Thursday, September 27, 2007

September 27, 2007 - Looking Goliath in the Eye

I realize I’ve been writing a lot, recently, about the health-care funding debate in this country, but that’s partly been because of the long gaps between medical appointments that lead to lots of “slow news days” with respect to my own health situation. (By the way, there’s going to be a further delay before I hear from the Tumor Board at Hackensack University Medical Center; they’d like me to travel up there next Thursday for a consultation with a Dr. Feldman, a member of the Lymphoma Department, before the Tumor Board makes their decision.)

I was concerned about the plight of the uninsured even before I got sick, but the ever-growing flood of window envelopes pouring through my mailbox has led me to feel even greater compassion for those who keep getting hit with budget-busting medical bills and have no way to pay them. Furthermore, my prior experiences of living in England and Scotland have given me a generally favorable opinion of single-payer, national health programs. I’m convinced that most of the tiresome screed decrying “socialized medicine” that we Americans hear so often is pure invention, promulgated by panicky people with no firsthand experience of how well the European and Canadian systems actually work for most citizens.

So, there it is. My cards are on the table. I believe our health-care funding system has become so bloated and dysfunctional that it's beyond any kind of tinkering. It needs to be rebuilt from the ground up. (Please note that I'm talking about our health-care funding system – the creaky, complex medical-insurance system that puts the needs of stockholders above those of policyholders, and wastes billions of dollars on pointless paper-pushing that could otherwise be spent on patient care. Against all odds, we still somehow have a health-care system we can be proud of - or, at least, that the insured among us can be proud of. The quality of care available to most insured Americans is still among the highest in the world – as is also true of national-health-insurance countries like Britain, France and Canada, that also manage the feat of caring for all their citizenry.)

Given that presupposition of mine, it will come as no surprise to hear that I was terrifically impressed by a recent essay by journalist Barbara Ehrenreich. She's written some interesting things in the past: most notably a provocative book, Nickel and Dimed: On (Not) Getting By in America (Holt, 2002). In that book, she chronicled her experiences working for several months at a time at minimum-wage jobs, trying to live on that salary alone. She had to work two jobs, seven days a week, and still nearly ended up in a homeless shelter. Her conclusion? In our economy, minimum wage is not a living wage – not even close.

In a September 20th blog entry, We Have Seen the Enemy – And Sur- rendered, Ehrenreich suggests that one of the most fearsome enemies the American people are facing today is the multi-billion-dollar medical-insurance industry. So cowed are all the presidential candidates by the bare-knuckle power of this industry (with the sole exception, she says, of the rarely-heeded Dennis Kucinich), that no one has come close to suggesting total, paradigm-busting reform, along the lines of universal health care. The most any of them are suggesting is baby steps.

Big Insurance is a mammoth industry indeed. Citing economist Paul Krugman, Ehrenreich points out that this industry employs "two to three million people just to turn down claims."

Our spiraling medical bills are not only paying all those pointless salaries ("pointless" because they benefit stockholders at the expense of policyholders). They're also indirectly funding both sides of an ongoing, ever-escalating war between doctors and insurers. The insurers get tougher, rejecting more claims. The doctors employ specialized office workers to circumvent the insurers' rejections. The insurers respond in kind, continually increasing their workforce of abominable no-men (and women). And on and on. Caught in the crossfire, uninsured and under-insured patients become "collateral damage."

Unlike other industries, which grow by producing more, the way the medical-insurance industry garners profits is exceedingly odd. It grows by turning potential customers away:

"The private health insurance industry is not big because it relentlessly seeks out new customers. Unlike any other industry, this one grows by rejecting customers. No matter how shabby you look, Cartier, Lexus, or Nordstrom's will happily take your money. Not Aetna. If you have a prior conviction – excuse me, a pre-existing condition – it doesn't want your business. Private health insurance is only for people who aren't likely to ever get sick. In fact, why call it ‘insurance,' which normally embodies the notion of risk-sharing? This is extortion.

Think of the damage. An estimated 18,000 Americans die every year because they can't afford or can't qualify for health insurance. That's the 9/11 carnage multiplied by three - every year. Not to mention all the people who are stuck in jobs they hate because they don't dare lose their current insurance.

Saddam Hussein never killed 18,000 Americans or anything close; nor did the U.S.S.R. Yet we faced down those ‘enemies' with huge patriotic bluster, vast military expenditures, and, in the case of Saddam, armed intervention. So why does the U.S. soil its pants and cower in fear when confronted with the insurance industry?"

I'd encourage you to take a look at the entire essay. If nothing else, it will give you something to think about.


