September 15, 2009

Why Healthcare Reform Matters

Unless you've been living under a rock or whiling away the summer on some tropical island beach Corona in hand (and if you have been crashing on a beach for three months, please let me know how you pulled that off), you've probably been subjected to the debate over healthcare. You've been bombarded with all kinds of messages, purported facts and politically-driven imagery all trying to help you make up your mind how you should feel. I don't have the magic bullet, the perfect bi-partisan plan that will make everyone feel good about their political careers and the health of their constituents. But something has to be done. Because what I know is this - a country is only as good as the care it renders to its most disadvantaged. And in that respect, the US is woefully inadequate.

Here's what makes me say that. And keep in mind these are cold hard facts, not influenced at all by political bias, though I most certainly have one.

  • During 2007 and 2008 87 million people were uninsured at some point - a week, a month, a year.
  • Nearly 32% of working-age adults and the families they support had a gap in insurance coverage for at least a month between 2006 and 2007.
  • 85% of the individuals who lost coverage during that time were uninsured for at least a month.
  • 17% of you will lose your employer-based coverage during the next two years.
  • Under current policies, an estimated 66 million Americans will have no coverage by 2019.
  • 15% of young adults have one or more chronic condition which will, most likely, be considered a pre-existing condition for which they may be denied coverage.
  • 68% of uninsured individuals receive no medical care when sick, receive no testing of any sort or take necessary prescription drugs.
  • 45 states allow insurance companies to discriminate against individuals based on pre-existing conditions.
  • 12.6 million people - not including the elderly - were denied coverage based on pre-existing conditions over the last three years.
  • Your health care costs are, on average, $341 higher annually to support delivery of healthcare to the uninsured.
  • For every $12 insured individuals spend on healthcare, $1 supports the uninsured.
Whenever I discuss a remotely social or political problem some emails me or comments essentially saying you've talked about the problem but where's your solution? To head those comments off, I'll say this - I'm not a healthcare expert or policy wonk. You don't want me deciding this. Or if you did, you'd pay me more. So, while I have a good handle on the problem, I'm short on solutions. What I do know, I'll reiterate - we're only as good as the care we render to our most disadvantaged.

What's the answer? Is it a government-regulated and managed health plan? We're the only advanced democracy that doesn't manage the health of it's citizens. Or do we subsidize the states or the individuals? Or do we do nothing?

Posted by Chris at September 15, 2009 6:06 AM

I would like to see Healthcare Reform. By this I mean, laws to make the Insurance Companies do what they are supposed to with out their fancy little loop holes. I would like to see reforms so that when Susie has a hang nail and gets it fixed, and suddenly develops an infection, she can't sue the doctor or hospital for 10 bazillion dollars. I would like competition in health insurance. Thus providing people with more affordable options.
I do not want the government running the show. They already do so many things really badly, and I see this as another train wreck.
If they really want to help the people with their healthcare, then man, make some laws, hold the Insurance companies accountable and stay the heck out of the rest of it.
I have a preexisting condition and it is one that the socialized medicine counties will not treat. I am treated now with medication, and I do very well. But how terrible it would be for Nancy Pelosi, Harry Reed or Pres. Obama to tell me, "Sorry, you are too expensive to maintain, so here is your death letter."

Posted by: Maribeth at September 15, 2009 7:43 AM

I totally agree with you that something has to be done about Health Care. But as someone who works with an insurance HMO and a health care provider that is in the top 25 in eight major specialties and provides the only significant indigent care in my region, the current proposals are going to kill my organization.

Where I work, we turn no one away, insurance or not. Yet the cuts we will get from the current reform will make it practically impossible to keep the doors open.

One of the things that really suck is that shifting of funds to provide health insurance to all will prevent many people from getting adequate care.

A long time friend in Holland almost lost his sister to a treatable disease because they could not get an appointment to see a doctor. Large numbers of people there are now getting private insurance on top of Govt health care because they can't see a doctor fast enough otherwise.

I do not like the fact that people don't have health insurance, I have always been scared about when that will happen to me. But I can tell you that unless we look at this differently, we will all lose out because the overall standard of care if you get sick will be less.

When I was getting my medical ethics degree we had a visiting professor that served on the committee in England that determines whether people get "extrodinary" care. He said it was very hard to determine who received treatment or not. It is sad when a committee gets to decide if you get treatment for your disease based on what they think the outcome will be because the government cannot afford to treat everyone.

I don't believe that it is the govts job to manage the health of its citizens because I think I am capable of doing that myself. But I do think we should make it easier for those people who can't get insurance through their employer to be able to do so.

