This is the second ramble in a series of two about health care. The first ramble (Ramble #18: Health Care – What’s the Problem?) focuses on the reason why health care reform is necessary and the dangers of inaction. This ramble (Ramble #19: Health Care – What’s the Solution?) focuses on the current Obama proposals and examines other successful foreign health care solutions. My goal with this second ramble is to examine some fundamental philosophical ideas about health care reform and introduce specific ideas being considered by our government.
Alright, so the underlying question that will govern this entire thought process is the following:
“Should the child of a gas station attendant have the same chance of staying healthy or getting cured, if sick, as the child of a corporate executive?”
This was a question posed by Princeton University professor Uwe Reinhardt, one of the nation’s leading authorities on health care economics. Professor Reinhardt has said that people need to determine if medical care should be like public education – where every American simply has a right to it – or if it should be treated like a luxury good. He says that currently health care is like fine dining; if you have the money, you get it, and if you don’t, you won’t. Professor Reinhardt goes on to compare health care with the government response to natural disasters. For example if a hurricane or flood were to strike some American city. “That’s social insurance,” he says. “It’s a natural disaster, and I would say if a lady in Mississippi has breast cancer, isn’t that a natural disaster, too?”
The job of a nation’s government is to protect its people. As it states in the Declaration of Independence:
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
That is why we pay taxes. We have our government provide us with many socialized services, such as the police department, public libraries, and the fire department. So why should health care be any different?
Now, let me pause here and explain a very crucial point, before some of you may label me as an advocate for so-called “socialized medicine”, or a “public option.” The role of the government is not necessarily to provide health care through some social program, but it should at the very least assure that its citizens (all of its tax paying citizens) have access to affordable health care. I’m in no way supporting big government, only responsible government.
It’s time for those opponents of health care reform to wake up and notice that the right to Life, one of those very dear unalienable rights stated above, is being taken away by these health insurance companies. As I stated in the first health care ramble: According to a recent estimate by the Urban Institute, lack of health insurance leads to approximately 27,000 preventable deaths in America each year.[1] This should be unacceptable for our government. As a nation we need to stand up and declare our right to Life.
Ok, so let’s talk about those nearly 50 million people without insurance. Let’s first state some facts about this figure. It originated from a survey done by the U.S. Census Bureau. Actually, the figure they came up with was approximately 47 million. It should be noted that even they think that number is a little high. Also, this figure did not differentiate between citizens and illegal immigrants; it only counted “residents” of the nation. According to the National Coalition on Health Care, or NCHC, there are 46 million uninsured, where the “large majority” or 80%, are native or naturalized citizens. This means that 20%, or 9.2 million of these people are illegal immigrants. To be absolutely clear, some estimates are as high as 12 million uninsured illegal immigrants. Make no mistake about it, I believe only people that pay taxes should be able to benefit from government programs, or any form of health care reform (but this is neither the time nor place for a discussion on illegal immigration). So for all intents and purposes, let’s assume the number of uninsured Americans, is really more like 35 million. President Obama and Congress have routinely made it clear that illegal immigrants would not be covered in some sort of a public plan (the practical way in which that would be implemented and enforced is unclear).
While on the topic of a so-called public option, let’s examine some details behind that. The overall idea of health care reform is to increase competition in the markets, thereby lowering health care costs, including premiums. As I pointed out in the first ramble on health care, currently there are monopolies forming. These are dangers in capitalism because there is no longer any “invisible hand” that will keep prices affordable for consumers. Health insurance companies know they’re pretty much your only option, so you’ll pay whatever they tell you to pay.
This idea to reintroduce competition into the health insurance market is one of the reasons behind Obama’s idea of a public option. The plan is to create a national health insurance exchange consisting of several private companies along with a government run public option. Since the government option would be able to avoid costs like property taxes and other regulatory fees, as well as have lower administrative costs, it would be able offer very low prices. This in theory would force the private insurers to lower premiums in order to stay competitive. Well that sounds all well and good, but there are some problems with it too.
One common argument against the public option is that since its costs would be so low, private insurance companies won’t be able to compete and will be driven out of business. The idea is that private companies can’t compete with government run services. One example to counter this often given by Obama is the comparison of health care to the shipping industry. FedEx and UPS are private shipping services and compete with the government run shipping service known as the post office. Now, he does seem to have a valid point that the two private companies are certainly able to compete against the government run service, but the ironic part is that he will often also add that not only can they compete, but the post office is in real trouble lately. Perhaps this comparison would be more convincing if he just left off that last point.
The fact is, however, the post office isn’t doing too well, and this is a valid concern for those opponents of the public option. There is another common example given, however, by those who advocate a public option. Take for example, public and private schools. Neither are running the other out of business, but instead there is an equilibrium reached from the following reason: speaking very generally, public education as a whole tends to be thought of as sub-par, whereas private education may be better, but you have to pay a lot more for it. Basically, you get what you pay for.
The examples on each side (the possibility that private companies may run government run services such as the post office out of business, or the possibility that an equilibrium can be reached as in the education system) don’t really lead me to believe one way or another that the public option will run private companies out of business, or the public option won’t be able to create competition and lower prices. To me, it seems like there’s no way of knowing for sure what will happen, unless it is actually implemented.
