Wednesday, September 16, 2009

A Healthcare Quandary

The healthcare debate has been a long and complicated one. Yesterday I was listening to NPR while driving -- yeah, I know, not the most conservative of sources. They show their liberal bias in almost every minute of every broadcast. However, this particular conversation did clarify for me one of the primary quandaries of our healthcare situation. Here it is:

One of the continuing difficulties of our health insurance system is that insurance companies can (and do) refuse to cover people because of pre-existing conditions. I know this is true because within the past month my husband tried to get insurance coverage for him and me. He was flatly denied for himself because he was, in the past, diagnosed with asthma. No company will accept him now for an individual plan. Period. In order for my husband to have health insurance, he must work for a large company with a group plan.

Now, people hate this. The very people who need care the most (those with medical conditions) are the ones who can't get coverage! It's ridiculous. I understand their outrage.

However, did you ever consider this from the vantage point of the insurance companies? If they had to accept EVERYONE, all the time, who exactly would apply for insurance?

Why, the sick people of course. Duh. If we couldn't be turned down for pre-existing conditions, we would all wait until we were sick, and then apply for insurance. Why pay all those premiums while you're well?

And employers would do the same. They wouldn't pay premiums for employees who were WELL, when they could just wait until someone felt sick, and THEN get them coverage.

Then see what a state the insurance companies would be in: paying out medical bills for all the sick people, and not getting premiums from all the well people. They would quickly close their doors - why stay in business?

According to the government, the only solution to this, is to require the insurance companies to accept EVERYONE, but also to require EVERYONE to have insurance. That way, the insurance companies can still function.

And if you require every single American to buy insurance, some will not be able to. Some can't afford it; they'll need help. They'll need subsidies to help them buy it, and who could give out that kind of subsidy? Why, only the government, of course.

So, tada!! The government is now part of the "solution."

I'd never quite heard this version of the situation before. And although I know there may be good contradictory arguments to this line of thinking, it makes sense to me in the main. I can see the difficulties of the insurance companies. I feel the needs of the uninsured.

Does it strike anyone else as bizarre that we, the sick, need such a complicated mesh of bureaucracy in order to access what we NEED: a visit to a doctor? How did we come to this?

Adam had another healthcare thought recently, about "rationed care." He pointed out that all systems we're looking at, will give us rationed care. Right now, our present system denies care to those who cannot afford it; they're excuded from care. The government gives care (medicaid/medicare) to the poorest, but we still have a large swath of the population that can't afford insurance at its present exorbitant premiums. They also don't qualify for government handouts.

But Obamacare (or whatever name you like to give to the government option) will ration care as well. It has too. It must cap the amount spent on those who are the most costly and who offer the least return to the state: the very sick and the very old. If you are close to death (or, as the British healthcare system calls it, "Due to Die"), doctors may note that expensive care has little chance of returning you to even nominal health. They may gently recommend to your family that you be allowed to "die with dignity."

[Isn't it funny how putting a tube or two into a 25 year old car-accident victim isn't considered undignified at all, but putting them into a 92 year old Alzheimer's patient suddenly robs him of his human dignity? Why?]

I don't have solutions to these quandaries, but I'm thinking on them. Hopefully we all are.

"But when a long train of abuses and usurpations pursuing invariably the same object evinces a design to reduce them under absolute despotism, it is their right, it is their duty to throw off such government, and to provide new guards for their future security."
- from the "Declaration of Independence"

1 comment:

  1. The best health care we have ever had was while we were in the military. I realize it is probably because the doctors that took care of us were also employed by the military. I have no idea what the answers are to this mess. My main concern at this point? Mental health care seems to be far down the list of priorities in this country right now. But I have many, many more. It can be a bit overwhelming.
    I remember though, that God tells us in Matthew 6.27, "And which of you by being anxious can add a single hour to his span of life?"


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