The High Cost of Doing without Universal Health Care
Here’s the news that rocked my little world this week: We got a call that a family friend, let’s call her Lorraine, was in an ICU, barely able to breathe on her own. In the last few weeks, there’d been some mumblings about “not feeling a hundred percent,” but no hint of anything seriously wrong. The diagnosis came back in a couple of days: fourth stage breast cancer which has spread to a number of other organs including her lungs. If you know anything at all about breast cancer “staging,” you know there is no fifth stage.
Lorraine, it turns out, has no health insurance. We didn’t know that, in fact, we’d been content to believe that her consulting business was going as well as she said it was. In her late forties now, she’s a former accountant who never could find another decent job—also a news junky, an avid reader, and an energetic volunteer in a number of worthy causes. She’s usually balancing a half dozen projects at a time, all of which she’s ebullient about.
But it turns out she’s been struggling with the cell phone bill and the rent. A few weeks ago, unbeknownst to us, she’d moved out of her apartment and into a free room offered by one of the nonprofits she volunteers for. The cost of a mammogram – well over $100 – must have been out of reach.
The current discussion about President Bush’s health saving accounts proposal needs to include Lorraine. The idea, laid out in his State of the Union address, is that we should each have a “catastrophic” health insurance policy for the big ticket items like breast cancer, plus a tax-deductible savings account for the little things, like mammograms. If we have to take “personal responsibility” for our doctor visits and routine care we’ll be thrifty about it – or so the thinking goes – and the nation’s medical expenditures will stop spiking like an Ebola fever.
It’s an old idea, going back at least to the Clintons, that the problem with the American health system is that we, the consumers, just consume too much. Make us mindful of the costs by raising co-payments and other out-of-pocket costs, and we’ll stop indulging in blood work-ups, MRI’s, prostate exams, and all those other fun things.
President Bush, meet Lorraine. Her problem wasn’t that she feasted on unnecessary care, but that like so many of 45 million uninsured Americans, she wasn’t getting any care at all. Maybe, when she first noticed the lump, she should have staged a sit-in at the nearest clinic until they sprang for a free mammogram. But her idea of “personal responsibility” was not to be a bother to anyone.
And how much does the “personal responsibility” theory even apply to the insured population? I have insurance – at enormous cost, because I’m not part of a group plan and I’m an ex-breast cancer patient myself – but that doesn’t mean I choose what care I get. It’s not my idea to have annual mammogram and pap smear. The doctor had to threaten tears before I’d submit to a bone scan, and they’ll have to drag me in for a colonoscopy. No one aside from the rare victim of Munchausen’s disease goes looking for recreational medical care.
The fact is there’s a big difference between the economics of health care and that of, say, costume jewelry. We the consumers control the demand for costume jewelry; we can splurge on it or leave it alone. But we have precious little control over our demand for health care. Sure, we can exercise and refrain from smoking and sky-diving and swimming with sharks. We can eat right too (whatever that may mean, with the dietary advice fluctuating from month to month.) But it’s the medical profession that determines how often we need our blood drawn, our breasts squished, our cervices scraped or any of the other nasty interventions they have to offer.
If the medical care we consume was under our own control, I’d say, sure, save up for it and use it wisely. But it’s no more in our control than the wind and floods we insure our homes against. When something is not in our control, we share the risk with some form of insurance. We don’t say: Save up because you’re on your own.
You think it’s too expensive to have universal health insurance? Let’s be hard-headed about Lorraine’s case. If she’d been diagnosed earlier, she might have gotten by with a mastectomy and a bout of chemotherapy instead of burning up Medicaid dollars in an ICU. She might be out volunteering for the needy right now, instead of lying in terror in a hospital bed.
Here’s the news that rocked my little world this week: We got a call that a family friend, let’s call her Lorraine, was in an ICU, barely able to breathe on her own. In the last few weeks, there’d been some mumblings about “not feeling a hundred percent,” but no hint of anything seriously wrong. The diagnosis came back in a couple of days: fourth stage breast cancer which has spread to a number of other organs including her lungs. If you know anything at all about breast cancer “staging,” you know there is no fifth stage.
Lorraine, it turns out, has no health insurance. We didn’t know that, in fact, we’d been content to believe that her consulting business was going as well as she said it was. In her late forties now, she’s a former accountant who never could find another decent job—also a news junky, an avid reader, and an energetic volunteer in a number of worthy causes. She’s usually balancing a half dozen projects at a time, all of which she’s ebullient about.
But it turns out she’s been struggling with the cell phone bill and the rent. A few weeks ago, unbeknownst to us, she’d moved out of her apartment and into a free room offered by one of the nonprofits she volunteers for. The cost of a mammogram – well over $100 – must have been out of reach.
The current discussion about President Bush’s health saving accounts proposal needs to include Lorraine. The idea, laid out in his State of the Union address, is that we should each have a “catastrophic” health insurance policy for the big ticket items like breast cancer, plus a tax-deductible savings account for the little things, like mammograms. If we have to take “personal responsibility” for our doctor visits and routine care we’ll be thrifty about it – or so the thinking goes – and the nation’s medical expenditures will stop spiking like an Ebola fever.
It’s an old idea, going back at least to the Clintons, that the problem with the American health system is that we, the consumers, just consume too much. Make us mindful of the costs by raising co-payments and other out-of-pocket costs, and we’ll stop indulging in blood work-ups, MRI’s, prostate exams, and all those other fun things.
President Bush, meet Lorraine. Her problem wasn’t that she feasted on unnecessary care, but that like so many of 45 million uninsured Americans, she wasn’t getting any care at all. Maybe, when she first noticed the lump, she should have staged a sit-in at the nearest clinic until they sprang for a free mammogram. But her idea of “personal responsibility” was not to be a bother to anyone.
And how much does the “personal responsibility” theory even apply to the insured population? I have insurance – at enormous cost, because I’m not part of a group plan and I’m an ex-breast cancer patient myself – but that doesn’t mean I choose what care I get. It’s not my idea to have annual mammogram and pap smear. The doctor had to threaten tears before I’d submit to a bone scan, and they’ll have to drag me in for a colonoscopy. No one aside from the rare victim of Munchausen’s disease goes looking for recreational medical care.
The fact is there’s a big difference between the economics of health care and that of, say, costume jewelry. We the consumers control the demand for costume jewelry; we can splurge on it or leave it alone. But we have precious little control over our demand for health care. Sure, we can exercise and refrain from smoking and sky-diving and swimming with sharks. We can eat right too (whatever that may mean, with the dietary advice fluctuating from month to month.) But it’s the medical profession that determines how often we need our blood drawn, our breasts squished, our cervices scraped or any of the other nasty interventions they have to offer.
If the medical care we consume was under our own control, I’d say, sure, save up for it and use it wisely. But it’s no more in our control than the wind and floods we insure our homes against. When something is not in our control, we share the risk with some form of insurance. We don’t say: Save up because you’re on your own.
You think it’s too expensive to have universal health insurance? Let’s be hard-headed about Lorraine’s case. If she’d been diagnosed earlier, she might have gotten by with a mastectomy and a bout of chemotherapy instead of burning up Medicaid dollars in an ICU. She might be out volunteering for the needy right now, instead of lying in terror in a hospital bed.