Tuesday, August 4, 2009

The U.S.: Rich Yet Stingy

Rosaria of the blog Sixty Five Now What? has published a series of great posts on the health care bill now being debated in Congress. Since I'm just sitting around, waiting for the eclipse tomorrow, I thought I might as well weigh in on the topic. For anyone who does not follow the U.S. political scene, this is the big bill that allegedly would make sure everyone in the U.S. has insurance coverage for health care.

One quick disclaimer: I am neither an idealist nor cynic. I live in Washington DC, just ten blocks from the Capitol. In my job I work with many Congressional staffers from both sides of the aisle, so I have a particularly hands-on sense of what it's like to legislate for our top heavy, sprawling, crazy nation. I am a health care professional so I hear stories every day about doctors, hospitals and insurance companies. You would not believe the stories I hear, really you would not believe how faulty our health care system is, how poorly treated everyone is, from overworked, sleep deprived doctors to nurses to patients of all stripes. Our situation is really bad.

Here's what I know for sure:

1. The health care bill is more than 1,000 pages long. Though there are people on the committee who know a lot about certain chunks of the bill, no one really understands everything that's in there, whether or not it can be put into practice, how much it will cost and how it could actually work. I'm not hoping it will pass ASAP. I'd rather have them spend time thinking about it, coming to know what's in there, first. The Civil Rights Act was passed in 1964 and though things have improved, there are still many people who are officially and non officially denied their civil rights every day. Civil rights lawsuits are filed every day. It didn't really work, you see. It's a problem.

2. Being covered by insurance is not at all the same thing as having access to effective health care. Plenty of people who are covered by insurance, on paper at least, are routinely denied health care. Their claims are rejected, they're dropped from a plan for "pre-existing conditions," they are denied the right to see doctors they choose, or procedures that make sense to them. The insurance industry is in serious need of an overhaul. Their practices are truly obscene - greedy bastards!

3. The way medicine is practiced currently is not sustainable. This great article published in the New Yorker a few weeks ago explains that unless the medical "industry" is radically restructured, it won't matter who signs the check because no one except the rich will be able to afford health care. The article compares two American towns' medicare/medicaid cost per person, then explores the reasons for the difference in cost. GREAT article.

4. Sharon Jackson, a Canadian friend says (on Facebook): I am Canadian. 6 years ago, I had major surgery. Cost to me? Free. My daughter just had a baby in the hospital. Cost to her? Free. Our friend is getting over a compound fracture of his leg, has a plate, a pin, and needs months of physiotherapy. Cost to him? Free. Our system is definitely not perfect,and yes there are wait times, but no one goes bankrupt here because their child is sick. You have to be crazy not to want some form of this for at least some of your people. I believe Americans are famous for generosity of spirit???

Is she talking about socialized medicine? What's wrong with that?

The last thing I can say for sure is that my heart goes out to everyone involved with health care reform. It is a quagmire. Even trying to think about it makes my eyes roll back in my head. I thank God every day for my excellent health, I really do. And wish good luck to all the rest of us while we try to deal with this.

I could go on here and talk about medical ethics, overtreating people who are mortally ill, "spa" wards for rich people in hospitals, and the complete ignorance and arrogance of the medical industry about very effective alternative practices. But ... 'nuff said, oh yeah!


Cynthia said...

I completely agree that we have to make it possible for all people to have health care. Your points here are reflective and reasonable. If we cannot get health care reform, we must have a problem with our fundamental values.

ellen abbott said...

As I've mentioned before, we have no health insurance, never have. It's just plain too costly. And as you pointed out, those with insurance have no guarantee that they will get what they need from doctors they choose all the while paying more for that insurance than they probably pay for their mortgage. And the things is, eventually, you pay off your mortgage. Not so health insurance. We are lucky to have good health and the ability (so far) to pay our medical bills as needed.

