Cross-Posted Comment & Further Thoughts On Health Care

[hobsonphile.livejournal.com]

Last night in a private entry, I related my own experience as a formerly uninsured American:

I realize that the plural of anecdote is not data, but since many folks on President Obama's side of the issue seem to believe that people's personal experiences with national health care constitute an argument, let me throw in my own experience in the American system. Because you see, for some years, I was an uninsured American with a chronic debilitating illness and a quite meager salary - and not once was I denied care. Indeed, the hospital, my rheumatologist, and even "big pharma" pulled out all the stops to give me the treatment that I genuinely needed: my biologic medication was sent to me completely gratis by Abbot, the vast majority of my hospital debt was forgiven (I paid the rest on a manageable installment plan), and my own physician offered everything from free cortisone injections to free prescription meds. Indeed, I was told that the medical school in my area was willing to perform free abdominal surgeries on needy patients. The only catch was this: my mother and I had to speak up and formally request help from said entities. The upshot: American medical professionals, who generally do care about helping people - yes, even those eeeevil pharmaceutical companies - seem to be willing to step up when you document true need. Nothing in my (admittedly limited, yet distinctly relevant) experience suggests that any reputable American hospital would let a child languish with cancer because her parents can't pay the bills. Something would be done. After all, what is St. Jude?

I believe many people have a distorted apprehension of who the uninsured are. I was uninsured for most of 2003 and then from the end of 2004 to the end of 2006. Why? In the former case, I was unemployed; in the latter, I had switched to my current job (which I love) with a small company that does not offer health benefits. These gaps were due to my personal choices; in the second situation especially, I knew what I was getting into. And as I explained above, I was okay; it was sometimes an enormous pain in the butt to hit up various charitable programs and set up installment plans, but my rheumatoid arthritis was treated. Ultimately, after a series of hospitalizations in 2006, I decided to get an individual plan with a ridiculously high deductible to cover the catastrophes, but due to said deductible, I still pay for my routine arthritis treatments out-of-pocket. I suppose you could say that even now, I am only partially insured - but I continue to do okay for all of the reasons outlined above.

How many of the "uninsured" are just like me, I wonder? How dynamic is this class? How many of the forty million are people in career transition or people who are self-employed? I think this question needs to be answered; I think it's very disingenuous to assume that there is absolutely no choice in play here. I chose my current lot - and I put on my big-girl pants every month and shell out 25-30% of my income (which is not much, just in case you are keeping score) to keep all of my moving parts in halfway functional order. I suppose that's why I sometimes feel the urge to call the waaaaambulance on privileged (and insured) liberals who get moist-eyed over the uninsured. We are not all indigents with poor, malnourished children who have been sucker-punched by the system. Indeed, in my state, the very poor - especially those with dependent children - can already get aid. Perhaps what liberals say is true - perhaps this aid is inadequate. I'm willing to discuss how we can shore up the baseline benefits for the lower working class, the disabled, and the like. But that's not what most liberals want to discuss. What they want is a full-on universal entitlement for people like me - people who have elected to remain uninsured or partially uninsured - as well as the populations who really do need to have a safety net in place. They want a European style system in which everyone is in on the government plan (except for the rich, who will always have the wherewithal to do whatever they want regardless of the left-wing's idolization of "equality").

Why? Because most liberals simply don't believe in the concept of personal responsibility. This is perfectly encapsulated by how an individual on my friends list mischaracterized the observations of the originator of this thread. I read through the entire thread, and what I understood was this: the poster was arguing for at least a modicum of individual accountability. S/he quite rightly pointed out that not all people are poor and/or uninsured through zero fault of their own. S/he also pointed out, as did pat_t below, that many people simply just can't be arsed to take proper care of themselves despite all the hand-holding in the world. On the other hand, s/he also repeatedly acknowledged that there are some populations that really do need a hand up and overall seemed entirely open to the opposing viewpoints of those who responded. Now how did the aforementioned member of my reading list summarize his/her viewpoint? "Poor and disadvantaged people deserve to get the consequences of their "failure" good and hard." This is not even in the same neighborhood as the correct interpretation.

It's very difficult sometimes to remain Christian and not nurse the desire to throttle some people.

Let's lay this out in very stark terms: leftists believe that the man who spends his days and nights strung out on heroin and crack is not any more responsible for his poverty than the immigrants in my parish who speak only a smattering of English and thus struggle to get by on the thin wages accrued from menial - but honorable - service labor. Leftists further believe that people like me - people with computers and cars - are entitled to take from their neighbors' pockets simply because they are technically - and often by choice - uninsured. This is a universe in which the sky is green and grass is pink. There is a difference - a very real difference - between each of the above three classes of people.

