Tuesday, August 18, 2009

Wellness for All

Health issues have been, for reasons I've previously noted, a topic of concern in my household of late. I do not understand, however, why they've become so political elsewhere, when they should be primarily economic (in the home-keeping sense of the word), which is why I feel pressed to devote more space than usual to my own take on the situation.

The ephemeral notions of "life, liberty, and the pursuit of happiness" on which this nation was, in part, founded have set up expectations among some of the citizenry that government should be practically invisible (it shouldn't tax, it shouldn't tell you what to do, and it sure as hell shouldn't interfere in the market). "Liberty" has become a mask for fiscal and personal irresponsibility because it seems to mean (from what I can hear over the screams) freedom from government interference in anything (except in regard to sex and its consequences) and (especially) freedom to pack any kind of firearm I want, whenever and wherever I want.

There isn't much talk in these crowds about the freedom to hold civil discourse on important issues, or liberty as being built on a marriage of rights coupled with responsibilities.

I was taught by those fierce nuns at Dominican School in Taipei that caritas was a basic Christian virtue. I was also taught that citizenship required civility. I never read anything in the New Testament (and I read huge chunks of it in the original Greek) about its being acceptable to shout down any idea you don't particularly agree with. Caring about the health and well-being of ones fellow citizens is one of those virtues you'd think would be among the first on anybody's list of responsibilities.

I'm not going to get into the emerging evidence that many of the town hall meetings designed to discuss health care reform have been infused with corporate money and recruiting by the industries involved, or by their spokespeople. I'll leave that to Rachel Maddow, who seems to be on top of the situation. But I do want to talk about the "shape" of medical care in this country, and even make a plea for reason in the debate about public options and/or single-payer plans.

The bugaboo surrounding "socialized medicine" is tied to the old-school statist Communism of Lenin and Stalin. As you may have noticed, that model of socialism has all but disappeared, and is only still maintained in marginal (although potentially dangerous) areas of the world, like North Korea, where charismatic leaders have managed to jam their citizens' neural responses with some kind of political opiate.

Lots of perfectly reasonable countries in the world (well, reasonable to me) are governed by systems that combine elements of socialism with free-market economics, like England, France, Germany, Sweden, Denmark, etc. All of these countries have universal health care, lower health costs, lower infant mortality rates, and comparable or lower abortion rates, but somehow because America is different (read: better), we can let our free-market system decide who gets taken care of and who doesn't. The "invisible hand" that keeps the market from being too focused on its own well-being will take care of things for us. Everything will be fair and earn a profit, and we'll have the best health care system in the world. I can hear the moldy remains of Adam Smith rolling around in his coffin as I type.

Smith, as a few folks may remember, having read his Wealth of Nations and Theory of Moral Sentiments in economics class, said in the latter book that "By acting according to the dictates of our moral faculties, we necessarily pursue the most effective means for promoting the happiness of mankind" (Part III, Ch. V). I'm pretty sure he didn't mean "promoting the happiness of a select group of mankind."

The truth is, we do not have the best health care system in the world. We actually do a sorry job of birthing babies and seeing our loved ones die with dignity, according to their own wishes. We pay more and get less than any other major industrial nation. [For a variety of sources to support this contention, see the WHO World Health Report 2008--the chart is on p. 82--and posts on The Science Blog and The Moderate Voice]. Yes we do a lot of research, but that doesn't make up for the the fact that so many citizens of the country lack coverage at all.

To be sure, excellent care is available to all who can afford it. I'm a prime example of this fact. I have a pricey (very) insurance plan with a $500 deductible that covers 100% of about anything except elective cosmetic surgery and sex changes. My bill for treatment at the Baylor Heart Hospital, Resort, and Spa cost about $135,000, of which I ended up paying $166 (the amount left on my deductible for this year). The insurance company actually shelled out $35,000 (after paying only the negotiated prices for each segment of the three-page bill I received)--which makes one wonder how much all of this stuff actually costs.

But what about the poor sucker who's worked his tail off at minimum wage for years, eaten crappy food because he lacks the education and the pocketbook to shop at Whole Foods (Oops! There's another can of worms!), goes home after work and watches TV with a six-pack of Bud Light next to his La-Z-Boy? I apologize in advance for the stereotype, but it's been exploited in other quarters for opposite reasons.

When this guy feels chest pains, as he inevitably will, he's going to end up in the ER, where you and I are footing the bills through the aforementioned blue-chip plans, and through various taxes that support public hospitals. And the insurance companies are still going to make a profit, even though Joe Six-Pack may well die or become disabled.

Admittedly, I've cost my health care plan a considerable amount of money, and they're in the business of making money. But I've also paid them a truckload--and so has my company. The combined stated costs of my surgeries over the last fifteen years (a four-vessel bypass and a valve replacement) is about $170,000 (not counting any of the tests that led up to the actual chest-crackings). Notice, by the way, how the costs of comparably difficult surgeries has risen in the interval. The monthly cost involved, spread over fifteen years, is under $1000 per month, even at full rates, which the insurance company does not pay. If the actual paid amounts of this last hospitalization were spread out over seven years (half the time between operations; that should take care of the tests and drugs my plan has also paid for), the monthly cost to the insurance company would average in the neighborhood of $415--less than what my company and I pay in premiums.