The situation in this country is a travesty. the wealthiest nation in the world and we can't provide health care for our citizens. And why is that? Greed, plain and simple. I don't see any real reform coming in my lifetime. It's too complex and the way our government works, any real plan that could change things will be nit picked to death because all the people who get wealthy from the status quo will use that wealth to make sure change does not happen. As Cynthia says, we have a problem with our fundamental values, have had this problem which is why we are in the shape we are in.

Insurance for everyone is not the answer. And what do they mean by affordable. That is so relative.

Reya Mellicker said...

Ellen I haven't had health insurance since I left my job with the San Franciso Symphony in 1992. A huge piece of my personal budget goes towards therapeutic massage and acupuncture. My dentist is a neighbor and client so we do a lot of trades - massage for dental work. My internist is also a client, but luckily for me, I have only had to see her once, when I had pneumonia last year.

It wouldn't surprise me if the medical industry completely falls apart in our lifetime. When (if) that happens, reform will happen.

I'm not hoping that occurs. Don't know what to hope for. It's a mess.

Merle Sneed said...

I think we would be money ahead if we took the insurance companies out of the healthcare biz.

Nancy said...

Thanks for your take on this huge problem. When I lived in Minneapolis/St. Paul there was an insurance executive that I think lived in the area that actually made a percentage of all monies spent on health care that year in his bonuses. It's time for them to go!

Deborah said...

here here

and can we do a round of

"Oh Canada. . "

love to you

Joanna said...

As a Canadian I just don't get the fear of "socialized medicine" that seems so pervasive in America. We get to choose which doctor we go to, although we don't get to choose hospitals because there are only one or two in an area. They all offer pretty much the same standard of care though. We pay about than $100 a month for a family of three and it covers pretty much everything, although there would be waits for elective surgery.

I think the fundamental issue is mixing up profit with health care.
To me it's shocking that health insurance companies make huge profits while refusing health care to sick people that they are taking premiums from. I think it's sad that the world's wealthiest nation can't provide basic health care for all its citizens. I very much doubt that the USA will achieve universal health care as long as the profit making insurance companies are running the show.

Dan Gurney said...

Bloggers should address this issue. I enjoyed Rosaria's series on the topic. Michael Moore did a movie "Sicko" which gets to a part of the problem: the guys writing the laws are corrupted by insurance and pharmaceutical lobbyists.

I agree, too, that it's simply a matter of priority. More than 1/2 of all federal money is going in one way or another to the military keeping us safe from the Soviet threat. Ooops! I mean the terrorists.

Have we forgotten Lincoln's wisdom:
“The best way to destroy an enemy is to make him a friend.”

If we funded the military and Peace Corps about equally we could save more than enough to take care of everyone's health including the most important member of our community, Mother Earth's health.

Reya Mellicker said...

Dan, the people who actually write the laws are not members of Congress but their staffers. Only the most senior staffers are wined and dined by the lobbyists. Staffers know what their bosses want them to put into these laws, but they are SO not corrupted. Every one of them I work with are trying to make a difference by doing what he/she thinks is right - of course their individual opinions vary about what will work.

A very few members of Congress are corrupt. Most of them are decent, hard working people with the most terrible reputations.

Come hang out in Washington for awhile, get to know some of these people, have a glass of wine with them. They're good folks, almost all of them. Really!

Liza Ursu said...

I am a proud Canadian, and thank the universe every day for my health as well, although I do try and take an active part in that. I really question just how sustainable our own system is (by 2031, 20% of our population will be over the age of 65, and birth rates are declining).
You know I just don't get our world, especially when we are talking about money!!!!!! We created it, and yet it is in control.
It really shakes me up to think that a person has to choose (and there is one right now) between eating, having a place to sleep, and treatment/living. Those aren't choices that you shouldn't have to make in America the beautiful (or the world for that matter).
Thanks for this thought provoking post Reya.

John Hayes said...

Great take on the situation-- I especially like your point #2. & yes--when I wrote about health care on RFBanjo, I noticed how readers from Great Britain expressed their overall satisfaction with the NHS. It's interesting that most of the countries with socialized medicine have a higher life expectency than the US--some, like Canada, Sweden & France, way higher. US ranks 45th worldwide in life expectancy. France, 9th; Sweden 10th, Canada, 14th--this per the CIA--not exactly a liberal think-tank!