Again and again, leftists - particularly European leftists - demonstrate that they are completely disconnected from reality. "We Brits are good at standing in queues!" one cheerily quipped in the replies to another left-wing European friend's post on American health care. When I stumbled upon this, I was frankly gobsmacked; it was like reading a dispatch from another planet. Such a comment demonstrates that some folks on the other side of the pond have become so inured to the hassles of their respective systems that they either can't or won't make the leap of imagination necessary to understand why so many Americans are resistant to Obama's national health care project. "The private health care business is alive and well in the UK," another commenter notes. And you have not mulled over what that might indicate? "Insurance companies ration care too!" another, thinking herself clever, points out. There's just one problem with that line of argument: we can shop around for private insurance. We can even sue our insurance companies if it comes to that. Will we be able to sue an American NHS? "Obama Care did not sanction 'death panels'." Okay - even if we grant that this was not the original intent of the end-of-life counseling elements of the bill, what are we to make of the Oregon cases cited by reality_hammer here? Can you really assure us that the federal government will not interfere with our end-of-life decisions in this manner? Really? "We should treat smarter," intone Obama and his supporters. And what qualified you people to make that determination? "Preventative care for everyone will save money." Except the CBO, if Krauthammer's column is accurate, apparently doesn't think so. "Health care is a human right!" That may be so, but in reality, health care also costs money. That is the nature of the fallen world we live in. Thus, it behooves us to take the time to think soberly about the matter and devise a plan that will actually work. What we should not do is ram entitlement behemoths down the throats of a largely unwilling populace.

We are dealing with a classic clash between what Thomas Sowell terms the anointed and the benighted classes. Those in the anointed class believe that if they can dream up a lofty, "compassionate" ideal that satisfies cosmic notions of social justice, they should be allowed to implement that ideal, by God, and the potential costs be damned. Those of us in the benighted class realize the truth: option A may seem more cosmically "just," but if we can't implement it without doing tremendous damage to our livelihoods, our liberty, our human dignity, and/or our chances for salvation, we are morally obligated to settle for the less-than-perfect option B. Perfection is only achievable in heaven.

Comments

[agilebrit.livejournal.com]

What I don't get is that we're talking about handing over the rest of our health care to the same people that run those train wrecks known as Medicare, Medicaid, and the VA. Let the Feds get those houses in order before they go mucking about with the rest of us.

[hobsonphile.livejournal.com]

YES. This.

ETA: I should add that my brother is legally blind and on Medicaid, so I'm actually personally acquainted with that circus.

[lazypadawan.livejournal.com]

Insurance, and treatment, would be a lot more affordable if there was a real free market to buy plans and if there was tort reform. But neither figure on the Obamacare grid.

[zansa-san.livejournal.com]

Zomg, a fellow RA, and on therightfangirl, no less! Can I friend you?!

[hobsonphile.livejournal.com]

As I understand it, this is pretty much what the AMA wants. But who wants to listen to actual doctors?

[hobsonphile.livejournal.com]

You're also a fellow confirmed Roman Catholic. By all means! ;)

*friends*

[audiodrops.livejournal.com]

Wow! This was an excellent read, and very interesting.

I think people just think it'd be easier if the government handled everything for them, and we're jerks for not wanting that.

[hobsonphile.livejournal.com]

Yes. I believe this is why the AMA's proposal - which I think is one of the most sensible I've seen - seems to be off the table for much of the left. The AMA would decouple insurance from employment, giving health care vouchers or tax credits to the poor (who often don't have jobs with cushy benefits) and the chronically ill (who are forced to pay more because they are not good risks) and allowing people to select their own private insurance. But as you say, such a set-up involves too much of that dreaded personal responsibility for some.

[ohinternets.livejournal.com]

FORGET MEDICARE AND MEDICAID, y'all, we're handing over the rest of our health care to the same people who run those trainwrecks known as the DMV - that's enough of a case against socialized medicine for me!

[ohinternets.livejournal.com]

This was so refreshing to read; it is a very nuanced analysis of the situation IMHO.

I am a freelancer, but uninsured, also by choice, as I could take on an extra project every month to pay for private insurance, but choose not to for now, opting for greater time to care for my child. I do have health discount program through Ameriplan (http://ameriplanusa.com) which is very affordable for me and covers almost everything in an affordable way. In the dental discounts alone, it has paid for itself literally hundreds of times over.

