Health Care

healthcare

I have health care on my mind this morning. Over the holidays, I had a change in my normal migraine headache symptoms. While I’m not actually that concerned about it, any change in a pattern of a neurological process needs to be investigated to rule out any of the nasty stuff that could cause it.

I’ve had migraines since my teen years, and have managed to not need the services of a neurologist until now. However, when you call the nurse at your doctor’s office and tell her your vision is blurred in one eye with a headache, they tend to get a bit fussy with you when you refuse to go to the ER right then. They end up compromising with a referral to a neurologist. (I am fairly certain my file is getting flagged as a problem patient!)

I knew that the visit to the neurologist would trigger an MRI. I didn’t anticipate the other tests it would trigger. I now get to have a slew of tests – bloodwork, the MRI I knew was coming, an EEG, and a venous doppler study. In addition, the neurologist found signs of perhipheral neuropathy (which basically means the nerves in my feet aren’t working quite right) so I got to go in this morning and subject myself to electrical torture for a nerve study of all of my extremities. That test was nowhere NEAR fun, but that’s not the point of my musing this morning.

I am grateful to have a good job, and one that has a reasonably good health insurance. The way it’s set up allows me to have money taken out pre-tax (an FSA) to supplement the money my company puts up (my HSA) to cover the deductible and other expenses until the out of pocket maximum has been reached. Even so, a large chunk of money is taken out each paycheck for my premiums in addition to the FSA contribution. I’m lucky in comparison with a great deal of the country in that I make enough to be able to afford to set it up this way and see my doctor whenever I need to, and have whatever tests are necessary to either diagnose a problem or rule out a bigger problem.

Last year because of some non-insurance-covered expenses with my kiddo, I had already spent my FSA money when my heart condition developed. So I had to put my out of pocket expenses for that (several thousand dollars) on credit cards I had worked hard to pay off. Had I not had that option, I would have had to ask my parents for help covering the expense or taken a loan on my 401k (or cashed it out), or I wouldn’t have been able to have my heart procedure done. Never mind that I was barely functioning with the symptoms I was having – it wasn’t an emergency procedure, so if I couldn’t pay that several thousand dollars, I’d have had to just live with it until it progressed to a life-threatening condition. It was a little scary.

Now, I completely understand that I am more privileged than a huge percentage of the population, and I am exceedingly grateful for that. I am not posting this as a whine fest. I realize completely that I have several safety nets – I have decent credit, I have parents who are able to help in an urgent situation, and I actually have a small 401k built up that I can draw on if it’s truly an emergency. I also know that I overspend and there’s a number of ways I could cut back (and should) and save even more. I’m overwhelmed in my privilege.

What makes me incredibly sad about the state of our nation is that if I didn’t have those safety nets, I could be dead right now. Millions of people in our country can’t have the battery of tests I’m having done right now to make sure they don’t have a brain tumor or a brain bleed. They couldn’t have had the heart procedure that I needed last year, which easily could have resulted in my death, though probably indirectly. They can’t see their doctor on a regular basis to keep an eye on their health. They enter our medical system when it’s an emergency, when the care needed to save their lives is more costly by far than the preventative care would have been. The safety nets that some people say are out there for them, a lot of times aren’t. Some counties, but not all, have a free health care system. But those with jobs that just don’t pay quite enough for health insurance and care, usually fall through the cracks because they make too much to qualify. Wait times are amazingly long, if you’re lucky enough (or un-lucky enough as it were) to qualify, and if you can actually get an appointment. Those providing the services are trying to make it better, but funding keeps drying up.

My position isn’t a popular one with a lot of the people in my life. I completely and totally support and advocate for Universal Health Care. I don’t pretend to know enough about the macroeconomics to know what the best solution for providing it is, but I believe it’s necessary that we as a nation figure it out. It could be a government-run single-payer system, it could be a system of regulations on insurance companies with a government provided fallback, but I believe it’s absolutely critical.

