The debate rages on. President Obama is scheduled to address the nation and both Houses of Congress next Wednesday evening. Debate continues among neighbors on my street. Earlier this week Tish and I listened to speakers at a rally at the local university. There was an article in this week’s edition of Newsweek (September 7) offering detailed explanations of the five biggest misconceptions about healthcare reform. These are “You’ll have no choice in what health benefits you receive;” “No chemo for older patients;” “Illegal immigrants will get free health insurance;” “Death panels will decide who lives:” and “The government will set doctors’ wages.” Note that NONE of these assertions are true.
Unfortunately nearly all of the debate concerns not how healthcare is actually delivered. Instead most of the debate centers on issues related to how healthcare is to be paid for – a single payer system, private insurance by for-(mega)-profits, competition between government and non-government plans, or any number of sometimes odd mixtures of private insurance, public insurance, and proposed co-operatives. How our care gets paid for is truly important for it has many implications about who is eligible, who gets left behind, what conditions and treatments are covered, how many citizens go bankrupt due to medical bills, as well as the general health of the citizenry, an issue with national security implications.
But in all this we hear little about reform relating to how care will be delivered, how costs (heading for 22% of GDP) can be better managed, and how we might improve the country’s general health. As noted last week among industrialized nations, the U.S. spends more than any other nation, have the shortest life expectancy, the highest infant mortality rate, the highest obesity rate, and rising incidence of some cancers, diabetes, and heart disease in women.
Typical readers of this blog have all had experiences like long waits in the emergency room, waits getting admitted to the floor, answering the same innumerable questions each time we visit a doctor or hospital and sometimes several times to several individuals during a single visit. We have gone to specialists who order tests that we know we have already had performed. In hospitals we have to guard against being given the wrong medicine or the wrong dose. We have had to wait to have our call lights answered because of overworked staff.
There is a nursing shortage that will get worse as we baby boomers continue to age. Something that I noticed when I practiced nursing – a significant number of experienced nurses traded their nursing uniforms and long, difficult hours at the bedside for a chance to wear nice street clothes, work nine-to-five, no weekends and predictable lunch breaks working for insurance companies, reviewing charts and pressuring physicians to discharge patients. There are a lot of insurance companies and each needs its own “utilization review” nurses. That’s a lot of nurses not contributing to people’s health but rather, by extension, contributing to insurance company profits.
In the dentist office last week I came across a March issue of Time magazine whose cover featured an article “So You Think You’re Insured – Think Again”. A Time staffer wrote about her brother’s medical problems. He had a $2500 deductible so he avoided going to see a doctor for months for mild but unusual symptoms. After his primary care physician was unable to discover the cause, the man again put off going to see a high-priced specialist. He was in medical debt $14,000 before he even had a diagnosis. Then his insurance company, to whom he faithfully paid monthly premiums, decided that his life-threatening condition wasn’t covered. The author cited a 2005 Harvard study of more than 1700 bankruptcies. Researchers found that medical problems were behind half of them – and three-quarters of those bankrupt people actually had health insurance. As Elizabeth Warren, a Harvard Law professor who helped conduct the study, wrote in the Washington Post, “Nobody’s safe … A comfortable middle-class lifestyle? Good education? Decent job? No safeguards there. Most of the medically bankrupt were middle-class homeowners who had been to college and had responsible jobs — until illness struck.”
I have had two bouts of leukemia, a bone marrow transplant, and a variety of treatment related health problems over the past four years. I am now in fair health and am even starting to believe I may be cured of this hellish disease. I have something new to worry about. As I continue to live and to age, if I do become ill again with the same or even a different disease, could be coverage be capped off. It is hard to say how much has been spent on my health in the past seven years. My bill for the drug that saved my life, Campath, alone approaches $200,000. All those weeks in hospital, all those transfusions, CT scans, biopsies, and hundreds of blood tests probably puts my total on the near side of a million dollars. How much is a life worth? I don’t know. But all that was worth it to me, worth it to Tish, and to my children and grandchildren.
Some balk at the estimated $600 to $900 billion dollars. Why was there not the same level of complaint at the $1 trillion we have spent on fighting in Iraq? Why is there always money for wars and never enough for healthcare or education?
As I said last week, I have a more global view of healthcare system. I have seen the good, the bad, and the excellent in a score of countries. And again, I don’t pretend to have the answers. No single person does. The issues surrounding the delivery of quality care to 300 million Americans are enormously complex, nearly as complex as the human body of which we have just a partial and imperfect understanding.
If doesn’t take a genius to see that we have major problems with our current healthcare system. But not having all the answers is no excuse not to actively participate in this debate, to study the issues and proposals with critical and inquisitive minds, to write to our Senators and Congressmen, and to demand the best plan that they can devise, that gives the best outcomes to the greatest number of citizens at a cost our country can afford.
Are You Underinsured?
Twenty-five million Americans pay for health insurance but have inadequate coverage. There’s no magic formula for figuring out how much coverage is enough, but here are a few pitfalls to avoid:
•High deductibles. A 2007 Commonwealth Fund report found that 25% of the underinsured pay annual deductibles of $1,000 or more, a red flag for scant coverage.
•Caps or omission of services. Read your plan to check for limits on drug coverage or per-day hospital fees, which may leave you with bulging health-care bills.
•Temporary or short-term policies. Buying into these plans may disqualify you from comprehensive long-term coverage later, especially if you have a pre-existing condition.
•Serial short-term policies. Each successive policy you purchase treats you as a new beneficiary, so changes in your health may later be considered a pre-existing condition.