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I’m a bit perplexed by the initial Christian response to the health care crisis. Now, you might not know there is a crisis. If you are college educated and employed, you are likely to have Aetna’s golden ticket tucked into your wallet. Go get a check up, laugh at the $15 co-pay, and be grateful for living the American dream. But what about the others? And what’s driving this crazy health care debate/debacle/disgrace? I look forward to writing a couple of blogs that track through the issue of health care. I know, me and 10,000 other writer-wannabes, trying to scale Mount Everest in slick Adidas sneakers. But I hope we can see Conversant Life do what it does best - create a platform for a healthy discussion. I don’t mind if you disagree with me or others who post, just think first and post second. If you are one of the wing nuts who recently took up screaming at Congressmen in crowded town hall meetings, head back into the attic and unravel the next conspiracy. The rest of us want to have some adult time. It seems that one missing item in the “discussion” has been facts. Not liberal facts or socialist facts, not Fox Facts or some other version of the truth. Simple, true, clear facts.
Before we get moral in our discussion, let’s get real. What do we say about 9.4 million children without health insurance? 47 million American’s who can’t walk into a Doctor’s office with a crisis, but end up at the Emergency room; already overcrowded by the other 46,999,999 people who can’t go to a Doctor. Each year the number goes up by one million. Can we agree that this is a problem? So, if these are facts, what is our response? I want to throw out three opinions to develop more as we go, in light of the facts we have engaged. Three opinions:
It’s not a simple issue captured in a sound bite. It’s not an “us against them” proposition. It’s bigger than our own preferences and scarier than our individual fears. Let’s think and engage together and see where we come out. |
Comments
A quick question - why do we use the term 'health insurance' as in '47 million Americans have no health insurance, including 9.4 million children' and then state that there are '9.4 million children without accessible health care?' Are we mixing our terms? Does not having health insurance really preclude one of receiving health care? Certainly there are problems with the system that need to be addressed, but lack of access to health care coverage should not be confused with the lack 'or perceived lack?' of access to health care.
Personally, I regularly transport a church member to his doctor office (who only accepts walk-ins) and who is willing to negotiate his fee where an individual has no coverage. My experience is that many doctors (not all) are willing to work with those that have no health insurance and adjust their fees accordingly. Likewise with prescription drug costs. Many drug companies have programs to assist with those who cannot afford their prescriptions.
We can address this problem together.
I think you are making a really good point. I actually went back and changed that when I was writing, but still was not certain. Does health insurance equal access to health care? I guess that depends. What about "pre-existing conditions?" Not sure how they work, but I have heard some tales.
And, as you say, does not having health insurance equate to not being able to access health care? Having spent a good bit of time in developing nations, just about any emergency room in the US would look pretty good to most people on the globe. How do we set a standard? What's the "plumb line?"
I think that a lack of health insurance absolutely leads to a lack of access. People without insurance often make terrible decisions about their health because the cost is prohibitive, or end up in dire financial situations when they've sought treatment. Doctors are also driven by health insurance, and don't recommend services for things they know they won't be reimbursed for. My husband has been hospitalized three times, and each time he was discharged according to his insurance coverage, and not based on a doctor's recommendation. Insurance (or lack thereof) absolutely affects care.
Great post.
Kristen, your recent post blew me away. I'm going to refer to it in my next post, if you don't mind. My wife and I were talking about your experience this morning. It really shifts the issue for me, as your experience brings the crisis much closer to home. Scary stuff.
I need to do some research on the model that exists, in which doctors respond to insurance instead of need. A very important, very "bottom line" point to be explored.
I don't mind at all! I would love more info on the "insurance vs. need" decision process. I only have my limited experiences, but it certainly seemed influential. Even in having babies, where the length of hospital stay was solely determined by which insurance carrier I had, as opposed to need for recovery, etc.
Thanks, Kristen. My initial reading has been . . . a little disturbing. Efficiency comes by eliminating people who need care, profit is generated from specific, high margin tests and drugs. No wonder we are in such a mess.