This summer, I was blindsided by non-cosmetic oral/endodontic emergencies that even with my considerable discounts, amount to about $5000 worth of bills. Not that private insurance would've helped much with that anyway but I would wager that in this economy, few people have $5000 saved to pay for dental bills, much less most self-employed single moms, and it's been a real struggle.

However, what I found was that with my discount plan, my private high-end dentist was only a little more expensive than the PUBLIC health/ dental clinics, and unlike the public dental clinics, the private dentist does not have a 3-month wait for an EMERGENCY appointment. My church is helping me with part of the bill; family is helping with another part, and the rest? My private dental care provider has agreed to payment plans. Not credit - I make too little for CareCredit and the amount was too big for my income at my bank - he's just agreed to take it on good faith that I'll pay him back and has worked with me to get it taken care of. I have had to seriously call around and it has been a huge hassle, but in a week or two, I will be completely fixed. You can almost always find that private healthcare providers will work with you; they WANT to heal you, and don't want to see you suffer.

Having said that, my little boy is severely and permanently disabled and was on Medicaid for a few years because I really could not afford the super high deductible and the premium that was higher than my rent due to his pre-existing conditions. Medicaid is a hot mess - the pre-exisiting condition penalty needs to GO. On Medicaid, he had to wait A YEAR to see a pediatric neurologist for suspected epilepsy, and that's not even with Medicaid being universal. Pathetic!

He's on his dad's private insurance now. World of difference in terms of both wait time and quality of care. I contend that anyone who thinks government-run healthcare is a pie in the sky has never had the misfortune of having to be on it.

Having said that, I agree that there are populations, such as the very elderly, the infirm, the mentally ill/ developmentally challenged, children living in poverty and other people who NEED a hand up. It's just a much smaller margin than people think.

I do disagree, though, that recovering drug addicts aren't in that population. As a Christian, I believe in the power of redemption and I think that there should be some kind of help, private or otherwise, in place for people who legitimately want to turn their lives around. And for those who don't, though in theory it sounds good to make a crack addict pay for his own overdose expenses, I'm not sure how realistic it is to expect to cash in on that bill. ;)

[hobsonphile.livejournal.com]

Having said that, my little boy is severely and permanently disabled and was on Medicaid for a few years because I really could not afford the super high deductible and the premium that was higher than my rent due to his pre-existing conditions. Medicaid is a hot mess - the pre-exisiting condition penalty needs to GO.

The AMA and I agree with you on this. If people are so eager to spend money on health care, why not eliminate the pre-existing condition penalties by supporting subsidies for those who most need medical treatment? (Full disclosure: I too have been penalized due to my rheumatoid arthritis. As I said, though, I'm doing okay; I'm not here with my hand out. ;))

I contend that anyone who thinks government-run healthcare is a pie in the sky has never had the misfortune of having to be on it.

My brother, who is legally blind, would probably respond with an ardent "WORD!"

I do disagree, though, that recovering drug addicts aren't in that population. As a Christian, I believe in the power of redemption and I think that there should be some kind of help, private or otherwise, in place for people who legitimately want to turn their lives around. And for those who don't, though in theory it sounds good to make a crack addict pay for his own overdose expenses, I'm not sure how realistic it is to expect to cash in on that bill. ;)

I concede that you're probably right on that last bit. ;) And as a Catholic, I too believe in the power of reconciliation and redemption. In fact, I believe redemption is possible even for murderers and war criminals! But I think we have to be very careful not to confuse reconciliation with leniency. I can forgive a murderer, but he still must be punished with a lifetime term in prison. We all must suffer the temporal consequences of our sins; indeed, if we are are shielded from those consequences, we, being human, are far less likely to make the changes necessary to achieve our redemption. While it sounds cruel to many modern ears - particularly since we've all been inundated with "addiction is a disease" propaganda (more on this in a moment) - drug addicts often must be brought to their knees before they will be motivated to make good. Whether you call it "tough love" or "hitting bottom," I've seen the phenomenon - or, rather, the results of tough love's opposite - in my own extended family. Compassion is one thing; enabling, something else entirely.

Once an addict has made the genuine commitment to straighten out, by all means, someone should help them out. I'm not terribly comfortable with that someone being the taxpayer, though, as recidivism in this population is rampant, and drug treatment is sometimes abused (especially by narcotic addicts who want the enhanced high they get immediately after detox).