Posted by: goodsnake at September 15, 2009 7:49 AM

I don't have any solutions either but like you agree something needs to change. My oldest son is uninsured right now. He graduated from college but has yet to find a full time job. And when he does there is no guarantee it will offer health benefits.
My mother is one of those crazy right wing nuts and she is completely opposed to any kind of public option (only because that's what shes told by the likes of Limbaugh and Beck)....she cant even see how it could help my brother who has severe heart problems. His employer recently dropped his insurance because it was too expensive for him to pay. SO now my brother has to pay $600/month for health insurance. He is a chef at a small restaurant. he doesn't make a lot of money, this is really hard for him, but yet my mother still refuses to see how a public option could be so beneficial to him. Boggles my mind.

In a kind of related news, check this out:

Posted by: Lisa at September 15, 2009 7:58 AM

To the previous commenter who stated that you are a right wing nut because you listen to Limbaugh or Beck: I have an MBA, a CPA, and several other professional certifications. I am well educated and well informed and I listen to those people just as much as I listen to NPR. Yes, it is sad that people have no insurance or get dropped but it will be even more sad when those people supposedly have health insurance and do not receive treatment because their heart condition is not covered. People with Medicare get denied treatment everyday for things not on the list of approved treatments. Every insurance has a formulary that determines what they will pay for. Just because he has insurance means his condition will be treated.

Insurance is about someone else taking on the risk that you will get sick. There are so risks that are too expensive to take on, government option or not.

I really would appreciate people looking up the "death committees" that existed in the 1970s with renal dialysis because there were not enough machines to provide treatment to everyone who needed it. Committees decided who got treatment and lived, and who did not and died. When a family member of someone with influence got denied, they went to Congress and Congress passed a bill providing Medicare coverage to all people with Kidney Failure.

They could do that because they had the resources to do that, but when it is government paid for health care, there won't be any additional resources to pay for it.

Posted by: goodsnake at September 15, 2009 8:24 AM

I don't know the answer, either, but I know we need to do something. I think we're at the point now where we just need to agree on something imperfect and get it out there. No solution is going to fix everything overnight -- the important thing is to try something.

Posted by: julie at September 15, 2009 8:48 AM

Stop trying to draw me off sides! I had a discussion with a very bright young woman in my office. I told her I'm not necessarily opposed to all the health care stuff, but there are scenarios that play out that make this dang near impossible to resolve. The greed of insurance companies, doctors who don't want to have to hire more people to fill out paperwork, government inadequacy in administering programs, people who will cheat the system. The need is there, no doubt, but the current methods and offices to administer it all, I do not trust.

Posted by: Knot at September 15, 2009 8:53 AM

I don't feel like I have all (any?) of the answers either but I do have opinions, so here goes. Many of my feelings about healthcare have been influenced by the fact that I went many years without insurance in between aging out of my parents' insurance and getting a job that offered coverage. If you have never lived without insurance for any length of time, try it, I can pretty much guarantee that you won't like it. Even if you can afford to go to the doctor without insurance, you have to stop and think about whether or not the visit might reveal some "preexisting condition" that will preclude all future coverage. Talk about a catch-22.

I think that all people who can't get coverage for one reason or another should be placed together in a group and given group coverage. Everyone should be required to carry coverage of some sort or another (you have to have car insurance if you have a car, right? why not require health insurance for all those who have a body?). I think it is criminal for health insurance companies to negotiate rates that are just a fraction of the billed cost for a service. I have to get blood work done twice a year to monitor a health condition. The billed cost is somewhere in the neighborhood of $400, and the insurance company ends up paying about 10% of that. That means that anyone who gets the same blood work who doesn't have insurance will get zapped with a bill that is ten times higher than what my mega-insurance company paid. That's not right either.

I wish someone had an answer that was good for everyone.

Posted by: Elizabeth at September 15, 2009 8:54 AM

I agree that our health care system is woefully inadequate. I think both parties are too busy wanting it their way to see that right now is not the time for bickering or grandstanding. The system is broken, it needs fixed,and they need to find their happy medium now before things get worse. No band aids this time, just fix it without bankrupting the country or missing the people who need the most help.

Posted by: Jeff A at September 15, 2009 9:10 AM


It's a tough nut, and I'm no more qualified to take it on than you. But I have been wracking my brains here, and I think that some solution lies in the use of more AI "doctors" that run through the decision tree logic for diagnosis and assigned treatment, and more telemedics. For the AI "doctors", have call centers where someone can call in, report their symptoms, and be assigned a treatment ( including perscriptions if necessary ) for common ailments ( flu, sprains, etc. ).

