The Health Care
Crisis in the United States
by Carol Abbott ©
Recently I have been reading a lot of criticism aimed at the Health Care legislation titled The Affordable Care Act (and which is sometimes wrongly and rudely called "Obamacare" by people who disapprove of the administration's valiant but less than completely successful effort to provide a means of obtaining basic health coverage for all of America's citizens). One of the provisions that is drawing special ire from some people is the individual mandate that will require every citizen to have a medical insurance policy. People are so mad that they will be forced to buy insurance and say "no one should be forced to purchase such a policy in a free country like America." (Never mind that most of those who are the most vocal about this "outrage" are owners of medical insurance policies themselves, either through a plan at their job or because they are older than 65 and get really good coverage from Medicare and have the funds to also own a supplemental policy like Blue Cross/Blue Shield or AARP.)
In rebuttal, many well-meaning people equate the health care policy requirement with the nearly universal mandate that requires any one who owns and drives a car to carry automobile insurance. But then other well-meaning but opposed people come back and argue that owning a car isn't mandatory but is, instead, voluntary so "not everyone has to buy auto insurance BUT EVERYONE will have to buy Health Insurance" and that is suppose to PROVE their point that mandatory health insurance is WRONG!!!
Hummm....let us think about this: Okay, here is what I have come up with. Please following me as I think this argument through....
It is definitely true that no one is forced to own a car....but every living human being does own a body. Unfortunately, due to circumstances that are quite often beyond individual control, nearly every body will at some time or other, turn on it's owner and break down (bad knees or a bad heart), have an accident (falling down the basement stairs or sliding on ice while crossing a bridge late at night and hitting the bridge rail causing concussion, whip lash or broken bones) OR they will develop some mechanical problem (get sick). A body isn't like a car, so owners don't have the option of just towing their body home to the garage and parking it until they save up the money necessary to put it back into running condition and taking the bus (sending someone else to work or school) in the mean time.
So you can see what I am saying I'm sure: Every person should plan ahead for illness or accident in the same way that any car owner must have insurance to protect themselves from the unexpected. If you do not have a health care plan in place and you or a member of your family is diagnosed with leukemia, or breaks a leg, requires stitches to close a cut, or even something simple like stepping on a nail and needing a tetanus booster, you will want to have (and should expect to have) a level of medical care that will help in your recovery. People that make the conscious choice NOT to purchase a health care plan will still need to be 'fixed' and so will seek out assistance at any place possible -- going to a private doctor if you have money in the bank, a hospital emergency room, visiting a clinic for indigent people if there is one in your community, maybe the nurse care clinic at some place like Walgreens, if the problem is the flu or something else that isn't too complex. Now a broken leg can be set, tetanus shots take a few minutes, getting well from the flu takes a couple of weeks of home rest and pushing fluids, but getting treatment for cancer could mean one or more surgeries, perhaps chemotherapy or radiation treatments, hospitalization(s), dozens of follow-up visits to the hospital or doctor's offices.
In every one of those alternatives, someone (maybe not the patient) will have to pay for treatment. And pray it's not cancer (or one of the other major medical types of illness, such as a heart attack or stroke) that lays you low because Treatment is NEVER FREE. And even worse, you may not be able to find the help you need for a long-term illness if you are not lucky enough to be a millionaire, because state agencies have had to cut funding for all types of medical aid, since local economies are being impacted by the same types of revenue problems affecting individuals and the federal government in the past decade. The medical community is not offering medical services treatment from the goodness of their hearts even if the hospital is staffed with the most compassionate people on this earth. As a matter of fact, hospital emergency room care is among the most expensive form of care available. A shocking number of hospitals are being forced to close their emergency rooms because to continue running them would drain way too much of the operating budgets from cash strapped hospitals. So when you are in need of such 'emergency care' you may have to drive farther and wait longer to get the help you need and it will cost a lot of money.
Now you may be able to say with absolute honesty that you have never been sick enough in your entire life to require help from a doctor, that you always look both ways before crossing the street and that both of your parents are healthy with no medical history and still going strong at 85 years old. So there is absolutely NO REASON that you will ever need medical insurance. Good for You!
I really hate to rain on your good fortune, but I should remind you that an accident can happen to anyone who is in the wrong place when a drunk (driving with no insurance) runs a red light or that you might be on a hike in the Rockies and have a tree - weakened by high water - fall on you as you walk by (as happened to my nephew). I've personally known a couple of skinny health conscious friends who had undiagnosed heart problems and experienced sudden heart attacks. And diabetes, high blood pressure and other hidden but potentially serious medical problems are running rampant through the citizens of the United States these days. Sometimes these go completely undetected but still cause irreparable damage for many years including early death.
