them, I found myself dismissing some responses, partly, I suspected, because they didn't agree with my own position.  Then, as I thought more about it, I decided that the answers might just be theoretical because the respondent hadn't been on both sides of the question.  That may or may not be some form of rationalization on my part, but I think it's relevant.

In any case, it's time to lay out my answer, explain why, and then explain how that decision could favorably impact the entire United States and solve a bunch of problems that we all face right now.

In order to understand the question, I want to frame it this way.

As an advanced society, what does it say about our values if we blithely accept that more than 30 million people...perfectly legal citizens...cannot get simple health care?  What does it say about us when we accept that perhaps as many as 50% of the personal bankruptcy fillings are because of unpaid medical bills?  What does it say when we refuse to provide adequate "keep well" services and force people to use emergency rooms, thus making what medical care they do receive the most expensive possible?

The answer speaks volumes.

We, collectively, treat medical care as something you can have if you can afford it. It's that simple.  If you can't, die!  You didn't matter.  The fact that you no longer had medical insurance because you were one of the millions who lost their job is just...tough!  Real tough!  This, to me, is not any remotely reasonable definition of an advanced society.  Heck, I'm not even convinced it meets a definition of a primitive society.

So, my answer is that health care is currently a Privilege, while it should be a Right!

Now, the obvious next question is also simple:  Okay, if it's a Right, then how do you pay for it?

That's a good question, but I do have an answer.  First, however, let's take a minute to look at the system currently in place.  Let's see what's broken, and how it's broken.  Then, I'll propose a simple way to fix it, money in the process.

At some vague point in past history, employers began providing health insurance as a benefit.  There are some different answers about exactly when this began, and where it started.  I do know that Borsig, a firm in Berlin that built locomotives and did other heavy foundry work, was one of the first to create a program of sick leave and a primitive form of Worker's Compensation.  It wasn't much, but it was a heck of a lot more than nothing, which was what everyone else was doing.

In any case, the beginnings no longer matter.  What's in place today is what counts.

If you work full time for a major employer, it's likely they provide some level of health insurance.  You may be able to cover yourself and your family (dependents).  You likely have to pay a portion of the premium, although that's not always true.  Remember that one of the major issues with the car makers was that the contract they signed obligated them to pay those costs for retirees too!  That's important.

However, you may have limited choices.  Your employer chooses which insurance company you get, or may provide a choice.  Usually that's either "regular insurance" or an HMO.  I know there are differences, but for this discussion they're not important.  You may also have a Health Savings Account.  Most policies include some level of co-pay for services, so you actually have to pay something out of pocket when you go to the doctor.  They also typically pay only a portion of prescription charges, and things like hospital stays are also not covered completely.

Now, if you're not employed, or covered by your employer, you can buy the same sort of coverage yourself.  Depending upon your job and wages, that bill may exceed what you make, so for many people, that's not really an option.  I can pay the rent, put food on the table, and maybe buy the kids some clothes...or do none of that and have health coverage.  Those aren't realistic choices, even though they are the real choices people make every day.

If you get a new job, you have a waiting period, usually about 90 days, before you'll be eligible for coverage with the new employer, assuming they offer it.  So, during that time, you darn well better not get sick or injured.  You're on your own.  And when that waiting period is over, the new coverage might not cover what you have, since insurance companies love to cite "pre-existing conditions."  Whatever you do, don't change jobs or coverage while you or your spouse is pregnant!

Oh, you have high blood pressure and have been taking drugs.  Well, we won't pay for those drugs.  It's a pre-existing condition.

You can have a heart attack, go to the emergency room, then be admitted to the hospital, spend some time in ICU, and then finally make it back home.  Then, a month later, you get the bill.  After the insurance company pays their part, you're left with the rest.  Maybe it's...oh...just $30,0000.  They want it in 30 days.  So, while you're trying to get well and the company is trying to decide if you'll be able to resume your old position, you're also trying to figure out where that money is coming from.  In the end, you lose your house and your job.  Dying starts to look a bit too attractive as an option, and you find yourself asking if it was all worth it.

Your child is sick, running a significant fever, complaining of an upset stomach and other things, and the solution is obvious.  However, before you even consider hopping in the car to head to the doctor, you have a discussion about whether you can afford to go and what bills won't be paid so you can pay the doctor.  You pray he/she doesn't prescribe some costly medicine.  Maybe you decide to wait until tomorrow and hope.

You receive a call that your child has fallen, and before you think of anything else, you consider the cost of whatever treatment is going to be required.

In short, the system is broken.  It's causing tremendous stresses within our society that need not exist.  On top of that, if you follow the news, you've probably heard that health care costs just keep going up...way faster than the overall rate of inflation.  In Oregon, one of the major insurance companies just applied for a 20+% rate increase...and they had a significant increase just a year ago!

You may like or dislike the health care bill passed by Congress, although I'm betting that very few people actually know what's in it.  We heard little bits and pieces, but only those that served a specific political point of view, and some of those were outright lies!  There are, and never were, Death Panels.  And, as for the statements that "someone would be deciding if you get coverage?"  Guess what.  In that contract you might have with your insurance carrier, there's always a clause that says the "System Administrator" decides such things.  That's somebody you will never, ever meet, but he/she makes those decisions for you already. most cases, they do it with an eye towards the profits for the company.

In Part 2, I'll explain the way to fix this, and why it's better.


leah said...

Don't be surprised if this ...somehow... gets emailed to the White House...after part 2, of course.

Anonymous said...

I definitely agree with everything you have said here! I am so disgusted with our country on this front, and I feel like your last entry about the Haves and the Have Nots certainly ties into this. So many of these big-whigs have no freakin' clue what it's like to not have health insurance and be forced to make these decisions every day. I am definitely looking forward to Part 2!

Craig Allen said...

Thanks to both of you. My hope is that people can read part two completely before jumping to conclusions.

Yes, alacrity, this is yet another example of Haves and Have Nots. However, it is one part we could change if we chose to do so.