Truth, The Real Public Option

(4 pm. – promoted by ek hornbeck)

Around the same time that the health care reform act was being hotly debated, several months back, I wrote extensively about my own experiences.  I’ve struggled with chronic illness the whole of my life, and so not having health insurance was not exactly any bargaining chip for me.  The no-insurance option shouldn’t have to be anyone’s experience, yet this is still true for many I know.  Many people my age (thirty) and younger who have had to endure extended periods of unemployment due to the economy must depend on benevolent parents, should they be young enough, or instead beg for whatever available government coverage can be achieved.  At worst, they must make do with no coverage, hoping and praying that they don’t get seriously sick.  My sister is a prime example of the risk you take when you don’t have health insurance.  An injury, followed in rapid succession by an illness, required extensive care, depleting what little savings she had and leaving her in debt.  She always worked somewhere, but only managed to find jobs in the service industry, low-wage endeavors that did not provide insurance to employees.      

Returning to myself for a moment, so long as I had employer-based care, my problems with out-of-pocket expense and general frustration were relatively minimal.  Even private insurance has its problems, but I have to say that my experiences with government-provided coverage has been mixed.  Nowadays, however, some of the same issues long extant with government-based plans have been observed within private carriers.  These include increased premiums, a raise in co-pays, and a steady rise in the amount of money extracted from one’s paycheck to cover enrollment.  So this is not to say that I don’t think any public option should not be provided or even that I’m not fortunate to have what I do.  I’m merely stating the reality, which is that existing government run plans are not yet up to par in many areas.  Allow me to elaborate further.    

As I am formally disabled, I rely completely on Medicare and Medicaid for health insurance coverage.  After being deemed officially, federally disabled for two full years, Medicare coverage becomes one’s primary insurance.  Before then, I had to depend solely on Medicaid, which has even more limitations.  Being low-income, I also retain Medicaid coverage as secondary.  In what is called the “wrap-around” plan, Medicaid is supposed to pick up what Medicare does not.  Out-of-pocket cost, for me, has gratefully never been a serious headache.  My problems have been usually been a simple matter of inadequate coverage and delayed treatment.  

A tremendous amount of misinformation has been recently floated by Republicans regarding the nature of Medicare and Medicaid.  Those who wish to gut it and assume that doing so would somehow fix budget shortfalls clearly have no understanding of the way these systems really work.  Though I am fortunate to reap the benefits of both of these tax payer funded programs, I must admit also that the two of them do have some severe coverage gaps.  Good luck trying to find a psychiatrist or a psychologist that will take them, even in a big city.  In addition, the way the programs are structured, Medicare by itself rarely, if ever, picks up 100% of the cost.  Contemplating the ludicrous, obscene cost of run-of-the-mill procedures and medical services is enough to make one ill by itself.    

Due to two recent unforeseen reactions with medication, I had no choice but to call 911 and be taken by ambulance to an ER.  One ride in an ambulance to a hospital around three miles away ended up costing nearly $500.  Of that hefty price tag, Medicare picked up around $300.  If I didn’t have the wrap-around option in place, I would have been responsible for paying the remainder myself.  It’s a mixed blessing that I don’t.  No one wants to live at the poverty line.  But for many who may not be the poorest of the poor, $200 is a substantial cost to pay.  And that’s just getting you where you need to be.

I tallied up all the charges from one two-and-a-half hour long Emergency Room visit, and found that the cost ran somewhere close to $1000.  Before contemplating whether or not certain tests and procedures are truly necessary, one has to confront the greater issue, which is the obscene cost of health care in this country.  The health care reform act is still a few years away from total enactment, of course but I worry that the price of even maintaining basic health will continue to increase between now and then.  Politicians and ordinary citizens have discussed ways to keep inflation in check, but few really confront the basic issue.  Much like with college education, health care should NEVER cost this much, for any reason.    

Medicare (in a way Medicaid never does) is good to periodically mail me an itemized list of how much everything I charge to insurance really costs, plus how much it agreed to pay for each.  I try not to think about how many thousands of dollars in debt I’d be if I didn’t have any coverage at all.  But as pertains to larger issues like privilege and other offensive assumptions, I’ve never once been given this information as pertains to Medicaid charges.  Should I then assume that the thinking in not providing me any information regarding cost of treatment is that the average someone living in dire poverty doesn’t know how to read?  Or am I thought automatically to not be capable of understanding basic math?  Is the program so broke that they simply don’t have the money for paper and postage?  No matter.  

