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There are multiple tragedies that have taken place, but most are not the "fault" of the healthcare system. The daughter was uninsured by choice, one can assume. This is an error many young people make.

It appears that the family exhausted funds on the daughter (understandably). However, was there an opportunity for the daughter to access state funds such as Medicaid? This was not related.

The husband is another of the tragedies. But what health insurance options were available to the family? Could they have gotten a policy with lower deductibles and co-pays? Could they have obtained long-term care earlier in their lives? I am not trying to be cruel, but could better financial decisions along the way have avoided some, if not all, of this financial issue for the family?

What has happened is awful and real. However, if the government pays for all of this, from where will the money come to do so?

It is quite easy to talk of universal healthcare in the abstract, but costly to implement it. It will ultimately require rationing. Is the US ready for that? Canada has it, and not because of the current government. My wife lived there for thirty-five years and can relate horror stories under both the liberals and conservatives. How about this: her father waits in the emergency room for forty-eight hours to get into the ICU! No transfer to another hospital offered.

Rationing is a way of life. In the early '90s Toronto had four MRI machines for 4 million people. Philadelphia, a similar-sized city, had over fifty. Philly may have too many, but Toronto certainly has to few. Why?

Universal coverage may be the answer--but not run by the government, please.

Gerry Good

Long Beach, CA

Apr 10 2009 - 3:20pm

Web Letter

Life isn't fair. I feel sorry for Ms. Michelman's family members for the unfortunate events that have afflicted them. And it is unfair that Ms. Michelman has had to devote more of her life caring for her family than many others have had to do.

People who have spent time on the message boards here know me as Darin_the_Troll. Many of you know that I am an actuary. Actuaries do many things: the most common is to quantify the financial consequences of risk.

Here's a riddle: What do hundreds of millions of people buy with the hope they never use it? The answer is, insurance. Actuaries determine the price of insurance. In order to do this, we need to understand what insurance is. Too many people believe insurance is what gives you money when bad things happen to you. That's not insurance, that's Santa Claus.

Insurance is the pooling of similar risks. If there is a 1-in-1,000 chance that your house will burn down, I need to charge 1,000 people (with $200,000 homes) $210 dollars each. So that I will have $10,000 for expenses (I need to file financial reports with the state insurance department, keep electronic records, etc.) and $200,000 to replace the home of the unlucky one. It is not rational to expect me to simply replace every home that burns down. I can only replace the homes of the people that participate in the pooling by paying the premium.

It is hard to imagine a figure more tragic than Ms. Michelman's daughter. A young woman who was just beginning her life, was paralyzed in an accident. But I have to ask, why didn't she have health insurance? Why didn't she have disability income insurance? Surely it wasn't that she couldn't afford it. If she could afford to pursue her dreams of working with horses, surely she could afford to insure against the risk of sickness or accident. She was aware of the risks involved with working and playing with 1,500-pound animals, but she chose to accept those risks and self-insure. Call me old-fashioned, but I believe that is irresponsible. Now, I'm not blaming the victim. I didn't say she deserved to be injured. But I do believe it is irresponsible to accept risks when you know others will have to pay the costs of your risks.

I do not believe that the purpose of government is to subsidize you (at taxpayer expense) so that you can pursue your dreams. I do not believe the purpose of government is to eliminate the consequences of irresponsible decisions. (Again, it is not irresponsible to take risks; it is irresponsible to take risks when you know others will have to pay for the consequences of your choices.)

As to her husband, if the LTC policy doesn't pay for his care, he should have purchased a bigger policy. LTC is one of the best values in insurance. Twenty years ago they were terribly under-priced, and insurance companies have lost billions of dollars because they were under-priced. As to his health policy, $8,000 sounds like a lot, but he spent four months in the hospital. His total bill was probably $200,000 dollars and his share not even 5 percent of the total cost.

To each according to his needs, from each according to his ability--that economic principle has never worked in the history of the world, and it never will, because people are motivated by self-interest. If you find your abilities far outpacing your needs, your abilities will suddenly disappear. If we are to leave anything to the next generation, we must, on average, produce more than we consume. If we engage in private insurance, we will all, on average, produce more than we consume, but the unlucky will consume more than they produce because they will be subsidized by people who pay insurance premiums and never collect.

Basing your healthcare on need alone will certainly ensure that people produce less.

Darin Zimmerman

Charlotte, NC

Apr 10 2009 - 2:33pm

Web Letter

I read with interest the story of the problems of extremely costly health problems. What was missing was an acknowledgement of personal responsibility.

To go without health insurance is not responsible. I am self-employed, so I must deal with the problem/costs 100 percent. But if one is willing to assume high deductibles, insurance is relatively reasonable. But you are protected from the ravishing impact of a catastrophic event. A single young person can get excellent insurance for less than $100 per month, less than most people spend at Starbucks. Yes, you will pay the first $3,000 of expenses annually, but you will have excellent coverage for a terrible fall, Parkisons, cancer etc. And this is from your first-tier insurers, Blue Cross, United etc.

