A View From The Press Box

I agree with Sam's comment that we need to look elsewhere and see what we can devise that would provide coverage for all Americans in some form of universal health care system.

I recall the 24-hour care developed by some workers' comp carriers in conjuction with HMOs wasn't perfect, but could make a starting point for a future system where coverage could be afforded to people and their families through an employer/insurer consortium consisting of workplace, health and compensation carriers.

This would continue the availability of safety and health services, wellness services and would then expand to all Americans through nationalization.

It seems the health and comp insurance carriers claims services could be a good fit for this type system, and might get it off the ground better than some wildly complex bureaucratic system engineered by the government.

But then again, what do I know? I've only been dealing with insurance, safety and health care for 42 years, and the government has much more experience in wrapping red tape around things than I!

Incidentally, the wait times for critical surgical procedures in countries with nationalized systems often result in death, or disease progression to the point where the procedure is no longer viable in extending the patient's life.

We visit Ireland and the U.K. regularly, as well as receive their news on a daily basis. While their system does relieve one of the financial burdens of health care "bankruptcy," you are far more likely to have a delay in, or forego a procedure that will save or extend your life there than here, due to a lack of doctors, space or funding.

Many see that as a trade-off for the security of socialized medicine.

You have to look no farther than the Veterans Administration here in the U.S. to see a vestige of the same issue when care is delayed due to lack of funding, doctors and facilities. Just multiply that by 300 million patients for a start.....

I work in a facet of the insurance business dealing with liability claims, and often have to review medical histories as part of my job.

I have reviewed histories of extremely poor people who've gotten amazing amounts of treatments as needed--paid for not by private insurers, but by the medicaid systems.

I don't know if you can put a real number on the total spent by state agencies, but it has to be accounted for in any discussion of a universal system. Especially since we seem to already have one.

The hole in the health insurance system comes when a person is fired or quits a job, and there is no insurance in the transition period.

We read often of the 40-to-50 million uninsured, but rarely do we read that of that figure many, many millions are uninsured by choice.

Many of this number have employer-sponsored health programs, and young [invincible] employees opt out because they feel they will not need the coverage in the short-run. Some opt out because of the cost, yet it is available, and others purchase it, so it is once again choice.

Affordability is a tricky issue because Americans live and spend for today, and lifestyle may be a matter of poor choices--i.e., buying a new car, taking a vacation, etc., instead of buying health insurance.

Also, lost in the discussion is the fact that historically health insurance was never intended to cover us for every time we sneeze, but rather for serious-to-catastrophic problems.

If we don't build in some kind of personal cost factor into whatever form the coming national health program ultimately is, huge dollars will be squandered by excessive abuse of anything that is "free"---even though such national health will always be an uncontrolable tax burden, -probably on the same 5% to 10% of taxpayers that already pay 80% of all the taxes now.

We all need to pay something towards our health insurance in order to keep at least some semblance of a personal financial interest.

Finally, I just had emergency appendectomy on the 4th of July. I was in and out of Waukesa [Wisconsin] Memorial Hospital in about 26 hours. I experienced absolutely the best personal care and attention from the entire surgical staff...as good an experience as one can have under the circumstances, so our system is NOT broken or even substantially broken, as Mr. Moore insists.

SAM RESPONDS:

First of all, thank goodness you are okay. I hope your recovery is coming along well. But I wonder whether you had insurance to pay for the procedure. Should an uninsured person have such an emergency come on, they might indeed get the care, but it could put them heavily into debt or bankrupt them.

I would beg to differ about the state of our market. Any system with 40-to-50 million uninsured is substantially faulty, I believe.

You are correct that some might choose to go bare, but I would bet the percentage is relatively small. In any case, if there should be a national healthcare program, everybody would have to pay--the cost could be charged just like Social Security and Medicare, via withholding. So the whole country would share the burden of keeping America healthy.

All the issues you raise about lifestyle choices, cost control challenges and the like are certainly valid, but they exist in countries with universal health insurance as well, do they not? I would be curious to find out how those countries meet these challenges.

TOM HAS THE LAST WORD:

Thanks for the response and get-well wishes.

Yes, I do have insurance, but I also carry a $4,000 deductible, and I understand that most people may not be able to afford that level of self-insurance.

My understanding is that an uninsured person, presenting themselves at this or any other hospital, would receive appropriate care to solve the medical emergency. Then the issue of payment would have to be dealt with--monthly payments, etc., or no payment at all from the recipient.

The hospital would ultimately pass any unpaid costs onto the rest of the patients using the facility via higher room/board costs, fees, etc.

I don't disagree that with 40-to-50 million---if that is even an accurate figure, as I just read some study indicated it was overstated by up to 10 million. It is still far too high by any standard.

I do believe the Congress should thoroughly investigate all of the best national health care systems throughout the world, taking the best features for all of them and then going to work on crafting a U.S. system.

