For whatever reason, there are a lot of people who seem to believe the negative rumors associated with the national healthcare reforms Congress is trying to bring about with HR3200. Quite simply put, these people are wrong. While it’s true that there are many facets of the current healthcare scenario that are good — the technology available today is simply amazing — the manner in which it is administered is absolutely appalling. For starters, corporate insurance companies, and to a slightly lesser extent pharmaceutical companies, have got us all firmly by the balls. Why is this, and why are people so afraid to let go of a system that doesn’t work, and is only going to get worse? In this case, I think we will have to attribute their extreme anxiety to the same Rovian fear mongers that got us into Iraq and Afghanistan. Yep, Republicans who are stuffed deep into the pockets of corporate interests. Disclaimer: I do not mean to suggest that all Republicans are scuzzy corporate whores, and there are plenty of Dems who are, but there is a very cohesive group of Republicans whose lipstick can be seen smeared on the zipper flaps of many of the worst corporate entities (do I really have to dredge up Enron, Haliburton, or any of that not-so-ancient history?). Like my grizzled editor always tells me, if you want to find the source of a problem, follow the money.
The reason why I think that the most bitter opponents of healthcare reform are off base comes from a variety of sources. Some of it is from what I’ve read and soaked up as one of print media’s ink-stained wretches, but a lot of my view comes from working in the medical field for three years (I was on an ambulance crew for a year and a half, and worked in an emergency room as an EMT for almost two). The real kicker came for me within the last year, when I started dating a girl who is in the midst of filing Chapter Seven bankruptcy paperwork due to a $150,000 medical bill (consequently, two thirds of all bankruptcies are filed because of unmanageable medical bills). Somebody drove her off of a cliff, and after nearly dying from internal bleeding, she was left holding a big bag of debt that has proven too heavy for her to carry.
During my time working on an ambulance crew, and later as a patient care tech in the ER, I found that the industry was largely driven by pharmaceutical and insurance companies which paid little heed to either patient or provider welfare. It was all about bottom line, and this manifested itself far beyond the ER docs griping bitterly every day about the reimbursement so stingily doled out by insurance providers. This scourge showed itself more profoundly in the people who came into our small ER on a daily basis. Because so many people couldn’t afford health insurance, the ER — a place where they by law cannot be refused care — became like a regular doctor’s office. I can’t tell you how many sore throats I saw on the disposition list, and most of them weren’t even strep! Unfortunately for those patients, ER visits are markedly more expensive than going to a primary care doctor. Unfortunately for everyone else, beds that might be needed for real emergencies were otherwise occupied.
Now lets take a moment to go back to those bitching doctors. They had good reason to complain because insurance companies pay them based on how many procedures they perform, not factoring in final patient disposition. The doctors I worked with were always thinking of better ways to see more patients in a day. Granted, an ER should see fast turnover, but fostering a factory-like output of bodies is never a good way for medical providers to make money. At a town hall meeting on healthcare reform that I attended in Santa Barbara last night, Congresswoman Lois Capps (D-CA) called this an archaic, disease-based treatment system. Well, if preventative treatments and doctor visits aren’t covered by health insurance, and if doctors are cranking out patient discharges like Model-T Fords from an assembly line, how is she wrong? Furthermore, many doctors order extra tests that aren’t needed just to avoid being sued for malpractice (the insurance for which is no cheapie, even in California, where legislation has been passed to limit its cost). I can’t tell you how many times our overworked X-ray techs rolled their eyes and frowned blackly at the waste of time (which, of course equates to money for the patient) that was generated in their little corner of the world.
I’m not saying there aren’t people who abuse the system, but it seems to be more because when people get sick, they get scared, and without good education as to what they’re supposed to do with their bodies when they’re not working right, they go to whoever will help. As far as deductibles go, that’s fine for minor visits or the odd sore throat, but preventative maintenance should be not only incentivized, but people should be better educated about it in school. While I understand that insurance companies don’t want to get ripped off, and there are plenty of malingers who malign the system, that doesn’t justify leaving people out in the cold because a few bad eggs are causing a stink. HR3200, with all of the problems its 1,000-pages of legalese is bound to contain, makes sure that everyone gets some kind of coverage from somewhere.