For more serious / larger issues, have telemedic clinics setup in the same fashion as the new "speedy" doctor clinics are being setup ( the ones you see in Walmarts and the like ), where a remote doctor or specialist assembly lines through patients using remote touch robotics.

At first, it seems like you are "missing out" because you don't have that personal touch of a doctor. But honestly, when was the last time you dealt with anyone in medicine that they didn't just blow in, spot check you over, and write a script or tell you something like "yeah, eat right, get exercise"?

Finally, for the hardcore need doctor issues, then you're dealing with real doctors ( like people are now ) but the bandwidth should be opened up more because you've offloaded all the "chatter" of the smaller issues.

Posted by: metawizard at September 15, 2009 9:28 AM

The thing is I like my healthcare, I like my doctors and I do not want that to change because someone else doesnt have coverage. I can pay more but do not ask me to change my healthcare for someone else.

Posted by: linda at September 15, 2009 9:29 AM

My husband has cerebral palsy, so has had a pre-existing condition since birth. His current employer will not cover him, so he uses Medicare. He has been denied a cholesterol medication. He has to live off samples from his PCP, after those run out, we will have to pay $2 a pill. He is getting an out patient procedure done tomorrow, and was prescribed a medication to prepare for it. Medicare covered $10, we paid $50. He has an allergy and has to have an Epi-pen on hand at all times. Medicare covers 2 per year, so if he has 3 outbreaks, we are on our own. This is how hard it is for the government to pro IDE care for the people they cover now. Once you add in whatever percentage of the population you believe is uninsured, the government will be in way over its head. The only thing they can do is throw tax money at the problem, which does not help anybody in the long run.
Currently, 400 out of all of the medical school graduates go into gastroenterology. Over half of the practicing doctors in this specialty are over 55. Soon, these doctors will retire, and there will not be enough new ones to take their place. With the current system, we are inching ourselves into socialized medicine without any government assistance. Adolescents aspire to be movie stars and dancers instead of doctors and researchers. The government needs to set up incentives for completing a medical degree without including partisan programs.
I don't know of anyone that says nothing needs to be done, we just disagree about how to accomplish the task at hand.

Posted by: Tess at September 15, 2009 9:29 AM

It BOGGLES MY MIND that a first world country with such a huge population does not have government based health care. It is a right I have taken for granted in the two countries I have lived (Australia and Canada).

I am well enough and well off enough that it hasn't had a huge effect on my life (other than giving birth 4 years ago) and yet I feel strongly about the matter. The reason is because what is going on in the US is WRONG! It reinforces class-ism in its worst form and by extension racism. Private insurance leads to overinflated health care costs and leaves people financially devastated for no reason other than they wanted to be healthy.

It is socially irresponsible to not take care of those in society who need assistance. I'm not talking giving people welfare handouts, but doesn't it make sense that a healthier population would be more able to work and help themselves up? Why is it everyone outside of the US sees this and yet so few Americans see it themselves. Is it the legacy of racism and ignorance in the country you cannot shake?

And then there is education in your country...

Sorry, but for a forwards thinking, cutting edge country, the US sure is BACKWARDS with respect to simple human rights concepts.

Posted by: jacqueline at September 15, 2009 9:52 AM

Great question, great responses and thoughts.
I don't have a solution because I don't see a solution for all the uninsured people.
I've been on both sides - worked for an insurance broker and now am currently a business owner with group insurance for my husband and ee and have individual ins. for me and my son because the group plan is too expensive to add us to it!
I PERSONALLY think insurance companies are money hungry bastards. I think the reform needs to start right there.
Reading the Medicare subscriber issues, does make me wonder if the government can handle it but then we've dealt with my father's medicare, have never had an issue (he's in the hospital about once every year and a half) but his medicare supplement costs a small child's arm and leg.
As someone else said, even if it's imperfect, let's do something.

Posted by: NancyJ at September 15, 2009 10:31 AM

WOW! What a hot topic. I have not discussed this with anyone. And while I value everyone's opinion and love this blog, I will continue to not discuss this.

I know, I know. I am not sticking my head in the sand. I just have not formed my complete opinion. I can see a lot of sides of this issue, and I have not yet drawn a conclusion as to where I personally stand.

Have a great day! Thanks for the mind thought, on a Tuesday no less, Chris.