We spend more per person on healthcare in this country than any other industrialized nation, and we don’t provide adequate care for a huge percentage of our citizens. True, there are health care systems in some countries that I wouldn’t want to emulate, but there are plenty of countries who are managing to provide universal coverage and do it for less per person than we spend. Are these systems perfect? Of course not. But they provide basic needed care across the board.

I’ve heard a number of arguments against universal coverage and I’m going to take this opportunity to respond in an environment where I can’t be shouted over, which frequently happens when I try to discuss this with some people in real life.

“The government can’t be trusted to manage healthcare, they will muck it up.” The funniest thing about this argument is that more often than not, it’s being made by people who are on Medicare, and fight against any changes to Medicare. Once again, not perfect, but if you qualify for Medicare, you get pretty decent basic care. Financially, the Medicare system is likely solvent with modest tax increases over the next 75 years.

“We would lose the best healthcare in the world.” Ok, there’s two major issues with this. The first is that while we do have an incredible health care system and tons of technology, the fact is that we have the highest rate of preventable deaths in the industrialized world, by a huge gap. If you’re privileged, you have the best health care system in the world. If you’re not privileged enough, you get the worst which is nothing.

“There’s no such thing as free healthcare” and “why should I pay for someone else’s medical care?” These go hand-in-hand. First off, there’s also no free roads or highways. You could argue that only the people who pay taxes should be able to drive on them, but that’s not the point of public services. Unless you are paying out of your own pocket to the doctor, hospital, lab company, radiology imaging company, etc. you aren’t paying for your own medical care. You’re paying into an insurance pool, and that pool pays for your care. If you need anything more than basic checkups, then healthy people in that pool are paying for your care. The reason for healthy people to pay into the pool is that someday they’ll have an accident or illness and they will in turn need care paid for by other healthy people.

“Healthcare isn’t a right.” No, it’s not. Neither is having the fire department respond when your house catches on fire. It’s a matter of what we as a society think is important. Right now most people are a layoff away from being without insurance. In this country, that means they’re a layoff away from having zero medical care unless it’s life threatening. The burden of insurance is falling more and more on employers, and creating more and larger gaps for people to fall through. I believe it would be beneficial to business in general and thus to our entire economy, to remove this burden from emmployers, who at this point pay benefits (of which health insurance is not all, but it is a huge percentage) almost equal to the salary of the employee. Think what business could do if they didn’t have that burden.

“Healthcare is a personal responsibility, and people should buy insurance if they can’t pay for their own medical bills.” Again, while there are a few of you out there paying every medical bill out of your own pocket, that’s not the reality for the vast majority of people. And I daresay the people paying out of pocket by and large would be up a creek without a paddle if they came down with cancer or needed an organ transplant. If you’ve never searched for an individual health insurance policy – especially if you have a pre-existing condition – I challenge you to see how much it costs. You are losing the benefit of a pool when you buy individual health insurance, and it is reflected in the astronomical premiums that most people could in no way afford, and they usually come with extremely high deductibles that they also could not pay. To anyone who thinks this is a viable alternative, consider my heart procedure – if I couldn’t come up with $4,000 on the spot, I couldn’t have had my heart fixed. If I’m paying $1,500 a month in health insurance costs (no, I’m not exaggerating) then it’s highly unlikely I can save up $5,000 or $10,000 to meet the deductible if I have a serious health problem. And if the only work you can find is minimum wage, or even “flipping burgers” wages, good luck affording that $1,500 a month for insurance in the first place, that is, if you want a safe and warm place to live and food on the table.

“Universal healthcare would lead to rationing” and “Canadians come here because of the long waits” and “DEATH PANELS!” These frankly chap my ass. Anyone who thinks we don’t have rationing now has never dealt with insurance companies. The insurance companies are the true “death panels”. And the Canadian thing is a smoke screen. Most Canadians don’t come to the U.S. for care unless they have an emergency and are already here. Sure, there are some rich Canadians who do, but that’s an anomaly that’s not even statistically relevant. Yes, there would be increased demand, and the health care system would have to figure out how to manage it, but other countries manage to do so.