Ronda Laveen said...

I really don't understand our fear of universal health care. Is it just fear of the unknown? For a long time, the medical community was very resistant to universal health care because of low reimbursement issues. But now, they are turning in the other direction. They spend a lot of money and time billing, re-billing and fighting for the dwindling reimbursement they receive from insurance companies.

I find it embarassing that we, as a country, can spend so much money on aesthetics but so little on keeping our people healthy. With our resources, we should be setting the example for the world.

Jeninacide said...

Great post! I am also neither a cynic nor an idealist- but I do know that SOMETHING has to be done which is a huge part of the reason I am going to school for holistic health. An ounce of prevention is worth a pound of cure and having the ability to treat a lot of ailments naturally will be a huge asset to myself and my family even if I never get to build a client base!

I believe a lot of people are over-treated, over prescribed, etc, while a lot of people have no health care whatsoever. I also think it is ridiculous that I have to pay over $500 out of pocket every month for my husband and child to have insurance that they NEVER USE. The only time my son has ever used it (beyond checkups and immunizations) I had HUGE bills regardless that I am STILL paying off. It's just stupid. And annoying!

A Cuban In London said...

This is an issue that has always baffled me. As a man who was born in a developing country with free access to healthcare and has relocated to one where there is a good National Health Service (despite the fact that people never waste any chance to knock it and Labour wants to sell it off to the highest bidder) I have always been confused as to why successive governments in the US don't want the best for their people: free healthcare.

Many thanks for your thoughts. Much welcome and a powerful insider's view into a complex problem.

Greetings from London.

steven said...

hi reya, i'm canadian. i was born in england. i've never not known access to healthcare no matter how poor i've been.
perhaps because of that, or simply because there is a quality of rightness about it, i wish for all people the right to quality care for their bodies and minds that is reflective of the most advanced technology and knowledge, and that mines and accesses the depth and wealth of knowledge that has been accumulated outside of the professional medical world.
i hope that america continues to focus on realigning itself with the world that is clearly presenting itself and says a teary and quick goodbye to the one that died a while ago. have a peaceful day. steven

Reya Mellicker said...

Jeninacide - I think there is also a whole area around personal responsibility for health that we avoid. Instead of giving up pizza and other junk food that gives people heartburn, we prescribe drugs to they can continue eating crap without noticing how bad it is for them.

I have a client who drinks 10 cups of coffee a day, then takes 3 different sleep pills in order to sleep at night. When I asked her if she had ever considered giving up the coffee, so she could give up the pills, she replied that she likes her addictions. I had no idea what to say to that! Why didn't her doctor tell her that coffee was the source of her problem instead of prescribing the sleep pills? Weird! Expensive! Stupid!!

Teaching people that exercise, fresh air, good food, and ample rest is the foundation of good health could go a long way towards cleaning up the mess.

I have so many opinions about this, as you can see!!

Barbara Martin said...

Being a Canadian, our health care isn't exactly free. The taxes we pay are higher than our American counterparts. Though wait times can be lengthy for surgery, if it's life threatening the wait is shorter. I had major spinal surgery two years ago to reattach a Harrington Rod, and was fortunate to have it done by the best orthopedic surgeon for spines at one of the best hospitals in Toronto. This was after requesting to my family doctor that I wanted the best to ensure proper surgery and recovery. I had limited medical insurance through work, and the provincial health plan paid for the surgery. As the rod was loose and threatening to pierce the skin at the top of my back my wait was only three months.

Reya, a great post to get the people involved in getting things done. The wheel needs to SQUEAK to get things changed.

Mary Ellen said...

Great post, Reya. I guess I'm an optimist about this situation, though I don't think things will change quickly. I think that at length business leaders in the US will insist on real health care for all (or more) of us because they are not able to compete with countries that have it for their citizen/workers.

CalBuckeye said...