Posted by: debb at September 15, 2009 11:40 AM

I think the insurance industry (and the pharmaceutical industry, but that's another post) needs to be heavily regulated. They should not be able to deny anyone coverage for any reason. There needs to be an option available for EVERYONE. Not an option we can choose if we have the money to pay for it. Because I'm sorry, unless insurance is $1 a month, there are still going to be a lot of people who can't afford that. Lack of income or lack of a livable income should not determine ones access to health. I've had a lot of people tell me in the past year that we should just go to the ER for the various stuff we've been dealing with in our household because they can't refuse treatment. But they won't hesitate to charge us thousands of dollars we don't have anyway.

I am pro universal health care. I would not mind having Sweden's system or even the NHS. I think before we can achieve that though, our government itself is going to have to see some reform. It has, under various administrations, run Medicare, Medicaid, and Social Security into the ground. Ideally, if we had national coverage, we wouldn't even need the designations of Medicare and Medicaid. We would all be receiving the same amount and quality of care. It's just ridiculous that our infant mortality rate is as high as some third world countries' while a country like Sweden boasts an incredibly low infant mortality rate.

Posted by: Sparkle Pants at September 15, 2009 12:25 PM

I agree with you. I have NO solutions, but I know something has to be done. And soon.

I've never had insurance. My parents haven't ever really had it (maybe they did before I was born- who knows what was going on then). Whenever we've been sick, it's an ultimate battle. Do we go? Can we pay? What if it's bad? As if, not going and not knowing it was bad was going to cure what it is. I know many people in the same predicament.

My dad has a hernia that needs surgery. Except it would cost thousands of dollars, and he'd possibly need it again, because these things can undo themselves. So for the past seven, eight years, he's just... had a hernia. And gone to work. And he does landscaping. Pretty physical stuff. And there's no end in sight, because as I understand it, even if he were to go to try and get insurance, he already HAS the hernia, so they would be jerks about it? I don't fully understand, but I know it sucks.

Posted by: caleal at September 15, 2009 12:32 PM

I am a few of those statistics. I had no insurance for 3 months in 06, after I was laid off, could not afford COBRA, and was waiting for my new health care to kick in. Lather, rinse, repeat same exact thing in 07. Fun times, fun times.

I also have a "pre-existing" condition. Actually, three of them. I have a medical eye condition that is so severe that my medical insurance - through my employer - required that I get a rider for my eyes. Stating that I acknowledge that they won't cover it. I have severely thinning retinas, and have a very, very real, very, very high risk of my retina detaching and requiring immediate surgery. Should that happen - I'll be paying for that out of my pocket. And if the retinal opthamologist doesn't agree to small payments paid over time, that $20,000 surgery, plus the associated costs, will hurt me in a bad, bad way.

I have tons of ideas on solutions - but - no one listens.

Posted by: Mindy at September 15, 2009 1:18 PM

sweet baby jesus you just got some opinionated books to read in your comments section. i don't have the answers either. at this point, i'll take what i can get from this administration because i see some good things coming from even the very littlest reform (michael pollan recently wrote a great oped in the NYT). but something just doesn't sit well with me regarding making it a right that everyone have access to INSURANCE. i'd rather hear that it become a right that everyone just have access to CARE... but that kind of makes me sound like a SOCIALIST or something...

Posted by: kati at September 15, 2009 1:45 PM

I am the parent of a special needs child. When he began recieving benefits for his disability, I was amazed at the healthcare coverage that we began to recieve as a supplement to our regular health insurance. It was far better than the coverage that we pay to recieve. So I ask this, why could I not pay my premiums to a government managed plan. One that puts my children's health at a higher ranking in importance than some fat cat executive's profit margins. No one should ever be denied care while some executive is siphoning off the money that should be paying for a child's chemo. Leaving our health in the hands of businessmen is just ignorant and dangerous. And what about all the other government managed systems that we use happily? Our roads. Our schools (yes, not perfect, but we're working on that, too). Our state and national parks. I'm ready to trust our government with this. Far more than I will ever trust an insurance company.

Posted by: Sara at September 15, 2009 2:37 PM

I wish that I had the answers, but in my humble opinion SOMETHING MUST change and be done. People should not be dying while our HMOs fight over their care. This happens way too often with all kinds of treatments.

People here in the USA are fearful of change and the government getting involved. They whine and complain of the medical system in Europe and Canada. But, if you watch BBC News or documentaries on the subject and listen to their citizens--the vast majority love their system. Why, because it is affordable and your covered.

I see the day where even the well off can't afford health insurance and I feel that day is coming sooner than later. Our monthly expenditures just to maintain our healthcare have skyrocketed over the past few years.

I'm the mother of a special needs child with a disability. I am worried sick what is going to happen to him when he can't be covered under our plan and is an adult as he has pre-existing conditions with his disability and asthma. Will he be covered and under what capacity?

