I’ve been mulling over exactly how to express my numerous thoughts on health care reform for some time now, and after finally managing to catch Keith Olbermann’s special comment from Monday on the subject, I’ve got it in my mind to write something now before I get otherwise distracted again. I might leave out the bits explaining the public option since I’d hope they already know what it’s really about, but I might leave them in anyway, just to be fully forthright in my communication to them. I will be sending something similar to this (probably condensed somewhat) to my senators, my representative, and to President Obama once I’ve posted it here.
First, let me start by establishing something. I’m married to someone with hyperthyroid and IGA immune deficiency. These are pre-existing conditions as far as the health care industry is concerned, and would either bar her entirely from coverage, delay her coverage entirely by an unconscionable number of months while I pay absurd premiums to NOT get the insurance I’m paying for, or delay the coverage of her treatments for those conditions and anything the insurance company deems to be related (which, as above, would probably be everything) for the same aforementioned period of time. I find it morally reprehensible to discriminate against people who need coverage simply because they actually need it. It’s absurd, and it ought to be completely illegal. An insurance company can certainly make a lot more money by only taking money from people they know will never cost them anything, but at that point, why not stop bothering with the “insurance” moniker and just start taking donations on the street corner?
I am actually offered health insurance through my employer. Unfortunately, while I could probably afford the 75% discounted premiums for myself that my employer offers, I don’t make anything even close to the amount of money needed to also cover the 100% of premiums it would require to pay for my wife’s coverage as well. Yet because I’m offered health insurance but “elect” not to take it (because doing so would prevent us from buying things like food), I’m considered by Republicans and even some blue dog Democrats as being someone who has freely chosen not to have health insurance, and thus not worth worrying about as one of the 50 million Americans left out of the current system. Furthermore, since that 75% discounted premium makes up most of what we spend each month on my wife’s health care in an already tight budget, even insuring just myself is a prohibitive expense, and one that I would feel unimaginably guilty about taking on at the potential cost of my wife’s health. Even this offer of insurance is ephemeral, though. My employer is looking at possibly having to cut benefits due to rising costs and the poor economy, so even if we were both insured through my job, there is absolutely no guarantee that we would receive the same level of coverage, if any, over the next few years.
I can’t even get on the Washington State BASIC health insurance program, because our limited income is still about $100 per month above the maximum permitted income level. Unfortunately, there is still a huge gap between the maximum eligible income for BASIC Health and the minimum required income to afford employer-provided or privately-purchased health insurance.
In my frank opinion, health care is a public service, like the police and fire departments, and should not be a for-profit industry that places more importance on money than the well-being of human lives. However, I also understand that moving from our current system to one more similar to those in Europe or Canada in one massive step is politically, socially, and economically impractical. Thus, I think that a public option for health insurance is the best option for people such as myself: a guaranteed program that can never be taken away for those who either do not care for or cannot afford to participate in the private insurance market.
Republicans have been making a huge stink about the public option, making all sorts of wild accusations about it being a government takeover of the health care system, or an intrusion of government bureaucrats into the health care decision-making process. They ask if we like going to the DMV, or the Post Office, and to imagine what health care would be like if it were similarly operated (some even bizarrely threaten that the public option will turn Medicare into a government-run system, when it already is, and enjoys widespread popularity despite this tragic “handicap”). I believe they are being disingenuous at best, or are outright lying at worst, about the purpose of the public insurance option, and do a disservice to the public discourse by spreading misinformation to their constituents and their colleagues. Its purpose is not to take over the health care industry, or even the health insurance industry. In fact, if it works as poorly as they claim it will, their fears about en masse migrations to its coverage seem bizarre and contradictory.
The public option will not replace employer-provided health care. In fact, provisions would exist to prevent most employers from switching to it (I believe there are exceptions for small businesses because paying private insurance premiums as a small business owner is very difficult – I know from observations at my own company – in which case switching would probably be preferable to losing your coverage entirely due to rising premiums, I would think). While the health care reform bill would also mandate that coverage be provided by employers, again small businesses (the ones Republicans are always concerned about) would be exempted from this mandate and the ensuing fines for non-compliance.
Yes, it will cost money to fund the public option, but if planned wisely, and given sufficient bargaining power, those costs can be properly controlled, and money can in fact be saved over the long term as the uninsured become the insured, and the average taxpayer stops footing the thousands of dollars in medical bills that are incurred every time someone unable to pay for a trip to the doctor has to go to the emergency room. Insuring everyone will lead to an overall more healthy country as illnesses can be caught in their early stages with inexpensive screenings, not when they’ve fully presented and are more difficult or even impossible to treat with advanced medications, therapies, and surgeries. And a healthier nation is a more secure nation, a more productive nation, and a happier nation.
Frankly, I would welcome the opportunity to have a government bureaucrat involved in my health care decisions if it meant I actually got to go to a doctor without it costing me an arm and a leg (the amputation of which would cost me further still, no doubt). It can’t be any worse than having an insurance company claims handler involved in the process for privately insured individuals… in fact, it might even be better, considering how good private insurance companies are at squeezing blood from stones. Unless you’re uninsured, there’s already someone standing between you and your doctor with a checkbook in their hand… if they don’t pay it, you have to, and if you can’t, you don’t get the care you need. Those who are afraid that the government is going to ration care should take a look around: insurance companies already do. The public option will not kill your grandmother or your unborn child, even if assisted suicide and abortion are procedures that may be covered. You, your loved ones, and your doctor will still be the ones making those decisions, just as if you were insured by a private insurer.
