Thursday, May 14, 2009

The Great Debate Begins

The great debate over health care in the United States on like “Donkey Kong”. All sides are teeing up their best talking points and will probably fill the air with so much smoke and smog real facts and real issues for real people will be obscured.

Progressives will remind everyone there are 50 million people without insurance of any kind and bankruptcies are rampant because of health care costs. They will point to the fact the USA, along with Turkey and Mexico (two countries I know we want to emulate), is the only industrialized nation without some form of national health care. What they won’t talk about is the potential cost of changing our health care system and what some of the potential unintended consequences could be for the average American.

The conservatives are surely going to ring the “government can’t do anything right” bell and you will hear all about how the government will get in between you and your doctor. They will point out how Great Britain and Canada basically suck anyway so why in the world we would want to emulate those socialist jerks. What they won’t say is insurance companies are between you and your doctor (assuming you are healthy enough to get insurance) and the insurance company dictates your care. What will be glossed over is that “free market” insurance companies dictate who their customers will be, who they will serve and how they will serve them. It’s not a free market when market pressures don’t exist.

Change is coming. It’s coming soon. You know change is inevitable when health care industrial forces begin to agree that change is necessary. I’m not the sharpest knife in anyone’s drawer and I don’t know how we fix this very complicated issue. It comes down to whom you do you trust, the government or free markets. For me – I don’t really trust either one, I trust myself and I trust my doctors.

There are a lot of very bright people who know a lot of health care statistics, there are experts on our current health care delivery system, insurance math wizards who can do actuarial tables in their sleep and we probably don’t want to know what all the drug companies know. Me, I’m more of an experiential learner and due to significant life changes I have a somewhat unique perspective on health care.

I worked for a large corporation for 26 years and was swaddled in the cradle of corporate sponsored health care. I had no clue what it was like to try and find an insurance company to actually insure you. I had no concept of trying to really understand health insurance contracts, that’s what Human Resources did.

Then the first shoe dropped. I was down-sized. I had to face the reality of finding a job that provided insurance or an insurance company willing to take a gamble on my health, Then the 2nd shoe dropped (how many shoes are there??), my 50 year old wife had her first of two major strokes which left her permanently disabled and in need of 24 hour care and supervision. There goes the option of getting another job. My new job, professional caregiver, found me; only it had zero health benefits.

What I have discovered over the ensuing years is that you cannot take insurance for granted. I had to scramble and eventually found a policy for a 52 year old man who is too short for his weight, but other wise healthy. It’s called the really expensive plan with a really high deductable. My premiums started at a remarkably reasonable $250 per month. This year, for my 55th birthday, the insurance company sent me a Happy Birthday greeting with a notice that my premium would be over $400 per month. As for my wife of 30 years, first there was a high risk pool, yeah for that, and now Medicare, so far so good for that. All told our costs for insuring our medical care, even with Medicare, roughly $1000 per month. We are fortunate we can afford it; I don’t know how others do it.

Now we are facing the great possibility of badly needed real change and real reform in our health care system. And, trust me on this, the only ones who think our system doesn’t require change is the ones who have great insurance and the money to pay for it. I know, based on my experiences over the last years, change is not optional here, it’s an imperative. But, what does this uber-medical user hope comes for the health care reform? –

First, do no harm, be careful of unintended consequences. My wife has had miraculous and wonderful care through the most traumatic of circumstances. The innovation of our medical system saved her life. Quality health care providers have made her life safer and better. New and old antibiotics have been our life line. Her Family Doctor is patient, kind, thoughtful and circumspect about everything he does. This is the kind of treatment everyone should be able to get. Health care reform should not endanger what we do right, it should add to it, it should ensure there are more great doctors and make sure they are fairly compensated. It should guarantee the doctor and the patient make health care decisions. These decisions must be based on what is reasonable, not what the “free market” dictates.

Insurance companies must be controlled. Right now, they choose who they cover, they choose how they will cover you and ultimately what kind of care you will receive. They decide what medicine you will receive, they decide what tests you can have, they ultimately decide if you will have surgery. And, they do all of that for profit. I’m not against profit; I’m not against insurance companies. But, we have to realize, when profit motives and patient care are misaligned, the insurance company will always choose profit, that’s their job.

Patients with chronic illnesses need assistance in how to best manage their condition. My wife and I are lucky; we have the financial means which enables me to be a fulltime caregiver. Many people don’t have the same good fortune. Our goal, along with her doctors is to keep her out of the hospital, keep her out of emergency rooms and keep her away from intrusive, expensive procedures which do not add to the quality of our life. By coordinating her care and by being available her Doctors have been successful in saving money and keeping her safe. Full time case managers who work for the patient could save money and make life better.

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