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A Simpleton Tries to Understand the Health Care Debate

by: William Fisher, t r u t h o u t | Op-Ed

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(Photo Illustration: Jared Rodriguez /
t r u t h o u t)

        Now, the first thing I want you to know is that I'm no health care policy expert. Far from it.

    But, like the rest of us, I have a body and a mind that can get sick. So, I'm a participant in the debate whether or not I want to be.

    And being about to mark my 81st birthday gives me a shorter time to participate but, arguably, a heightened motivation.

    Over these past months, I have been drowning in seas of data and analysis and opinions and lies and spin about health. But very little of it has actually been about health. A lot of it has been about process, such as the process in the sausage factory through which legislation gets crafted. But mostly it has been about money - money headed for so-called health insurance companies.

    Now, maybe I have a simplistic mind, but frankly I don't understand why health care and insurance companies keep appearing in the same sentences.

    After all, these two things are not the same. Insurance companies are not in the health care business. They are in the risk business. They assess risk and then charge you a fee - it's called a premium - to protect you against that risk. Just like your car or your home insurance. If your car gets wrecked, the insurance company doesn't make it better; it gives you money so that you can make it better. Same with home insurance; if a storm tears your roof off, your insurance company will send a contractor to fix it.

    So it is with health insurance. Health insurance companies don't do a thing to make you well if you're sick. That's the work that's done by physicians, nurses, hospitals and clinics. And these two groups - health care professionals and health insurance companies - are far from buddies. In fact, they're pretty intense enemies.

    The reason is that the health insurance companies, being in the risk business, do whatever they can to reduce their risk. So, they are more than likely to deny all or parts of the care your doctor is prescribing to make you better. Their loyalties are to their shareholders. Shareholders who've seen a run of great profits, based on ever-rising premiums, based in turn on generous government subsidies and an almost total lack of competition among all these companies.

    Oh, I forgot to mention that our Congress, in its infinite wisdom, gave these health insurance companies the same antitrust exemption enjoyed by major league baseball. This means they can fix prices with impunity. Trouble is, they haven't been staying fixed for long; premiums have been increasing exponentially year after year. And there's been no noticeable improvement in our health; in fact, our health has gotten steadily worse.

    These companies go still further to reduce their risk. For example, if you get sick your insurance is quite likely to be dropped - an action the insurance companies antiseptically call "rescission." They rescind a lot. In other words, just when you're sick and need coverage the most, that's when they tell you "you're out!"

    Then there's the "pre-existing condition" gambit. I just read about three denials that seem really gross. One was refusing coverage to a victim of domestic violence, which the company ruled was a pre-existing condition. The second refusal involved a newborn, who the insurance company claimed was too fat. And that was followed by a third refusal - because the infant was too skinny.

    Maybe, like me, you've been reading Karen Tumulty's pieces in TIME on the health care issue. She captures the facts as well as anyone I've read. And she has assembled one hell of a chamber of horrors - about people with serious but treatable illnesses who were told, essentially, to find a charity to help because we, the insurance company you've been paying to reduce your risk, have been too busy reducing our own. Very few happy endings here: patients have died as a result.

    Same thing happens if you get health insurance at work, but lose your job. You can buy something called COBRA - if you can afford to pay three or four times what you were paying when you had a job.

    Gee, it must be wonderful to run a company set up to take risks on people getting sick - but which has only healthy customers!

    Now, here's another wrinkle to think about. How'd we get to this place where employers provide health insurance to their employees? And take it away when they fire you. Well, I'm told this practice started back in World War II when the US had wage and price controls. Your wages couldn't be increased, so along came health insurance to make up the difference - and give employers even more economic power over those who work for them.

    Seems downright un-American to me.

    In fact, seems to me this whole health care debate is struggling to reconcile two contradictory narratives we Americans invented to help us understand ourselves and our history. One is the narrative of rugged individualism. In this bit of mythology, everyone is John Wayne and nobody needs anyone's help to meet tough challenges - least of all the government's help.

    Then there's that other bit of American mythology, the part that talks about how, when the going gets rough for our fellow citizens, we all rally round and share our energy and our wisdom and our compassion to make things right again.

