A friend of mine just moved across the continent to the West Coast to seek a new life for herself. Her prior employer’s insurance coverage has just elapsed. Which brings me to today’s subject.
What is health insurance? Auto insurance is insurance. You get paid upon an accident. But do you with health insurance? Clearly, I will argue "no", so if you are a car or a human with no time to spare, leave now and be a four-wheeled jerk.
The rest of us, kids, let’s play a game of Imagine (no copyright, free distribution license, GNU, boilerplate, boilerplate). Imagine you get sick (had an accident if you’re a car). If you’re a car, you get paid. If you’re the egalite-fraternite-type-human with rights for liberty, property, happiness, yet not the happiness of affordable health care, employment , or comfortable retirement, what can happen to prevent your treatment? Imagine, your company drops its health plan. According to the U.S. Census Bureau , the percentage of the population covered by employer-based health insurance has fallen every year since 2000, from 64.2% to 59.3%.
Imagine your company goes belly up.
Imagine you lose your job because, imagine, the unemployment rate as of this writing is in the double digits. No Census Bureau data needed.
Imagine you leave your job voluntarily because your grandma, who lives in a house on the other side of the wolf-infested Dark Forest, needs her medicine.
Imagine you depend on your spouse for medical coverage and imagine she runs away with her health insurance agent because he’s so much better off than you are.
Or imagine you live in the worst depression since the great Depression. Your employer drops its health plan because health care is getting more expensive or the company is in bad shape. Or imagine, you get sick and losing many work days costs you your job. Your wife leaves you because the insurer has a job and you don’t. And here you are a lone afloat in the individual insurance market without a job, a wife, or a rescue boat in sight.
Imagine you do get sick but your insurer, the one who ran away with your wife in the first place, rescinds your policy because he’s such a douche or because you didn’t read the fine print in which your contract clearly specifies that your insurance doesn’t cover the treatment you need. Or he hires a detective to plunder your medical records to find a reason to deny you insurance.
Now you don’t need to imagine that whatever this is, it is not insurance. It’s employer-subsidized health care for the duration of your employment. Much like your retirement is. Once you’re in the individual market, you don’t have to imagine that you have no right to affordable health insurance. An insurer can refuse to insure you, charge you a premium only Bill Gates can afford in a free market only Bill Gates can afford. The problem is Bill Gates doesn't need insurance. At least not of the health kind. Bottom-line medical care will always rise with time. Itmakes a fool out of your insurer, who need I remind you is happily banging your wife right now probably right in front of your kids in Bermuda, if he would NOT charge you for your potential medical care more than it would cost you out of pocket.
With a bottom-line pharmaceutical industry, the motivation for fast cures is very small indeed. I am reminded of that horror-pic, Extraordinary Measures, that I wandered into by mistake at the movie theater in NYC. Rather the highest revenue can come through disease or wellness maintenance. In the recent issue of Popular Science, an article announces the beginning of expiration of a pharmaceutical patent block this year to wind down by 2016. Many brand-name drugs bringing in $140 billion in sales will be replaced by cheap generic versions using their patent. The upside is that prescription drug costs will decline in the next 10 years. Pfizer’s patent exclusivity on Lipitor which has garnered Pfizer $12.4 billion in sales in 2008 and is one of the most profitable drugs in history will expire. FDA approval of drugs has fallen from 35 a year in 1996 - 2001 to 22 in 2002 - 2007. Vioxx problems, a prescription pain reliever, were to blame after studies showed that over a hundred thousand patients suffered heart attacks. Without the $12 billion Lipitor revenue and other brand-names, R&D funds would decline despite of the growth of superpharma concerns: Pfizer’s merger with Wyeth and Roche with Genentech. To generate more revenue, the companies will bank their R&D funds on their biggest cash cows: obesity, cancer and immunological and neurological diseases that require maintenance but cannot be cured completely just yet.
Medical insurance doesn’t cover patients with pre-existing conditions, often has no prescription drugs benefits, doesn’t cover specialists, doesn’t cover hospitalization or does at trivial expense and has gargantuan deductibles. There’s more that regular health insurance plans don’t cover than do. When I was employed as a freelancer, clinging to the life raft of individual insuance, my deductible under HIP from the Freelancers’ Union, was $5K on top of the monthly $300 premium. I couldn’t afford to go to the doctor to check my wonky knee. When the opportunity came up to downgrade my freewheeling life of an international gigolo to an anchored-down zippered-up desk jockey position, I did me harm by making the expedient choice because of the inexpensive PPS attached to the job.
