Thursday, January 21, 2010

More Healthcare Thoughts...

I was reading a post over at Iceman's blog and it reminded me of a caller to the Mark Levin show last night (link in right column). Normally when you think of public health care, or talk about it, or see an ad about it, you think about those who desperately need care for serious illnesses but are unable to pay for it, lose their home, etc. The 'extreme case' stories, right? And it makes a lot of people want to help.

But there is another fact about public health care systems that I think we all need to keep in mind while debating the issue, or even just thinking about it on our own. It's the fact that the system incorporates far more than just the extreme cases that do need help. It also carries people who can afford to pay health insurance from a private company (especially in our country where there are few other options, it's Basic Health or bust), it carries people who choose not to work more and earn more money to pay for their care, it carries people who choose to lead risky lives and have others pay for it, etc.

On the Mark Levin show, a 20-something student called in and said he supports the idea of the public option because he cannot afford health insurance. He said he cannot afford $500 or so a month and could not go on Blue Cross/Blue Shield because he 'made too much money the year before'. The radio host asked a few key questions to get to the bottom of this and it was revealed that the student lived at home with his parents, did not pay rent, worked part time, drove a truck, owned a blackberry (that he claimed his student loan paid for), and was a full time student with an English-major, hoping to become a teacher. Mark flat out told him "I don't want to pay for your health care". I think that was a valid response. Why should other people pay for this 20 year old man with no pre-existing conditions to block his insurance path, just because HE chooses to work only part-time while going to college? Seriously - Why?

When Mark asked the guy if his parents could help him out, he said something like 'not really' or 'not much'. So Mark suggested the guy work a bit more, have his parents help a bit, etc but still the guy said he can't afford it. Well he manages to pay for his truck (which he admitted he only drives a few miles to college and back), and his gasoline, so if he could walk or take transit or car pool, that would free up some money right there. Etc etc. There ARE ways that many many people could pay more for their insurance but this is the point- THEY DON'T WANT TO! But they want other people who are working hard for their own families to pay for it.

Yes there are a lot of sad scary stories out there about people having a horrible accident or illness hit their family and are in dire circumstances, and those are the people we are shown to get us to support a public system. But there are most likely MORE cases of normal regular folk who could actually pay for their own care but choose not to. What's to stop this student from putting off college for a year or two, working his butt off to get a lot of money saved up in the bank, and then going to college and living off that money including health insurance? Oh I know - he CHOOSES not to do that. And at the same time decides that YOU should pay for his care.

Something is wrong with this picture and I think that's why so many people in the US are taking issue with the whole idea.

Again it reminds me of when my boyfriend's uncle said last fall "don't you care about the guy down the street?" [My boyfriend was expressing his dislike of the total public basic health system up here] and my boyfriend said "No, actually, I don't. I have 5 people in my house to look after. I have 3 children to care for and pay for. So No, I don't care about that guy down the street who I've never met". Is that really really mean? Or is it more realistic?

And having a public system does not automatically save you from losing your home anyway. I happen to know for a fact that the people who rented my house before us lost it and had to move to a smaller cheaper home because the husband was on disability and unable to get his medical condition worked out, but his disability payments were not enough to cover this home's rental fee. I've also talked on here before about my mom's friend - she was almost 65 and hurt her shoulder but it took 2 YEARS to get her surgery done. In the meantime, she lost her home (which was just a trailer!) and she had to move in with her sister. Her disability was not enough to pay for her regular daily needs. When she finally got her surgery, she was retirement age anyway and just said 'screw it' and only works part time now, still living with her sister. A public system is not the be all and end all cure of all our problems, but it is portrayed that way a lot.

I have had a few run-ins but generally have good care. But is that because I am younger, still able to work another 30 years, and have young children in my home? I started to notice as my older friends age and their kids move out, their health care starts going down the toilet. Like an example I gave on Iceman's blog where in 2008 I only waited a week or so for a heart ultrasound after my doc heard a strange murmur (turned out to be a muscle wall thickening), but my coworker in early 2009 had to wait 7 months for the same thing. The SAME thing. I was 35 with a 4 month old preemie infant and two other kids at home, she was 48 with no kids at home. Hmm.... It just makes you wonder sometimes. Is that rationing? Is it fair? What makes my life more worthy than my coworker's in the eyes of the system?

Oh and I should add another example of how the scanning machines and other specialized treatments are NOT booked up 24/7 yet people wait months for appts. When I was pregnant with my last child, they discovered a problem. I was suddenly handed sheets with weekly ultrasound appts, every other DAY appts at the hospital for more tests, and weekly appts with an obgyn. Just like that - lickety-split. I had so many sheets of papers and appts I could hardly keep track of everything. If another person walks in after me and needs an ultrasound on their stomach but has to wait 4 weeks, what does that tell you? It tells you that care IS rationed, with priority given to emergency appts (which is what I was classed), and everyone else being pushed to the side. But it also tells you that the machines are sitting there collecting dust a lot of the time. No one was canceled in order to fit my appts in. I asked because my friend happened to be at the radiology desk, they were all OPEN appts just sitting there waiting for someone to fill them. I'm glad I was able to get in of course, we needed to keep a close eye on the baby, but it really made me think hard about our system. As it happens, I only used up 1 week of my appts instead of 7 because my son had to be brought on early to save his life, but I can bet $$$ that my un-used appts were not passed on to others waiting. My name was just scrubbed from the list and that's that. Open again, and collecting dust. I never did have an ultrasound at the special clinic so that left 7 open appts that probably were not filled unless another emergency case came in. I had an ultrasound at the hospital instead because they had kept me overnight. And another 2 days later (again at the hospital, with a portable machine I didn't even know existed), and then baby had to come out immediately. There is an awful lot of equipment available to us, just sitting around, but it does not get used to it's full capacity due to our type of system. There should be a middle ground, shouldn't there?