    Neither of these narratives is true, but we like to believe both of them anyway, even if they are myths and contradictory myths at that.

    Now, it seems to me there's a third bit of American mythology that's getting overlooked. That's the bit that talks about certain inalienable rights we all have, among which are life, liberty and the pursuit of happiness. That's from our Declaration of Independence, written by our founding fathers.

    I like to think of life, liberty and the pursuit of happiness not as states of being, but as goals. That's because we've never achieved 100 percent of any of these three freedoms. So they - and we - are works in progress.

    But it's pretty hard to imagine pursuing much happiness if you happen to get sick, get cut off by your health insurance company and find yourself on your way to medical bankruptcy. Isn't that the point where we invoke that other piece of great American mythology - the one that says now we circle the wagons, pool our resources and find a way for all of us to help all our fellow citizens?

    Well, there's only one way to do that and that way is to use our government. The government is us; we pay for it; we own it. We need to make it work for us.

    Sure, there are a lot of folks out there who are telling us we can't go down this road because it will lead us into the dreaded socialized medicine: A government takeover of health care.

    So what? Forget the labels; that's propaganda. It's the same sleazy accusation that was used against FDR's New Deal in the '30s and again in the 1960s in the right-wing efforts to demolish LBJ's Great Society.

    But, in fact, it's exactly what we're already doing for our seniors under Medicare, for our men and women in uniform, for our veterans through the VA - and for every member of Congress. Seems to work just fine for these folks.

    So, why is it going to be such a disaster for the rest of us?

    When you think about how much we pay for health care and health insurance in America - many times more than the most advanced countries in the rest of the world - and understand that we get substantially worse results, one has to conclude we must be doing something wrong.

    We need to fix a bunch of things beyond predatory, uncompetitive, profit-centered health insurance companies. But neutering these vultures would be a start.

    Maybe it's time to tell our Congresspersons how we feel.

  

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Comments

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Extremely well presented!

Extremely well presented! Tied all the pieces of the puzzle together seamlessly! Bravo!

I'm three years younger, but

I'm three years younger, but just as wise. You said it perfectly. Yes, we need insurance reform, but we need health care reform even more urgently. The system is broken. Part of that system is how we pay for it. Eventually it will have to be a human right. A single payer system that is a public service.

I could not say it better.

I could not say it better. Why in the world should employers pay for their workers health care? Why in the world should health insurance companies still exist when we know that government health care for federal employees works so well? And how will the so-called health care reform not end up as a giant taxpayer funded give away to the insurance companies? Think about it: everyone will get some kind of private insurance, and the taxpayers will pay for those who can not afford it themselves (and the insurance companies still control what is covered.) It is outrageous that this conversation is even going on.

This is the Will Rogers

This is the Will Rogers version of what's happening in the health care debate. It's hard to argue with, and for very good reason: it's friendly, unpretentious, and makes fun of the truths we think we live by, but rarely do. That's the 'ol cowboy who only knows what he reads in the newspapers speaking. He makes us laugh at ourselves, but a little self-consciously. "Must be some truth in there" we think, and rightly so.

NICELY PUT. THANKS! Phillis

NICELY PUT. THANKS! Phillis

Thank you for your comments,

Thank you for your comments, Mr. Fisher. I, too, believe that I must have a simplistic mind. What I don't understand is why we aren't looking at the causes of poor health to begin with, like stress, pollution, lack of exercise, processed foods and GMO's, poor sleep habits, drug side effects, etc. The predominant mindset these days seems to be that disease is a given and now we have to figure out how to pay for it. The truth is that the body is designed to heal itself given the right nutrition, etc. But, disease has become a huge profit center for hospitals, pharmaceutical and insurance companies and they have no incentive to speak about prevention. Why aren't we looking at the impact of too many meds prescribed? (See "Our Daily Meds" by Melody Peterson) Why don't we hear about the impact of GMO's that the FDA legalized in 1996 and that parts of the EU have now made illegal? (www.responsibletechnology.org; this May the American Academy of Environmental Medicine called for the eradication of these as they have a proven, severe long-term effect on health, www.aaemonline.com.) At www.naturalnews.com, reports can be found about companies and organizations involved in Breast Cancer Awareness Month and how they have many conflicts of interest, such as those who produce chemicals that cause breast cancer and then produce the drugs that can help it to go away. There are profits coming and going, with people dying in between. Finally, a great read is Dr. Bruce Lipton's "The Biology of Belief" (the 2006 Science Book of the Year), which proves that our genes are not our destiny and how our environment, beliefs and perceptions effect our health. Although once we realize the impact that we have on our own health and begin to take responsibility for it, how will these companies make their billions then? Ignorance does seem to be bliss, at least for some!