Julie Orvis Marcinkiewicz said...

Glad to see you bringing the topic up again, Carl. As I mentioned in a previous post to your blog, I saw this issue from the prespective as a licensed insurance sales agent in Massachusetts. Believe me it's a racket! and the sales people can make a lot of money on this, which seems like a waste of the consumer's money to me along with all the advertising dollars that go into advertizing health plans (and pharmaceuticals).

As I think about it, I believe we would be better off if we thought about it "health care finance" because we would see it as something necessary, even inevitable, like obtaining shelter or education. No, we call it insurance - to be thought of like car or homeowners insurances. Individually, accidents are not inevitable, house fires are not inevitable. Even floods in many cases (unless your on a river bank or sea shore) are not inevitable. Communally all these occurances are inevitable. Some people will have accidents, house fires and floods and the effects are devastating. It's important to protect our assets against these occurances. Healthcare, on other hand, is inevitable. We will get sick and need to see a doctor. We will need to see the doctor even we don't get sick, in order make sure that catch ailments early when easier to treat or even preventable (as in the case of some heart disease and adult diabetes). Granted some will get sicker that others but as country sharing in that cost, with single-payer system, seems so much more efficient than having average family cost for health insurance be $900-$1600/month (or $10,000 to $19,000 annually). Whether I pay individually or my employer pays for, that is to much. Every other week, when I see my payroll deduction for this ($280) it burns me up! Between me and Historic Deerfield, it comes to wopping $1100/month for plan to cover Paul and me! Would the comparable taxes to cover the same thing be as much? I seriously doubt it.

The argument against national health care seems to be that we would loose choice and quality of care. Who really has choice now with restriction the HMOs put on their customers? Or if you have choice, there is limitation on the amount of coverage, so real choice comes out of your pocket in either case.

Health insurance creates a whole layers of costs that seem unnecessary - from commissions to the sales force and marketing cost to paying stockholders in case of for profit insurance companies.

I have heard of studies that show medicare gets more the dollar spent than any of insurance companies. Why aren't we learning from this?

On another point, you talk about insurance companies making money while denying people coverage. In Massachusetts (and Washington) we have a "gauranteed issue" state, meaning no insurance company can deny any one for any reason, as long as they willing to pay the premium. (Definitely a good idea if you are relying on insurance to pay for health care) A lot of insurance companies left Mass when that came into effect in '97 (good riddance) but how do companies get around it now? The use of managed care first of all or in the case of the company I sold for - limiting coverage to higher end ailments. For instance - expensive drugs for chronic ailments, or medical "equipment" were not covered. For instance, the company would cover the surgery (up to the limits of the policy) for a pacemaker or articfical knee but wouldn't pay for the hardware. Also there are lifetime limits or limits per visit. For instance $1000/day for chemo. I always wondered if that was enough.

I could go on and on and thankfully I'm out of it.

Carlos ("Carl") said...

I'm glad to see, Julie, that I'm not the only one who's got some passion about this issue!

In "Sicko," Michael Moore makes the interesting argument that we happily let the government run urban fire departments, and no one goes around screaming like Chicken Little that this is "socialized firefighting." Ben Franklin started the first of these socialized fire departments back in Colonial days; no one in America has ever known anything different, so nobody sees it as being a problem. Why, asks Moore, should health care be any different?

I was horrified to read of the slick tricks you talk about, like an insurance company funding a knee-replacement operation but not the knee. On the subject of the $1,000-per day cap on treatments, my oncologist billed my insurance $7,000 for each of my 6 chemotherapy infusions (a cocktail of 3 chemo drugs plus Rituxan), all of which I received in a single day. After the insurance company had negotiated that price down, they paid 80% of a base price of around $3,000, I recall. If my insurance had maxed out at a grand a day for chemo, I would have been facing one monster of a bill.

Thanks for posting.

Anonymous said...

Carl and Julie - I have appreciated your cogent comments. I'm ready to sign up for Ehrenreich's army! The wasted time and money are horrendous - but the anxiety which works against healing is yet another cost of our broken system. It's time for a change. (No wonder that, when I took an internet mini-test, the results indicated that Kucinich was the candidate for me!)

blessed with healthcare,

Carlos ("Carl") said...

We also need a candidate who has the leadership to gather people together and get them to believe that together they can persevere against the giants. This health-care issue is absolutely huge in voters' minds. I think it may be the number-one issue for many people, even bigger than Iraq. I'm convinced that if one of the candidates who's already got a fighting chance has the courage to pick up a few smooth stones and ready the sling, he or she will not stand alone for long.