Health care. Because dying is not that great.

23 11 2009

Now that I’ve addressed the media, education and childhood, I figure it’s time to whomp something out regarding health care. Conveniently, I have some recent, relevant experience with the current state of health care that might inform the debate a little. Or not. But I’m going to discuss it anyway.

Early in 2006, Massachusetts hammered out a state law requiring every resident – even college students – to have some form of health insurance. At the time, proponents declared it would save taxpayers huge amounts of money in the long run and provide everyone with access to quality, needed health care. Opponents retorted it would increase government control, add to the ugly spectre of socialism, and stifle innovation and enterprise. Largely, these are the same views echoed in the debate over health care reform on a national scale.

It’s really too soon to tell, with any certainty, who was right or wrong about what, and how right or wrong they were. I don’t pretend to have data of that scale or focus. What I can offer is some good, old-fashioned anecdotal evidence, and a dash of what us Yankees like to call “common sense.”

I have completed a journey through the new, statewide, universal health care system, knuckling under to the law that threatens to swipe my tax refunds if I don’t. Not that I expect to see much refund, but I try to land on the friendly side of the law wherever possible, so I dutifully showed up at appointed dates and times, confirmed my lack of private insurance, my lack of access to private insurance, and offered up some pretty basic evidence. I gave my name and address, shared my DOB and SSN (all information the state already has,) and submitted the necessary paperwork. In this case, all they were after was a proof of income (easy enough, and also already known to the IRS) and proof of citizenship (birth certificate. Again, freely available from the town where I was born).

I went to my doctor’s appointments, had my maladies treated and tests examined, all without demand for payment or promise of payment. I filled out my forms and waited. A few weeks later I received a notice in the mail. I did not, in fact, qualify for the state’s standard, top-tier insurance plan because as, wretched as I am in the grand scheme of things, I actually needed a great deal more wretchedness to qualify. This was both disappointing, to know that I was not close enough to the bottom to  qualify for something, and heartening, to know that things could be worse.

I did, the letter informed me, qualify for a different program for people truly wretched, but not quite on their last legs (I’m on my second-to-last legs). The plan provided me with a full range of health care options, access to many doctors at hospitals and health clinics, a prescription plan, access to specialists, even extras like discounts on health club memberships, classes about diabetes, help to quit smoking, etc. All of this provided at a cost, not that most people can afford, but that I can afford. Actually taking into account my real-world ability to pay. I’ll stay covered under this plan until my income places me out of it, or until I get access to other insurance (like through an employer).

As a result, I will see my doctor if I get sick and it doesn’t go away on it’s own. I will continue to get medications and tests I need to stay healthy. I will not need to wait until a problem becomes a costly emergency. Apart from my own welfare and well-being, I will actually cost society less and contribute more.

So far, the system works. For people unable to pay for the plan I’m enrolled in, there is another tier that is available at zero cost. That’s right. Free. No premiums, no-copays, no costs for medications, no bills at all. Granted, the criteria for that plan requires a dire situation, and the bill is footed completely by we, the general, tax-paying public. But I can’t imagine there are many people who would WANT to be the situation it calls for. Even fewer who are able to scam the system very well for very long. And compared with the number of people this helps? This is a no-brainer.

I can’t see how expanding this to a national system is anything less than a no-brainer. Sure there will be problems. And sure, there will be costs. But what else are we going to spend it on? Another war? More subsidies and tax breaks to grow and build things we don’t need? Another pittance refund check in the spring? I’m not saying I don’t care about the (enormous) cost of this effort. But I do wonder aloud “how much more will it cost us, in dollars and in quality of life, if we don’t do this?” “What do we have to spend it on that’s better?”

Keep people healthy, keep people safe, give them enough to eat, and you’ll find they’re willing to do quite a lot for you. Educate them well, and they’ll go one step further and start doing things for themselves AND for you. Food, health, education, safety. This is one of the four cornerstones, and I see no reason to ignore it because it’s going to cost something.

I’m open to suggestions. Anyone who can show me a viable way to get everyone insurance, cut down on the costs, and realistically pay for it has got my attention. Two caveats, though: Please do not suggest tax cuts and incentives to private providers.

Incentives are like pouring water into a sinking boat, in the hopes that the weight of the water will squeeze it out the holes in the bottom. Health care and insurance cost too much, partly because of the providers themselves, and paying the people who are overcharging us so they’ll overcharge us less is an obviously stupid idea to anyone old enough to count with both hands. So forget “incentives.” The system has no desire to cut costs because that also cuts profits. If the system was willing to reign itself in, it would have done so long ago of its own accord.

Tax cuts are like using Tylenol to treat a broken leg. It will make us feel a little better, but the leg is still broken and we’re still gonna die if it’s not treated. I’m all for cutting taxes, to a point. I like my money, and I’d like to keep more of it. But, dear elected officials, you don’t charge me enough in taxes to pay for the care I need and everything else you’re supposed to provide. Give me back $12,000 a year in taxes and I can pay for my own health care. Mind you, then the fire department will have to take a credit card number before saving my house, the police will need an account in good standing to patrol my street, and you’ll pester me about joining the state militia to protect our borders. Pointless. But I’ll have total control over my private health care, for which I will pay not what’s fair, not what I can afford, but “what the market will bear.”

Take, for example, a $200 stimulus refund check. Do I like getting my money back? Sure. Would I enjoy an extra $200? Yes. Did it make any lasting difference at all in the economy? Not a bit. Because $200 will not fix my problems. $200 will not get me a month ahead on my bills, fix the brakes on my car, pay for my uninsured ER visit (easily a few thousand dollars without tests) or pay my credit card bills down (average outstanding credit card debt for American households that have a credit card was $10,679 at the end of 2008). And as our elected officials learned, when faced with disappearing jobs, shrinking income, rising housing costs, rising food costs, soaring fuel costs, soaring health care costs and rising credit and bank fees, if we get $200—or even $600—we’re going to save it, not go buy a new purse or a digital camera. Even $600 each, while a big help, is useful mostly for our personal economies. While reducing debt and increasing savings are good long-term strategies, neither will kick start the largest economy on earth, and the money is not enough to make a lasting difference, even individually. I liked the $600, but in the end the projected $152 billion cost for 2008 of the whole plan might have been better spent.

Health care costs too much. We all have a personal responsibility to help provide for ourselves, but much like credit, the current system is stacked in favor of those who already have it, and against those who need to get it. Communism and socialism are not the only alternatives. We do not all have the right to champagne, luxury cars and 4,000 oil-heated square feet. We do all have the right to food, shelter, safety, education and having injuries and illnesses treated and—where reasonably possible—prevented. We can do a lot to level the playing field without privatizing business and without redistributing wealth. Making health insurance, and as a result, health care, accessible and affordable—actually affordable, not just slightly cheaper—is a great way to start.




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