Your Canadian friend says: "You have to be crazy not to want some form of this (ocialized medicine) for at least some of your people."
Well we do have it right here in California, BUT for the illegal Mexicans. My friends (American Citizens) are billed for every charge they incure, even if they are un-insured and must take out loans and the illegals? Hye, come on in, have a baby free of charge compliments of California. And some wonder why our state is banrupt?

Mrsupole said...

CalBuckeye is totally right about it here in California. That is how our system works, illegals get it all for free and we have to pay.

I think that if they want universal healthcare in the US then we should all be entitled to the same kind that the Congressmen and the Senators get. If it is good enough for them, then it should be good enough for us. That is what bugs me about it. That they will have a different kind for their families and then the rest of us Americans will get a different kind. Well I say equal is equal and Universal is Universal. Whatever they get then we should get. That is the best way to make sure that we all get the best. There are not two levels of Americans. The priviledged government Americans and then the rest of us lower class Americans. No we are all equal and I do not want anything unless it is the same as they get. And if what they want to give to us is so great then it should be great enough for them and their families. I am not sure so many people know about this. My brother works for the government and so I know that they will get a different and better kind than we the average citizen. So until we all get the exact same thing then I am totally against this crap they are trying to push on us. Just think about it.

God bless.

Tom said...

you hear horror stories about socialized medicine...but mostly from the Right...you hear horror stories about families denied health care in this country...mostly from the Left...
Being lower middle class I find I have to pay for everything...from health insurance to college bills and everything inbetween...no freebies for me or my kids, no tax breaks no nothing. And just because i have health insurance doesn't mean I don't have to pay for basically everything up to 1500 bucks...for everyone in the family...( people in this country are getting sicker and more and more cannot afford a decent education) Something needs to be done...but what?!!!

Lizzy Frizzfrock said...

Thank you for this post Reya. It is succinct, to the point, right on target, etc, etc.
I love Cynthia's & Ellen's comments and am so happy to see Joanna (a Canadian) chime in on the topic! Why are people so afraid of a universal health care system or socialized medicine or whatever we decide to call it? To me it is just backward thinking or perhaps no thinking.
Many people who are against this type of health care turn to the poor and disenfranchised or immigrants to direct their discontent. I don't know why they can't or won't see that it will help us all.

Steve said...

I despair of ever solving this problem. The fact is, the medical industry -- physicians, hospitals, insurers, pharmaceuticals -- is INCREDIBLY strong in this country. I completely agree we need a fairer, less costly, more accessible system. But I'm not optimistic we're ever going to get it.

Bee said...

I agree about the quagmire aspect, but I hope that the U.S. has reached the point of accepting that the current system HAS to be changed to something more equitable. The lack of health care is always cited when non-Americans criticize our country.

Jennie said...

I have put a great deal of thought into some of the contributing issues that make up some of the causes of our "health care" crisis and impending implosion of the current system.

Part of the problem lies in the direction of personal responsibility, or lack thereof, in managing one's own health.

Part of the problem is that medicine has become an industry, like any other, with the bottom line being profit.

Part of the problem is that insurance companies are making a fortune on refusing to pay for certain care, and some, like medicaid and medicare, reimburse at such a low rate that most physicians avoid primary care altogether.

Part of the problem is that families demand that "everything be done" when often the best choice would be to pull back care.

Part of the problem is that most folks ignore the advice of their physician and do as they please, thus wasting resources, time and money.

Part of the problem is that some doctors are greedy, and our current system makes it very easy to sign on to the greed wagon.

Part of the problem is that technology exists that allows us to do things that shouldn't (and in the past haven't) been allowed by nature to occur, such as keeping folks alive who would otherwise have crossed over.

Part of the problem is that people have begun to view medical care as a right, which is very different from viewing health care as a right.

Part of the problem is that so many folks are being rewarded by this system that there is nothing to make it stop.

And there you have a brief list of a few reasons why all of this is a royal mess.

I know that part of my work is to help be a part of the solution. And for the record, I am a primary care physician who will be working with a mostly medicare and medicaid population.

More later.

lakeviewer said...

Thanks for extending the discussion and focusing the conversation.