The Broad is Back!

August 15, 2009

A Few (thousand) Words on Health Care Reform

“People are very open-minded about new things – as long as they’re exactly like the old ones.” ~~Charles Kettering

The health care debate has been raging all summer, and lucky me, I’ve been ignoring it.  I’ve been too busy working to pay attention, but that doesn’t mean I don’t care.  I very much care, as my son and I are part of the over 46 million Americans without health insurance.  I haven’t been able to find full time work for the past year, so I’ve been working three part time jobs.  That keeps the roof over our heads and the bare minimum bills paid. I pay the car insurance (because I can’t get out of my lease), but I can’t afford private health insurance.  I make too much for Medicaid, but now that my son is over 18, he can apply for coverage.  And now, thanks to my strong union, I will be eligible for health care through my employer in the fall.

But in the time I spent overseas, I lived in two countries with national health and one with mandatory health insurance.  Taiwan and Sweden were the national health countries, and in Switzerland, insurance is mandatory. If one isn’t covered through an employer, there is an affordable option available through the government.

Sweden is often held up as the exemplar for national health, and while I wouldn’t go that far, I can say that in most instances, it was fine.  My son is an epileptic, and as a child under 18, all of his medical care was covered.  When we came to America, even with the insurance I had the first year, my co-pay was over $300 on an office visit and some blood work.  And he’s supposed to see the doctor twice a year.

Of course, on the flip side of that, my taxes in Sweden ran close to 50%.  Through taxes, I paid for the care there, as well, but when my husband and I were out of work, my son still got the care he needed.  I checked some policies, and private health insurance for myself alone would cost about 25% of my yearly income; for the two of us, about 44% of my income.  Add my taxes to 44% and I’d be paying well over 50% of my income, so cheaper in Sweden.

One major problem with the Swedish system is that it’s overtaxed. Unemployment is high—about 10%–and with an ageing population, there’s too much going out and not enough coming in. And Sweden only has a population of nine million people.  Administrative costs are relatively low.

Swedes also register with the government and are assigned doctors, whether you like them or trust them or not.  I was very lucky with my son’s doctor, but terribly unfortunate with the “specialist” I was assigned.  To be perfectly blunt, she was inept at treating my disease and prescribed something no longer prescribed, in fact, something contraindicated.  When I balked, so did she and my care went downhill from there.

I can’t see Americans enjoying registering with the government and being assigned doctors.  According to the White House, this isn’t even something on the table, so I can relax about that.

America has fine health care, but it’s just not affordable.  And one thing alone is not going to fix the mess we’re in.  America’s health care woes are caused by many factors: profit-driven insurance and pharmaceutical companies, foolish laws, core ideals about personal responsibility and American’s poor health habits.  And frankly, labels don’t help. Am I left or right? Am I socialist or capitalist? Am I liberal or conservative? Throw out the labels and just think.

Insurance rates are high for doctors.  People sue for huge damages, so doctors have to have the insurance.  On the other hand, I’ve seen firsthand the devastation that can happen to families in which there has been a medical mistake.  Friends who are unable to sue for damages because their state has a statute of limitations have faced bankruptcy while caring for their son who incorrectly treated following his premature birth.

But the insurance industry in this country is not a nice group of kindly folks, no matter what image their PR firms try to show.  Michael Moore’s Sicko was typical Moore showboating, but it did point out some hard, if obvious, truths.  People in healthcare shouldn’t be profit-driven. But in a capitalist society, that’s how it works.

Insurance companies lobbied for laws so that doctors could not charge people without insurance lower fees.  They got the law. Sounds fair at first glance, but in reality, doctors rarely get the billed amount sent to insurance companies.  They are usually sent a percentage.  So when I walk in the door without insurance, I have to pay the full amount, but the person next to me, with insurance, pays a co-pay, and the insurance company pays “the rest”. But the insurance company doesn’t always pay all of it, so I’m stuck paying a larger price. Also insurance groups often get “group rates,” something the non-insured can’t get.

