As far as Obama care goes, there is one thing which should tell you that is is just another government scam to steal your freedom and your wallet: As of June 2011, Obama had already given waivers as political favors to 28 Unions representing 517000 union workers who contributed over $600,000 to his campaign. If it is in our interests, and so good for us, why are Obama’s special union friends waivered out, and why would they want to be?

Bill

“Excessive bureaucracy is created.”

“[I]nsurance itself is one of the reasons health care is so expensive.”

“[A] single payer system would help lower the costs.”

I’d like to present a few examples of what is happening across America. I don’t pretend that my study is at all scientific; in fact, it is entirely anecdotal. But sadly, these anecdotal stories are all too easy to find across America. I don’t pretend that similar scenarios are not happening in other industrialized nations with different health care delivery systems. In fact they are, and a large part of that dynamic is due to technological and pharmaceutical advancements in health care delivery. Research and development is not cheap and I certainly do not expect scientists, doctors, engineers, lab technicians, nurses, or anyone else in the health care industry to work for free.

Patient PT is a 50 year old musician who was diagnosed with multiple sclerosis about 5 years ago. Though the positive diagnosis has put a damper on her ability to work, she does continue to work, and a typical work week is over 40 hours. Excluding all other medical expenses–and I can assure you, there are many–just one of the medicines that she is on costs about $50k/year. Without the medicine, her ability to work and be a productive member of society would be severely curtailed. Without Medicaid paying for her medicine, she would undoubtedly be both bankrupt and unable to be productive member of society.

Patient NM is a 13 year old girl who fell sideways on her ankle during gym class. For reasons beyond the scope of this response, no comprehensive medical evaluation was performed until 36 hours after the injury occurred. I was with NM’s mother when she was taken to the emergency room (her ankle was swollen to about the girth of a football by this point), and I was with her mother when the bills for emergency services provided arrived. She had no medical insurance (which means patients are billed at a lower rate than if they had coverage) and the fare for 3 hours of medical services (two doctors whose time totaled less than 30 minutes, an air cast, an X-ray, the admissions clerk and the triage nurse) totaled approximately $3000. Ultimately, the medical expenses were discharged through Chapter 7 bankruptcy.

Patient MS is a 45 year old factory worker who was diagnosed with lymph node cancer approximately 5 years ago. He had medical insurance at the time of his diagnosis, but his necessary care has far exceeded the limits of his coverage. His goal is simple: he just wants to be well enough to return to work someday and be a productive, working member of society once again. To collect past due medical bills beyond his terms of coverage, he has liquidated his entire retirement fund. He hasn’t been able to live on his own since his diagnosis and treatment began, so he’s moved back in with his parents. Living with his parents, without any money left in his retirement fund, the bills for health care services continue to pile up, far beyond his means to pay.

Patient PB is a 47 year old single mother of two who was paying $500/month for health care coverage through the temp agency that employed her. Last fall she spent one week in the hospital for necessary, life-saving surgery; without which, her children would have been orphaned. Apparently, $500/month worth of coverage has a $30k/year limit on payouts. But a week in the hospital totaled over $100k. Even if she liquidated all of her assets toward medical expenses, her net worth would be -25,000 dollars. Bankruptcy has not yet been ruled out, but settlement negotiations continue as I write this.

Patient GM is a 55 year old factory worker who needed surgery on her ankle in order to continue working. Her employer offers three different tiers of health care coverage through their providers. Since she still had outstanding bills from a hysterectomy a few years ago, she elected the “middle tier” of coverage; otherwise she would not have been able to meet her necessary monthly expenses. Paying over $300/month for coverage, she is left with over $5k of non-reimbursed medical and rehabilitation bills. “Had I had any idea I’d still have to pay that much after all my insurance contributions over the years, I wouldn’t have had the surgery,” she told me. Currently bill collectors are calling her demanding payment, else the bills will be sent to collections. She has not yet ruled out bankruptcy.

These are not stories that I heard on the news or pulled of the internet. These are real people that I know and interact with on a regular basis. And yes, my appeal is largely emotional due to that fact. Every time I see or interact with these people, I don’t fail to recognize how “lucky” I am to be healthy, nor how quickly all that I’ve worked for and saved can evaporate should I need emergency medical services.

Though I have not reached any firm conclusions about what constitutes a best-case scenario solution to the problems with the health care industry in America, a few things seem obvious. First, due to advancements in technology and research which elevate the costs of medical services and health care insurance, the cost of quality care is rising faster than the means to pay for it; which is true for an ever increasing number of Americans.

As a result, rationing will occur in ANY delivery model. In single-payer models–where all citizens pay for access to health care services, so that all citizens can continue to have access–that rationing is described by whatever body governs the system. In our market-based, (predominantly for-profit) American model, that rationing occurs by health insurance providers, via maximum benefits allowances and bargaining agreements between doctors and the insurance and pharmaceutical industries. Ultimately, the for-profit model means that rationing is performed by shareholders. In the Peterscare model that you describe, patients are self-rationing, which would likely lead to some uncomfortable outcomes, since patients often lack the knowledge of risks and consequences and costs associated with their health care decisions.

I really don’t want this discussion to devolve into class warfare, but for the wealthiest Americans, top-shelf health care services will always be affordable. And while you speak loudly and clearly against “entitlements,” a $300k birthright allotment is itself quite an entitlement. And unfortunately, a child with a brain tumor (another example that I’m familiar with) can blow through $300k in no time…so then what? I’m really not sure what might constitute legitimate “entitlements” in American society; obviously not iPads, TVs or health care services. But the fact of the matter is that insurance itself (in any model) IS an entitlement program, as the premiums collected by the healthy are used to subsidize the care for the unhealthy. When healthy citizens opt out of coverage due to the ever-increasing costs of insurance, that only increases the financial burden on all who continue to purchase insurance.

I do appreciate your input on this timely topic, Mr Bill. Though I’ve not seen you in quite a few years, I am aware of some of the horror stories you’ve endured as a patient. For that, I respect your input as valid and worthy. I really don’t know what the answers are to this national dilemma, but perhaps us intelligent, ingenious, creative Americans can come up with something better than what many of us already have. And maybe it’s time to take an honest and hard look around the world to evaluate the outcomes in other countries. Hopefully, we can do this without a bunch of partisan bullshit slinging.

Best regards,
DAR