Posted by: One Mom's Opinion at September 15, 2009 3:14 PM

Our healthcare in the UK isn't perfect but at least when we need to fight the system we only need to fight on care grounds, we don't need to fight just to pay for it.

When I was a kid reading Judy Blume and Paula Danziger books I didn't understand why people had to pay when they went to the drs. My mum explained an extremely simplified version of insurance and how it worked in the USA. It wasn't so long ago that I still naively believed you all pay fair insurance premiums and get equal treatment when you need it.

Posted by: Katherine at September 15, 2009 3:47 PM

I have my strong opinions. They are based on the following facts:
I went for over 10 years with no insurance EVEN though I could pay for it. I was denied for several pre-existing conditions.
My brother had good health insurance. He got brain cancer in 2007. He was bankrupted by the treatments not covered. He was denied brain rehabilitation by his insurance company. He has no short term memory and has a diminished capacity to take care of himself. With brain rehab he might gain back some of his capacity to function in society.
Here is a great article delineating a similar problem for Nikki White's family: She died because she was too ill to work and therefore lost her insurance coverage. She died at age 32 of a treatable illness.

Now my opinion.
I think it's morally indefensible for insurance companies to use rescission to drop ill people who have done nothing except get sick. I think it's morally wrong to tell someone that they can't go to the doctor if they are ill because they can't afford it. I think talking about "cheats and lazy people who just don't work hard enough" is cheap talk from people who have never lived on a daily basis with no access to insurance coverage and are therefore priced out of having any access to medical care at all. When people choose to die rather than bankrupt themselves for medical care for TREATABLE DISEASES it makes me sick and so sad.
When we shrug off the working poor and others who the insurance companies have deemed unfit for care, we as a people are saying that we've decided it's OK for certain people to die. We are in effect becoming that "committee" that people rail against.
If you are fine with that, so be it. I'm not.

Posted by: tulip at September 15, 2009 6:58 PM

Wow, these comments are interesting, and frightening at the same time.

I'm Canadian and our system is far from perfect -- in fact, there is a shortage of family physicians and our hospitals are over crowded. Demographics are partially to blame (bad planning and politics I suspect is the rest.) The other issue we are facing is that there are many seniors and people with chronic conditions who can't live at home and need long term care but there aren't the spots. If we gave out death letters, I'm 90 per cent sure we wouldn't be having this problem.

If you look up some of the issues Canada faced in putting in place universal health care in the 1960s, you'd see many of the same arguments, you are having now.

I'm not sure I understand this correctly, but there is medicaid for those on welfare. The people most affected by this are the working poor. Those folks working two minimum wage just to make ends meet, who work hard, but don't have coverage at work. Strikes me that maybe, these are the folks you want to support...

Posted by: Nat at September 15, 2009 7:16 PM

I've lived in Canada all my life, and all my non-Canadian relatives live in Europe (mostly the Netherlands). I can understand why there is debate about *how* to implement universal health care, but I am still boggled that you don't have it yet. Sure, the Canadian system sucks on a lot of fronts, but at least we have a system set up that we can complain about and work on fixing.

I don't envy the Americans having to go through this for a moment, but it does have to be done. Health is not something to be run for profit.

Posted by: Kat at September 15, 2009 9:37 PM

Man, there are alot of great comments and ideas here! SO here's what I've learned:
-Health care in America sucks.
-Health care in other countries also sucks.
-The people in other countries dont necessarily like what they have, but they take some strange pride in the fact that they have something, and they dont seem all that interested in improving it.
-Americans are trying not to go broke while they hope for a system that might actually work.

Am I on track here? Okay, I kid... but seriously, what if we got rid of insurance companies altogether? I'll bet healthcare prices drop pretty fast when they stop getting customers.

I can't wait to see Dr's offices with huge inflatable hearts outside of them with a big SALE banner across the front...

Posted by: scott at September 16, 2009 2:34 AM

I have a pretty good health plan. We took our kid to the doctors for a regular check up. We waitied an hour and half past the time of our appointment. The doctor said "Sorry you had to wait." That was it. Sorry.

The doctor knows that even with my pretty good health plan, it would take a very long time for me to change my primary doctor to soemone else because I was mad that they made me wait. There is no competition. Competition is what drives prices down. This is where I think they need to focus on changeing the health care.

I do not think the fed should do it though, I think it should be left to the individual states. Many Dems and Libs (hell lots of people) that I know are against standardized testing in school because it is unfair to students due to every one's various back grounds and demographics.

I also think it is unfair to standardize health care.

Posted by: William at September 16, 2009 8:15 AM