Insurance companies have also pretty much killed off the idea of a lone doctor practicing out of his basement.  When I was growing up, and I’m not yet 50, my doctor practiced from home, as did most of the doctors in town.  And I grew up in suburban New York, so not exactly the “boonies”.  When I moved back to my mother’s in the 90s, my same old doctor was still practicing.  He was a wonderful physician, and he apologized that an office visit was now $35.  The doctor I’d had just a few years earlier in “upstate” New York charged $50 for a routine office visit. This week I paid $95 for an office visit for my son and was shocked it was so low.

One reason for the cost is that now thanks to insurance companies, doctors spend small fortunes on paperwork alone. Couple this with sky high malpractice insurance premium, and you have a recipe for disaster.

A friend of mine who is a veterinarian has complained about the mark-up medical doctors give to supplies—vets and “human” docs use the same materials in most instances.  She has a point, but then I thought of the costs associated with running a physician’s office.  Most people don’t have pet insurance—the number is growing, but it’s considerably less than human insurance—so there’s no one who has to do that paperwork.  And vets do have malpractice insurance, but as much as we love our pets, they aren’t human.  There are no lost wages or multi-million dollar settlements made on pet care errors.  So for physicians, the cost of insurance has to be covered somehow.

I really don’t mind physicians getting a large salary.  Most made years of sacrifice and paid through the nose for their educations, and they hold my life in their hands.  I would love to be making what they are (the average US general practitioner, internist or pediatrician makes just under $150,000 a year according to the website since I have as much education, and I hold the future of the country in my hands, but that’s another story.  Of course, that’s the average salary.  That means that there are selfless physicians working for $30K in America’s rural and urban poverty centers while there are profit-driven folks raking in obscene amounts. But that’s capitalism.

Doctors today are major employers—they have nurses, LPNs, office staff and so on.  Physicians have to pay salaries and often benefits, as well.  All that is reflected in the price of a visit. I get that, as well.

Many states also succumb to pressure groups, making insurance companies cover all sorts of things on minimum plans.  Boston Globe columnist Jeff Jacoby wrote a very enlightening piece on this “Healthcare: Do we need the Lexus?” that I highly recommend.  Let me include one very eye-opening paragraph:

Forty years ago, there were only a handful of benefits that health policies were required by law to cover. Today, the Council for Affordable Health Insurance identifies an astonishing 1,961 mandated benefits and providers. While any one mandate may not add appreciably to the price of an insurance policy, in the aggregate their cost is huge. The Cato Institute, citing the Congressional Budget Office, estimates that state regulations increase the cost of health insurance by 15 percent. And since “each percentage-point rise in health insurance costs increases the number of uninsured by 300,000 people,’’ as scholars John Cogan, Glenn Hubbard, and Daniel Kessler point out, it is clear that the proliferation of insurance mandates is one reason why millions of Americans are uninsured.

Frankly, if the insurance mess was cleaned up, there would be a lot more affordable private insurance that would be available for people to purchase.

I haven’t even treated pharmaceutical companies here.  One example: my son’s epilepsy medicine costs me about $170/month.  I just discovered, after 23 months in this country, that the generic version is less than $12/month. Don’t get me started on advertising drugs on the TV and in magazines.  I am a very educated, pro-active patient, I research (and not on Wikipedia, but in medical databases—I’m a doctor, too.  Not a medical doctor, but research is research).  Americans for the most part have wised up about the over prescribing of antibiotics, but we still love to medicate ourselves.  I’m not anti-medicine. But I do think we overprescribe and just generally overmedicate. Learning about all the new drugs while watching the after dinner TV shows is too much.  I went to the pharmacy in Switzerland to get children’s cold medicine for my son and the pharmacist handed me some homeopathic tablets. They worked fine and were cheap.