Quickly, I also want to make a point about the Post Office and the DMV. These places are often criminally understaffed, and/or run by the same apathetic people you encounter in ever other service-oriented industry in America. Think about it: how many more times has someone at McDonald’s treated you poorly compared to someone at the DMV? Sure, the DMV and the Post Office employees have no real motivation to care about you, but really, neither does the register monkey at Mc’Donald’s, FedEx, UPS, the concession stand at the theater, etc. It’s often just as hard to get fired from a customer service job in private industry as it is to get fired from a government job running a post office register. In fact, depending on where you work, it might be harder to get fired from a private industry job because of union protections. People have a bizarre tendency, it seems, to isolate only bad experiences as coming from government offices, while often minimizing the broad majority of decent (or even really good) ones, and at the same time doing the opposite with private industry. I think the constant Republican drumbeat of “government is always the problem” has contributed mightily to this, despite its demonstrable falsehood. A government is only as good as the people who run it, and if the people who run it are actively dismantling it from the inside, it’s obviously not going to work very well at all.
Those who favor deregulation of the health insurance industry rather than tighter checks on their behavior should look at the past decade and see what deregulation has gotten us. Health insurance premiums are skyrocketing while wages are not. Credit card companies engage in deceptive and even fraudulent tactics to extract money from people through late fees by changing payment dates without warning, or spiking interest rates when balances on other cards change dramatically (this one happened to me when we moved to Spokane, because we put a lot of the gas expenses on a separate credit card with rewards for buying gas). Mortgage lenders give enormous loans to people they know will be unable to pay for them. Lenders and their insurers repackage these crap loans until they seem to be made of solid gold, then sell shares of those loans as solid investments, destroying the entire economy when their bubble finally collapses. The SEC fails to investigate one of the largest Ponzi schemes in recent history. Food industries hire private contractors to inspect their food, and nationwide outbreaks of E.coli and salmonella result from contaminated spinach, tomatoes, and even peanut butter due to negligence and corruption in the inspection process.
Some argue that insurance companies should be allowed to offer the same plans nationally, and benefit from the economies of scale that come with a larger pool of insureds. The problem is that while it sounds good in theory, we already have a model for what happens when companies are allowed to incorporate in any state and offer services in another: the credit card industry. Many incorporated in Delaware, where the laws regarding credit cards are very lax, and their operations are regulated by the State of Delaware (and how many people in the US like their credit card company?). You can bet your left kidney that the same thing will happen with the health insurance industry if they’re allowed to go national: incorporation in the state with the laxest regulation laws and a continuation of their existing practices on a broader scale.
Private industry will always look for the quick buck, and cut any corners it needs to in order to make that happen. It’s just human nature, and industry is made up of nothing but people (very rich people who can buy a lot of influence and favors, but still people). When such corners start including things like food safety, or a person’s health, such behavior is inexcusable, dangerous, and deeply immoral. It is the responsibility of an independent third party with a vested interest in the common good, not the corporate good, to ensure that such corner-cutting abuses are prevented, because if they aren’t, people get sick, and people die. The health insurance industry has had years to get its act together, bring down costs, and actually insure the entire population of the United States. It’s well beyond the realm of second chances at this point. We’ve been talking about insurance reform since well before I was even born, for crying out loud, and none of the things people have complained about over the years have ever been fixed. It’s time for external corrective action, and the only mechanism large enough to drive such an action is the government.
We need a public option. It is borderline criminal that the richest nation in the world is millions, perhaps even billions of dollars in debt due to health care expenses; that 50 million people (that’s 16.7% of America) are uninsured, with millions more under-insured; that we spend more on health care than any other nation and have nothing to show for it; that one of the highest causes of bankruptcy in this nation is health care costs. Our system is broken, perhaps even fundamentally, and while this reform bill won’t correct the core problem of health care being a for-profit industry, it should at least level the playing field enough that everyone can afford to get the care they need.
The insurance industry is spending $1.4 million a day to defeat the bill being put forward by Democrats in Congress, just as they fought against the Clinton reform, just as they fought to prevent Medicare from negotiating prescription drug prices. The insurance industry will fight this reform tooth and nail because regulation and competition will cost them money and lower their obscene profits, not because it will harm patients or ration care. But the greatest insult and crime in all of this is that much of that money is going straight to our duly elected members of Congress, on both sides of the aisle, in a desperate attempt to buy off their votes and thwart the will of the people who elected the Democrats in November to execute their agenda in overwhelming numbers. People want change (well, people who aren’t Republican, anyway), and they deserve to get what they voted for. Representatives, Senators, Mister President, don’t let the insurance companies, pharmaceutical companies, and hospital corporations take away our health care any longer. Don’t let them take away my wife’s health care any longer. Give us the public option, or get the hell out of Washington D.C.