5 comments:

  1. I see the biggest problem with the health care debate on both sides of the border is we confuse private delivery with private pay. In Canada, both are essentially public, in the US both are essentially private.
    The problem is neither approach is really good.

    In Canada, the inefficiencies, inequities, and waste are alomost universally because of public sector involvement in delivery of healthcare. The actual process of collecting health premiums, whether through taxes or the "health premium" in Ontario, and distributing that cash to doctors and hospitals is many orders of magnitude more efficient than the US system of dealing with hundreds of insurers and plans.

    On the other hand, when you look at the myriad challenges facing doctors and hospitals in delivering timely and appropriate care, the roadblocks and policy insanity invariably come from civil servants and politicians with no knowledge of medical or pharmaceutical practices.

    The ideal situation seems to be a hybrid, with single payer and private delivery.

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  2. There doesn't seem to be an easy answer. In my current system, I feel like some dude behind a desk is deciding whether I should get the care my doctor suggests or not and then when I can get it, but then with insurance they are deciding if they will cover something or if they will offer me coverage at all. In either case decisions are taken out of our hands, out of the patient's hands and it's frustrating. But I would rather have more choice, since it's MY life and MY health, or my childrens', loved ones, etc.

    Should people behind a desk somewhere be in charge of our care, or should WE? I think the answer to that should be pretty obvious.

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  3. It is troubling that you would advocate dropping out of school, so he could be trapped in some unsecure, low wage, no where job (and that's if he's lucky: apparently, one needs a masters' to become a panhandler).

    It is also trouble that you, like so many others, have a problem helping this kid get coverage (via taxes for universal coverage). Someday, after this same kid who graduated college and is making decent money at his job would also be paying for your health care.

    Helping your fellow man is part of being a member of society

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  4. Perhaps it is troubling to some, but perhaps I was raised to take responsibility for my own life and was not taught from birth that other people should help me along every avenue of life. It's also quite an assumption to guess that not necessarily wanting to help every other person in my country with their healthcare means that I do not wish to help my fellow man. Perhaps you should ask what I do with my money and time before dropping such assumptions ;) You might be surprised.

    Does not going to college automatically mean a person will only be able to get a minimum wage job? That is very strange since all of the people I know personally who make good money (6 figures) did not do a single solitary day of secondary education in their lives. Making double what most of my college friends make even 15 years post graduation. Oh sorry, one of them makes the same.

    Is there a law that you have to go to college at age 18 in order to make something of your life? Is there a rule that at age 20 you should be half way through or so and well on your way to an esteemed career, or your life is worth nothing? Where does it say that a person cannot take a couple of years after high school to EARN money to save up to help them out when they go to college? And where did I say this student should Drop Out? Perhaps I am saying that before he started college, seeing as he was an adult, he should have thought about a few more things and worked them out in his head instead of hoping that other people would carry him on their backs.

    I happen to think education is very important and if someone wants to go into a career where college/uni is needed, then they should be able to. But they should not expect others, total strangers, to help them out. Already a lot of tax payer dollars go into funding education systems, paying staff, keeping the systems going. A lot of private money goes into them as well, which helps further the education of every student attending - how much more do they want? They want money for student loans, living expenses, book allowances, and health care costs. Why? Because they CHOSE to go to college and did not take a moment to at least attempt to financially better themselves first?

    Why is it troubling to think that people should be somewhat responsible for their own lives? I went to college, I know it is difficult to work and study but you have to do what you have to do in order to get along in this world. My bf barely passed high school but somehow he makes twice as much money as I do. I guess I should tell him that he went about it all wrong and got himself trapped in an unsecure, low wage, nowhere job (but what on earth does that say about my college educated requirement job... oh boy!).

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  5. As an added thought in reference to the hypothetical student paying for my healthcare one day - does it not count for anything if I have 30 or 40 years of working and paying taxes under my belt? We could spin this back and forth all day but I think it would be important to note that many people who need extra care in their golden years have already put 40 years into the tax system. Why should it be assumed that the younger generation is paying for them? I'm at almost 19 years of paying taxes now and have used very little health care, luckily not having any major illnesses to deal with. So by the time I am retired, if I need some extra help for creaky bones, have I not paid enough into the system already? I did not start out on purpose expecting everyone to help me out, I had no choice. In Alberta the choice is made for us and we go along our merry way. But in a country who does not have that fully set up yet, can you not understand why some people are leery of the change? Why is it troubling to question those who would expect others to help them out when so many are perfectly capable of helping themselves first?

    The student in my example admitted that he made too much money last year to go on blue cross this year - so what did he do with that money? He admitted to living at home and having a student loan for college and living expenses - what happened to last year's cash that he made? If he chose not to save enough to help himself out on his career path, why are other people expected to pick up the slack, and why are they frowned upon when expressing unwillingness to do so?

    To me - THAT is troubling. After a possible 40 years of working, I'm supposed to thank others for my health care? Um no, I think I will thank myself and perhaps my father for teaching me the importance of self-worth and respect and accomplishment.

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*Disclaimer

These are my views and opinions. If you don't agree or think I am sadly misguided, that is your view. Feel free to share your thoughts but I also reserve my right to moderate content (IE foul language, excessive flaming, etc).

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