Republicans and even some Democrats, Liberals and Independents are very prone to saying this: "The United States has the best medical care in the world." Sadly to say, this isn't even close to being true. Even in something so basic as Infant Mortality there are forty nations that have better records than the U. S. and some of those countries would surprise you -- Hungary, South Korea, Slovenia, the Czech Republic.
In 2007 (the year for which we have the necessary figures to report) the citizens of the United States spent about $7300 per person on health services (from their own pockets, from their insurance company pay outs and from public sources such as Medicare and Medicaid) and the average life expectancy of citizens was about 78 years. Since there were 302.2 million citizens in the U. S. in 2007 that is a very large chunk of change (two trillion, two hundred six billion and sixty million dollars - more or less). Unless you were having a very bad year, you probably didn't spend the average, but somewhere in the United States someone was very sick and spent five, six or ten or one hundred times that amount. The same year (2007) Mexico spent $823 per person and got a life expectancy of about 75.1 years. The United States and Mexico are both nations without Universal Health Coverage.
All the other countries that were on the same chart* were countries that had Universal Health Coverage in 2007 and here is a very interesting set of facts:
The United States averages 2.3 physicians per 1000 citizens. In 2003, that was only good for 52nd best in the world. Fifty-one nations had more physicians per thousand, including Kyrgyzstan, Latvia and Lebanon as well as Germany(3.4) and Italy (4.2) and Cuba (5.91).
One of the most alarming statistics is that the Health Care cost as a percentage of GDP (gross domestic product) has risen every year from 1960 (when it was 5.1%) to 2009 (the last year we have numbers for). It was 17.4% in 2009. This is a number that should have every American concerned - Democrat, Republican, Independent and all the Tea Party people as well. It means less money for all of us to spend on other items. Both the practical and the frivolous. It affects all citizens to some extent, but it affects all people with modest incomes the most. Families who make under $100,000 will 'feel' the pinch much more than wealthy Americans who make $250,000 or more. And IF you are a family or an individual struggling just to pay basic needs with no savings safety net, you will be pinched worst of all and might have to go without prescription medicine or a visit to the doctor because you cannot afford it at all if you want to pay the electric bill this month!
Even these few facts (sorry about all the numbers but sometimes numbers can give us the most accurate way of understanding the facts) really demonstrate that the United States is seriously lagging behind other countries in some really critical ways. Especially when it comes to the total dollars spent on our citizens' health care as compared with the benefit of these costs. There are areas where the United States excels and those would include the quality of our medical facilities and equipment. Many health care professionals around the world can only dream of attaining some of the stellar technology that we take for granted here in the United States. We have some of the best medical schools in the world and medical research and new drugs are supported here on a level to match or exceed much of the rest of the world.
But if you are among the 48 million + citizens who does not have or has recently lost health care insurance coverage and then has the extreme misfortune to become ill or have a serious accident, you may have more than a little trouble agreeing with some politician stating that "we have the best health care in the world."
The Affordable (Health) Care Act was passed by both houses of Congress and signed into law by President Obama. It is an attempt by our huge, complex country to begin getting a manageable plan of health care for the largest majority of American citizens. It was determined that for such a plan to be successful and cover the vast majority of our citizens, it must mandate that all people obtain and retain health care plans to cover themselves and members of their immediate family residing in their household or away at school. Any citizen wishing to participate but unable to afford the premiums for coverage would be eligible for monetary assistance in order to help pay the premiums. As with any type of insurance plan, the thinking is that risk will be spread over the largest possible base of citizens and, though some will not use any or only a very minimal amount of their protection, others who are less fortunate will have enough coverage to allow for competent medical care during a serious illness. It is the exact same principal that comes into play with homeowners insurance, renters insurance or auto coverage in millions of households every year. Most people (excepting the very poor, who cannot afford premiums) would not think of going unprotected from possibly losing their car or their home or possessions. Why would these same people willingly and enthusiastically risk their health?
There is precedence for putting your property (your home) at this sort of risk. In some parts of our country there are fire protection zones that are covered ONLY by a paid fire-fighting force. All people in the area must pay in advance for fire protection. Records are kept and if you should accidentally or on purpose not pay for a year's dues and then have a fire at your home, you will not be able to call the local firefighters to respond to your problem. Most of us have seen news stories that tell of what happened. These unfortunate victims witnessed the total destruction of their family home or a barn being burned down to the ground and the grief and helplessness of watching it happen. That must be a nightmare. But it does allow for 'free choice' and the ability to make a decision that is not coerced in any way.