That being said, however, the fact is government programs are not always well run. If government were to be involved in health care, chances are there would be a lot of people falling through the cracks. Chances are the government would have to ration care. That is, the government would have to tell you which procedures would be covered under their plan. Now, this shouldn’t be terribly shocking news, since in reality that is what health insurance companies are doing now anyway. The question is would you prefer a private insurance company making mistakes and rationing care, or the government. From that standpoint, there really is no difference. The difference comes in principle. The idea that the government is doing something like this instead of private companies, as should be expected in a capitalist society, is a legitimate concern. With a public option, the government would get significantly more power over its citizens.
Ok, well you could be thinking if you don’t want the government to have that control over you and your health, then don’t join the public option. This is a point that Obama makes quite frequently. He says that if you like your health insurance, you can keep it, which is only partially true. If you receive private individual insurance, that’s absolutely true (unless of course your health insurance company goes out of business). However, if you receive employer provided health insurance through a group plan, you don’t really have a say in whether or not your company decides to switch insurers. So you would then be forced to partake in the public option. You would be forced to put the government in control of your health. You would be at the mercy of a government run program, and as is evident with the post office along with countless others, they don’t generally have a good track record for success.
I believe this is the main legitimate problem educated opponents against the public option could voice. They don’t want government to interfere with their lives. You may or may not agree with that, but it is a legitimate point. The kinds of things being spit out to the media by people like Sarah Palin and Rush Limbaugh are not quite as legitimate. It was Palin who had coined the term “death panel” in an effort to incite public fear against Obama’s proposal. One thing in the proposed bill (the infamous 1,000+ page bathroom reader) that could even give such connotations would be an included provision for end-of-life counseling. The provision would provide Medicare coverage for an end-of-life consultation every five years, and more frequent sessions if a person is suffering a life-threatening disease. Health providers would be required to explain to seniors the end-of-life services available, including “palliative care and hospice.” Palliative care is a medical specialty focused on relief of pain, stress and other debilitating symptoms. It can be delivered at the same time as treatment that is meant to cure you. Hospice care is similar because it delivers the same pain relief, but is focused on terminally-ill patients (patients who no longer seek treatments to cure them and who are expected to live for about six months or less). So-called “end-of-life” counseling is nothing to be afraid of; it is not euthanasia; it is not mercy killing or anything of that nature. In fact it is a provision that is provided in most private insurance plans as well. End-of-life counseling is far from a “death panel.”
Perhaps what Palin was referring to with that term wasn’t that provision, but perhaps it was the necessity to ration care. The fact is the government will have to determine what they will pay for and what they won’t (plastic surgery, in general, shouldn’t be covered for example). Health insurance companies ration care. It is necessary. The difference between what health insurance companies do and what the government would hopefully do is quite simple: most insurance companies will ration care to make a profit, whereas the government will ration care to keep people from taking advantage of the system. So this idea of “death panels” – the idea that Obama will decide who lives and who dies; the idea that Obama will go around the country killing grandmas – is utterly preposterous. It’s comments like that which inhibit necessary health care reform. There are legitimate concerns with a public option, so focus on those instead of just fear mongering.
Actually, it’s because of those legitimate concerns that I personally wouldn’t want to see a public option. The idea behind it – the theory of making competition – is a good one, but there are just too many risks involved, not the least of which is creating a bigger government.
Luckily, the public option is not the only option for health care reform! As Obama has said, that only accounts for a small sliver of the reform necessary for this country’s health care system. But what are the other options?
Well, let’s back up and look at the overall goal of health care reform once again. I believe it is the role of a responsible government to not necessarily provide health care, but to make it accessible and affordable to all of its citizens. So if a government-run public system is out, then one obvious answer would be to simply have more regulation. The government won’t provide you care, but it will keep strict laws against these insurance companies in order to ensure that its citizens get fair treatment. The Health Insurance Portability and Accountability Act, or HIPAA, was passed in 1997 and was a giant step forward toward regulation. As I mentioned in the previous ramble, it allowed people with pre-existing conditions to get at least some access to insurance. Without that, cancer survivors, people born with multiple sclerosis, diabetics, and the like would not be able to get insurance at all. That was necessary regulation, and provided access to health insurance to a huge amount of people.
Another form of regulation that I would like to see passed is something to stop health insurance companies from dropping patients from their coverage. If you’ve been paying money for a certain insurance policy for nearly 20 years, for example, then you suddenly get seriously ill with cancer or something similar, it should be illegal for that insurance company to drop you just because they don’t want to pay the bills. Otherwise, what’s the point of even having insurance?
Other necessary regulation that should be put into effect would be to bust up some of these health insurance monopolies that are forming. With only a couple main choices in this country, these companies can charge whatever they want and Americans have to shovel out the money. In contrast to introducing a public option, this is almost certainly guaranteed to create competition and lower premiums.
Finally, something has to be done about health care costs in general. I’m not talking about health insurance companies price gouging; I’m talking about pharmaceutical companies overcharging, unnecessary tests done by doctors, hospital costs, etc. Now, I’m no expert in this area, and I’m not even sure what can be done to combat against these things. The thing is, something has to be done. Health care is placing a large unnecessary financial burden on every American family and the country as a whole (meaning programs like Medicare and Medicaid).