"Maybe it's time to tell our

"Maybe it's time to tell our Congresspersons how we feel." I have. I told Mary (Bono) Mack. She voted over 92% in line with George W. Bush over the eight year period he was artificially installed in office - first by a combination of voter fraud and intimidation and the second time "by ditto." Mary is a hard-core Republican. Her response to my request for single payer care was - and I paraphrase (accurately): "I don't believe government should be involved in funding or running health care programs. It's the role of employers to provide health care to its workers." Mary Mack has been fully paid for by the wealthy elite Republicans and ignorant evangelicals living in Palm Springs, Palm Desert, Cathedral City, La Quinta and Rancho Mirage, many of whom, if they wanted to, could (& perhaps do) purchase their own mini-hospitials or on-staff, live-in physicians to get the health care they deserve and can afford - and which many others - obviously - including me, do not deserve and cannot afford. "If you only worked like us,"... they often lament, "then you'd know that what you pay for in this country is what you get. Tough luck, poor folks. It's sink or swim in this great nation of the stars and stripes!" This article is one of the best to come out on T.O. Its minimalistic, even lyrical style & perfectly executed paragraph sequences make it a mini-work of art, like a simple, but beautiful Bach theme. Thank you T.O. for offering this one to us readers.

We probably will not get any

We probably will not get any type of government run health care from the current bill in Congress, but we WILL get a bill that has the government working as enforcer for the insurance industry, via a mandate. How is that NOT having the government involved? We have the insurance industry complaining that the uninsured are responsible for raising rates on the uninsured. That's a lie, because the insurance industry does not pay for any care of the uninsured - providers and taxpayer pick up the tab.

How is it the great

How is it the great communicator that is supposed to be our president can't get out and say this. And BTW the democratic party is screwed if it passes the bills that are already out there

Not very truthful for being

Not very truthful for being on "TruthOut". For an article by a site called TruthOut, they left an awful lot of "truth" "out" of this op-ed piece. No mention of health care providers and their rates which have nearly tripled in the last 10 years. More spreading of the nonsense that the government runs Medicare, FEP or TriCare. Medicare is run by the "vultures" this writer says can't run things. FEP, the Federal Employee Program, the insurance Congress and all federal employees have? It's a BCBS insurance plan bought by the Government. Yep, it's a plan owned and run by a "vulture" and that the government pays for just like any other employer-purchased insurance plan. TriCare, the military insurance? You guessed it. It is actually several private insurance plans purchased by the employer (the US Government) from private insurance companies (i.e. "vultures"). Every time a left jumps out with this nonsense, the intelligent US citizen sees through it, and another nail is driven into the coffin that now holds the public option.

I'm 88 and can't figure out

I'm 88 and can't figure out why those clowns in Washington can't just select a Medicare solution for everyone. I'm fairly satisfied with how it works. Many keep saying you can't select your own doctor. If you are satisfied with the one you picked out means you have not had a problem he has screwed up yet. Exactly what do you know about doctors? Mostly he has a bedside manner you like. My worst mistake was selecting a doctor recommended by my doctor. I picked him but wound up with permanent trouble with the knee he replaced. Universal Health Care certainly can't cost more that that 4 to 5 billion a week war in Afghanistan. Have a nice day.

