Wednesday, July 29, 2009
Health, Health Care, Reform, Objections, and One Independent Bookseller's Response
A friend e-mailed me an article entitled “5 Freedoms You’d Lose in Health Care Reform.” Let’s go down the list one item at a time.
Freedom to choose what's in your plan. Well, I don’t have a plan. Don’t have health insurance. Can’t afford it. Have looked at various plans, and there is not one for me. I have been priced out of the market by companies who offer expensive plans and people who can afford them. “Good” health insurance pays the medical costs of a middle-aged person who has a slight dizzy spell, is put through thousands of dollars’ worth of tests, finally told there’s nothing wrong and she should “get up more slowly” in the morning. A lot of people make a living because of such coverage, but it drives the cost of health insurance sky-high, leaving a lot of us behind.
Freedom to be rewarded for healthy living, or pay your real costs. Another freedom I do not currently have. When I go to the doctor, I am charged the full, i.e., highest, amount listed for my visit and/or procedure. If I have to buy drugs, again I am charged the highest price. This is because I do not have health insurance. Luckily, I am very healthy; I am not, however, rewarded for healthy living. Friends and relatives with insurance get price breaks not only because insurance pays—their insurance company pays less than I am charged, because the companies are big and can bargain for better prices. Those of us who can’t afford insurance pay more than big insurance companies have to pay to cover their paying clients. A friend picking up a prescription forked over her one-dollar co-pay and asked, out of curiosity, what the “real cost” of the prescription was, and the pharmacist answered coldly, “That’s none of your business. You’re not paying it.” I might have been charged $80 for the same drug. How much did my friend’s insurance company pay for her prescription? Twenty dollars? Less? It’s none of her business and none of my business, according to the insurance companies and pharmacists. The doctors, I can tell you, have no clue. Read on.
Not long ago, a doctor thought I should, to be on the “safe side” (though he was pretty sure his diagnosis was correct), have a battery of expensive tests. I asked how much the tests would cost. He didn’t know. He asked one of his employees to call the place that gave the tests. The people there didn’t know, either, how much the tests would cost. “Our billing company takes care of that.” Americans are asked to be “responsible,” behaviorally and financially, for their own health care and then asked, if they do not have health insurance, to hand over blank checks to providers. This is a freedom?
Freedom to choose high-deductible coverage. This sounds good. I wish I’d ever been able to find it. Oh, we’ve looked into the question and have been offered a high-deductible plan, but there is a very high ceiling to the cost of such a plan, so that you can choose lower coverage, but you’re still paying the same as if you had higher coverage. You can bring the cost down to the third floor, but you sure can’t get it to the bargain basement. Bargains in high-deductible coverage are either a myth, or everyone claiming to offer them has ruled me out. Why? Because I’m self-employed? I don’t know, but I got tired of lengthy investigations that never once turned up a reasonable result.
Freedom to keep your existing plan. Again, I don’t have a plan. Once I had a plan, a very good one. University employees have been spoiled in this regard for a long time, but those days are numbered, whatever changes the government does or doesn’t make. One state decided to stop making employer contributions to retirement plans, since employees received a substantial tax reduction from the federal government. That’s retirement, not health insurance, but the writing is on the wall. How many people do you know who stayed in jobs solely for the health insurance—and then got laid off or had their benefits reduced or stripped when their hours were cut back or who got all the way to retirement only to find the benefits they had worked for had evaporated or came down with a serious illness and found their policy cancelled? Without government intervention, you have the freedom to keep your existing plan just as long as the company can provide it to you at great profit to itself and no longer.
Freedom to choose your doctors. This has been the panic cry as long as I can remember. At least Shawn Tully is honest enough to admit that HMOs curtailed the freedom in the same way a government plan would need to do. But guess what—private insurance plans do the same! If doctors don’t “participate” in the plan you have, you can be seen by them only on an emergency basis. You cannot, for example, choose a surgeon to operate on you and have your insurance pay that surgeon if that surgeon is not a participant in the insurance plan. There are probably a lot of people who don’t know this, as we did not until David was in the hospital in Florida this past winter. My freedom to choose a doctor is curtailed by my ability to pay, but that is always seen as okay by financial freedom hawks, so why is it any bigger problem that someone with insurance might want to choose a doctor whose fees would not be covered by that insurance? You want someone else? Pay for someone else! Oh, suddenly the shoe is on the other foot?
Someone else asked me earlier this summer, "Do you work out?" I don't go to a gym. What I do is go out in field and woods with my dog, and that (along with a grateful attitude) is my health insurance policy, insofar as I have one. Sarah and I went for a good hike this morning--fresh air, sunshine, refreshing breeze, lots of interesting things to see (and, for her, smell) in the woods--good exercise for both of us, refreshing body and soul. No insurance company is going to reward me for this. My getting out in the woods with my dog is its own reward, in the moment. I don't have to worry that it might not pay off in the future, after I've sacrificed my whole life to have it in place.