For those of you against big government regulating big business, I understand your concern with these proposed regulations. However, health insurance is fundamentally different than just about any other business in this country. Health care is a necessity. It is really the only life or death necessity that we must buy. Regulation on an electronic store, for example, is ridiculous. The government shouldn’t step in and regulate prices on 50 inch wall mounted plasma screen 1080p HDTVs. Things like that are a luxury, whereas health care is a necessity.
Alright, but there is at least one other promising option other than government-run public health insurance or just regulation. It’s something called a health insurance cooperative (or co-op for short). Basically a whole bunch of people get together and become their own insurance providers. They establish contracts with doctors and hospitals and they set the rates and determine who can join. The only difference is the government isn’t in control. According to Timothy Jost, a law professor at Washington and Lee University who has written extensively on health care policy, including the feasibility of establishing health insurance co-ops has said the following, “the basic idea behind any nonprofit co-op is that a whole bunch of consumers get together and produce something that might not be produced or would be underproduced.”[2] Co-ops have been in existence in several industries throughout the United States, especially in rural areas. There are things like electric co-ops, farm co-ops, dairy co-ops, etc. In fact, this concept has actually been applied to health insurance in the past as well. In the 1930s and 40s, the Farm Security Administration had sponsored one in the Midwest which had insured 600,000 people.[3] The support of the FSA was withdrawn, however, in 1947 and the co-op collapsed. Two insurers have survived: Group Health Cooperative of Washington and Health Partners in Minnesota. The main problem with health insurance co-ops is getting started. As Jost said, “you need to establish a brand identity, figure out how to handle claims, develop actuarial expertise, establish reserves, and meet state licensing requirements and solvency requirements.”[4] Health insurance is very local and the market is very difficult to break into. Just trying to get a few businessmen together to start a co-op to compete with Aetna or Cigna is not going to happen. The key is going to be government involvement in the start-up. The U.S. government has a brand identity and can setup an extensive and inclusive network. In order for it to be a co-op, however, once the network is setup, then there should be no more government involvement.
In principle it’s a very good idea. It has all the positives of the public plan such as, it would give health insurance access to millions of Americans and it could possibly drive down premiums in the private sector due to low administrative costs and a non-profit model. It avoids one large negative: government-run health care; in fact, it is based on the same principle as democracy as whole: the people are in charge.
Let me preface this next section by saying the following: I love this country and I truly believe we have the best form of government on earth. It allows for freedom, human rights, and free enterprise. I believe in capitalism. Ok, with that out of the way, let’s compare our current system with those of foreign countries. In general we as Americans tend to have a different way of looking at things than the rest of the world. To be blunt, we tend to look out for ourselves. I think the main reason why we haven’t implemented some form of so-called “universal health care” is that we don’t want to put tax money towards a system where it would pay for someone else’s health care. We don’t have a very strong “love your neighbor” attitude. But what we fail to realize is that someday (whether you’re insured or uninsured) the system will probably benefit you as well. In fact, it could even potentially save your life. It really comes down to that all too popular, yet surprisingly appropriate, question of: What Would Jesus Do? Would Jesus approve of our current health care model where insurance companies are out for profit while dropping coverage to those with expensive medical bills and denying coverage to those with pre-existing conditions? Not to say a totally government-run health insurance program is the best policy, but if one is to be implemented, we as a country would have to get past our current look-out-for-ourselves mentality.
When comparing our health care system to those of other industrialized countries, it seems like we’re in the Stone Age. Every other industrialized country (France, Sweden, Germany, United Kingdom, Russia, Canada, etc) pays for a higher percent of health care spending than the U.S.
Here’s some data for these countries which can be found on cnn.com:
United States
Percent of health spending paid for by government:
45.8%
Government health spending per capita:
$3074.0
Total health spending per capita:
$6714.0
Infant mortality rate (per 1,000 births):
7.0
Life expectancy at birth:
78.0
Canada
70.4%
$2754.0
$3912.0
5.0
81.0
France
79.7%
$3233.0
$4056.0
4.0
Sweden
81.2%
$3143.0
$3870.0
3.0
The U.S. system is the costliest system in the world, yet we have a lower life expectancy and a higher infant mortality rate than countries like Sweden whose government pays nearly half the amount of money as the U.S. on total health spending per capita. Now, there are definitely some flaws to foreign systems. One thing you might hear a lot in the news is that in Canada, due to their universal health care coverage, cancer is found faster in patients than in the U.S., however, there is a higher cancer survival rate in the U.S. Why is that? Because in Canada, you have to get in line to get treated. There are other drawbacks to the Canadian system as well. Such as the fact that you can’t pick your own doctors and you need a referral to see a specialist. For any type of health issue you must first see a general physician, and then they will refer you to another doctor and make the appointments if necessary. It should also be noted that something like 10% of every Canadian’s income goes to pay for their costly health spending per capita, second only to the U.S.
Ok, there are flaws to any system. If you’re looking to make a perfect system with 100% coverage and 100% satisfaction, you’re dreaming. It won’t happen. A public option is not necessarily the best option, but certainly isn’t the only option. The fact remains that we need drastic health care reform, and we need it now. But, like I said before, I love this country. I believe it’s the best country on earth, and in the past when we’ve been faced with difficult problems, we’ve been able to come up with creative solutions. We don’t have to simply mimic some foreign health insurance program. We can learn from their examples and mistakes. We can come up with a uniquely American solution. I know we can.
“…where we are met with cynicism, and doubt, and those who tell us that we can’t, we will respond with that timeless creed that sums up the spirit of a people: Yes We Can.”