“Taxes will go up.” Yep. I would just leave my response there, but I feel that people will want more clarification. Yes, universal health care will cost more. However, I personally believe that a lot of the cost will just be shifted around. Instead of paying your portion of premiums at your job, you’ll pay higher taxes. Some people will end up paying more, some less, but mostly it’s just going to shift the line item on your pay stub. I don’t have any research to cite, mainly because I’ve read tons of it over the years and am generalizing and don’t have the time to track down the studies when I can’t even remember the organizations that did them. But yes, I fully admit the cost to people who are working above the poverty line is likely to increase – though not as much as lots of people believe. I believe that this is an important enough thing that it’s worth it. This is a values argument, not a fiscal one. I’m not going to say that if you think it’s not worth even a small increase that you’re hard hearted, but I would ask that you think about how many people are literally dying for lack of care, and where your values lie on the subject. My values say it’s worth it. Ultimately, it will be society as a whole that has to make that judgment. I hope that the majority feels as I do.

“Anyone can go to the ER.” Ok, this one chaps my ass more than any other. This is one of the things that drives up health care costs, and strains hospitals’ budgets to the point of struggling to stay open. Yes, you can go to the ER. You can rack up huge bills that they can’t make you pay (though they CAN and WILL ruin your credit and hound you with collectors) and you can be treated for the immediate life threatening condition. However, once an ER determines that you are not in immediate peril, they cut you loose unless they have a “fast track” which functions as an urgent care center. The costs of the “fast track” are usually absorbed by the hospital (since a large number of fast track patients can’t pay) in order to keep their ER running efficiently. Which means that these costs are passed on to all of us via taxes, increased health care costs which drive up premiums, or other indirect mechanisms. When people only have the ER for care options, by the time they enter the system their conditions have progressed to the point that the cost of care is astronomical compared to what it would have been if they had received preventative care. If the ER is the only care a person can get, we have a broken system.

Now I’m getting myself worked up, so I’ll stop there. I think I’ve made my point.

—————–
Ahem.

This sort of post is guaranteed to demonstrate how many people actually read my blog – either directly or through Facebook. I fully expect to be deluged with comments and criticism. I fully expect that some people will be rude and insulting, because this sort of post seems to demand it.

What I’m going to ask is that you think long and hard before you hit the “send” button on your comment. If you’re just going to re-hash arguments I’ve already addressed, then you’re just beating the deceased equine and I’m not going to even respond. If you’re going to be rude and insulting in any way, I’m not going to respond. One of the tenets of my religion is that “we don’t have to think alike to love alike.” You don’t have to agree with me, but if you can’t be civil with me about it I simply won’t engage. As for my WordPress account – if you haven’t already commented on a post and been approved, your comment will not be posted until I approve it. My criteria for approving comments does not require you agree with me, but it does require civility. I don’t have to let you in my space IRL or here if you can’t be civil. I’m pained that I even have to include this paragraph, but the nature of the internet tends to bring out the worst in people.

All I ask is that you follow Wheaton’s law — “don’t be a dick.”

Sources:

