On the Health Care debacle

Aug 18, 2009 by Daniel Ross-Jones

Contrary to some people’s opinion, last time I checked I was still a card-carrying member of the Democratic Party.  (Well, OK, they don’t generally issue membership cards anymore.  But you get the sentiment.)  And, speaking as a Democrat, I want to say this:

We need health care reform immediately.  That is a given.  There is absolutely no reason why we should be in the position of having the most advanced health care network in the world yet have it be the least accessible.  The arguments of rationing health care, of a particular brand of natural selection, the fear that the government will tell Grandma she can’t have a life-saving surgery, they’re all blowing smoke up our collective bums.  The private sector already does that! Since deregulation in the 1970′s and 1980′s, we have been systematically and socially conditioned to fear the government and trust private interest.  Nowhere is this more despicable than in health care.  We are trusting our very lives to people whose sole interest is making such obscene amounts of money it is nothing less than criminal.

Last December, I went in for my annual physical.  I’m insured by Blue Cross Blue Shield of Illinois, part of the largest network of health insurance in the U.S.  While according to my policy preventative care is covered, BCBSIL informed me that particular visit was not.  They didn’t specify why, and when I even called they didn’t provide any rationale.  They simply told me the visit was not covered and now I needed to pay.

In January, I went in to the doctor again, this time because of a massive sinus infection coupled with strep throat.  (I don’t normally get sick, so when I am immobilized in pain, I know its time to go in.  Besides the fact that strep scares the living crap out of me.)  My insurance this time covered half the cost, though it was processed as being out-of-network.  Again, according to my policy, I was at an in-network facility, but BCBSIL justified it by saying that since I went to the urgent care operation — which, unbeknown to me, is outsourced to a different provider, even though it is in the same office — it was out-of-network and I was responsible for paying the higher coinsurance.

Question number one: What difference does it make who tells you no, rejects your claim, or creates the network?  Here are my examples, on the largest health care network in America, of experiencing just that.  Both of these instances were in large hospital systems.  Both of these instances were with the same insurance provider, the same individual.  So what difference does it make that BCBSIL told me no, but if a government administration tells me no, then somehow it is more obnoxious?

Here’s the second given: I don’t very much care how reform is accomplished.  There are some who are outraged over the past couple of days because the Obama Administration has been signaling it is ready to consider other alternatives to single-payer coverage (Medicaid).  Before I delve further into this, let me state for the record that yes, I do believe a universal health care system is the most long-term, sustainable, cost-effective, efficient solution.  I believe that it is an embarrassment that we don’t have this already.  It is yet another indication of how far behind the rest of the First World we are, even as we attempt to prop ourselves up as a global beacon.  But that all aside, the answer isn’t in who pays the bills, the answer is in how the system is governed and regulated.

And we return back to the late 1970′s, early 1980′s once again.  The mantra of the decade was Deregulate, Deregulate, Deregulate.  If we just deregulate everything, competition will flourish and the market will take care of everything.  Government oversight is unnecessary, an obstacle to trade, and generally harmful for business.  The individual is king, and will speak with her or his pocketbook.  If individuals want better health care, they can pay for it.  If individuals want better schools, they can pay for it.  If individuals want better products, they can pay for it.  Deregulation was good for jobs (more competition means more business means a greater workforce), deregulation was good for government (shifting the burden off government meant a trimmed budget and payroll, which meant fewer taxes and more liquidity in the economy), deregulation was good for individuals (more choice, more options).

Yeah, except that’s not exactly how it worked out.  You see, history has an awesome way of repeating itself.  Remember how the 1920′s lead to a Great Depression?  The stock market crashed because no one was paying attention.  No one thought they needed to pay attention — it wasn’t government’s role to oversee.  (And we had myriad more regulations then than 2007.)

Deregulation is not entirely bad.  I, for one, love Southwest Airlines and my cheap airfare.  Without deregulation, Southwest would still be prohibited to establish a hub in Illinois as they have done.  I do think we have too many airlines in general and the market is saturated, but that’s a discussion for a different time.  But when you fire the overseers, when you allow the market to dictate policy, you greatly expand the gap between the have-nothings and have-everythings.  And that is where we’re at with health care.

Private insurance carriers have no reason to cover everyone.  Why should they?  Its a drain on their resources.  Instead of making a $14 billion profit, they might be forced to make “only” a $10 billion profit — or worse yet, an $800 million profit.  That’s going to seriously cut into margins.  </sarcasm>  So, to protect their assets and financial position, private insurance says, “No, we won’t cover you because you have acne.”  Or if they are going to cover you, they’ll charge a severely increased premium so that it remains effectively out of reach.

If health care reform only accomplishes expanding the accessibility of health care, allowing more people to be covered with private insurance, bringing some controls and regulations back to the system that requires it to function in an ethical, responsible manner, I will die a happy person.  I will congratulate the Administration on a job well done.  More control and oversight is the Chevrolet solution instead of the Cadillac solution of single-payer.

I do not fear the government.  I may distrust it from time to time, I may disagree with Administrations that come and go, I may even exercise my Constitutional right to lodge my protest in a civil manner with my representatives whom I have elected, but I do not fear it.

I do fear people who make my life decisions without my interests in mind, but only the interest that my hard-earned money makes them.

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