-Barack Obama, Election Night 2008.
I encourage you to take another few minutes to review some of these true stories from real Americans about this health care crisis that can be found on BarackObama.com (http://stories.barackobama.com/healthcare/). The following specifically encapsulate positive experiences by Americans in foreign countries.
Jerry from Plainview, TX
My husband and I were visiting with a foreign exchange student in Sweden that we had sponsored several years ago. My husband had to be transported to the hospital via ambulance at about 1am. The ambulance arrived within 10 minutes after asking if they needed to be there sooner. The EMTs were professional and competent. My husband was taken straight to an examining room. His fever was 104 and rising. His care was thorough and comprehensive. He was in a private room within an hour and being given further diagnostic exams within two hours. Medication was started and all ended well. They used his driver’s license for identification and only asked diagnostic health questions. When we left we did not get a bill. What he did get was an arm band with his Swedish medical social security number on it that can now be used if he needs medical help in Sweden in the future. My husband happens to be a physician and was more impressed than I could have ever expected with the level of expertise, speed, and quality of care extended to us. It is so sad that we cannot find a way to not only return the favor someday to strangers but to our fellow Americans.
(http://stories.barackobama.com/healthcare/stories/189614)
Margaret from Cowpens, SC
Dear Mr. President, the main reason I decided to remain in Germany after serving and completing my enlistment in the USAF was the excellent health care system here. Sad and pitiful, isn’t it… that I would CHOOSE to stay in a foreign country and obtain a German residency/working permit rather than return to my own country because of the lack of health care services and astronomical costs of medical insurance. I have a son who is diagnosed with hydrocephalus, CP, and has various physical and mental disabilities… so for me, this decision was a no-brainer. PLEASE PLEASE fix the US health care system! While the German social health care system is far from perfect, it is ten-fold better than the current US model. I would love to return home to the US one day and not have to worry about whether or not I can afford medical coverage for my child. Until that happens though, I will remain here in Germany.
(http://stories.barackobama.com/healthcare/stories/187650)
[1] Health Care Horror Stories. (http://www.nytimes.com/2008/04/11/opinion/11krugman.html?_r=1)
[2] So What’s a Health Insurance Co-op, Anyway? (http://prescriptions.blogs.nytimes.com/2009/08/17/so-whats-a-health-insurance-coop-anyway/?hpw)
[3] So What’s a Health Insurance Co-op, Anyway? (http://prescriptions.blogs.nytimes.com/2009/08/17/so-whats-a-health-insurance-coop-anyway/?hpw)
[4] So What’s a Health Insurance Co-op, Anyway? (http://prescriptions.blogs.nytimes.com/2009/08/17/so-whats-a-health-insurance-coop-anyway/?hpw)
Since this seems to be the hot topic as of late, I think it makes the most sense to focus some time writing my own opinions on this matter. This topic represents the first time that I have to split up what I have to say into two separate rambles in order to keep reasonable lengths of entries. This is the first ramble (Ramble #18: Health Care – What’s the Problem?) and it focuses on the reason why health care reform is necessary and the dangers of inaction. My goal with this ramble is to unite the two apparently divided groups into one common belief that something must be done. The second ramble (Ramble #19: Health Care – What’s the Solution?) focuses on the current Obama proposals and examines other successful foreign health care solutions.
The fact is simple: health care in this country is broken, so for those of you with the “if it ain’t broke, don’t fix it” mentality, guess what? IT IS BROKE! I believe that is a fact that transcends party lines; it is a fact that should be accepted by both democrats and republicans because it affects them equally. This is not a partisan issue. This is an American issue.
There are several reasons for this broken system, such as (1) health care in this country is monopolized by a few health insurance companies whose primary motive is to make a profit, (2) most health insurance companies deny applicants with pre-existing conditions, (3) the uninsured in this country receive less care than the insured, and (4) the rising cost of health care is beginning to get out of control and places an unnecessary financial burden on every American family as well as the country as a whole.
The main reason why health care is broken is the following: health insurance companies are just that, companies. They are in it for a profit, period. They don’t really care about your well-being. As long as you keep writing them a check, they’re happy. This is fundamentally wrong. Something as important as health care should not be profit driven. These health insurance companies take advantage of people all the time because of this. They’ll happily take your money no questions asked as long as you’re healthy, but as soon as you get sick with some catastrophic illness such as cancer, paralysis, or the like, and the bills start getting too expensive, they’ll drop you.
This should not be acceptable behavior, otherwise what is the point of having health insurance in the first place? You pay a premium with the peace of mind that some day when you get sick, you’ll be covered – but then it doesn’t happen. This “kick the sick” policy of health insurance companies is beyond disgraceful; it is dishonest and inhumane. With no action from the government these practices will continue unchecked into the future for as long as the companies know they can get away with it.