I suppose that those people who choose not to carry medical insurance could make that individual decision -- perhaps even for their entire family if they can get past the idea that their child might suffer needless pain or untreated illness at some time in the future. It would have to be a legal document that would be sworn out in such a way that would completely protect any medical provider from being held responsible to provide care to someone that becomes ill or has any injury that is not the responsibility of another person who has adequate liability insurance to cover treatment. It would allow a person who does not want to be "forced" to purchase medical insurance ("Don't Tread on Me") to maintain their 'individual integrity'. It could be done but it would harden people into selfish characters having to call up records on the computer and tell that unfortunate person "Sorry, you have opted out of insured medical care. We cannot help you unless you can pay for this service in full right now." If you think telling someone that you cannot respond to the fire that is burning down their house is hard, try imagining that you are telling a man with his arm broken in three places that you cannot help him.
But remember, it was your choice to opt out because you did not want to be 'forced' to purchase medical insurance! Doesn't that make you feel better?
So far The Affordable Care Act is the only fully functional and even half way practical plan to have been put forth by anyone, Democrat or Republican. I do challenge each of you readers, if you disagree with the present plan which is The Affordable Care Act, to ask your elected representatives in Washington (Congressman and/or Senator) what plan for health care they have that would allow all citizens, young, old, rich and poor and all in between to have a personal health care policy that will offer them comprehensive and competent care if they are sick or injured. I would remind you, that an answer that is as vague as "use the free market" or "cut out unreasonable regulations that stifle competition" or "just get costs under control" without detailed, workable specifics is NOT AN ANSWER. IT IS AN EVASION. If we continue to believe that our politicians will actually do any of those very hard things on their own, we will still be waiting and hoping for the rest of our shortened-by-no-medical-care lives.
Part of the problem is that most politicians are beholden to companies and CEOs that provide medical care, medical and pharmacological products and those that lobby for those entities. It takes a small fortune to run a single election in this country. When you think that Congressional Representatives must do this every 24 months and that the campaign cycle is at least 6 to 8 months long each time, it is a miracle that they find any time at all to do the job for which we have elected them. To have the necessary money to be competitive, politicians must be able to go back repeatedly to companies that will give them large donations. IF a politician does not 'help out' these medical and drug companies by giving them favorable treatment in legislating, that politician won't find many donors for the next election cycle. Politicians may be self serving and realize who 'butters their bread', but they are not stupid. So we, the people that they are suppose to be legislating for, will always be given second place status so long as these decisions are in the hands of legislators.
We have been given The Affordable Care Act, in an attempt to level the field a bit and every Republican Presidential hopeful is promising that the first thing on his(her) agenda when elected will be to see that this Act is dismantled as quickly as they are able to do it. Romney, Perry and Bachmann and perhaps one or two others at the debate on September 8, promised action on this law on "day one", whatever that means. None of these politicians put forth any plan to solve the health care crisis in this country -- only that they would do everything in their power to take away the Affordable Care Act from the many millions who at last have some hope and help for medical insurance coverage for them and their children. Both the rank and file of Republican voters and members of the Tea Party (and let us not forget to mention the high dollar money guys that are financing much of this 'grass roots' movement) are behind this plan to kill the bill. The Tea Party has taken to carrying Don't Tread on Me flags and are generally outraged at a plan, the sole purpose of which is to attempt a guarantee of health care for all Americans. Does this mean that the members of the Tea Party, as well as many regular Republican voters, don't give a damn whether Americans have health care if they have lost a job, have spent all their savings, don't have any prospect of getting meaningful employment any time soon and may be struggling just to feed and house their families? After watching a couple of the Republican debates I am shocked and saddened to observe that this appears to be the case.
I do have to wonder IF these rabid people would have the same opinion if it were a member of their family who lost a good job, could not afford to keep up COBRA insurance payments, had sent out over 200 resumes and made over 150 phone calls to uninterested and overwhelmed human resources departments. All while burning through their savings to keep up with the bills and fill the car with gas and agonizing over the fact that all the stress is causing a dangerous spike in his wife's blood pressure. If it is your son, your nephew, your sister...are you still cheering for them to fail to keep it together because of the concept that people should be free to make their own choices and have the dubious freedom to fail as well as to succeed. Are you there for them with your retirement savings on the line? Because if you are not able to rescue them, maybe you might be grateful for a social safety net to help them in time of great need. In 2011, there are several million of those people. They may not be your relatives (yet) but remember the phrase: "There, but for the grace of God...".
Without health care for the unfortunate, do these less than compassionate Tea Party Republicans hope that many will just stay home, curl up and die and 'stop being a drain on the rest of us wonderful members of society' ? I really do want to know what Tea Party-ers think.