Alternate treatments are marginalized here.  I’ve ingested thousands and thousands of dollars of harsh drugs that have left me with permanent side effects because I have stage IV endometriosis.  In Sweden I tried acupuncture, and it worked. I was off pain medications for years thanks to that treatment.  It’s not for everyone, but it works.  My American doctors laughed at the notion (so did my Swedish doctor, but once I had my run in with her, I was on my own for health care).  My Swiss doctor, who is a world famous researcher of endometriosis, prescribed hypnotherapy and massage therapy, as well as herbal treatments, all of which provided relief.  On a whole, Swiss doctors, along with many other European doctors, are not threatened by blending traditions.

And finally, the thing I am seeing get in the way of discussion so that we can’t even make a small change is America’s core values.  As many have correctly pointed out, health care is not something to be provided for by the government. The Constitution and Bill of Rights don’t mention health care at all.  Of course, in 1776, health care was a pretty rudimentary item. Catastrophic medical bills weren’t an issue.

America also likes to pride itself on being a caring country. Some people claim that we are a Christian country, and while I don’t agree, our culture, like all of Western culture, is solidly based on Judeo-Christian-Islamic values (all three are sons of Abraham, following the same basic rules given to Moses).  Just about any religious value system includes caring for the sick, so that’s at odds with our capitalist values on some levels.

Of course, we say that people have the right to life, liberty and the pursuit of happiness. I guess health care falls under the life part.  So it can get sticky.

When we discuss issues that involve core values, things can get heated.  We see this by the knee jerk reactions on both sides of the discussion.  People are no longer discussing health care—they are discussing what it means to be an American.  They don’t articulate it, but that’s what it is.  In America, the word “socialist” is a bad word, but we have Social Security and Medicaid and Medicare.

As you can tell by the previous 2000 words, this is a complex issue.  As the New York Times notes in its helpful article “A Primer on the Details of Health Care Reform:”

Each side hopes to win ground by boiling down one of the most complex policy discussions in history into digestible nuggets.

Not only are the sides turning this complex discussion into sound bites, most Americans seem to be perfectly happy with looking no further than those sound bites.  When I started really looking into President Obama’s health care reform, I found it confusing and amorphous. And I have 20 years of experience reading freshman compositions.  I am not being facetious. Most students today have incredibly weak logic skills, yet I read their papers and ferret out meaning.  Before I was a teacher I was a legislative correspondent. That’s a fancy term for being a reporter in the state capitol, reporting on legal stuff.  I’ve read more bills and laws than most non-lawyers.  I’m not a neophyte at this.

At the end of the day, I do wish there was a way I could afford health care for my son.  I don’t mind paying premiums at all, but I can not afford to pay 44% of my salary to cover us both.  As President Obama rightly points out, health care costs in this country are out of control. Something should be done.  Now we have to see exactly what gets put on the table. It all seems unformed still.

One final point: Americans have to take responsibility for their health. Americans are some of the fattest people in the world, and even many who are thin have deplorable diets.  I’ve written about this before, what and how Americans eat, but we need to take control of our lives.  When I am a rich philanthropist, my ultimate goal in life, I want to teach nutritious cooking to young people and young mothers. And I mean real nutrition, not the government-sponsored ideas of nutrition.  I’m overweight myself, and I work at getting thinner, but I do know that my diet is relatively better than the average American.

Drunk driving is also something Americans do more than most places I’ve ever lived.  In Sweden, a country known for massive drinking, people simply don’t drink and drive.  Not just because there are stricter laws; driving while drunk is stupid, and almost every Swede I’ve ever met at parties, where I was the designated driver, has asked why Americans are stupid enough to drink and drive.  Answering that we have the freedom to do what we want just doesn’t sound right.  How many millions does drunk driving cost in medical bills per year?


1 Comment »

  1. […] misdiagnosed my kid, but I felt like they were earnestly trying to find answers, at least.  And I’ve written about the health care mess as well, but the more I see, the more disheartened I […]

    Pingback by The Contemplative Broad is Edging her way Back « The Broad is Back! — March 9, 2010 @ 5:29 pm |Reply

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