There is also significant reason for monopoly fears in health care. Data from the American Medical Association (AMA) shows that in 43 states, a handful of top insurers have gained such a stronghold that their markets are considered “highly concentrated” under Department of Justice guidelines, often far exceeding the thresholds that trigger antitrust concerns. 95% of the 294 metropolitan markets studied were above the “high” concentration mark (a score of 1,800 or higher on the Herfindahl-Hirschman Index, or HHI). 67% were nearly twice the value considered as “high” (they scored a 3,000 on the HHI). According to the AMA, there have been more than 400 mergers among health care insurers in the past decade.[1] Health care giants such as UnitedHealth Group and WellPoint represent the two largest carriers in the nation, and in 2008 they were numbers 25 and 33, respectively, on the Fortune 500 ranking of U.S. companies.[2] Health care is big business and big profits. The CEO of UnitedHealth personally earned more than $90 million in 2003 and more than $120 million in 2004 in salary and incentives.[3] As of the end of the second quarter of 2009, UnitedHealth said net earnings were $859 million – a 155% increase from $337 million a year earlier.[4] Health insurance companies are no different than other big businesses in this country.
Think health insurance companies aren’t profit driven? Linda Peeno, a doctor whose shocking testimony stunned Congress in 1996, is a former medical director for a large health maintenance organization (HMO). In her testimony, Linda said, “In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this because, in fact, what I did was I saved a company a half a million dollars for this.” She went on to say that her denial earned her a reputation as a “good medical director” and helped her career. She went from making a few hundred dollars a week as a medical reviewer to a six-figure income as a physician executive. “In all my work, I had one primary duty, and that was to use my medical expertise for the financial benefit of the organization for which I worked,” she said. “I know how managed care maims and kills patients, and I’m haunted by the thousands of pieces of paper on which I have written that deadly word: denied.”[5]
Another huge (and very personal for me) reason why I strongly believe in health care reform is that many health insurance companies will not insure people with pre-existing conditions. There’s just too much risk that they won’t make a profit from them. The reason why this is personal for me is because of my back injury. The way things stand right now, I am a 21 year old male, non-smoker, with no life threatening illnesses, but because of my previous injury, I’m more prone to injure my back again in the future, and these health insurance companies know this. So if I do get coverage, then my premiums will likely match this “no-profit risk.” This idea of denying pre-existing conditions is especially repugnant when insurance companies refuse to insure cancer survivors or things of that nature. One stride towards combating against the injustice of “pre-existing conditions” was made on July 1, 1997 when the Health Insurance Portability and Accountability Act, or HIPAA, was passed. Basically this states that in group insurance policies, this exclusion is not allowed. Since there are more people involved in group polices, health insurance companies can afford to cover pre-existing conditions because there is a good chance they’ll make up the difference elsewhere in the group. For example, if a company offers health insurance to its employees, within that group there are going to be people who are healthier than average and will take less money out of the system, and there will be people who are less healthy than average. All in all, insurance companies view group policies as less risky. There is a catch, however. With a pre-existing condition, even in a group policy, there is something called a pre-existing exclusion period, which thanks to HIPAA is a maximum of 12 months. That is, if you have a pre-existing condition in a group policy, for the first 12 months of your coverage you cannot receive any payment for any medication or other treatment of your condition (this is still ridiculous for cancer survivors since they have to wait a year to receive financial help with their medication if the cancer were to come out of remission). The fact that pre-existing conditions can be insured at all is only really relevant to group insurance policies, however. Since with an individual, there are no other people that may be healthier than that one person (as in a group policy), insurance companies view them as a higher risk. HIPAA rules only govern group policies, not individual ones.[6]
With all that said, however, there is yet another catch! Not really surprising since these health insurance companies are all trying to make money. When an insurance plan does not officially label a certain condition as a pre-existing condition but essentially treats it like one, it’s known as a “hidden pre-existing condition exclusion”. Under HIPAA regulations, they are not permitted in group plans, but they still could occur in individual plans. That’s the point. The fact is, with our current health care system, people with a pre-existing condition are denied health insurance coverage. Plain and simple.
Ok, those are just some ways even people with insurance in this country stand to benefit from health care reform. These are major problems with our current health care system, and I haven’t even mentioned the nearly 50 million Americans that aren’t insured. Until now.
As George W. Bush famously said, “I mean, people have access to health care in America. After all, you just go to an emergency room.” While this is technically true, practically speaking, it is far from acceptable. If a terribly sick person who was a few minutes from death’s door came stumbling in the emergency room, say from a gunshot wound or perhaps a debilitating seizure they suffered a few hours earlier, then they will (generally) get treated. That’s just part of the Hippocratic Oath taken by medical staff. I did add a parenthetical “generally” because of the following story of Dawnelle Keyes and her 18-month-old daughter Michelle.
On May 6, 1993 Michelle became very ill. She was vomiting, had diarrhea and was having trouble breathing and a very high temperature. Michelle’s mother, Dawnelle, called an ambulance, which took her to the nearest emergency room at Martin Luther King Jr. Medical Center in Los Angeles. The doctors believed she probably had a bacterial infection, which could be treated with antibiotics. But he didn’t conduct a simple blood culture or treat her with antibiotics because her health plan, Kaiser, told him not to. You see, Martin Luther King hospital was not a Kaiser facility. Kaiser said the simple test and treatment had to be done in a Kaiser hospital. But Michelle became sicker and sicker. She became lethargic and unresponsive. Dawnelle pleaded to them. She pleaded for her daughter’s treatment. And no one would give her antibiotics. Over two hours later Michelle had a seizure. Only an hour after that Michelle was transferred by ambulance to Kaiser. Within 15 minutes of arriving, she died.[7]
There are problems with the line of thinking that emergency room care is sufficient.
First of all, regular care will identify and treat health problems before they become severe enough for emergency room care; more than 40% of uninsured adults have no source of regular care.
