The Sick Finish to Healthcare Reform

Thoughts about a health care system that doesn’t want to make you healthy, personal experiences with it, and what effects the Massachusetts Senate election might have on Obama’s most important domestic initiative.

Health! Where is your care?

We’re* among the lucky ones; we have health insurance. I’m on my wife’s plan and she gets it from her employer. We’re not part of those 30 million in the United States for whom a simple chill could have fatal consequences because they can’t afford health insurance, are illegal aliens, or work for an employer who doesn’t provide it.

So we’re home safe, right?

Just before the end of last year, my wife’s employer announced they were switching health insurance providers. They can do that in America. The insurers are private corporations and whichever of them is the low bidder gets the contract. But that’s often not to the employees’ advantage.

The employees at my wife’s company reacted with some uncertainty: How high will my monthly premiums be with the new insurance? How much will my co-pay be for a visit to the doctor? What’s the out-of-pocket maximum I’ll be responsible for in the event of an accident or a serious illness? What’s the deductible, i.e., the amount I’ll have to pay myself, regardless of the cost of the procedure? Where’s the three-tiered price package of the “life max,” i.e., that critical point of treatment costs which, if exceeded, will result in the company canceling my insurance — regardless if I still need treatment or have a chronic illness?

Pre-Existing Conditions

My wife’s co-workers were worried. Would the new insurance company consider current illnesses as “pre-existing conditions” that would exclude them from coverage? I know someone who experienced exactly that. He suffered back pain and was treated by a doctor, no problem. His employer switched health insurance carriers. The next time he went to the doctor for back pain, a red flag went up at the insurance company. His medical records indicated a “pre-existing condition.” He had to hire an attorney to threaten the insurance provider with a lawsuit before they paid.

Some further research brought me a little peace of mind: New York state has already forbidden rejection for pre-existing conditions. But still . . .

Free, As In Market

Health insurance in the United States works a bit like automobile insurance in Austria. In case of a damage claim, there’s always a lot of haggling. The difference is that long after the damage has been done, the outcome could still well be deadly for the health insurance customer on financial grounds alone.

The health care business is one of the most profitable in Yankeeland. The objective of the insurer is to maximize profits, not to improve the health of the people. At the same time, the cost to the insured isn’t dependent on income; it’s strictly a negotiated amount between the insurance company and the employer.

Market logic dictates that large corporations get the best deals for their workers simply because they employ more people. Small businesses, on the other hand, often cannot afford to cover their employees or at best have to pay significantly higher premiums for significantly inferior coverage.

And because medical procedures are expensive, the insurance companies try to reduce their outlays. “Payment denied” is a short phrase that is sometimes a death sentence for the insured.

It’s Sicko

But there are other reasons why the American health care system sickens people. The bureaucracy is inefficient, expensive and time wasting — that is to say, all those things that the so-called free market is supposed to overcome. This dysfunctionality adversely affects the patient, the physician, the employer and the taxpayer. Physicians, pharmacies and companies have to hire people to comb through insurance regulations that are nearly impenetrable, even to professionals.

Every prescription and medical procedure must be laboriously crosschecked through lengthy litigation (which often results in long waiting times at the doctor’s office and the pharmacy). If one isn’t in the government’s Medicaid program (for needy people under certain conditions) there is a co-pay charge for each office visit, each emergency room treatment, and every ambulance call. Even the Medicare program for seniors has to be supported by patients reaching into their own pockets.

The Great Project

But what was that? Time for change? Didn’t President Obama want to change all that? Coverage even if you lose your job? No more “pre-existing conditions” clauses? A government-run insurance plan as an alternative to the private schemes, financed by reallocation? Relief for small businesses so they can afford to give their employees insurance? Acceptance of the uninsured into various programs? Health care reform that’s virtually “universal” and similar to what Senator Ted Kennedy fought for his whole life?

Not anymore. The electoral defeat suffered by the Democrats in staunchly Democratic Massachusetts showed that Americans don’t really want change. Just one year into a new administration, hardly enough time for any meaningful reforms to take effect, Americans have already had it up to here with “government spending” and “socialist” health care reform and all the other horrors of an administration that has done everything wrong and nothing right. That’s the early diagnosis from CNN and all the rest. Tea Party Forever!

Instead, they elected a man to fill the second Massachusetts Senate seat whose political philosophies coincide exactly with those of Bush-Cheney (albeit a man who was scrupulously careful during the campaign to pass himself off as Independent and not Republican). Lower taxes, less government, anti-Washington; the old simplistic GOP answers to all the complex problems of the modern world. During times of crisis, all they do is cloud the memory. One year is long enough.

Hello 1994!

With that shift in the Senate balance of power, Republicans now have the ability to block any legislation.

If Obama’s health care bill had to lose so many feathers being dragged through both houses of Congress, we can all just forget about any meaningful reform emerging at the end. Republicans are united against it anyway, society has been desensitized to the problems and conservative Democrats are in the mood to bail out.

Can these election losses (see also New Jersey and Virginia) at the local level be considered a normal reaction to regime change at the national level? Well, duh! Could it be that health care deals certain Senators cut with the administration played a role and made Obama’s “change Washington” rhetoric meaningless? Hello-ho! Could the losing Democrats in those races be accused of running old school campaigns as lame as the one waged by McCain-Palin? That, too, has been advanced as an excuse for those electoral losses.

The Great Depression was a disease, too.

A majority of opinion polls taken immediately after the Massachusetts election, however, showed that Obama’s health care reform package was the main cause for most voters to cast their ballots for a former underwear model. That happened in Massachusetts, not only a traditional Democratic stronghold, but a state that actually offers its citizens health care that comes very close to Ted Kennedy’s “universal” dream.

That it should be Ted Kennedy’s death, of all things, that made it necessary to hold a special election that wound up destroying his dream post-mortem fits in seamlessly with the Kennedy family’s darkly bitter history of personal and political tragedy. A death with consequences for millions of others.

Stupid Change

Opinion polls on health care in the USA always have the same result: the majority of Americans are satisfied with the current insurance system. But don’t these surveys only reflect the opinions of those people with health insurance who have so far been fortunate enough to keep both their health and their jobs?

If everything is going so great, why is the most common cause of personal bankruptcy attributed to escalating health care costs? Why do so few people seem to care that the American health care system is the most expensive and least efficient in the western world? Could it be because so many Americans have been raised with a burden that makes them fear the unknown and any government intervention?

Oh, by the way: The insurance changes made by my wife’s employer almost worked. Our monthly premiums went up sharply even though we chose less expensive and worse coverage. The first time my wife made a payment to the carrier, he credited it to someone else’s policy. And despite paying cash on the spot for treatment, I got a letter yesterday from our doctor demanding I remit my co-pay.

And we’re among the lucky. We’re healthy and we’re — uhhh — insured.

Editor’s Note: The author is a foreigner living in the United States.