Thanks, Kristen. My initial reading has been . . . a little disturbing. Efficiency comes by eliminating people who need care, profit is generated from specific, high margin tests and drugs. No wonder we are in such a mess.
If you're talking about one visit to the doctor to treat strept throat, lack of insurance doesn't equal "no access to care." Some doctor will see you on a walk in basis and maybe give you a free sample or maybe your generic prescription only costs $5-15.
Older adults frequently take $4000-5000 in medications per year. This may be amerliorated by a few free samples and drug company assistance on some of the medications, but that perhaps takes a $1000 off the total. Still out of reach if you're poor and uninsured. So you choose between medication and food or rent.
If you need hospitalization or an outpatient surgery, say a hernia repair so you can get a job, you're looking at something more in the range of $10,000, completely out of reach (until you come in as an emergency with it strangulated), or you have a gallstone that causes periodic attacks of disabling pain that lasts for hours (but doesn't qualify as a life threatening emergency for which a hospital must care for you despite no insurance). The price of outpatient surgery for your gallbladder will probably be in the $15,000 range and if you go in and offer to pay cash up front some outpatient surgery centers may negotiate down to $12,000.
So for many people not being insured does equal not having access to medical care, or at least important aspects of medical care.
Some point to healthy young people as a population that does not need health insurance because they don't need health care. Thanks, Doc, as your post provides more examples of why that is not true. Not to mention the issue of "pre-existing conditions" when someone wants to get health insurance.
I was always kind of uncertain about the idea of healthcare for all, I mean if you walk into an ER you have to be helped, right? I thought this until I was hit with a more personal experience.
A college educated friend who owned his own business, and was paying the premiums to have his own health insurance, had to make a choice a few months ago when the poor economy was effecting his business - his choice? Pay the mortgage or pay for health insurance. He chose to drop his health insurance. Three weeks ago he had a bad infection on his leg. He walked into the ER - they bandaged it and sent him home saying it wasn't bad enough for further treatment. He fought with them, explaining how badly he felt. They sent him home. The next day he passed away in his home. Would he have passed away in the hospital? Who knows, but I can't help but wonder if it was I who went there, with my Aetna insurance and $15 co-pay, they would have done a little more.
I'm not certain that Obama has the answer, but I think it needs to be calmly discussed and a solution needs to be found.
Scary story. As you note, it's hard for me to relate, as I've always had good health care. My dad was career military, so I enjoyed government health care until I turned 18. Your comment sheds some light on the issue in the first comment. Thanks!
I'm teaching Canada this week at conference populated by Americans, Canadians, and Europeans. I wish that our American naysayers would have real conversations with real Canadians and Europeans, rather than drawing conclusions from the caricatures and fear tactics of Rush Limbaugh. I've never spoken with a single person from Europe or Canada (and I teach in Europe regularly) who is discontent with their health care systems; not a single person!
I think that behind this conversation there's a larger conversation having to do with our commitment to the "common good". Independence and autonomy are built into our American genes, but in an increasingly isolated and individualistic culture (where barn raisings are a thing of the past) we're becoming functional Darwinists, where the strong, well employed individuals who don't have pre-existing conditions, have the privilege of access to health care and the rest play a game of Russian roulette, hoping that tumors won't find a home in their bodies because if they do, they're on their on.
What's strange to me is that it's Christians, still wed to the religious right, that are clinging to this Darwinian model, a model which is utterly contrary to the teachings of Jesus and the heart of God's kingdom.
I only ask that, before drawing conclusions, each of us try to talk to real people who are living under models different than our present one. I know these conversations have changed my views.
Richard, what do you think about race as part of the equation? People without coverage/care access are disproportionately people of color. Not to be too simplistic, but I wonder how much that weighs into all of this. White priviledge and health care?
Our country has not recovered from racism. I think it's more like alcoholism; we're in recovery with occasional relapses. But that said, I believe it's an isue of economic privilege. In as much as unemployment is associated with race and other economic issues are associated with race, then coverage and care access are racial/ethnic issues. But anyone with money can get insurance (providing you have no pre-existing conditions) and get care (see my note above for equating coverage and care).