Second, people will often postpone medical care even when they know they need it due to the expense.
And finally, even though emergency rooms will treat anyone that comes in with an acute health problem, they will bill the patient afterwards. Anyone who’s ever been in an emergency room knows that by just walking through the doors and waiting for someone to see you can cost a couple hundred dollars (and that’s before the outrageous costs of medicine or other procedures).
Overall, there’s no two ways about it: uninsured people receive a lot less care than insured people. And in some cases, this lack of care kills them. According to a recent estimate by the Urban Institute, lack of health insurance leads to approximately 27,000 preventable deaths in America each year, just like that of Michelle Keyes.[8]
If you think this can’t happen to you, you’re wrong. If you think that since you’re covered by your employer’s health insurance, everything will be ok, you’re wrong. Let me paint a perfectly plausible picture for you amidst these hard economic times. Your company that you work for has been making some cutbacks recently; they’ve been letting quite a few people go. You go to work hoping that today isn’t your last day. Your boss walks towards your desk and gives you some good news and some bad news. The good news: today isn’t your last day. The bad news: Friday is. Well, now what? No more job. No more health insurance. Guess what? You’ve suddenly become a part of those nearly 50 million uninsured Americans. Well now you had better go find another job, and fast. What’s that? The effects of this bad economy have doomed you yet again? Turns out that after a few weeks you can’t find a job. Well, a few weeks turns into a few months, which turns into a year… or more. And now, guess what? Oh, come on, I bet you can guess. You get sick. But I’m not talking about just the common cold. No, I’m talking seriously ill. After a few months of not feeling all too well, perhaps even dizzy or maybe you’ve even passed out once or twice, you finally decide that the blood you just coughed up is the last straw before you stop putting off going to a doctor because you are afraid of the outrageous bill (remember, you have no health insurance). Turns out you’ve just been diagnosed with cancer. Now what do you do? What can you do? You had better do something to help pay for these enormous health care costs looming in the shadows. Chemotherapy itself can cost anywhere between $30,000 to $60,000 (or higher), and when it is partnered with necessary cancer drugs that can cost upwards of $100,000 (rising at a rate of 15% each year) the bills start to add up. Did you try getting some loans? A second mortgage? Oh, by the way, I hope your credit is good enough for all this too (because if it isn’t, well looks like your only option is bankruptcy). By all of these methods, including eventually selling your house and significantly downsizing, you are somehow able to come up with the money for all the necessary treatments. After a two year long battle with cancer, you miraculously come up with a clean bill of health; the cancer seems to be in remission. Now you can finally move on with your life… err, wait… now you have a pre-existing condition, right? Oh, so sorry, turns out you’re not going to be able to find anyone willing to insure you, and if you do, you’ll be paying through the roof in premium costs.
Perhaps there are still some of you out there thinking: yeah, that can’t happen to me. First of all, my company is doing really well right now, in fact. I’m in no danger of being laid off from my job. Secondly, I take extremely good care of my health. I get regular check-ups; I wear sunscreen so I have a decreased risk of skin cancer; I don’t smoke, so I have a decreased risk of lung cancer; I watch my cholesterol, I have an impeccably healthy diet, I exercise regularly, so my risk of heart disease is next to nothing; I have no family history of any life threatening diseases. I am a 100% perfectly healthy individual.
Ok, so you wake up one Tuesday morning, eat your Total for breakfast (now with extra fiber!), perhaps even go for a morning run (only 10 miles today, you’re feeling a little lazy). You get to work only to find out that your boss has been involved in some international conspiracy and has laundered all of the company’s money to over-seas bank accounts, and your company will officially be in bankruptcy within a week. Guess what? No more job. No more health insurance. Now, being the perfectly healthy individual you are, you’re not too worried. After months of searching for a new job, you’re driving to a very promising interview and while going through a green light, BAM, you get hit by a semi-truck who ran a red light. You wake up in the hospital and after first wondering how it could be possible to have so many tubes and sensors connected to your body, you are then informed of the 12 emergency surgeries that have already been done just to stabilize you and the 7 more necessary to repair other internal injuries, not to mention the combined 16 reconstructive surgeries necessary for your arm and your face. If you only had health insurance!! Of course, of those 9 reconstructive surgeries on your face, only 3 of them would have been covered by any ordinary health insurance anyway because the rest would be considered cosmetic surgery (you don’t need to have two front teeth, right?).
Although I’ve been somewhat lighthearted throughout these last few stories, in all seriousness, my point is: it can happen to you. It can happen to me. It can happen to ANYone. There are countless ways you can lose your job (and therefore health insurance) through no fault of your own. There are countless ways you can end up with astronomical medical bills, even if you’re perfectly healthy. This can happen. This does happen. It happens to the uninsured and the insured alike. It happens everyday in America. But it doesn’t have to end so badly. What if you didn’t have to get a second or third mortgage? What if you didn’t have to sell your house? What if you didn’t have to declare bankruptcy? Think that doesn’t happen? Medical bills are the number one cause of bankruptcy in the United States. I highly encourage you to read an article that can be found on consumeraffairs.com (http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html). For those of you not so compelled, here is the gist. In 2001, Harvard Medical School conducted research on this topic and arrived at the following results:
Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001.
UPDATE: In 2007, medical bills caused 60% of personal bankruptcies.
