18 August 2009

What a mess.  The health care debates have become so cumbersome, so entangled, that for moments here and there, my brain sees nothing but a kind of fog, and haze of issues and terms and talking heads and bizarre signs held up at ridiculously chaotic Town Hall rallies.  If the fog clears, what’s left is a horrible spaghetti of words and intense passions and close to home issues like will I be able to care for myself if I get really, really sick.

So, spaghetti strand by spaghetti strand, let me try to sort this out.

First of all, it’s not just one big health care issue.  It’s a combo of health care coverage for more people, health insurance industry reform, and quality of care.

One the biggest issues, in my most humble opinion, is the quality of care issue, tangled with a somewhat separate issue, the cost of that care.  We have a weird mix of the best and worst of health care in this country; certainly it could be better.  We have amazing technologies, and at the same time people dying because we can’t get health care for them.   In the current debate, this has become a side issue (except for when Canadian and British health care is invoked as some kind of demon of the health care world compared to our supposed perfect and superior system), but to my mind, it’s an important one.

Whatever the quality, health care costs wildly too much for most people’s incomes, and for reasons which are their own little knot of noodles in the spaghetti bowl.  Deferment of the cost of caring for the un- and under-insured is part of the mix, health insurance charges is another.  For someone like me, health care and health insurance are literally unaffordable, and like many, my health plan is simply to stay as healthy as possible, and stock up on a lot of cheap home remedies, like good aspirin and thick wool socks in the winter.  But insurance? out of the picture.  The insurance companies do not offer plans which fit in my budget.  And if they did, would they cover my ongoing problems with allergies, lower back pain, bursitis, and the start of arthritis?

Ah, yes, the insurance companies.  Another tangle.  Do they really need to charge so much?  And if they do, can it change from supporting outrageous profits, mass ad campaigns and the Gucci Gulf lobbyists, and instead put money into covering people who actually need to pay for their care, instead of booting them off for getting sick, exceeding unrealistic limits on coverage, or for enrolling in the program with health issues in the first place?

And, oh my, the employer issue.  Another topic which is barely discussed right now in the face of people screaming about the very existence of health reform bills.  Our insurance, if we have it, generally comes through our employer, and does this really make sense?  I get it that the employer can support the financial burden of health insurance as part of an employment package, but should the employer be picking (or changing, or dropping) our health insurance for us?  Can’t we separate financial (and hopefully pre-tax) contribution, and whether it’s the employer or employee who picks the actual insurer and the medical professionals they will reimburse?

Which brings me to choice, and rationing.  Lotsa bitchin’ going on right now in these discussions (or rants) about how health care will be rationed if Obama gets his way.  My first thought upon hearing about how the gov was going to ration health care (and I’m only now seeing it reflected in the media) was that we currently have rationed health care, because of how the insurance companies restrict the options we have, or cut off care, or eliminate people from their rolls.  My thought?  Maybe the government would play more fairly, which is why I like the public option.  The health insurance industry has certainly proven that it can’t, or more likely, won’t play fair with their customers.

Okay.  The Public Option.  Quite frankly, I’m a bit confused by its details, but my basic understanding is that we’re talking about a Medicare-like insurance system which the government administrates, in order to reimburse private health providers for their services.  Again, sounds like a system that might actually play fair, hopefully for both clients and providers in the system.

My limited understanding is that the objection to this sensible-sounding system is that it will sponsor the big bogeyman of capitalism, UNFAIR COMPETITION (!!!) to the poor, beleaguered health insurance companies:  read, lower profits to the executives.  Bring on the violins!  God forbid they should have to take one less European vacation, buy one less yacht or suffer through a summer with only one vacation cottage (of approximately 12,000 square feet, of course).  My god, they might have to fire a nanny, or a gardener.  They might have to sacrifice that $15,000 gown for a humble $3,000 outfit for the next banquet or ball or dinner out with the hubby. 

Obviously I am not sympathetic.

I think it’s fair to ask, should health care even be a source of profit?  Does it make sense for private companies to profit from the disasters of disease, injury and congenital health issues?  I’m not saying that people in the health insurance industry should be poorly paid (though that is tempting…) and certainly health care providers should be able to make a decent income.  But, in the case of the health insurance execs, does it make sense for their average annual income to be more than 11 million apiece?  Can’t they live on less, say a mere half million or something?  There is something seriously out of balance when execs are raking in the dough at the same time as they are denying coverage, kicking people off their rolls, and generally charging so much that average people can’t afford to keep or even buy into health insurance.

And speaking of bogeymen, as I was a couple of paragraphs up there, what about this socialized medicine issue?  Does the proposed health care reform really resemble a socialized systems, or has the right just thrown the label around because it’s scary, and the word “communism” has been so overused that it’s lost it’s punch?  And if the label socialism applies, is that necessarily a bad thing?

Let’s go to that ever-ready source for the modern info seeker, Wikipedia:

Socialism refers to various theories of economic organization advocating state, public or common worker (through cooperatives) ownership and administration of the means of production and distribution of goods, and a society characterized by equal access to resources for all individuals with an egalitarian method of compensation.
[emphasis mine; links lead to Wiki articles]

Gee, sounds utopian.  And the part of our health care system which resembles this the most is that of the military:  completely government run, with the state owning the facilities, employing the workers, and basically providing the whole health service to folks who themselves are government employees.  Medicare sort of qualifies, to the extent that though it is administered by the government as a single-payer system, but the health care itself – doctors, hospitals, treatments – are privately held and operated.

Enough spaghetti!

So, I’ve identified quite a few strands in my glop of noodles:

quality of care
health care costs wildly too much
the insurance companies
covering people who actually need to pay for their care
the employer issue
choice, and rationing
The Public Option
should health care even be a source of profit?
socialized medicine

Now, I just need some sauce…

And, by the way, we’re not going to put grandma in front of a death panel.  I didn’t want to include that in my list of issues, because it’s patently bizarre, but JUST IN CASE, let it be known that this flaming liberal doesn’t support death panels.

I do, however, support a big improvement in health care.  Let the noodles be untangled!