A life example helps illustrate what is wrong with health care in America.
On October 22, 2000, shortly after dropping out of my first attempt at college, I went out job searching. My parents had informed me that I was now an adult and would be responsible for my own living expenses. Late in the afternoon I went home and sat down to watch television. Though I awoke that morning feeling fine and had had an interview at Vanguard Airlines I was not feeling all that particularly well. Choosing to stay in rather than meet up with friends, I got myself a glass of water and sat back down at roughly six o’clock.
At 10:30pm, my parents came home from working in their furniture store (I had worked there during high school, but late in 2000 the economy was faltering and they could no longer afford to employ me). My glass of water was still half full. I lay motionless on the recliner; eyes open but barely able to respond. Face flushed and sweating, my mother (who still held her Registered Nurse license) easily recognized that I was gravely ill.
Unable to garner the strength to move my body my parents, both in their 50s, had to carry my 190-pound body to the car. In the Emergency Room I was given intravenous fluids, medicine and ice packs in an attempt to lower my core temperature from the 104.3 degree fever that was threatening to literally cook my brain. Alternately vomiting, convulsing and unable to move and passing in and out of consciousness, doctors took cultures and blood samples in an attempt to determine what was so rapidly consuming my body and threatening to end my not-yet-twenty-year-old life.
It turned out that a common bacterial infection—one that I had experienced before as a child—was the cause of my sudden illness. As my core temperature fell below 102 degrees and my senses returned, I was informed by the ER physician that I had a severe case of Strep Throat.
I left the hospital in my parent’s care at 3 o’clock on the morning of October 23, a prescription for amoxicillin and lots of fluids and rest in hand. My core temperature had dropped below 101 degrees and, though exhausted, I was wide awake and able to control my body once again.
Four months later, coming home from a late night of loading mail and baggage on airplanes in sub-freezing weather, I got additional surprise news from the hospital: My insurance provider, Blue Cross/Blue Shield, had covered only $623 of my $1,856 Emergency Room visit. I would be responsible for the remaining $1,233. Their reason: We hadn’t called my Primary Care Physician to approve the visit.
I was shocked! “Isn’t this exactly what insurance is for?!” I asked my parents. “We’ve been paying these people $120 a month for me for years, and they only cover $600?!”
I was too naïve, too uninformed to know the truth: I didn’t have health insurance. Instead I had “Health Maintenance.” Insurance, you see, covers the insured when faced with something catastrophic and unexpected. My Preferred Provider-style (PPO) health maintenance plan was not meant for such things; rather it was meant to help with the cost of regular medical expenses, such as family doctor visits, regular preventive screenings and normal checkups. My health plan was not meant to cover me if, for example, I got into a car accident, if I broke my leg or if doctors discovered a golf ball-sized tumor in my brain. In the state in which I lived, full coverage of that kind was available, but only as an add-on to my PPO plan.
It was later that I discovered why catastrophic coverage was not easily available: Each state has enacted mandates for coverage such that in most states “health insurance” is no longer actually insurance. Mandates that include coverage for colonoscopies, mammograms and doctor visit co-pays. Mandates for chemical dependency treatment (colloquially called “rehab”). Mandates that include vaccinations, regular screenings and myriad other health maintenance issues.
As more mandates are added, health insurance companies are forced to lower or drop coverage in other areas. One of those areas includes the original purpose of health insurance: catastrophic care.
Unaware of all of this, I paid my bill and, being a nominally healthy and active 20-something, I dropped my expensive and (to me) useless PPO. I began to search in vain for catastrophic-care-only health insurance, not able to understand and uninformed as to why I could not find it. During the next several years, I was counted as one of the forty million uninsured Americans.
Fast-forward a little over eight years. It is the summer of 2009, and the population has grown to over 305 million Americans, 47 million of whom are uninsured. I am no longer one of them. I went back to college, got my Bachelor’s Degree and then my Master of Business Administration. I work a full-time job for a company that provides excellent low-cost health maintenance (with moderately good catastrophic coverage). Each day, however, I am bombarded with reports of how the private sector is not doing its job in providing good health insurance.
“The private sector doesn’t provide ‘health insurance!’ I shout at my television and radio. “The government won’t allow them to provide insurance without maintenance!” I seethe as I listen to a new President explain how government-provided health care is the only way to save our nation’s moral soul.
“Government is the problem!” I shout. “If they’d stop interfering with the private sector, maybe it could provide the catastrophic-only care that some of us want, at a price we’re willing to pay!”
But I am only one voice among the millions. They are millions of voices who don’t understand the complexities of the private insurance business, of government mandates, of actuarial science and of insurance industry cost structures. All they understand is that “health insurance” costs are rising faster than people can afford to pay them, and they know is that they want the government (the same government that caused the prices to climb so precipitously) to help.
There are others, to be certain. Other voices, other people saying the same thing as I. There are, however, too many who are shouting us down or who are so concerned only with the symptom of higher health care costs that they ignore the disease of overbearing and sophomoric government interference. They either don’t listen or don’t want to hear that the easy way—letting the government handle it—isn’t the best way.
So our Nation inexorably marches toward single-payer, government-controlled nationalized health care; a solution that has failed in every nation in which it has ever been tried. Even as Canada and Britain ration care for the elderly and refuse care for patients they deem too unhealthy, these systems are held up as examples to follow. Even as the Veterans Administration Hospitals fail at delivering care for the soldiers who fight to keep this Nation free, government health care is extolled as a panacea.
Twenty years after the fall of the Soviet Union, their broken system of good hospitals for the politically favored and bad hospitals for the rest is completely ignored as beltway politicians tell us that health care will improve if only the government is placed in charge.
And it may be too late.