Putting Human Lives into the Invisible Hand of the Almighty Market

My friend Sharon Hodde Miller recently made a plea on Facebook that seems to have resonated with a lot of people–including me:

Screen shot 2013-10-07 at 7.37.53 AM I’ve been called names for supporting universal healthcare, too (though I think that resorting to ad hominem almost always means that you’ve lost the argument.) I’ve also barely escaped drowning in the US healthcare non-system.

I hope it does not sound arrogant when I say that I think I’m in a unique position with respect to judging healthcare systems from the patient side of things–not because I’m any sort of policy expert, but because I’ve sampled it in no fewer than five different countries.

In February, 2005, we were living in California, and I was pregnant with our first child. The only insurance I’d been able to purchase–thanks to my ‘pre-existing conditions’–cost over $500 a month, but had an extremely high deductible, high co-pay percentage, and covered almost nothing.

Having a kid on that insurance would have cost half our yearly income.

May I also point out that we were saving to pay for graduate school IN CASH, having paid for the previous graduate school (yes, we are nerds) IN CASH. So the next time you hear someone say that people who are in favor of the Affordable Care Act (also known as Obamacare) are just greedy freeloaders, think of my husband and me, pinching pennies and saving as much as possible to pay for school outright. Don’t assume those who support the ACA are irresponsible morons who don’t know how to plan for the future.

There was, however, a great California program, funded by the tobacco tax, that offered a good deal to mid-income folks:

We bought into it for 1% of our yearly salary; they, in turn, covered all out-of-pocket healthcare costs, for me AND for the baby.

That isn’t to say that Blue Cross of California did not continue to drag their corporate feet (do corporations have feet? I’m assuming so, since they have Constitutional rights) before eventually paying the bill, causing the hospital to call me when my son was about 2 weeks old and screaming his head off round the clock to tell me I owed $10,000.  They eventually payed, but not before I had to wait hours on the phone while the recording assured how much Blue Cross cared about my needs.

Our family lived in Scotland for three years, and that’s where our second child was born. I received excellent, personal, and relaxed prenatal care under the NHS. I gave birth under seriously ideal–though not fancy–conditions, conditions that were CLEARLY motivated by concern for good care, not over might you sue me?  In other words, I was not pressed to take pain medication or forced to have an IV or continuous fetal monitoring, since none of those things have been demonstrated to save lives or improve health…but they’re things that come up in malpractice suits and so doctors and hospitals in the US insist on them because of ass-coverage concerns.

We departed the hospital six hours after the birth (by my choice; I could’ve stayed) and were visited daily for 10 days by midwives who weigh the baby, check us both over, and ascertain that we’re doing well, physically and emotionally.

(In a culture like ours where MANY women suffer serious postpartum emotional troubles, daily visits are not such a bad idea.)

Well, that’s just one country! What about the others?

In 2009, we were in Rome on a business trip/holiday. Graeme, who was just over a year, got sick, possibly with heatstroke. Fever was high; he was vomiting repeatedly, he was barely waking up. We went to the hospital and tried to make ourselves understood. Graeme was given an IV, and recovered splendidly. No mention of a bill.

Later that summer, we sampled French healthcare.

Our older son, Aidan slipped on a wet supermarket floor and fractured his leg badly. He was taken to the hospital to have his leg set, and had several follow up visits while we were there. At no point was any bill discussed or sent.

Later that summer, we moved to Germany, which has a system that’s most like the Affordable Care Act: everyone has to have insurance (individual mandate), working folks mostly get it via their employers, and the government helps out folks who for various reasons are having trouble.

Aidan had his cast removed, but needed (and received) physical therapy.

Concurrently, Graeme cut his head badly and needed (and got) stitches.

Concurrently, I got a really nasty case of mastitis (on the weekend OF COURSE), which meant I had to go to the ER on the bus. The bus ride made me sick(er) and I vomited the moment I stepped off, only to have a friendly German guy, accompanied by several toddlers, who were all going to see their sick mother/wife in the hospital, stop and ask if I was okay. I cried because they were so sweet and kind to my vomit-y self. I got treatment, and then a secondary infection from the antibiotics and had to go back to the doctor.

A few weeks later, my son Graeme got a really serious staph infection (MRSA) and was hospitalized for 8 days. The ER doctors laughed when I asked if our insurance would cover the hospitalization. “OF COURSE!” 