Imagine you are about to be hospitalized. If you have health insurance. If you have no “priors”, i.e., pre-existing conditions. What happens? The hospital actually outsources you to your family care. So not only do you have to make your own coffee at the coffeeshop, but you have to sew yourself up after your appendix is removed as well. An eighty year old grandma gets trained on how to wash a tube for her daughter’s catheter or change her bandages after invasive surgery. I suppose the short-term solution to medical cost-saving is not to use trained medical personnel. Here’s the vaunted American ingenuity at work! In the same vein, If a sewage pipe bursts in your house, you shouldn’t call the plumber. Put a bandage on it. Or take a plumbing course, which is less expensive than calling a plumber. Or move out. What if it’s the husband who must take care of his wife? Will he have to take time off work? Most likely. For how long can he do it and retain his employment? The average seems to be 120 days under most state laws. This not bad, considering. However take a coworker of mine who after a decade of hunkered-down data entry was diagnosed with acute carpel tunnel of both her wrists. Having opted for surgery and suffered complications because of the doctor’s delegation of his responsibilities to a resident, my coworker spent 9 months in home care unable to resume work. A carpel tunnel is not cancer. And yet to her, it proved more debilitating because of lost earning ability. Here’s another lesson in this. Many city hospitals unable to hire physicians to fill all slots because of financial constraints are opting to hire residents for the positions served by doctors in the past. This is another cost-saving that the modern system encourages, heaping revenue not on providers but on insurer intermediaries. In 1971, a mother giving birth to a non-caesarian child stayed in the hospital for 5 days. A caesarian – 10 days. Now, the mother gets discharged within 24 hours, sometimes with the help of legislation. Profitable? Yes. Efficient? Certainly. Quality care? Quality of life? Risks of negative outcomes? These get swept under the rug. In the end, these are not quantifiable indices and economists have no means to take note of them even if they wanted to. Then are we as a people, as proud Mericacans, saying life is not important? Take an example from WW2 Russia sending its troops to the battle armed to the teeth only with their exceptional patriotism, where every rookie would pick up the rifle of his fallen comrade. Imagine a circle of rifles borrowing a new pair of human legs and a trigger finger to advance a few meters into the heart of the enemy. This is the inanimate revolution. This happens when human life is made subservient to things. Read: critique of American consumerism. Take another revolution. Prior to the French Revolution, much of the same privatization of profits was going on. Then the Enlightenment placed emphasis on equality, humanitarianism, and quality of life. If history has a tendency to repeat itself, it is only a matter of time before Enlightenment reasserts itself and reinstates human values over the values of Mammon. Insured health care is just one cog in the modern ascendancy of corporate tyranny. The ongoing shift from democracy to corporatocracy some day will become our new American Magna Carta. Here’s hoping, kid.
And to resume our weekly tradition of solving one global crisis at a time. Here's my solution to the crisis of medical care in five sentences or more.
It is a well known fact that as monetized industries go, health care is one in which any person, dead or living, would give up her first-born for the chance to sew-up a torn off limb back onto her torso. More if it's a new and better limb or, even cooler, a claw. Read in this the biological imperative, spiritual degradation, WISIWIG, Res Ipsa Loquitur, qua es cogito ergo laude summa cum, etc., etc. The problem is that there is no market check on the runaway charges fixed to the invaluable service of sewing heads back on, especially in a social order without any matter of social safety nets such as guaranteed full disability or above-poverty-level unemployment entitlement. Getting injured or chronically sick equals death more often than not. Currently the check is being provided by the so-called insurers with doctors' dues being limited to a fraction of their billing appetites. However, the costs are a speeding locomotive and if you like to know where your money is going, here's a linkie. The solution appears to be in government's subsidizing medical students way through school in exchange for a commitment to gain experience as a government retainer for a number of years treating patients free from the motivations of profit or insurance companies' constraints, providing treatment at government-determined prices. This is nothing new. Even as we speak, a similar program requires new physicians' service commitment in the armed forces whose length is determined by the number of years the medical student's education was subsidized. Problem solved. Voila.
And to resume our weekly tradition of solving one global crisis at a time. Here's my solution to the crisis of medical care in five sentences or more.
It is a well known fact that as monetized industries go, health care is one in which any person, dead or living, would give up her first-born for the chance to sew-up a torn off limb back onto her torso. More if it's a new and better limb or, even cooler, a claw. Read in this the biological imperative, spiritual degradation, WISIWIG, Res Ipsa Loquitur, qua es cogito ergo laude summa cum, etc., etc. The problem is that there is no market check on the runaway charges fixed to the invaluable service of sewing heads back on, especially in a social order without any matter of social safety nets such as guaranteed full disability or above-poverty-level unemployment entitlement. Getting injured or chronically sick equals death more often than not. Currently the check is being provided by the so-called insurers with doctors' dues being limited to a fraction of their billing appetites. However, the costs are a speeding locomotive and if you like to know where your money is going, here's a linkie. The solution appears to be in government's subsidizing medical students way through school in exchange for a commitment to gain experience as a government retainer for a number of years treating patients free from the motivations of profit or insurance companies' constraints, providing treatment at government-determined prices. This is nothing new. Even as we speak, a similar program requires new physicians' service commitment in the armed forces whose length is determined by the number of years the medical student's education was subsidized. Problem solved. Voila.
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