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Thursday, September 3, 2009

Insurance is Not Health Care

To listen to the vitriol regarding health care reforms for Americans, you would think we were in the civil war again. I have noticed a number of trends in blogs and citizens meetings on health care reform and thought I needed to speak up.
Number one, insurance is not health care, it is a financing vehicle for people to pay for health care and this is available to approximately half of the United States population. In order to obtain "private health insurance" many conditions must exist such as:
1) The employer offers health care
2) The employee actually makes a living wage and can afford the premiums
3) A health insurance company serves their area and is accepted by clinicians and hospitals
4) The person is not disabled or otherwise uninsurable
5) Or an individual policy may be available in their region or rural locale
Obviously a lot of employers are not offering health insurance, which is representative of the "private health care system" we have now. As an example, I know someone who worked up to thirty-six hours a week for a nonprofit organization which refused to consider that fulltime employment, so they could exclude that employee from eligibility for the health plan. This represents a market failure in economic terms and thus encourages the government to step in to make up for private market lapses. This is an example of the abuse that happens everyday in business and why the Obama Administration is advocating a pay or play policy for employers. Yes, it is time that employers pay for health insurance or contribute into the regional pool for those workers.
Number two, it does matter when you access health care, because obtaining appropriate care in a timely manner not only saves lives, it saves society money. By refusing to provide basic health care to United States residents we are merely choosing to pay more later for manageable conditions. Examples of these are breast cancer, prostate cancer, prenatal care, hypertension, and diabetes. The current United States health policy, which does not provide fair and equitable access to primary care for all residents, is effectively saying we will pay more later for residents who have these conditions and defer treatment. For example, a young couple, in Arizona, did not have insurance when she became pregnant with twins, yet both of them had jobs. Consequently, she was not able to obtain optimal prenatal care, which resulted in a delay in diagnosis, with potentially tragic results. This lapse in treatment was not their fault, it reflects our shortsightedness as a people that we choose to pay the higher cost for our lack of effective treatment for those who need health care.
Number three, for those Rambo-types who think they can provide for their own health care on a pay-as-you-go basis, I would be willing to bet that you don’t have a chronic disease or a sick child or failing parent. All you have to do is look at the number of individual bankruptcies filed in this country for health reasons to understand the impact on people who were no longer able to pay. A person’s inability to afford health care is not some moral failing, it is a combination of poor health policy and opportunity or just plain bad luck.
Finally, all of the examples I gave have happened to someone in my family. I am sure the rest of you can think of similar examples in your families too. Can’t we put aside partisan differences and work together to improve health care access and delivery for everyone?


Anonymous said...

I think your first point addresses two issues. 1. yes, I can tell you from interning at a health insurance provider that it is, in fact, a business that functions first to make $ and that providing health care is much further down the line and incidental to the profit/stay-in-business, pay great salaries to the people that run the place, and other such priorities.

2. Not sure that employers do need to be the ones to fund. Under the current system, where employer funding is somewhat assumed, there are all sorts of inequities. A multispecialty health care practice where full-time employees cannot afford to cover their children. One privately held firm that pays 100% of employee premiums and another much more profitable firm that pays 1/3 as much per employee and has correspondingly lower coverage. 3. Where are the incentives best aligned? Even though there would seemingly be incentives to keep employees healthy (to be able to do the work, if nothing else), the second firm although focused on retaining employees longterm does not provide good work stations and most employees have ailments directly related to this. Many argue against government sponsored care because they focus on the individuals responsibility to stay well. With state funded care, there would be greater incentive to focus on public health in the literal sense of the word and invest in longterm preventive measures. This is a failing in the current system. As in the example of the second firm, each firm does not have the resources to also be experts on prevention, etc., and having a system that provides these resources seems more efficient....

Arlene deWinter said...

Excellent points Roberta!
I lived in the UK for 9 years and was able to afford dentists at 35 pounds a visit -- I can't even see a dentist here -- and in most of Europe, if you need medical help you get it and for a fraction of the cost -- even if you are not a citizen of that country. For instance the Bulgarian guy whose appendix burst and they took him no questions asked, and minimal charges.
Differences? Spartan hospital rooms, You have to share your room, No gizmos, gadgets, high def TV, BUT more human attention when you need something. One American, who broke his pelvis in Germany, stayed for one week in hospital. It cost him what he would have had to pay for one DAY in this country.
These health programs may be funded by taxes, but at least people are getting something they need with their tax money.
It is concerned with PATIENTS first, corporations last.
Take care,

Arlene said...

I also want to add that in Europe, hospital conditions can be Spartan and rooms shared. This makes it cheaper.
I wonder how much our system has become a slave not only to the insurance companies,and drug companies, but to the medical technology salesmen as well.