Doc, I think that it's interesting that race has not been mentioned. In part, because President Obama is African-American? The race disparity in health care is vivid and clear, but little has been said.
Hey Mark-
Good discussion; I liked your layout of what the main issues are: business, American, prolife, etc.
I think this issue is critically flawed at the beginning. The critical flaw is that 46/47 million, which someone else posted about so I don't really need to go on about it. My step sister is 20, young, an American, and feels so healthy that she elected to not get health insurance. Part of the 47 million that we're slamming our economy in the hopes of fixing something that isn't completely broken. I would love to see the national conversation focus on a more realistic number. From the WSJ: "To be sure, that oft-cited number from the Census Bureau is somewhat misleading because it includes illegal immigrants, healthy young adults who don't think they need insurance and poor people who are eligible for Medicaid." http://online.wsj.com/article/SB124812571962066393.html
Secondly, I must say that if I wanted something fixed and streamlined, I probably would not turn to the authors of Social Security, Medicare, and the DMV. The proposal seems to compound what is bad about our current system. Are insurance companies corporate, political, and financially driven? Of course. Do we really hope that our own Federal Government will behave differently, when we have seen so many examples of the opposite? Social Security is near bankrupt. Cash for Clunkers, a 2-month program, closed in 2 days, bankrupt. This is who we're turning to?
Lastly, the endgame here is clearly single payer- not according to a Rush Limbaugh, but according to Rom Emanuel, Pres. Obama, Nancy Polocy (sp), etc. If our goal is to get more medical coverage to the non/underinsured, why couldn't we increase competition by selling insurance across state lines instead of limiting our options? Why couldn't the government offer Hardship health insurance for the non-insured? I heard some congressperson say (don't recall who) this past week "we're tearing down a house to remodel the living room". I don't think we have to think about "death boards" to be truly, profoundly concerned about this.
I see how much of the US is financed by China, and how much the Federal Government spends as a percentage of the GDP (we're up to 35%, and budgeted to exceed 41%). The global financial balance- i.e., how much of America do we actually own- should cause any American- Rep. or Dem- to really shudder. So in closing of my exceedingly long comment (my apologies): (1) change the number. (2) Is the US Government really someone to turn to for streamlining and efficiency? (3) Does single payer accomplish the goal? (4) Can we afford this?
Thanks for listening. Appreciate your posts.
I like this post. I echo everything he said.
David, thanks so much for an excellent post. Greatly appreciate your thoughts and the clarity of your writing.
The number of uninsured is a moving target. And as you note, there are very healthy people out there who do not have, nor want, health insurance. The problem is when a young, healthy, uninsured twenty-something has a car accident. If she is taken care of by a public hospital, but needs some kind of continuing care, she is seriously in trouble. If she tries to get insurance, she has pre-existing conditions and can't get coverage.
I also agree, the government is not the place to go for a competitive company. Decisions by committee don't translate well into the public marketplace. But David, the industry is so large ($2 trillion) and so powerful, I don't know how else it will change. I teach business ethics for an MBA program and I've seen how reticent companies are to change, because the exist to serve their shareholders. There must be some kind of an intervention. What's the alternative?
No, I don't think single payer will fix everything. The issue is one of structure. I just posted a new blog on the issue. Would love to hear your thoughts.
Thanks again, David! Greatly appreciate your thoughts.
The healthy uninsured are playing a gambling game. When they lose, whether it's a simple fracture, pregnancy with complications, swine flu that may put a younger healthy person in the hospital, etc., the rest of us pay for it. That young healthy person will lose any small savings they have and their credit and the rest of us pay the bill, through taxes for medicaid and increased hospital rates and insurance.
I do agree that there are many reforms that can be made to increase competition, not the least allowing Medicare to bargain for drug prices and including those mentioned above.
David, if you get a chance, check out "Mama Manifesto" on this site. Kristen writes a great piece on what happened to her and her husband when they switched jobs and lost health insurance. To be honest, it scared me. I'm 42, starting to feel different levels of health than when I was younger. Very close to home.