By the way, regarding the aforementioned politically correct "addiction is a disease" mantra: it's not 100% true. There are very real physiological dimensions to addiction. On the other hand, while no one with, say, breast cancer consciously chooses to put herself in that position, drug addicts, crucially, do make that first conscious choice - and many other conscious choices after that. And as it turns out, they can also make the conscious choice to stop. Immediately after college, I worked with two researchers who discovered that if you give addicts money to stay clean, they stay clean. You can't tell a woman with breast cancer, "Hey - I'll give you a paycheck if you quit that whole cancer thing."

At any rate, to summarize the whole point of that ramble: I believe in showing compassion to those who are trying to sober up, but I stand by my original contention that drug addicts are in a morally different class.

[ninepointfivemm.livejournal.com]

I swear, if we get the DMV... We'll be waiting in lines that are akin to bread lines in the 30s.

[caromiofic.livejournal.com]

Yeah, we have a good friend that's blind and in chronic pain requiring methadone just to function, and he's gone through hell at times with CA's gov't care. He inherited money when his mother passed. Well, in order to keep his healthcare, he had to get rid of that money and have proof that he did, or he wouldn't be able to get his meds anymore. He's a blind guy with severe short term memory issues from brain damage and chronic pain from having his sternum shattered, and they wouldn't let him use his actually pretty small inheritance to pay rent, etc.

He's finally in a group home where he gets regular meals and they remind him to take his meds on time, but there's also little space or privacy. He'd rather be independent, but that's just not going to happen unless he wins the lotto and can tell SS and Medicaid to shove it. We didn't hear from him for quite a while after he lost his apartment and worried he might have had a seizure and died alone, so at least *this* is better than that.

[ohinternets.livejournal.com]

Tort reform, eliminating pre-existing conditions and allowing a free-market competition for insurance like they do with car insurance would make Obamacare obsolete for all but the neediest segments of our population.

I didn't say they were morally analogous, just that they were not morally dismissable and that withholding treatment isn't appropriate punishment for drug addiction. But there are no easy answers on that one.

[hobsonphile.livejournal.com]

I didn't say they were morally analogous, just that they were not morally dismissable and that withholding treatment isn't appropriate punishment for drug addiction.

I don't think I said we should withhold medical treatment - of course that's not acceptable. What I said was that the left was wrong to morally equate all those living in poverty as if personal responsibility plays no role whatsoever - and that it was probably not productive to shower entitlements upon people who might actually need a good wake-up call instead.

At any rate, as far as I know, hospitals are not allowed to withhold treatment due to a patient's inability to pay. If an addict - or anyone else for that matter - comes into a hospital needing treatment, that hospital is not only morally obligated but also legally obligated to treat them. So even if we took the radical course - which I don't necessarily promote - of refusing to pay for an addict's detox, that doesn't mean he wouldn't get it. It just means he'd be saddled with the burden of paying for it somehow, either through hospital charities, installment plans, etc; in other words, he'd have to take some responsibility for his choices.

[hobsonphile.livejournal.com]

Yeah, we have a good friend that's blind and in chronic pain requiring methadone just to function, and he's gone through hell at times with CA's gov't care. He inherited money when his mother passed. Well, in order to keep his healthcare, he had to get rid of that money and have proof that he did, or he wouldn't be able to get his meds anymore.

This, I think, is one of the silliest things about government aid for the disabled in this country. God forbid my little brother - who's a grad student right now and is, as I said, on SSI and Medicaid - start earning just a little too much. It's like a perverse disincentive to work - or do anything else to achieve a little independence.

[darthslacker.livejournal.com]

I know that there are recovering addicts and people who want to be drug free. I say we should at least try and help them-but with methods that work, not the pansy, politically correct ways that we have now.

I also know that drug addiction was a CHOICE for people. They chose to take that first snort of coke or heroin or use meth, etc. With the exception of babies born to drug addicts, drug users aren't victims but conspiritors in the abuse of their own body. Its not like someone dying tragically of breast cancer, etc. There has to be a recognition that in most cases drug use is the result of degeneracy, its not a disease.

I was a police officer for two years, and I saw college kids on drugs all the time. They weren't on drugs because of some tragic past or emotional trauma, but because they wanted the greated sensory experience or were too weak around their friends who were doing it. I saw these same idiots when I was in high school looking for a new thrill. I have a hell of lot less sympathy for these people than the people I saw who were suffering from medical conditions and were struggling to go through school or live productive lives. If I have a choice, I'm going to say spend MY money on those people and people who have shown a rock solid commitment to being drug free and then actually stay off drugs.