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Tuesday, September 29, 2009

The Healthcare Debate Refocused

Over at The Altantic's business blog, writer Derek Thompson asks, "Is Today the Public Option's Last Chance?" See, members of the Senate Finance Committee are expected to force an up or down vote on a government-run health insurance option -- and that vote may not turn out well for backers.

But is it "do or die" time for a public option? Probably not. There are several bills in both chambers of congress and only one doesn't include a public option. Max Baucus' Finance Committee bill is the black sheep here. There are four other bills -- three in the House and one in the Senate -- meaning that 80% of all healthcare legislation includes the option. If the Finance Committee votes down a public option, it will most definitely not be dead. A lot of people will try to pretend that it is, but you won't be able to accuse those people of being too forthright.

It strikes me that it's too easy to get bogged down in whip counts and horse-trading. Coverage of the healthcare debate is becoming like the coverage of an election; it's about the horserace, not the issues. I suppose it's easier to do things this way, since you have hard numbers -- i.e., inarguable facts -- to deal with. You can count those who've come out in support of the public option, those who've said they'd vote against it, you can poll the public and have them rate the president, congress, the two parties on a scale of one to ten, but the numbers aren't the story, because they aren't the issue. We're missing the forest for the trees. Yes, the process is important, but don't we need to understand the issue to appreciate the debate?

Here's the issue; the American system of healthcare delivery isn't really what you'd call a "system." An actual system would work -- even if it worked poorly -- but for many Americans, this "system" doesn't exist at all. The National Coalition on Health Care (NCHC) tells us that "62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Of those who filed for bankruptcy, nearly 80 percent had health insurance." They also report that "employer-sponsored health insurance premiums have raised at four times the rate of inflation and wage increases during last decade." Even for the insured, health insurance and healthcare have become just too expensive.

For the uninsured, things are worse.

ABC-13, Texas:

It's an epidemic here in Texas and Harris County -- people without health insurance. On Saturday, the uninsured lined up to get their needs met.

More than 2,000 people came to Reliant Center to see doctors for free. Many of the people we talked to can't afford health insurance, especially in the rough economy. Some say it shows the need for health care reform.

Doctors, nurses and volunteers arrived at around 7am to see patients in what is believed to be the largest free clinic ever held in the United States. The National Association of Free Clinics said it decided to hold this event in Houston because this is where it felt the need is the greatest.

"We had no idea the overwhelming response we would have, the cries for help from the city of Houston and the state of Texas," said Dr. Mehmet Oz, a doctor working at the clinic. "This is the largest health mobilization in Houston since Katrina. So a national disaster which brought out this kind of response is now paralleled by a national disaster, because this is just an average day in Houston, and there are thousands of people who need help."

That's the issue; a national disaster happening every goddam day. Ask yourself, is this really the best we can do? Other industrialized nations don't have these problems, so why is healthcare in America nearly identical to that of a third world nation?

Need a closer look?

St. Petersburg Times:

After her husband leaves for work and her daughters board their school buses, Monique Zimmerman-Stein feels her way down the cluttered hall into the kitchen, trying not to trip over the cats. She struggles to rinse the dishes, to mop the sticky floor. She tries to picture what her girls must look like now that they're 10 and 13. She hasn't been able to see their faces in two years. Her days are long and dark and quiet. Except for the phone. It rings six, 12, 20 times a day. The callers are bill collectors for hospitals, surgery centers, doctors and specialists, all demanding money the family doesn't have.

Zimmerman-Stein and her husband, Gary Stein, have Blue Cross/Blue Shield insurance through Stein's job at the Hillsborough County Health Department. They pay $90 a week for coverage. But the insurance isn't nearly enough.

"I know I won't ever see again. I'm not even asking for that," Zimmerman-Stein said. "I just don't think we should have to deal with constantly being harassed."

"She and her two youngest daughters have Stickler's syndrome, a rare genetic disorder that causes joints to dissolve and retinas to detach," we're told. "Zimmerman-Stein lost her right eye at 16 and now sees only enough light through her left eye to tell night from day. She and her children are constantly in and out of doctors' offices." At this point, they have no idea how much they owe -- maybe $20,000, maybe $200,000. They stopped opening bills months ago... What would be the point?

And this situation -- and so may similar situations nationwide -- isn't going to fix itself. in fact, it will get worse. "The Congressional Budget Office has estimated that job-based health insurance could increase 100 percent over the next decade," NCHC reports. "Employer-based family insurance costs for a family of four will reach nearly $25,000 per year by 2018 absent health care reform." So, not only won't you be able to afford healthcare without insurance, but you won't be able to afford insurance. The highly technical term for this situation is "damned if you do and damned if you don't."

So the issue, at it's most basic, is whether this is good enough. If you think this is just the best way to go about this whole healthcare delivery business, then you're either ignorant of the facts or a just plain lousy human being. People's lives are ruined or ended, people's dreams are being crushed, families are being destroyed. And people are suffering. Needlessly.

If this really is what you want, then it won't disappear from the planet if the US reforms its system. You'll still be able to get this same level of efficiency in places like Mexico or Somalia.

But if you believe that this isn't the best way to do this, that this is unsustainable, that this is plainly unjust, then that belief is in itself the issue; that this can't go on any longer. That this isn't what Americans deserve. That this isn't the best we can do.


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M said...

Superb points and solid logic.

john gordon said...

My concern with this health care reform, as an Independent, is that it’s all over the place, there are not enough specifics and it must be put into writing and as if “written in stone” so that not every illegal that comes to the US will get free healthcare and those that work hard all their citizen life in US pay for every “Tom, Dick and Harry”

Wisco said...

John, it is written in stone -- it always has been. Not that that makes any damned sense at all. I'm not really sure why we want a bunch of contageous people out there.

And you're paying for every "Tom, Dick and Harry" now -- you're just doing it the stupidest way possible. Why do you think it costs an insane amount for a Tylenol in a hospital? Because people who can't pay their bills get care, then the hospital passes that loss on to you. Meanwhile, these people have to wait until their condition gets so severe that they're either hospitalized or have to go to the ER -- i.e., until they need the most expensive care.

That sound like any way to run a railroad? It sure doesn't to me.

vet said...

You hit on something important when you pointed out that it's easier to report "unarguable numbers - i.e. hard facts".

There's just too many journalists filling too much air time. (Column inches aren't such a problem, because they're less time-critical.) But all those TV producers believe that they can't, or for some reason shouldn't, go on repeating the same things day in and day out - it's meant to be "news", dammit, and that means it has to be different from yesterday, or even one hour ago.

And if the only differences are trivialities, then - report the trivialities, dammit!

Otherwise, how would they justify their vast, expensive phalanxes of under-employed reporters?