Health care for some

I’ve had at least three conversations with people who are working on obtaining health insurance coverage this week. One was getting documentation in order to change to a spouse’s health plan following a recent marriage. Another had resigned from a job and the health plan from that job ran only until the end of the month. Another had reached the age of medicare and was trying to figure out the maze of possible supplemental plans. Heath insurance is complex and confusing in our country, to say the least.

The basic concept of health insurance is that everyone puts money into a pool through their premiums. When someone becomes ill, they dip into that pool to pay for their health care. the system works because not everyone gets sick. In fact it works so well that the insurance company can also dip into the pool for its profits and those profits in turn benefit shareholders who purchase stock.

There is a problem with profit in anything to do with health care. The problem is that there are fewer dollars available to pay for care. Profit is a process of extraction. Of course insurance companies aren’t the only ones seeking profit from the health care field. There are pharmaceutical companies and some medical laboratories. There are for profit hospitals that usually are niche hospitals, treating only a narrow band of health concerns and avoiding those which are more expensive and have less predictable demands. There are companies that handle billing and records and, of course there are collection agencies. And the list goes on and on. So much profit is extracted that per capita spending in the U.S. is almost twice the average of other wealthy, developed countries. And all of this expense is not purchasing the best health outcomes in the world. It is, however, producing record profits.

But profit is only part of what is broken about the U.S. healthcare system. Our system is based on unequal distribution of health care coverage. Some people have access to the system and others do not, or at least their way of being involved is vastly different. The three people whose stories I hinted at in the first paragraph of this morning’s journal entry all are either currently experiencing or have recently experienced significant financial distress. They know the struggle of trying to cover housing costs and groceries on limited incomes. They all have experienced delaying or failing to get preventive health care because of the cost.

All three stand in stark contrast with our situation. Both my wife and I are eligible for medicare and we have supplemental policies. Our employees pays the premiums on our policies. And we have excellent coverage. When my wife was in the ICU last fall the billed costs were tens of thousands of dollars a day. One day approached six figures. The amount that we had to pay after medicare and our supplemental policy was very low - in the hundreds of dollars. One of the people with whom I was having a conversation was struggling to afford a monthly premium of $1,600 for a plan with a $10,000 deductible for the family and an out of pocket maximum of $16,300. That means that virtually any hospitalization or major medical expense will exceed the family’s ability to pay.

We see the impact in the church all the time. The cost of health insurance is literally beyond the means of small congregations. They might be able to afford a pastor, but they can’t afford a pastor’s health insurance. The rapid rise in costs meant that the early 2000’s saw a dramatic decrease in the number of congregations that could no longer afford an educated clergy person.

So our system is definitely one of health care for some instead of health care for all. Because so many people find themselves unable to pay for major medical cost, hospitals are forced to spend millions of dollars trying to collect past due bills and then end up writing off huge volumes of unpaid bills which in turn drives up the cost of health care for others. Health care for some ends up with an uncontrolled upward spiral in costs for all. It is an inefficient system.

And the system may be coming face to face with a crisis that it simply cannot handle. A major pandemic of a new disease that is easily communicable. As the disease spreads there are people who are avoiding treatment because they cannot afford it. There are also infected persons who are spreading the virus because they have no paid sick leave and they cannot afford to take time off from work. Those who are working while sick include those who are responsible for critical elements of infection control, such as cleaning laundry and dishes and serving in nursing homes and other health care institutions. To put it bluntly, healthcare for some does not work when a virus is quickly threatening all.

The virus will spread. The number who get sick will grow. The death toll will rise.

The situation has been politicized with the party in power committed to repealing the affordable care act. They have already succeeded in repealing the individual mandate, which was an incentive for all people to have some form of insurance. We’ve gone back to large numbers of people going uninsured. And thought the rhetoric was “repeal and replace,” there has been no replacement, only repeal. No plan for addressing health care costs has been put forward.

Our system is broken in part because our process is sick.

Within this broken system are some brilliant researchers and physicians. There have been advances in treatment and care of injured and ill people and those advances continue. There are genuinely caring and serving individuals who work diligently to provide the best care possible for those in need. Well trained and qualified scientists are researching new cures and treatments with unprecedented accuracy and innovation.

It’s too bad that we are not allowing all of those who are ill access to those good people who are working to provide better health care.

Copyright (c) 2020 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!