He captured the essence of

He captured the essence of the problem...that insurance companies worry about their bottom line, not about our lives. And when they reject someone for whatever cause, it is the government that ultimately picks up the tab for health care, as in Medicaid, Medicare. Let's make it a better system that will accommodate everyone.

well told and an excellent

well told and an excellent conclusion ("We need to fix a bunch of things.... But neutering these [health insurance] vultures would be a start."). But Mr. Fisher got a couple of things wrong: 1. Medicare is NOT socialized medicine - the clinics, hospitals & care providers are all privately run (but the VA system IS socialized medicine). 2. We don't "pay many times more than the most advanced countries in the rest of the world". We pay about twice as much. But there's no good reason that we should pay ANY more - especially with worse outcomes.

dont know where the

dont know where the anonymous guy gets his info, but he is the one with the untruthful data. I am a physician, and I can assure you that health care providers rates have not tripled in the last decade. Besides, it does not matter what rate I decide to charge, it is the insurance company who benefits from anti-trust legislation who decides what they want to pay. And this decision to cut healthcare costs by decreasing physician reimbursement was all a lie. As we all know, costs have gone way up and it is partly because of new technologies, runaway malpractice premiums, and physician/hospital/insurance company animosity. This diversion of resources is not going towards improving healthcare- it being used to pad the insurance co balance sheets and inflate their CEO salary. It is time to rid ourselves of the parasitic insurance co middleman and return healthcare control to those who actually care about patients and their health.

"Medicare is a social

"Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over, or who meet other special criteria. The medicare program also funds residency training programs for the vast majority of physicians in the United States. Medicare operates as a single-payer health care system.[1] The Social Security Act of 1965 was passed by Congress in late-spring of 1965 and signed into law on July 30, 1965, by President Lyndon B. Johnson as amendments to Social Security legislation. At the bill-signing ceremony President Johnson enrolled former President Harry S Truman as the first Medicare beneficiary and presented him with the first Medicare card.[2]"

By now, it should be clear

By now, it should be clear to all that our form of corporate capitalism is not improving American life, liberty or happiness. Corporations, in cahoots with our own corrupted political representatives, have turned nearly every popular desire for a more humane society into a sword with which we are once again skewered. Of course, I’m talking about the health care reform, but it could be anything: control of climate change, better education, healthy food, renewable energy, useful information. Trying to follow the protracted legislative process that started out as an “overhaul of our health care system” has been tiring and, if you’ve been paying attention, horrifying. After a year (nay, 60 years), our representatives have decided, along with their corporate sponsors, that we don’t need health care reform. We really need a system where we will be hit with hefty fines if we don’t buy a product that we couldn’t afford in the first place. That product may or may not give us the health care we need. In fact it may be defective and actually harm the consumer, but it will cost a lot and is designed to make a profit for the purveyors of that product. Our legislative system is, by now, adept at such underwater flip-turns. We could have what over 70 percent of the public wants, Medicare for all. It could be paid for by a 15 percent cut in the military budget and/or a hike in the relatively progressive income tax. Easy. Except ... that the corporate/legislative cabal sees an opportunity to increase profits and kickbacks and isn’t going to let that opportunity go to waste by addressing our real needs with good public policy. Hence, the awesome contortions to make us believe that rubbing our noses in dog poop is the cure we really need.

As a 67 year old breast

As a 67 year old breast cancer survivor I can tell you that for those of us on a very limited income Medicare is not the way to go. I cannot afford to purchase the "extras" so Medicaid picked up the bill for hospital coverage but not for doctor coverage. This means that any medical emergency I have will force me to wait until it is hospital serious instead of being checked to prevent it from developing. Until this part of Medicare is changed, it will not work for everyone, it does not work for me now.

I also agree, well written

I also agree, well written essay. It eloquently and specifically points out that the "entity" currently spending millions on Capitol Hill to kill meaningful healthcare reform cares nothing about Americans' health or healthcare. It cares only about it's bottom line. That fact alone should be enough for anyone EXCEPT upper management of the CIGNAs and the Well-Points to support a public healthcare plan. The simple fact is that for-profit "healthcare" is the disease, not the cure. And the mainstream media collusion in this debate with the "entity" is outrageous and unacceptable. Today, newspapers are going under; tomorrow: the Fox network, CNN, USA Today, and other TV messengers of misinformation, lies, and half-truths. The words of Mr. Fisher are words of truth, and it is inspiring to read the many clear-eyed posts that have contributed to this debate (war between the People and the "entity") on Truthout.