With regard to the Canadian system that is supposed to be so terrific, a radiological practice in the Chicago Metro area has had a deal with a major U.S. auto manufacturer's Canadian facility to provide injured workers with radiological services because the queue in Canada takes so long that the lost wages benefits under workers' comp far exceed the cost to fly the injured person here (when not life threatening, obviously), put them up overnight and fly them back the next day.

I'm sure every country has major nightmares within their systems, so I am not picking on Canada.

We have friends in Holland, and a few years ago the lady was unfortunately stricken with breast cancer. Once diagnosed, the wait for surgery was over 3 months--not exactly a roaring endorsement of national health care, is it?

An emerging feature of many large company's health care cost factors, is an attempt to charge employees with unhealthy life-styles--smokers, obese persons, heavy drinkers, etc.--more for their insurance than those of us who generally have more "healthy" life styles.

Do you think it is going to be politically possible for the Congress to announce new national health care tax policy that basically says if you are fat we are going to charge you 50% more, or if you smoke we will charge you 100% more? These guys are still providing subsidies for tobacco growers in the Carolinas, for goodness sake.

It would be interesting to know if EU countries tax smokers more for their health insurance than non-smokers. I single out the EU because smoking is still relatively widespread there. I doubt there is a differential, but regardless, why should people with healthy lifestyles heavily [no pun intended] subsidize the obese and smokers?

I think the focus should on middle-class America. The lower-income levels qualify for state Medicaid programs but the middle class does not.

By middle class, I mean those families paying mortgages, car payments, child care, etc., but existing paycheck to paycheck.

I think it highly interesting that for the past 15 or more years, the focus of the debate over health care costs has been on the PAYERS--insurance companies, state agencies, patients.

Why hasn't it been focused on the BILLERS--hospital corporations, testing providers, physicians?

What is highly disturbing to me in this hopefully resurrected debate about national health care is that health insurance companies operate on a profit basis, which means the less care they deliver the more profit for the company.

I am astounded that this fact, which was brought out graphically in "Sicko," is not causing more disturbance in people's attitudes or opinions. This could happen to any of us who have health insurance!!!

So while we debate the standard-type discussion points like wait time and expense, the fact is that arbitrarily, insurance medical examiners are denying coverage for the neediest people for the most bizarre reasons, and they are getting away with this type of policy without a whimper from the American people.

Where is the ethical outcry and where is congressional oversight here?

This laid back and apathetic attitude we Americans experience comes from our having gotten used to being manipulated by our politicians, who are overwhelmingly pro-business, not pro-fairness.

American politicians do not have the political will to make it right and fair for all, and that is because we Americans do not show our outrage with their political decision making.

It is time we got involved in the politics of our lives because as we see with global warming, relying on government to keep the environment clean has brought us to the brink of catastrophe. Why? Because our politicians were not convinced global warming was ocurring.

If we believe this as " the truth" and not as political spin, then of course we will believe that national health insurance is tax-inefficient, that wait times kill people, and that socialism is on the upswing.

SAM RESPONDS:

I'm not ready to give up on the for-profit system quite yet, but believe there must be a way to police it better so people get a fair shake, and everyone has access to quality care.

As for the politics of the situation, there was an interesting comment by a Frenchmen, I believe, in "Sicko," as to why France has universal coverage and America does not.

To paraphrase, he observed that in France, if you even hint that the government might take away a basic benefit, hundreds of thousands of people spill into the streets in protest.

Here in the U.S., such passionate protests about people's rights are scarce. Whether that is because of general satisfaction, apathy or cynicism (what good will it do) is open to debate.

In the movie, the Frenchman's take is that in France, the government is afraid of the people, while in America, the people seem to be afraid of the government. I'm not sure I completely agree, but in effect this country is much more passive politically.

Not since the 1950s and 1960s with the marches for racial equality and against the Vietnam War (when a mandatory draft forced people to put their lives at risk, unlike in our current war, when we have an all-volunteer military) have people protested with European-style fervor.

BARRY G. HAS THE LAST WORD:

Sam, why are you not ready to give up on the for-profit system? When there is profit to be made on basic human rights and when this behavior is tolerated, then the old adage rings true--power corrupts and absolute power corrupts absolutely.

When for-profit systems have absolute power over decision making having to do with saving our lives, then there is an inherent struggle that takes place by definition.

The spin is that without the for-profit system, there is no innovation. If that is the case, why are we so down on the list in terms of world health care delivery? Shouldn't we be the healthiest people on the planet based on innovation and wealth?

Maybe it is happy people who create the most productivity, and that innovation is based on happiness factors and not communism vs. democracy. We need to get a grip, Sam.

We are becoming incapable of dissecting fact from fiction, and this will always benefit the powers that be.