A few months later, Graeme broke his leg.

I was totally impressed by the ER/ortho team that x-rayed, diagnosed, casted, and discharged Graeme in an hour flat. I’m not even exaggerating. It reminded me of the story my dad tells of a brawl that broke out at a beer fest he was enjoying in Germany. The whole thing was over and cleaned up in 10 minutes. Efficiency!

A few months after that, we were back in NY, Aidan broke his leg.

Thankfully, we were among the 1 in 3 or 4 New Yorkers that qualified for some form of government-assisted health insurance. Nonetheless, I spent HOURS (crying) on the phone trying to find a doctor who would take our insurance. Finally, we had to take him to another emergency room to wait for hours until he could be seen.

Let me tell you what REALLY gets in the way of the doctor-patient relationship. 

It’s not a government bureaucrat and never will be. It’s MONEY. It’s insurance-company bureaucrats. It’s Darwinian, and it’s heinous.

Believe me when I tell you I have also left out a lot of other things. These are just the highlights.

And I think you’ll believe me when I say that if I was in the US for all those things–or in less generous states like Texas–I probably would STILL be paying the bills. Or else filed for bankruptcy.

Did you know that the number #1 cause of personal bankruptcy in the US is MEDICAL EXPENSES?

Ours is the only developed country where people hold bake sales to help pay for folks’ cancer treatments, or lose their houses because someone had the misfortune of being hit by a car. It’s only by dumb luck that these things didn’t happen to us. Remember all the money we carefully saved to pay for our graduate educations in cash?

It should be within every person’s ability to take care of their health, and that of their children, without going bankrupt…or losing their house…or losing the money they’ve worked hard for…and so on.

I chuckle when I hear reference to “the US healthcare system.” Because there isn’t one. There just isn’t.

Oh, wait. There is one. It works great. It’s more socialized than the system in Germany. It’s called the VA. It’s socialized medicine! And it works great! My dad says that military healthcare was a major incentive for enlistment and re-enlistment in his day–especially for people who were married with kids.

As far as partisan politics go, no less a Republican than Richard Nixon tried in 1974 to make a ‘Medicare for all’ move. You know who opposed it vocally? Ted Kennedy. Because he didn’t want Nixon to make a move that would be so popularly, well, popular. Because it would’ve been. It probably still would be.

And according to Ben Stein (Nixon’s speechwriter) the Nixon plan was much more “comprehensive” (yea, socialist?) than Obama’s. What is this about? Massive change in what each party stands for, or total partisan b.s. all ’round?

I really don’t care which initial is in parentheses after a politician’s name. I just like to see policies that are good for the people who don’t have enough money to buy a dental cleaning, MUCH LESS A SENATOR. Besides, didn’t Jesus expressly say something about doing good to those who CAN’T do anything in return?

No system is perfect. But the US doesn’t have a system, period.

I now live in a country–Malawi, one of the poorest in the world–where people die every day of really preventable diseases, and part of the reason they die is that they can’t pay for treatment. Good hospitals exist–for those who can afford to pay, period.

Yes, there are the stories of the international community coming to the aid of the poor, and PEPFAR and other programs funded by US-AID are important and effective. But I’ve been in the hospitals and clinics that serve the poorest of the poor. They are sparse buildings with few supplies, and even I can tell that the doctors and nurses are not following “best practices.” They run out of the reactive agents to run HIV tests.

I’ve also been to the expensive hospitals, the hospitals that exist for people who can afford to pay. They are more than adequate. So if you have the money, you can get care. If you’re poor, you die.

Which hospitals do you think that Malawi government officials go to?

Which hospitals do United States government officials go to?

Do we really want to entrust precious human lives to the invisible hand of the almighty “market”?

Does that sound Christian to you?

Meanwhile, my cousin shared this video. If you don’t know the difference between Obamacare and the Affordable Care Act (or even if you do) you should watch it:

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8 thoughts on “Putting Human Lives into the Invisible Hand of the Almighty Market

  1. Excellent. Later this week I will be going to the regional VA hospital for my immunizations for Malawi, and I will send you a report of my experience (unless, of course, the socialist death panel decides I need to be euthanized instead).

