05 January 2011

Let's Talk

For the past month or so, I’ve been dealing with pain, numbness and weakness in and around my right knee. It’s absolutely maddening: I have to walk with a cane, my thigh intermittently burns like it’s on fire, anything touching it causes pain and my foot alternates between mostly numb and uncomfortably tingly. I love walking by myself during the day because there’s a certain Zen involved: I put my mind in neutral and let it go where it wants. I can’t do that right now.

I saw my primary care physician, and he referred me to a neurologist who gave me a very thorough exam while I alternately sat and reclined on an exam table in my underwear. (Two things about neurologists that have been my experience: I’ll eventually end up in my drawers, and they don’t work between Christmas and New Year’s.) The neurologist ordered 2 MRI’s, an EMG and a nerve conductivity test, which I had this week.

Nothing like spending an hour in a narrow tube inside a giant noisy machine or another hour on an exam table being shocked with electrodes and needles. The only thing that could be worse would be suffering through it all and paying full price for the experience.

Luckily, I have an increasingly rare benefit: good health insurance. My co-pays range from $10 to $15 per visit and test and from $10 to $30 for prescriptions. So far, I’ve shelled out $70 for what would have cost $4,000 to $5,000 without insurance. Since my insurer has collected about $70,000 from me and my employer over the last decade and the insurer has paid out about $10,000, I don’t feel so bad about using the benefit.

The level of treatment I have received isn’t available to a too-large number of people. If they have coverage, their out-of-pocket expenses for something like this would either be prohibitive or eat up too much of their income. If I had to pay 20% of everything up to a deductible cap, I wouldn’t be able to afford it. If I had to pay the much higher co-pays, I’d have to be choosing among which bills to pay.

My insurer doesn’t offer our policy any more. They discontinued it several years ago, but they will renew it with an annual price adjustment. Policies like mine almost don’t exist today. My insurer will renew it, but they haven’t issued new ones in years.

The basic healthcare that I take for granted isn’t available to millions. The good healthcare I value so highly is available to even fewer. And that’s a basic inequity. I have a good job with good insurance, so I can afford the care. Too many people don’t have that. They can’t afford to go to the doctor for minor things, much less larger ones.

Now that universal healthcare is back in the news, I’ve been thinking about why it’s important, and I’ve come to the conclusion that the benefits outweigh the price. Emergency rooms don’t get over-run with people who really need to see a GP but can’t. The ERs’ costs go down. Healthy workers are more productive. And critical and end-of-life care costs go down because people don’t come to the hospital on their deathbeds.

Empirical evidence suggests that it’s much cheaper to treat potentially fatal or debilitating illnesses and diseases when they are diagnosed early on. Common sense dictates that a healthy worker is a more productive worker (unless the illness is pure old laziness).

The cost of no insurance is infinitely higher than the cost of having it. 2 weeks in the ICU can easily cost $200,000. If insurance pays for most of it, the hospital has that much more towards not going broke. And regardless of who the insurer is, as long as it’s not the government, the private insurer will make a profit in the long run.

The biggest lie, distortion and cynical spin on any legislation in my lifetime has been the “government takeover of healthcare”. The government won’t be running much of it. It’s mandated certain coverage, but my state mandates that I have liability insurance on my car. They don’t care if I have comp and collision because that doesn’t impact anyone but me.

The lack of available healthcare harms everyone, whether they have insurance or not. If I wreck my car and don’t have the comp and collision, it doesn’t affect anyone but me. If I don’t have health insurance and rely on emergency rooms for primary care or don’t seek treatment until my condition is critical, everyone pays. They pay in the form of higher costs across the board.

I lived for years without any coverage, and my company’s health insurance makes up for a lot other shortcomings on their part. There hasn’t been money for a raise in a few years, but I still have my health insurance. It costs only slightly more than what I paid the last time I got a raise.

The Sarah Palins of the world talk about “death panels” and socialized medicine. The reform act under attack meets neither criterion. It does provide funding for end-of-life counseling, but that’s a good thing. When my father died, the hospital provided counseling so we could make the right decisions. The ones we needed to make but didn’t want to.

My family needed to hear a half-dozen doctors from many specialties tell us how bad he was and why he was going to die, whether we did anything or not. He might have made it a few more days, but the unanimous decision was to cut life support. That’s a “death panel”. I’m glad we had one.

I still don’t understand the resistance to healthcare reform. Maybe people think it’s going to cost them more, but they’ll pay for it one way or another. Whether it’s in the form of higher medical bills, health insurance costs or taxes, we’ll all pay. And the tactics of fear mongering and rabble-rousing that politicians have employed to oppose extending care to more people strike me as both insincere and elitist. They spin an important issue for political advantage (the insincere part) and don’t care about the enormity of the healthcare problem (the elitist part).

They have insurance, so why should they care? And fear is one of the strongest political motivators, so they use is any time they can. It boils down to the politics of indifference and fear.

It’s time to end the politically motivated politics of fear and talk about reality.

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