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:

The ‘Best’ Healthcare In The World (Or, “At Those Prices, It Should Be!”)

A number of folks have pointed me to this article in the New York Times: “American Way of Birth, Costliest in the World.”

via nytimes.com
via nytimes.com

If you’re the kind of person who scrolls through the comments section–not an activity I recommend!–you’ll see that I commented twice in response to the clever little embedded questions in the article. Having given birth once in the US and once in the UK, I had some things to say. In the case of this article, the comments are really telling. For example:

Screen shot 2013-07-02 at 10.54.35 AMI suppose one could justify the extraordinarily high cost of maternity care in the United States if the United States had corresponding extraordinarily high rates of maternal and infant health.

Instead, we have extraordinarily low rates of maternal health among developed countries. We’re 49th in the world.

A few years ago–before the Affordable Care Act had passed–I inadvertently facilitated another woman’s ire when I mentioned how excellent my maternity care had been in the UK, and how much I thought the US could improve maternity care. It’s not possible–America has the BEST healthcare in the WORLD! she cried–before calling me a ‘delusional Communist.’

To which I can only say: read Amnesty International’s report, Deadly Delivery (available free) and then we can talk.

In fact, I can say more than that, because I have actually experienced more healthcare services in more countries than anyone I know, and of the developed countries in which I’ve experienced healthcare, the US is the most expensive and least efficient.

As I wrote in jubilant response to the SCOTUS decision on healthcare, it’s by dumb luck and generous government insurance programs in liberal states like California and New York that healthcare bills haven’t bankrupted me and my family.

It should be within everyone’s ability to take care of their health–and that of their children–without going bankrupt.  A recent guest post on Timothy Dalrymple’s blog suggested that Christians who lean left in politics are “Loud on Poverty” and “Quiet on Abortion.”

But might not those things go hand-in-hand? Can anyone read the Times article and not wonder how many abortions happen  because women cannot afford maternity care, and can’t envision alternatives?

Last year I said:

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. So what is this about? Massive change in what each party stands for, or total partisan bullsh*t all around?

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?

If we truly value human life, we must strive to find ways to put quality, humane, and affordable care within everyone’s reach.

I’m sorry this post is turning out a bit rambly and excerpt-happy, but my dad recently shared with me reflections on his first visit to a VA (Veteran’s Association–dad is a proud Air Force veteran) doctor, and I think it is relevant:

As I drive home I think back through all the people I have spoken to who have been in this particular
health care system for a while—men and women, young and old, healthy and sick, pregnant or not—and all have said,
without reservation, that they have found the care to be excellent.  In fact, to date I have not heard a
single complaint.  That’s correct: not a single complaint.  Compare this with the constant complaints we
hear about health insurance plans, and the difference is stunning.

But how can this be?  This is a federal program—it’s socialized medicine!

Of course I’m brand new to the system, so perhaps my initial impressions mean nothing.  Perhaps
tomorrow I’ll find myself face to face with the infamous “death panels” of which we’ve heard so much.  

But somehow I doubt it.

The Best Healthcare in the World

LaVonne Neff, an editor, writer, and blogger I admire, has written an excellent post on healthcare entitled “Rationing is not a four-letter word”; it was called to my attention by my good friend Ellen Painter Dollar.

Ellen writes:

One of LaVonne’s strengths is her ability to write about current policy debates from a faith angle, and to do so convincingly without being strident.

LaVonne writes:

We Americans are smart. We could find a way to provide necessary medical care for everybody. Perhaps someday, when all our present Members of Congress have finally passed away, a totally new set of lawmakers will figure out how to do it. But first we’re going to have to realize that rationing can be a tool used for the common good, or it can be a buzzword used to scare people who haven’t noticed that haphazard rationing–our present nonsystem–is the cruelest approach of all.

and LaVonne again:

When you add government expense to private expense, American health care is 65% more expensive than France’s and 100% more expensive than the U.K.’s. And for that, what do we get?