http://www.cbpp.org/cms/index.cfm?fa=view&id=3532

http://content.healthaffairs.org/content/27/1/58.full

http://theincidentaleconomist.com/wordpress/phantoms-in-the-snow

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3 Responses to Health Care

  1. I’m not sure if Universal Health Care is the solution or not…I honestly haven’t researched it well enough to make a well informed decision for me. What I do know is this: I’m not sure, based again on what little I understand about it, that for our situation with two special needs children, it would be any better than the issues we deal with now. That being said, I do know this. In our current “employee backed” health care plan our rates have gone up yearly, currently we have about $1600 total taken out per month for health, prescription and dental care. Vision was dropped eons ago. Three years ago we were forced into an “up front deductible” plan if we wanted to keep our PPO and not convert to the company’s HMO plan. (HMO does not work—ever—for special needs kids, so we avoid it like the plague). Now we have to meet a $2500 per person/$10,000 family per year deductible every calendar year before our insurance benefits actually “Kick in”, aside from our providers having to honor the “in network” pricing. We max our FLEX plan, which covers only one of our family member’s deductible…usually Lexi’s, The other three of us are left, essentially, without coverage that we can use because we can’t get reimbursed for the high up front costs. We pay out of pocket for everything, up front. We focus on ensuring that the kids bills are paid…and Mike and I only go to the doctor if it’s absolutely necessary….and often we even push that envelope. The first six months of Lexi’s meds alone run us almost $450 each month…and that’s AFTER the ‘in provider network cost”, which is all we get until we’ve met that stupid upfront deductible. Most claims I have to appeal because the policy has so many exclusions that just about everything Lex needs, whether it be tests, care or equipment, is initially deemed as “convenience” (Really???) that the time alone I spend fighting the insurance company is ridiculous. The sad part is, is that we have one of the “better” insurance plans…or so we’ve been repeatedly told.

    So, who’s to say that universal health care wouldn’t make obtaining health care more affordable for us. At any rate…an interesting post to ponder.

  2. theantichick says:

    Unfortunately, from my experience in the medical community and fighting insurance companies, cases that are less than common like yours will always be a struggle. The main advantage I see in universal coverage, especially if it’s a single payer system, is that right now the insurance companies have a financial incentive to NOT pay for services they are contracted to pay for. While Medicare has certain restrictions and non-covered items, they are clearly delineated (ok, not INCREDIBLY clearly because you have to go to government documents for them, but you at least CAN find them) and if it’s a covered item, Medicare pays for it, no back-and-forth with the insurance company and multiple appeals involved. Also, *most* of the limitations on Medicare reimbursement are based on medical efficacy research, not on financial numbers.

    My example, FWIW. My knee surgery back in 2008 is classified Investigational and Experimental by every insurance company in the USA. Never mind there’s over 25 years (at the time) of historical efficacy data in Norway (where it was pioneered), over 20 years data from other European countries, or over 15 years of data from the USA, including many peer reviewed studies. The cost of the procedure (Carticel) was only slightly more than the alternatives which ARE covered, and it’s been proven to last 15 years longer than microfracture and 10+ years longer than a knee replacement. I couldn’t even get a straight answer out of the insurance company about the appeals process – we were 3 appeals in when I found out the wrong appeals were filed and had to start over. I’m actually amazed I got it approved. (But grateful.) In the U.K. I would have waited just as long to get it done (10 months) but I wouldn’t have had to fight the insurance company, just wait for the resources to be available. In most Asian countries, I could have saved enough to pay out of pocket for it in the same period of time.

    When most appeals against insurance companies are examined by a MEDICAL review board, the insurance company loses. Those medical review boards would be the ones determining approved/unapproved procedure lists, not CFO’s looking to better their bottom line.

    As for the real cost to us, there’s no real telling – but wouldn’t it be nice if we still ended up paying what we’re paying, but had real access to healthcare in exchange?

  3. Meagan Klein says:

    I want to thank you for your well thought out post. I tend to be skeptical about anything run by the government, but your post shed some positive light on universal healthcare. I know our health care system is broken. We may pay more for healthcare, but are rated below some third world countries.
    I don’t have the answer, but continuing with for-profit insurance companies surely isn’t working. I had to pay out-of-pocket for student insurance to get through school. My “negotiated” price was far higher than the out-of-pocket cost. A surgery that was less than $4,000 out-of-pocket would cost me $15,000. A doctor’s visit fee was $70, but because I had insurance and hadn’t met the deductible, I had to pay $92 for the same service. Looking at healthcare as a profitable venture instead of a service is what has messed with the prices, not the government. I also talked with a gentleman from England who informed me that they pay less per capita for national healthcare than we do just for medicare.
    Universal healthcare, if done right, can be a blessing. I am just skeptic of America’s ability to not mess it up. You gave me some new things to ponder. Thank you.

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