Medical bankruptcies affect nearly 2 million Americans annually (counting debtors and their dependents, including about 700,000 children).
Most of those bankrupted by illness had health insurance (more than three-quarters were insured at the start of the bankrupting illness. 38% had lost coverage at least temporarily by the time they filed for bankruptcy).
Most of the medical bankruptcy filers were middle class (56% owned a home and the same number had attended college)
In many cases, illness forced breadwinners to take time off from work, losing income and job-based health insurance precisely when families needed it most.
30% of families in bankruptcy had a utility cut off and 61% went without needed medical care.
Dr. David Himmelstein, the lead author of the study and an Associate Professor of Medicine at Harvard commented: “Unless you’re Bill Gates you’re just one serious illness away from bankruptcy. Most of the medically bankrupt were average Americans who happened to get sick.”
“The paradox is that the costliest health system in the world performs so poorly. We waste one-third of every health care dollar on insurance bureaucracy and profits while two million people go bankrupt annually and we leave 45 million uninsured” said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.[9]
Not only is the American health care system the most expensive in the world, but it is ranked #37 as a health system by the World Health Organization.[10] Health care costs in this country are absolutely astounding. On average, treatment for a brain tumor costs $200,000. A stroke - $140,000. Leukemia can cost up to $600,000. According to the National Coalition on Health Care, these are some facts on the cost of health insurance and health care:
In 2008, total national health expenditures were expected to rise 6.9% - two times the rate of inflation. Total spending was $2.4 Trillion in 2007, or $7,900 per person. Total health care spending represented 17% of the gross domestic product (GDP).
U.S. health care spending is expected to increase at similar levels for the next decade reaching $4.3 Trillion in 2017, or 20% of GDP.
Health care spending is 4.3 times the amount spent on national defense.
Although nearly 46 million Americans are uninsured, the United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens.
Health care spending accounted for 10.9% of the GDP in Switzerland, 10.7% in Germany, 9.7% in Canada, and 9.5% in France, according to the Organization for Economic Cooperation and Development.[11]
The overall message here is simple: the American health care system is broken. Badly. Health care costs are rising many times faster than inflation and employee paychecks, yet we still have nearly 50 million uninsured Americans having to make the choice between a house and health. This broken system affects everyone. Every single American. Whether you are uninsured or insured. Everybody everywhere in this country should be protesting in the streets FOR health care reform. These people at town hall meetings across the country have every right to voice their opinion against certain aspects of the Obama proposal. But hopefully they realize that inaction is not an option. Something must be done. And it must be done soon. The question is what are we going to do?
I encourage you to take another few minutes to review some of these true stories from real Americans about this health care crisis. Below are summaries of just some of the stories that can be found on BarackObama.com (http://stories.barackobama.com/healthcare/). To read the full stories, follow the links provided at the end of each summary.
Allena from California
Last summer Allena was mauled by a bear suffering injuries to her face. She was able to make it to a hospital where she received a grueling 7-hour emergency surgery, but because most of her injuries were to her eyes and facial structure, her surgeries were deemed cosmetic by her insurance company and demands a 30% co-pay before they will pay for the $300,000 bill for reconstructive surgeries. (http://stories.barackobama.com/healthcare/stories/189195)
Linda from Bainbridge, MD
She lost her job through no fault of her own and shortly after was diagnosed with cancer. She could have easily borrowed what ever money she needed, but she was denied treatment purely because she didn’t have insurance. Now she’s stuck paying huge premiums because of her pre-existing condition. (http://stories.barackobama.com/healthcare/stories/186744)
Kimberly from Memphis, TN
One morning while taking her dog on a walk, she fell face first onto the street after tripping on a tree root while chasing after her dog. She was taken to a hospital, but didn’t have insurance. After 5 hours of no treatment (and not even getting the dirt rinsed out of her wounds) she left the ER. Soon after, she received a bill for $13,000 for doing hardly anything except x-rays. (http://stories.barackobama.com/healthcare/stories/73299)
Bryce from San Jose, CA
Bryce and his wife have a health plan under Cigna and recently discovered his wife is pregnant. Turns out that a baby is not covered in their plan leaving them with literally thousands in medical bills. When they looked for other health care options, they found that no one else would insure them because his wife’s pregnancy is a “pre-existing condition.” (http://stories.barackobama.com/healthcare/stories/29624)
[1] Health insurers build up market clout: New evidence raises fears that local monopolies forming. April 17, 2006. (http://www.marketwatch.com/story/study-confirms-health-monopoly-fears?pagenumber=1)
[2] http://wiki.answers.com/Q/What_are_the_largest_health_insurance_companies_in_the_US
[3] Have We Become Insurers’ Enemies? (http://physician-assistant.advanceweb.com/Editorial/Content/Editorial.aspx?CC=81403)
[4] UnitedHealth profit soars 155%. (http://www.startribune.com/business/51360167.html)
[5] Sick in America: It Can Happen to You. (http://www.oprah.com/slideshow/oprahshow/slideshow1_ss_health_284/11)
[6] Pre-existing conditions exclusions. (http://health.howstuffworks.com/pre-existing-condition1.htm)
[7] “Sicko” Interviewees Tell Harrowing First-Hand Stories of U.S. Health Care Failures. June 14, 2007. (http://www.democracynow.org/2007/6/14/sicko_interviewees_tell_harrowing_first_hand)
[8] Health Care Horror Stories. (http://www.nytimes.com/2008/04/11/opinion/11krugman.html?_r=1)
[9] Facts about healthcare – health insurance costs. (http://www.nchc.org/facts/cost.shtml)
[10] World Health Organization Assesses The World’s Health Systems, June 21, 2000. (http://www.who.int/inf-pr-2000/en/pr2000-44.html)
[11] Facts about healthcare – health insurance costs. (http://www.nchc.org/facts/cost.shtml)
One thing that has been on my mind over the past year or so is this: what is the measure of a man? What exactly does it take to become a man? Does age play a role? Is it just experience? Or maybe there’s something else.