In all of our zealousness to balance budgets, I will concede that there probably is some degree of fat to cut from within Medicare and Medicaid.  Waste is found nearly everywhere.  But in all of these schemes, the day-to-day life of the average recipient of government-based care is somehow never under consideration.  Medicaid and Medicare both would run more efficiently if they were reformed, not scrapped.  I mentioned earlier the struggle in finding a psychiatrist and psychologist who would even take my insurance.  Their reasons for being reluctant are that Medicare pays out usually in one clump, after months of claims have been submitted.  Those wanting or even needing a steadier source of payment will not take it for this reason.  Furthermore, in accepting public insurance, limits are placed on how much any provider can charge for services and how much the system will pay out.  Call it greed or call it just trying to make a living, this further cuts down on the number of providers available to me.

Even when Medicare and Medicaid are accepted, options are nevertheless much more limited.  At the moment, I’m being treated for a protracted illness that has spanned nearly nine months in duration.  I am seeing three separate specialists.  I’ve never doubted the competence of the doctors, but I am concerned about their work load.  Being treated adequately requires me to seek care inside a university hospital system, but being that these places are among the only ones willing to treat me under my insurance, providers are already swamped with patients.  I sometimes have to wait up to a month before being seen.  In trying to keep finances from dipping into the red, making up for their own budget shortfalls often involves placing more work upon doctors and specialists alike.      

Additionally, many doctors and specialists who have treated me in the past few months are not much older than me.  Sometimes they may even be a year or two younger.  As is true with any occupation, making one’s name is part of the game.  Establishing a reputation for themselves is of paramount importance, so they are thus more willing to take a lesser amount in payment while they do so.  I appreciate a shared frame of reference when talking candidly with whomever is treating me, but it is notable how quickly our financial priorities change with time.  A marriage later, a standard of living later, perhaps even two kids later, I bet Medicare will no longer be listed under their list of “insurance taken.”  

But beyond these more concrete details is something else, namely compassion.  Not every doctor, specialist, or provider is obsessed with pure profit.  One should not dismissive the motive of altruism.  Some kind-hearted souls will take insurance with a reduced rate of payment.  Some will take sliding-scale fees for those unable to afford treatment otherwise.  It has been my observation that such attitudes are in the minority, but not nearly as uncommon as one might think.  Still, even living in a large city, one which has the good fortune to benefit from the closest imaginable proximity to the seat of power, finding adequate care for particular needs has been at times an exercise in frustration.  Altruism can only take one so far in the middle of sour economic realities.  I don’t blame those who practice medicine.  Instead I blame the absurdity of the health care industrial complex.  The government didn’t set costs and charges.  They’ve just had to somehow try to manage to keep up with them, and no amount of increased revenue is going to stem exponential growth.  

I often contemplate Franklin Roosevelt’s First Inaugural Address, which still speaks to us today.  His head majestically tilted upward, jaw resolutely set, Roosevelt’s body language connoted strength and authoritative guidance.  

In such a spirit on my part and on yours we face our common difficulties. They concern, thank God, only material things. Values have shrunk to fantastic levels; taxes have risen; our ability to pay has fallen; government of all kinds is faced by serious curtailment of income; the means of exchange are frozen in the currents of trade; the withered leaves of industrial enterprise lie on every side; farmers find no markets for their produce; and the savings of many years in thousands of families are gone. More important, a host of unemployed citizens face the grim problem of existence, and an equally great number toil with little return. Only a foolish optimist can deny the dark realities of the moment.

A few moments later, he continues,

Happiness lies not in the mere possession of money; it lies in the joy of achievement, in the thrill of creative effort. The joy, the moral stimulation of work no longer must be forgotten in the mad chase of evanescent profits. These dark days, my friends, will be worth all they cost us if they teach us that our true destiny is not to be ministered unto but to minister to ourselves, to our fellow men.

May it be so, forevermore.  

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