Monday, July 20, 2009

The problem isn't healthcare

You see, the problem we’re facing isn’t health care.  It’s the lack of ability to pay for healthcare that’s the problem.  Most people pay for health care through their insurance.  Most people’s insurance is provided through their employer.

That’s fine and good, assuming you have a job.  Most people don’t have any problem getting in to see a doctor.  You call, make your appointment, arrive a little early, pay your insurance co-pay, and you’re in.  Done and done.  It’s not like you have to wait 3 months to get a physical or anything like that.  Access is not the issue.


If we take a couple of steps back, though, and look at that little transaction of “seeing your doctor”, more can be revealed.


On that little trip to the doctor, we pay between $25 and let’s say $100 for the co-pay.  The remainder of the bill—the other $25 - $100—is covered by the insurance company.  That’s what “co-pay” means.  And, of course, we pay our monthly premium either directly out of our paycheck or checking account to the insurance company each month.  Also all well and good if you have a job.


We pay our $400 per month in insurance ($100 from the paycheck, $300 from the company, or some other relatively equitable split where the employer presumably picks up the lion’s share of the tab) and make our co-pays to the doctor for the minor tune-ups and check-ups that stave off the serious problems on the assumption that the $400 per month is providing some insurance that when there is a catastrophic injury—such as a broken bone, heart attack, stroke, cancer, or other bone-chillingly frightening medical nightmare—payment for medical treatment will be available.  The treatment will be available, mind you, the thing that worries us is that the payment for the treatment will be available.


The insurance company’s logic, of course, is that there are enough well people paying premiums without requisite catastrophic medical treatment for a long enough time that the cost for the relatively few major medical treatments will be more than covered as they come up.


The flip side to that, however, is that an insurance company can avoid paying for catastrophic medical payment, and thus conserve its income and cash for profit generation and dividends to shareholders, simply by denying a claim, dropping an individual from coverage, or approving a procedure just a few days too late for the dead patient to actually receive any benefit.


The problem isn’t access to health care, the problem is access to payment for that health care.  If we spend $400 per month (or more) to insure that payment will be available (even if the payment for care is more than our premiums), then that payment damn sure ought to be there  Unfortunately, if the choice is between profit and corporate performance, and fulfilling its part of the insurance contract, well, the insurance company is going to make damn sure that the contract is written in such a way as to guarantee the company a way out of that obligation.  “Oh, Mr. Cancer Patient, I see on your form you didn’t put your title as “Mr.”, you put “Mr” without the period.  Because you didn’t fill out your forms properly you are in breach of your contract and we’re going to have to drop you.  However, because we’re nice we won’t bill you for all your previous insurance claims against your policy, but we also won’t be refunding your premiums, either.  Sure, it sucks to be you, but at least we’re not you.”  Thanks, insurance company!!


I don’t know if the “government option” is the solution to the thing.  There’s a fundamental flaw in a system that requires you to either be rich or poor to get the medical care you need, but if you have means to take care of yourself, you’re going to have to burn through every penny in order to get the care you need.  Medical care should not equal bankruptcy.  Let’s say you have a job.  Through that job you have insurance.  Then you get cancer and you have to take an extended leave to be treated and simply cannot work so, you lose your job.  You’ve also lost that coverage.  (Yes, COBRA is available, but only if you can pay for it.)  Now, you’re unemployed, uninsured, and have cancer to boot.  The good news is that in a few months you’re going to be indigent and able to get financial assistance for that medical problem.  The bad news is that in a few months you’re going to be indigent—and possibly divorced, and maybe even dead.


It shouldn’t have to come to that.


A person’s greatest fear is to pile up some cash for retirement, then have a catastrophic injury come along and wipe out not only the savings for today, but the means for today and the savings for tomorrow.  A broken leg shouldn’t cause you to be destitute.  The fact that it happens is a tragedy by itself.  The fact that it happens here in the US, where we can afford to buy aircraft carriers and moon rockets is a horrific tragedy.


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