Well, you know what I’m going to say…

 

One Deadly Infection, Two Healthy Babies, and Three Broken Legs (or, how Government Healthcare Totally Saved My Behind)

Brace yourselves. I’m about to step on a soapbox.*

Much as I’d like to go all armchair-Constitutional-scholar and argue that access to affordable health care SHOULD be in the same category as education, fire-fighting, and law enforcement, I’m not going to.

I’m just going to tell you what has happened in MY family.

February, 2005, California

Pregnant with first child. Am on crappy private insurance that costs like $500 a month in premiums but covers almost nothing. Calculate that cost of having child will be approximately half our yearly income.

Freak out.

Find great California state government program that we buy into for 1% of our yearly salary, while they, in turn, cover all out-of-pocket healthcare costs, for me AND for the baby.

Whew.

Except that the insurance carrier (thanks for nothing, Blue Cross of California!) dragged their feet so long in paying that the hospital called me when Aidan was 2 weeks old or something and said I owed like $10,000.

Freak out again. They eventually pay, but not until I have to wait hours on the phone while the recording assures me that Blue Cross cares about me.

April, 2008, Scotland

Living in Scotland. Have received excellent prenatal care under the NHS. On the 20th, I give birth under seriously ideal–though not fancy–conditions, conditions that are CLEARLY motivated by concern for good care, not over who’s gonna sue? Am given pot of tea and plate of toast once baby comes.

Depart hospital that evening (by my choice, I could’ve stayed) and am 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.

October, 2008, Scotland

Graeme, about 6 months old, is really sick. Bronchitis with a fever and endless vomiting. I take him to the doctor a number of times just to make sure he’s okay–he’s not. We get orders for admission to the pediatric ward. Semi-miraculously, he recovers.

June, 2009, Rome

We are in Rome on a business trip/holiday. Graeme, now a little more than 1 year, gets sick, maybe with heatstroke. Fever is high; he keeps vomiting, he’s barely waking up. We go to the hospital and try to make ourselves understood. Graeme is given an IV, and recovers splendidly.

August, 2009, France

We are in France on a scholarship. Aidan slips on a wet supermarket floor and fractures his leg badly. He is taken to the hospital to have his leg set, and has several follow-up visits while we’re there.

broken leg #1

October, 2009, Germany

We are living in Germany now. Aidan has his cast removed, but needs (and receives) physical therapy.

At the same time, Graeme cuts his head badly and needs stitches, which he gets.

At the same time, I get a really nasty case of mastitis (on the weekend OF COURSE) which sends me to the ER. Then I get a secondary infection from the antibiotics and have to go back to the doctor.

November, 2009, Germany

Graeme gets a really serious staph infection (MRSA) and is hospitalized for 8 days and needs several follow up visits with a doctor. THANK GOD, he recovers completely.

July, 2010, Germany

Graeme breaks his leg, and I am totally impressed by the ER/ortho team that x-rays, diagnoses, casts, and discharges Graeme in, like, an hour flat. Reminds me of the story my dad told of a fight breaking out at a beer fest in Germany. The whole thing was over and cleaned up in 10 minutes. Efficiency!

broken leg #2

October, 2010, New York

We are back in NY. Aidan breaks his leg. Thankfully, we are among the 1 in 3 or 4 New Yorkers that qualifies for some form of government-assisted health insurance. Nonetheless, I spent HOURS on the phone trying to find a doctor who will take our insurance. Finally, we have to take him to another emergency room to wait for hours until he can be seen.

broken leg #3

(Because what really gets in the way of the doctor-patient relationship? Not the government. Money, and The Insurance Mess.)

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.

By dumb luck, that’s not what happened, and I’m grateful.

It should be within every person’s ability to take care of their health, and that of their children, without going bankrupt…and I think the free market has had a fair shot at making that happen, and lost.

I have to 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 have been. 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’m really hoping that yesterday’s decision means maybe we will.

(and now I will step off my soapbox.)

*Jana Riess advises that blogs are not soapboxes, and she’s right. </rant> =)