I pay slightly over $400 per month for care for my wife and myself, both close to retirement age, with the option to pick my own doctors, hospitals, with a several-million-dollar max limit. Yes, I have to pay most of the day-to-day costs, and that means it is in my interest to eat healthy, exercise, keep my weight down and give up technical rock climbing, another risky hobby I have enjoyed. But I am covered if I am run over by a bus, or develop one of those catastropic diseases.

Smoking, drinking, excessive weight, participation in high-risk activities demand that we take responsibility for this behavior. Many exteme health problems are beyond anyone's control, but fortunately the insurance companies can take this risk and at reasonable costs, if we act prudently in advance.

Dennis Storhaug

Littleton, CO

Apr 10 2009 - 2:06pm

Web Letter

Ms. Michelman's letter about the destitution visited upon her family when she tried to get healthcare is one of millions of such stories. Yet nowhere did she mention the obvious solution: single-payer health care a k a Medicare For All. Please visit my organization's website and view the sincere plea to the president by Mike Farrell, then take action to make healthcare a right, not a commodity. As Mike says: Everybody In, Nobody Out.

Clark Newhall

Salt Lake City, UT

Apr 10 2009 - 10:07am

Web Letter

A moving account of personal and family tragedy. Most of us could find ourselves in similar straits with a run of bad luck. Life is unfair. Personally fairly conservative, I have nevertheless come around to the view that universal coverage, i.e., some variation of Medicare for everybody, is warranted, both on grounds of equity and because of the deleterious effects our present jerrybuilt system has on the over-all economy. But the basic dilemma is intractable. The ever spiraling costs of Medicare alone threaten to bankrupt the country down the line if they are not somehow contained.

Should the Michelmans' personal misfortunes be largely addressed financially by the overall society? Perhaps. But multiply their sad situation, with all its variations, by the thousands or millions. There is no conceivable system, including those in Europe, that can give everybody everything the double-edged sword of modern medicine can provide, particularly at the end of life. The laws of economics cannot be repealed by a compassionate view of social justice. In short, some form of rationing, whether by private economics or governmental determination, is simply unavoidable. The choices are agonizing, but the best we can hope for is some mitigation of the vicissitudes of life and death, and any wider initiative will be hugely expensive. To pretend otherwise is a well-meaning but delusional evasion of the harsh facts.

Andy Anderson

Bronxville, NY

Apr 10 2009 - 4:42am

Web Letter

Ms. Michelman, I read your article with extreme interest because I personally have seen too many stories like yours. I noticed that you had no specific complaints about the medical care except the cost! If you really do have one last crusade left in you, then help bring medical costs down! I and other physicians know how to do this, but our hands are tied. The solution is to end liability lawsuits in healthcare. Prices will plummet overnight. And I warn you, it might not be a popular stand, but nothing else will work.

Lawrence Bailey, MD

Georgetown, KY

Apr 10 2009 - 12:35am

Web Letter

My heart goes out to Ms. Michelman and her family for the pain and indignity she has been forced to endure through no fault of her own. It is bad enough to have serious illness beset a family, but to then be stripped of any financial support to get care is unconscionable. Unfortunately, her sad story goes on all over our wealthy country, which cannot bring itself to create a just healthcare system for its citizens.

As a US citizen living in Canada as a permanent resident, I qualify for care under our Universal Health Care system. Yes, we have shortcomings, mostly due to lack of sufficient financial investment in our system by the Conservative leadership now in place. However, no one is exempt from care, even when there are waiting times for specialists, tests to be done, etc. Persons with serious illnesses are given priority care as well as emergency cases, and many of us are pushing for better coverage all around.

No one need go bankrupt in order to have healthcare nor lose their health coverage should they lose their job. This is true of most industrialized countries that deliver good care at a fraction of the cost of the United States.

I have supported the fight for a similar system in the United States for a long while, even before our current economic meltdown. Remember, such a possibility has been on the back burner since Harry Truman's presidency.

I am disappointed that President Obama is supporting a hybrid plan, involving the private sector as well as government involvement, since this will not address the serious problems we face. Since the majority of US citizens, a majority of the members of the American Medical Association and many other concerned organizations support a Universal Health Care Plan, the president is not responding to the will of the people on this issue.

Congressman Conyers has a Universal Health Plan bill before Congress with increasing support for its passage, and we can only hope that it will be passed eventually.Certainly, the desperate need for decent healthcare coverage should take priority over the vast amounts of money going to support our senseless military involvements.

Pearl Volkov

Burlington, Ontario, Canada

Apr 9 2009 - 9:42pm

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