Kate Michelman's letter is troubling, but even more troubling is the fact that her situation is only one of millions of nearly identical ones. Most of the other stories are happening to people who are not as articulate as Michelman and whose inherent pride forces them to face the health insurance catastrophe alone. If all these stories could be told as cogently as hers, at a Congressional hearing, we might approach the point where, to quote Bob Dylan, "Now's the time for your tears."
Our medical system has made incredible advances against disease. In parallel with it, the anarchy of our healthcare financing system is creating an unacknowledged crisis of anxiety around how to pay for those miracle cures. This mass anxiety in itself might constitute the new medical challenge of the next decade.
I am a self-employed resident of Massachusetts, and I was one of the responsible folks who bought their own health insurance before "reform" was adopted. Before reform, my health insurance cost was rising by 30 percent a year. Under reform, with the expanded risk pool, premiums are still rising, although at a slower rate. This cannot go on forever; at some point the cost of health insurance will outstrip my ability to earn enough to pay for it. Meanwhile, because my daughter is out of college, she cannot be put onto my policy, and because she is unemployed, she has to pay for her insurance out of pocket, despite having virtually no income.
The new health insurance policies developed to make healthcare "affordable" in Massachusetts generally have extremely high deductibles and copayments, which is simply a disguised way of making the expensive seem cheap. These policies are useful only to those who will never use the healthcare system. Those who do use it find out quite rapidly that primary care doctors are being ordered to cut their office visits to under ten minutes, and everything from prescription coverage to physical therapy needs to be fought for. People who are sick and injured are in no position to fight those myriad decisions.
It is true that no healthcare system, even single-payer, can succeed unless costs are controlled. As a society, we are paying a huge amount for healthcare. Those dollars are going into someone's pocket. Although every sector of the healthcare economy claims to be a victim, there has to be a sector that is being paid more than it needs to be paid. The overpayment may stem from greed, or it may simply arise from a multitude of tests, procedures and prescriptions that are unnecessary.
One silver lining in our present near-depression is that people are eventually going to realize they can make do with less. We need to be given the choice of a healthcare plan that is made truly affordable by providing no-frills care by decent, caring doctors who don't need yachts to feel important. We don't need the most expensive MRI machine, the potted palms in the waiting room or the six clerical assistants processing insurance reimbursements.
From my vantage point, the way to get there is to open up the VA system to everyone and clone its method of service delivery and cost control. We need to cover everyone, regardless of employment or anything else. We need to wind up with a system where no one going into a doctor's office needs to worry about anything except the diagnosis.
May 3 2009 - 11:13pm