By Dan Kurland
Charleston Gazette (Charleston, WV)
May 13, 2005
May 1-8 was Cover the Uninsured Week, a time to focus on the broader health-care crisis. Writer Alwin Hawkins sums up the situation fairly well: “Everything I see we can do to fix the problem is either politically, ethically or financially disastrous.” But that’s probably not what you wanted to hear.
Health care is funded in a la-la world of cost-shifting. Uncompensated care is covered by overcharging those who actually pay. Charity care is partially reimbursed by the government. Everyone thinks someone else is paying. No one realizes that whether insurance is based on individual contributions, employer contributions, or government programs, in the end individual citizens pay all health-care costs out of pocket, in higher prices and lower wages, or in taxes. And insurance companies, like casinos, never lose.
Oh, for a while there seemed to be a glimmer of hope. HMOs tried to restore fiscal restraint, and the Clintons, bless their hearts, thought by satisfying everyone they could satisfy everyone. But it just wasn’t that simple. Vested interests just don’t play nice with others. It’s against their nature and their interests.
So here we sit, watching retirees lose pension benefits, the employed endure higher premiums and co-pays, and businesses cut back benefits. Defined contributions replace defined benefits, and why shouldn’t they? Costs have skyrocketed. Why make promises you can’t keep? It’s not business’s fault that prices went up, or that workers want affordable health care.
As more people drop from the lists of the insured, states seek ways to insure the growing number of uninsured. Not by subsidizing insurance, of course. There’s no money for that. Instead they look to low-cost private insurance packages. But low cost implies low coverage. Fewer services, higher co-pays, higher deductibles and lower maximum benefits. Yet everyone benefits: The uninsured are offered coverage, the insurance industry gets a new product to sell, and providers are protected against the rising costs of uncompensated care. Without insurance companies, after all, how would people get health care? (Hint: the public education system.)
As states create new initiatives to insure the uninsured, reduced federal Medicaid funding forces those very same states to uninsure the otherwise Medicaid-insured. There’s a war going on, and tax cuts to save. We must keep our priorities straight.
And keep our values straight as well. People can make up their own minds when they buy a car, why not a heart transplant (read: consumer-directed choice)? They can save for a vacation, why not a bypass (read: health savings account)? Must government always tell us what to do? Smoking, drinking, Big Macs and Barcaloungers. Wait long enough and there’ll be a pill for obesity. We all know it. Trust me. Wait. You’ll see the ad on TV.
We have moved from physician-based health care to pill-based health care, from a needs-based (I feel sick) to a market-inspired (…may last for four hours…) health-care system. We take pills for diseases we never imagined we had, whether there is clinical evidence to support their value or not. Everything is marketing. Once physicians start owning imaging centers, they obviously need volume (patients) to amortize their investment. Economic necessity clearly cannot be denied.
Of course, in time it will all catch up with us. Skyrocketing prices and continuing unhealthy lifestyles will lead to fewer insured and more uncompensated care and increased financial strain on the health-care industry. Providers will be forced to turn away Medicaid patients because below- cost reimbursement policies are sucking them dry. Whoops! That’s already happening! Government will have to step in to save failing hospitals to assure medical care.
When people are dying on the streets — or worse, health-care companies are going south on the stock market — others might actually take to the street and demand something be done.
When providers no longer have economic and political leverage, real changes can be made. We’ll be free to replace doctors with nonphysician health-care providers for preventive procedures, to insist on doctor-pharmacist collaboration in disease management, and to reimburse home care instead of hospital care. We’ll have the will to limit each patient to a single transplant, to ban Cheetos, to forbid Game Boys, and to prohibit low-probability end-of-life care. We’ll be free to legislate that school buses drop our children a half mile from schools to assure they get their exercise, and that all school lunches have two vegetables (not counting ketchup).
At least we won’t have to make the hard decisions. They’ll have been made for us.
Kurland is health action coordinator of Covenant House and creator of the Web site www.criticalreading.com