I really do want to know why members of Congress, including Eric Cantor, John Bahner, Mitch McConnell, Paul Ryan, John Kyl, Michelle Bachmann and many others are so eloquent in expressing themselves about tax breaks for all kinds of special interest groups like the oil industry and cutting tax rates on corporations by 10%, even though many corporations paid no federal taxes in 2010. These legislators also are all for protecting the tax breaks of millionaires, the so called "job creators" (sadly, dispassionate observation on the effects of 10 years of lowered taxes which began in 2001 have not proven the creation of any new jobs from these so-called 'creators'). Unfortunately for America's citizens, these same Republican politicians seem much less interested in solving the health care crisis and the huge jobs crisis that is decimating the middle class and affects literally millions of their constituents.
At the same time, these Scrooge-like 'leaders' have spent a great deal of time and political effort to END an extension of benefits to the long-term unemployed, to cut feeding programs for little children, and they continue attempts to whittle away all types of assistance for the disabled, the marginalized and truly needy in our country. They've made a conscious decision to cut federal funds to educate public school children and help pay for teachers who will otherwise be laid off while arguing that to cut out tax breaks for corporate jets will undermine the very fabric of our nation. The fabric of our nation IS our children. If we don't offer a superior education to this nation's children, where will the next generation's medical professionals come from? Who will be competent to run the country, to be the CEOs of American businesses, to teach our children? Our politicians don't need to protect the bonus of some CEO who is flying off on the company jet to Saint Thomas for a fancy corporate meeting. Trust me, CEOs are perfectly capable of taking care of themselves.
For the children, the unemployed, the disabled, the fathers and mothers juggling one or more low wage, part-time job trying to keep their families fed and a roof over their heads, these politicians have nothing but empty words about how it is just too expensive to continue programs that offer help to the hopeless and they are only trying to control the country's debt. They do not appear to witness nor to care about the suffering, hunger, homelessness and misery of people without any safety net. Even though Congress members acknowledge that unemployment is over 9% (gleefully blaming President Obama but unable or unwilling to offer a jobs plan of their own and refusing to bring to a vote the Jobs Plan proposed by the President) and have sat idly by while thousands of homeowners slipped underwater in mortgages they can no longer afford because they have been laid off or fired from their jobs, they pretend to be powerless to act to make things better. They continue to insist that cutting away safety net programs for the neediest of our citizens is the best way to balance the national debt. And they ignore real privation, insisting that a balanced budget is the most important priority of the Congress.
Ultimately much of this misery was caused by the greed of Wall Street and by banks making insanely risky types of investments that were never prudent and began to collapse the financial markets. The Bank Stabilization Bill of 2008 allowed the rescue of Wall Street and the banks with 700 Billion in federal funds during a last minute scramble in the waning days of the Bush administration. The bank bail-out came from tax dollars paid by some of the same people that are currently being cut off from desperately needed federal aid less than two years later. Of course, saving the country was of vital importance; saving the country's citizens, not nearly as important, I guess.
Many Republican leaders and a majority of the hopeful candidates for the Republican Presidential nomination have expressed contempt for social security retirement payments and have plans to alter, end or 'privatize' social security which would mean turning it over to their buddies on Wall Street and allowing the whims of the market to determine if you have enough to afford to retire--ever. And don't forget that a key provision of the Ryan (Republican) budget plan is to end Medicare and replace it with a yearly payment so that seniors must go to the private insurance industry and bargain for insurance policies to be purchased individually. Oh yes, and remember that any premium above the grant will be the responsibility of the senior citizen purchaser. Let me remind you that private insurance companies are looking to maximize shareholder profits and selling affordable and comprehensive healthcare to old people with failing bodies and a huge likelihood of pre-existing medical problems isn't going to come cheap.
These same parsimonious legislators couldn't wait to pass laws that took funding from Planned Parenthood services that had nothing to do with abortion but did offer some basic health services to thousands of women who had no where else to go for a pap smear, a blood test or other tests and treatments for women related health issues.
Listening to the Republican debates and hearing the cheers and jeers from the crowd and the crashing silence of the debaters total lack of response when their audience seemed to endorse capital punishment and letting the uninsured die, I was eerily reminded of the shrieks of opponents to health care reform that screamed out in fear of 'death panels' that would supposedly decide that Grandma's time had come. It suddenly appears that the Tea Party is endorsing Death Panels for the uninsured. The Republicans and Tea Party members are willing to allow death -- so long as it is someone else's -- and they don't seem to have a problem with it.