Age must play some role in the measure of a man. Evidence of this lies in the age restrictions we have in place in our society. At the age of 16, it is legal to drive. At 18, you can go to war, get married, go to college, and are considered, for all legal intents and purposes, to be an adult; you don’t need your parents’ signatures or written permission for many things. At 21, you can legally consume alcohol. At 25, you can rent a car. At 35, you can run for President of the United States. There are several age restrictions in this country, but why? I suppose there is at least one irrefutable biological reason for one age restriction. The adolescent brain is still developing until the age of 21, thus the reason for the limitation on alcohol. The reasoning behind the other restrictions is something much more subjective. Lawmakers must be under the assumption that maturity comes with age; that an 18 year old is automatically more mature than a 15 year old; that an 18 year old can automatically make better decisions than a 15 year old. In general, there may be some merit to that solely based on the amount of life experience accrued over time, but don’t the age restrictions seem arbitrary? Perhaps an 18 year old, in general, is more mature than a 15 year old, but why is it ok for an 18 year old to die for his country and not a 15 year old? Is there really a single defining age where things just click? Maybe on the exact day of our 16th birthday, our “driving gene” suddenly kicks in and we’re instantly able to drive. At 18, maybe we’re suddenly able to get married and go to college on our own, but not yet able to drink responsibly for some reason. And at 25 you must be an excellent driver. The day you turn 35, you must have acquired all possible life experience necessary to run a country.
Although there are many, somewhat arbitrary, legal age restrictions, what about becoming a man? Is there a certain age for that as well when things just click? In the Jewish culture, a male is given a Bar Mitzvah when he is 13 and from then on is considered a man and given the responsibilities thereof. So is it possible to become a man before you can even drive?
Certainly it is absurd to think that on the morning of some random day exactly a certain number of years from our birth, we instantly acquire knowledge that was absent before 12 am. Age cannot be the driving force behind the measure of a man, but it is correlated with a much better gauge: life experience. In general, as people age, they acquire more wisdom from experience and life lessons. That is not the case for everyone, however. In scientific studies it is important to recognize the difference between correlation and causation. Just because life experience and age are correlated, doesn’t mean that age causes life experience. There are many 15 year olds that would be considered by most to be more mature than many 18 year olds. Unfortunately the best objective measure of life experience gathered is how many years you have spent on this earth. That’s why lawmakers have to rely on age, which can be a very inaccurate gauge.
So life experience and age are correlated and they seem to be a necessary requirement to become a man, but there must be something more.
Can a male in his 30s and picks pockets be considered a man? Maybe not. Can a male in his 40s, who has learned many life lessons, and just killed a person be considered a man? Probably not. Can a male in his 50s, who has learned many life lessons and has five decades of life experience, and beats his wife be considered a man?
Absolutely not.
So what is the missing element for the measure of a man? There are many interesting quotes that can be found by a simple google search that might help to explain this absent component.
“The measure of a man is what he does with power.”
- Plato
“The true measure of a man is how he treats someone who can do him absolutely no good.”
- Ann Landers
“The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.”
- Martin Luther King, Jr.
“The measure of a man is the way he bears up under misfortune.”
- Plutarch
“The measure of a man’s real character is what he would do if he knew he would never be found out.”
- Thomas Babington Macaulay
“If there be any truer measure of a man than by what he does, it must be by what he gives.”
- Robert South
“I would say that the surest measure of a man’s or woman’s maturity is the harmony, style, joy, and dignity he creates in his marriage, and the pleasure and inspiration he provides for his spouse.”
- Benjamin Spock
Clearly, there must be some moral component required to truly be considered a man; a component that doesn’t just automatically happen with life experience. You have to want it to happen; there must be an internal driving force, instilled by some powerful factor (law, religion, parents, etc.), that makes it very difficult to act immorally. This is probably the most important part of the measure of a man. For example, of the following two examples, which would you consider to be a man? The first is a young male, age 12, whose father left him, his mother, and his three younger sisters when he was only 5 years old. His mother has to work double shifts in order to just put food on the table and so this young male must raise his siblings. The second is the boy’s father.
A true man must be able to shoulder overwhelming burdens. A true man must be able to provide for his family. A true man must be able to overcome adversity. These are traits that cannot necessarily be taught, but they can be learned. You cannot teach a boy to overcome adversity, but through life experience (and as long as he has that internal driving force), he can learn methods to do so. So that is how this all ties together. Just as age was life experience in disguise, life experience is really moral strength in disguise. You gather life experience as you age, and you gather moral strength through life experience. What it comes down to, then, is not how many years you have been alive, or how many experiences you have had. What really matters is how you react to, and what you learn from, those experiences. That is the true measure of a man.