    My guess, based on previous dealings with this ghastly soulless government system, is that I will get the needed immunizations in an efficient and timely manner, for a copay that will be a fraction– as in 10% or less– of what mom had to pay because her expensive private insurance wouldn’t cover such things.

    It should be noted that so far the VA has not once put me on hold, listening to canned music and those chirpy little messages about how much they really do care about me. Instead I get a live human being every time, who politely listens to my concerns and provides the information of assistance needed. In the local clinic the staff are so polite and friendly that it almost seems like a dream.

    Further, in true military fashion the appointment times actually mean something– they give you an appointment for a set time, you arrive by that time, and are seen at that time. Once a clinician was 5 minutes late for my blood work because of a traffic delay and apologized so profusely that I had to reassure her that I understood perfectly and was not at all upset. The contrast with the arrogant indifference I’ve encountered all too often in the private sector was striking, to say the least.

    Of course it could be argued that I am a best case scenario, in that I am in excellent overall health, and that the soulless socialist government death panel nightmare is waiting, should I develop a serious condition. But I doubt it. So far I have not heard a single complaint– not one!– from any of the local veterans in the system. Given the well-known G.I. penchant for griping, that’s quite extraordinary.

    I only wish the program covered dependents, as did the military system. Apart from that, so far I think it is great.

  2. i love your dad. (and thank you for taking the time to put into words what i want my friends and family to understand, but am too fatigued with the political free-for-all to try to articulate.)

  3. I’m sure the VA would be much better if only the last election had turned out differently. After all, if there has to be a government-run health care system, who best to oversee it than a rich man who, having faithfully served his country by dodging the draft, really understands the needs of its poor and working class veterans?

  4. I really appreciate your thoughts here. We’ve had similar experiences overseas as well as in the States, though now that we’re living in Ireland long-term, also see how austerity measures and the Europe-wide recession not only affect nationalised health care, but are part of the consequences of mismanaged nationalised health care. I do wish, though, that my irish childbirth experience had been as lovely as your scottish one! Though we didn’t pay a dime (and only paid a small ER fee for our daughter’s 4-day hospital stay with pneumonia and our son’s overnight concussion), I would’ve gladly put down a few thousand for my own room, a sleep-in nursery, and an epidural. ;) Seriously, I do thank you for this and the perspective it gives. Shamefully, I’ve allowed myself to be censored when it comes to discussion of health care for all for fear of ministry repercussions. Shameful and ironic.

  5. Being Canadian, I find the american system (or as you put it, lack of system) insane. Now I am experiencing it first hand having recently moved here. I had my first baby in the UK (no frills, but great pre and postnatal care) Canada (by far my favourite experience, once in B.C., once in Ontario). And now we are in the US, I am pregnant, and my overwhelming thought is “what is this going to cost me”. Supposedly we have ‘excellent’ coverage (which I pay about 350 a month for, my husband is covered through work), but when I look in to the details (which are almost impossible to understand) it seems there is a lot we will be paying for (friends of ours on the same plan said it cost them 5000 to have theirs, yikes!! The truth is, it always has to be paid for, regardless of the country you are in, it’s HOW it gets paid for and who holds the power. Here, business holds the power – medical and insurance companies, and they are there to make a buck off of us. At home, everyone pays for the medical system, we all pay higher taxes and we all pay a low premium every month depending on our income. Doctors are paid by the state, so are hospitals. We are not held ransom by business to the same extent. It is not a perfect system, but it is a system and it works, and it is fair. It’s like public education – hah, that’s a thought. Why aren’t people getting up in arms about having to foot the bill for our children’s public eduction?? Maybe schools should only have to take ‘smart’ kids since they would hardly have to educate them. Those with the lower IQs would be too expensive to teach….so unless you qualify for MENSA you’re out of luck! ;). All this to say that I realize the US is a huge country and that you can’t expect what works for smaller nations to work for the US, BUT something has to be done, and some steps need to be taken, and the affordable care act seems to be the only somewhat sane and possible plan that anyone can come up with and get passed. From an outsiders point of view, the Republicans are acting like spoiled brats who lost an argument (fair and square) and now they want to have a tantrum at the expense of the nation just to see if they can get what they want. shamefull

  6. Considering that they’re nearly all rather well-heeled and receive a cushy benefits package largely at the taxpayer’s expense, I’d say shameful is the very least that can be said of them.

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