That brings up my next point, which is that in a democratic society — especially one as gargantuan as ours has become — along with the protections that such a monstrosity brings, we are somewhat responsible for those who can’t take care of themselves. The problem with the folks who say that everyone before World War II paid for their own healthcare so we should, too — apparently, this would promote more responsible use of the system and better lifestyle choices — is that they discount the many people who are getting just plain screwed. How would you feel if, God forbid, one of your children caught some terrible disease that put you tens or even hundreds of thousands of dollars in debt because someone said, “Sorry pal, paying for medical care is your fucking problem.” It seems to me that the benefit of buying into our whole society goes by the wayside because you’re not protected from shitty luck.
That very thing did happen to my girlfriend last year. Someone was driving a car, it went off a 400-foot high cliff with her inside, and she would have died had she not been picked up by a helicopter and rushed to the nearest hospital to correct her profuse internal bleeding and other injuries. The driver’s insurance didn’t pay, she couldn’t afford the $400 per month insurance offered by her $27,000 a year job, and she is now staring at multiple collection agencies who want a grand total of $150,000 for medical services rendered. Could anyone, with any seriousness, say that she should have been more responsible, or that her lifestyle choices were the cause of it?
Some opponents of the healthcare reforms proposed on Capitol Hill think that doctors are being paid too much, and that this is a major reason why paying for medical help is so expensive. All I have to say to that is, au contraire, my friends. Primary care doctors — the really important variety of physician that keeps you healthy before you have to be airlifted to New York City for a heart transplant — are going out of business left and right, not only because of the high cost of malpractice insurance, but because they cannot get paid enough by most insurance companies to cover their overhead. We’re seeing it here in Santa Barbara, but this isn’t the center of the earth — it’s happening everywhere. Plus, when you have to go several hundred grand into debt to go to med school, there has to be some kind of return on your investment, or you won’t be too motivated to do it (for example, I recently turned down offers to attend graduate jounalism programs at NYU and USC because I don’t fancy a $100,000 debt in return for a $35,000 a year job). That is why a lot of doctors are going into specialized residencies instead of becoming what’s needed — plain old physicians. The result is an overall medical system that is top-heavy with expensive specialists. Dr. Ned Bentley, a practicing gastroenterologist and the head of the Santa Barbara County Medical Association, said at Capps’ forum that he gets a lot of late stage colon cancer (the second highest producer of cancer-related death) cases that could have been headed off at the pass by regular checkups performed by, guess what…primary care physicians.
While regulating the shit out of everything can be an impractical solution, and government-run health agencies are in fact rife with inefficiency, private insurance companies are horribly inefficient and practically stealing from us to boot. Image paying premiums for years only to have some lawyer find some technicality in your record that allows the company to drop your policy as soon as something bad happens. We need to find some balance point where everyone is taken care of, but everyone is also liable for their actions rather than their luck. Otherwise, we may as well be living the law of the jungle, where the few haves have all, and the rest of us drink the koolaide and think that’s ok.
I don’t have the answers, and doubt that many people do, but I’m hopeful that our policymakers have selected more prudent advisers than during the last presidential era. As American society expands in sheer number of bodies, and hopefully becomes more mature, it would seem logical that we could finally shed the outdated image of the quintessential American as a rugged individualist who takes care of his or her own and expects in turn not to be bothered. That may have worked fine in the days of the old West when there weren’t so many people around, but with today’s throng, we can’t ignore the impacts other people have upon us even if we choose to ignore the people themselves. I’ll keep my fingers crossed that something better gets hashed out in Washington, but until then, I guess I’ll be busy helping my girlfriend with the misery of sorting out bankruptcy proceedings.