That would logically extend to all those babies they saved from abortion. The toddler with meningitis? No insurance...no church congregation coming forward to help... too bad...let him die. The 13 year old girl who has experienced physical and mental abuse in her home for her whole life because her mother was mentally ill and her father was an alcoholic druggie who left them a couple of years after she was born? She doesn't get enough to eat, has trouble in school because she misses a lot of days when she has to take care of her little brother and thinks she may be pregnant. She is depressed all the time now and is considering suicide. Her mother has AIDS from some long forgotten one night stand. It IS a sad thing. But don't worry about her, she has nothing to do with your privileged existence and will be dead soon anyway because the meds that might extend her life are way more expensive than she can afford.
These heartless legislators and their fellow legislators are the ones that are suppose to be coming up with a workable alternative to the Affordable Care Act. Yeah, right, that's going to happen! More likely to happen is if the Affordable Care Act is dismantled, as our Republican leaders wish to do, we will continue limping along the same path that existed for the decades before 2010. Our country, in those years, continued digging deeper into an unstoppable and very hard to solve area that included higher and higher costs for medical care and state-of-the-art drug therapy. In the coming years, far fewer employers are likely to continue offering medical insurance plans because premiums continue to rise, making it impossible to pay them and still make an honest profit. The attitude of Congress is also more to support the business owner over the employees which creates a climate that makes it acceptable to withdraw health care insurance as a benefit. At the same time, many private citizens have already been priced out of the individual insurance market because of high premiums or else double digit raises in established rates. It is not the sole responsibility of the insurance companies, because no one actually seems to acknowledge that perhaps it is health care costs themselves that are what needs some regulation.
Republican law makers are completely regulation-adverse. They continue to insist that the free market will regulate itself and that all our citizens need to trust that business has their employees' and customers' best interests at heart. That actually MIGHT have worked in the kinder and gentler past but I don't see it over-riding the self interest of most business owners and large corporations in today's greedy times.
While we must thank God for those people who are willing to go through the long, grueling training necessary for our doctors, surgeons and specialists and many other health care professions it is important to include the actual cost of delivering medical care as part of calculating a solution to the high cost of medical care in the United States. Most of the medical professionals take on enormous responsibility to save lives and provide care they can be proud of and that will safe guard their patients health and well being. A medical education is certainly a big ticket item and doctors, anesthesiologists, etc. all should expect a good quality of living for their hard work and years of sacrifice.
But the days of the small town doctor who cared for his neighbors and sometimes took out tonsils or treated someone for a few dozen eggs and a couple of chickens is very much past. Now, a doctor must buy malpractice insurance incase he makes a mistake; the doctor will need someone to keep his books and deal with insurance companies that all have different sets of rules; few doctors practice from a couple of rooms in their home anymore so he/she will need a suite of rooms in a central location with at the least a nurse or two to keep things moving along. That means someone to do payroll and pay the employee health care and social security and keep track of other benefits. And someone to keep up with the filing and answer the phones and sit at the front desk to make appointments and check people in. Then there is all the equipment and medical instruments, the costs of utilities, maybe rent and who knows what I'm forgetting. I know it all adds up to a bundle but with all that, the fees must still be competitive.
Thousands of doctors walk this fine line and make a very good living beside. SOME make much more than they need --- some make a whole lot more than is fair to the system. I know this is not something that we want to acknowledge, but until we get a handle on this part of the equation, we will not find a solution that will reign in the medical costs that keep our country from solving the very real problem of having medical care for every citizen.
I must remind you that at least 19 countries in 2007 have found a solution to some of this by going to a Universal Health Coverage system. Our country's leaders should be beating down the doors in these countries to find out the specifics of their plans and to begin to fashion something for our country that takes the best of what is working in other countries and adapting it for the United States. The time when medical health can be thought of as a for profit industry should be dialed back. Insurance companies try to improve their profits every year to satisfy shareholders. This borders on profiteering especially when coverage decisions are based on denying life saving treatment and/or tests merely for the motive of keeping profits high for investors. We are presently called the 'richest nation in the world' and if we can solve this problem of medical care costs and cut the actual cost by half, we could have over a trillion dollars every year to pay down the debt that Republicans claim is the main reason that we are in trouble in this country.
Now that seems like the best way we can all work together for this great land of ours. And it is way past time that we citizens demand a solution to the Health Care problem that includes relief for all our country's diverse population: the young, the old, the rich, the poor, the struggling middle class. We all deserve the chance to have quality health care. When people have their health, they can concentrate on other problems and bring the United States back to being the Greatest nation on Earth.
* chart from National Geographic source and this graphic: Oliver Uberti, NG Staff, Source: "OECD Health Data 2009" Organisation for Economic Co-Operation and Development
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