Wednesday, October 21, 2009

A Simpleton Tries to Understand the Health Care Debate

By William Fisher

Now, the first thing I want you to know is that I'm no health care policy expert. Far from it.

But, like the rest of us, I have a body and a mind that can get sick. So I'm a participant in the debate whether or not I want to be.

And being about to mark my eighty-first birthday gives me a shorter time to participate but, arguably, a heightened motivation.

Over these past months, I have been drowning in seas of data and analysis and opinions and lies and spin about health. But very little of it has actually been about health. A lot of it has been about process, such as the process in the sausage factory through which legislation gets crafted. But mostly it has been about money -- money headed for so-called health insurance companies.

Now, maybe I have a simplistic mind, but frankly I don't understand why health care and insurance companies keep appearing in the same sentences.

After all, these two things are not the same. Insurance companies are not in the health care business. They are in the risk business. They assess risk and then charge you a fee -- it's called a premium -- to protect you against that risk. Just like your car or your home insurance. If your car gets wrecked, the insurance company doesn't make it better; it gives you money so that you can make it better. Same with home insurance; if a storm tears your roof off, your insurance company will send a contractor to fix it.

So it is with health insurance. Health insurance companies don't do a thing to make you well if you're sick. That's the work that's done by physicians, nurses, hospitals and clinics. And these two groups -- health care professionals and health insurance companies -- are far from buddies. In fact, they're pretty intense enemies.

The reason is that the health insurance companies, being in the risk business, do whatever they can to reduce their risk. So they are more than likely to deny all or parts of the care your doctor is prescribing to make you better. Their loyalties are to their shareholders. Shareholders who've seen a run of great profits, based on ever-rising premiums, based in turn on generous government subsidies and an almost total lack of competition among all these companies.

Oh, I forgot to mention that our Congress, in its infinite wisdom, gave these health insurance companies the same antitrust exemption enjoyed by major league baseball. This means they can fix prices with impunity. Trouble is they haven't been staying fixed for long; premiums have been increasing exponentially year after year. And there's been no noticeable improvement in our health; in fact, our health has gotten steadily worse.

These companies go still further to reduce their risk. For example, if you get sick you're insurance is quite likely to be dropped -- an action the insurance companies antiseptically call "rescission." They rescind a lot. In other words, just when you're sick and need coverage the most, that's when they tell you "you're out!"

Then there's the "preexisting condition" gambit. I just read about three denials that seem really gross. One was refusing coverage to a victim of domestic violence, which the company ruled was a preexisting condition. The second refusal involved a newborn who the insurance company claimed was too fat. And that was followed by a third refusal -- because the infant was too skinny.

Maybe, like me, you've been reading Karen Tumulty's pieces in TIME on the health care issue. She captures the facts as well as anyone I've read. And she has assembled one hell of a chamber of horrors -- about people with serious but treatable illnesses who were told, essentially, to find a charity to help because we, the insurance company you've been paying to reduce your risk, have been too busy reducing our own. Very few happy endings here: patients have died as a result.

Same thing happens if you get health insurance at work but lose your job. You can buy something called COBRA -- if you can afford to pay three or four times what you were paying when you had a job.
Gee, it must be wonderful to run a company set up to take risks on people getting sick -- but which has only healthy customers!

Now, here's another wrinkle to think about. How'd we get to this place where employers provide health insurance to their employees? And take it away when they fire you. Well, I'm told this practice started back in World War Two when the U.S. had wage and price controls. Your wages couldn't be increased so along came health insurance to make up the difference -- and give employers even more economic power over those who work for them.

Seems downright un-American to me.

In fact, seems to me this whole health care debate is struggling to reconcile two contradictory narratives we Americans invented to help us understand ourselves and our history. One is the narrative of rugged individualism. In this bit of mythology, everyone is John Wayne and nobody needs anyone's help to meet tough challenges -- least of all the government's help.

Then there's that other bit of American mythology, the part that talks about how, when the going gets rough for our fellow citizens, we all rally round and share our energy and our wisdom and our compassion to make things right again.

Neither of these narratives is true, but we like to believe both of them anyway, even if they are myths and contradictory myths at that.

Now, it seems to me there's a third bit of American mythology that's getting overlooked. That's the bit that talks about certain inalienable rights we all have, among which are life, liberty and the pursuit of happiness. That's from our Declaration of Independence, written by our Founding Fathers.

I like to think of life, liberty and the pursuit of happiness not as states of being, but as goals. That's because we've never achieved 100% of any of these three freedoms. So they -- and we -- are works in progress.

But it's pretty hard to imagine pursuing much happiness if you happen to get sick, get cut off by your health insurance company, and find yourself on your way to medical bankruptcy. Isn't that the point where we invoke that other piece of great American mythology -- the one that says now we circle the wagons, pool our resources, and find a way for all of us to help all our fellow citizens?

Well, there's only one way to do that and that way is to use our government. The government is us; we pay for it, we own it. We need to make it work for us.

Sure, there are a lot of folks out there who are telling us we can't go down this road because it will lead us into the dreaded socialized medicine. A government takeover of health care.

So what? Forget the labels; that's propaganda. It's the same sleazy accusation that was used against FDR's New Deal in the Thirties and again in the 1960s in the right-wing efforts to demolish LBJ's Great Society.

But, in fact, it's exactly what we're already doing for our seniors under Medicare, for our men and women in uniform, for our veterans through the VA -- and for every member of Congress. Seems to work just fine for these folks.

So why is it going to be such a disaster for the rest of us?

When you think about how much we pay for health care and health insurance in America -- many times more than the most advanced countries in the rest of the world -- and understand that we get substantially worse results, one has to conclude we must be doing something wrong.

We need to fix a bunch of things beyond predatory, uncompetitive, profit-centered health insurance companies. But neutering these vultures would be a start.

Maybe it's time to tell our Congress persons how we feel.