If you factor in Beloved Spouse (who has a much less generous BCBS benefit), the per-family cost to Blue Cross/Blue Shield goes down significantly, because his total hospital time in the twenty years of our marriage is about three days, including one out-patient surgery. I don't even want to think about what my recent week of rest and relaxation would have cost us if I were covered under his plan.

When my mother was living out her final three years of life in Dallas, she was on Medicare and Medicaid (her total income was $300 per month from my father's Social Security), which paid a large percentage of her constant medical bills--but we paid the rest, and are still paying. Her hospital bills got "zeroed out" because she was essentially indigent, but we paid for the drugs that weren't covered. These were not cheap, and we were still living on adjunct pay because neither of us had yet secured a full-time teaching job. If we hadn't paid for even that much, she would have done without and died rather sooner. Mind you, the doctors at the Baylor Senior clinic did their best to fix her up, so I've got no complaint against those guys. But the system is deeply flawed, and the President is absolutely right to make fixing it a top priority.

Trouble is, the louder members of the populace are making it really difficult to get anything meaningful done, because all somebody has to do is scream "I don't want socialized medicine! This is a free country! Don't tell me what to do with my health care!" and the politicians scramble into their little warrens, and quake in fear of not getting re-elected if they do the sensible thing--which is to get to work reforming a system that leaves about fifty million people to cram the waiting areas at local emergency rooms.

Here's my deep dark secret, and the reason why I'm not moved by all the scary talk. I was taken care of by "socialized medicine" for the first eighteen years of my life. My father was career Air Force, and I was covered as his dependent. Get this, folks: under military health care (at least as I knew it), you don't get to choose your doctors, you wait for elective surgery, and you don't get to choose the expensive name-brand drugs. Just like those systems in Europe. But you do get high-quality care, and you get it when you need it.

In a few years I'm going to be eligible to participate in another socialized medical system, into which I've been paying for my entire working life. Most of the folks I know are happy with Medicare, and want to see it go on being funded. If they don't like the level of cushiness, they can pay extra to a private company and get additional benefits. And that's exactly the way any public option would work in the bills being proposed by Congress.

The difference is that Joe Six-Pack would finally have health insurance, because there would be something he could afford. And if he could go to a doctor on a regular basis, he might learn that eating Fritos and drinking beer and watching TV all the time might not be the way to prolong his life. And he would get help in changing his habits. And if he did end up on the critical list, he'd be able to have a doctor help him decide about living wills and such so that he could go out on his own terms. And no, the doctor would not decide for him.

I know I'm over-simplifying the situation--but not nearly as much as the screamers are, and most of them seem not to know what they're talking about. Whether or not they're being paid to hold up placards and bibles and such doesn't really matter. What matters is that they're getting in the way of serious, productive conversations about what's really going on, what's really in those bills, and what will happen to our kids and grandkids if we don't repair the system now.

Before I finally shut up for the moment, I offer Owlfarmer's Health Care Toolkit: A few random suggestions for improving the situation with little damage to our own pocket books.
  • Stop advertising drugs on TV. Period.
  • Stop advertising booze on TV. Period.
  • De-eroticize advertising; sex is not the only way to sell stuff.
  • Offer sensible, straightforward information about sex in middle school.
  • Insist that your children's school include physical education and health in their curriculum.
  • Prepare and eat healthful meals at home, with family or friends.
  • Get real exercise: run the dog, dig up the garden, mow the lawn with a push-reel.
  • Have children tested at birth for high cholesterol.
  • Know your family's health history, and act to mitigate congenital defects.
  • Have a yearly checkup.
  • Work hard, but not too hard (if you've got work, that is).
  • Play. Rest. Talk. Read.
  • Drink in moderation and stay sober.
  • Walk or bike to places you can reach easily without driving.
  • Stay out of the mall; shop at places where you have to walk around in the open air.
  • Help reduce chemical particulates in the air by driving less, avoiding chemical "air fresheners" and artificial "fragrances," reducing your use of petroleum-based products, etc.
  • Support local agriculture by buying seasonal produce at farmers' markets or grocers who sell local farm goods, or by joining a CSA.
  • Read labels; know what you're eating and how much processing is involved.
I could go on and on and on, but I think these are good ways to reform health care at a very basic level, and they're all stuff I've blabbed/blogged about before. If we want to change the way health care is provided and administered in this country, we also have to take on our share of responsibility for staying well. The first five of these require community effort, but in the end, change starts at home.

Image credits: Ayers Cathartic Pills label; Van Dyke, Charity, both from Wikimedia Commons.


jabblog said...

Excellent! I had been intending to blog about this issue but you have expressed the arguments articulately and succinctly. My son and his family are about to return to UK after two very enjoyable years in NYC. They have discovered that the slightest ailment in any of their three children has led to very thorough investigations - perhaps a good thing but the suspicion is that such panels are conducted for profit rather than necessity . . . but then what do the ordinary folks know? We haven't done six years' medical training ;-)

Owlfarmer said...

Wow! You got to this before I'd even gone through the edit. Glad it made sense anyway. As always, thanks for reading.

clairz said...

This is such a well-reasoned, calm discussion. Thank you. I believe that I will send a link to this post to all those alarmists who keep sending me offensive, screaming emails about the dangers of "Obamacare."

Unknown said...

Bravo and thank you. love the list.

Owlfarmer said...

Thanks for reading, Janice. For those of you who read my semi-frequent spoutings on health and well-being, I highly recommended Janice's blog, "Wellness For All."

Unknown said...

i'm honored to be counted among your blogs of reason and i look forward to reading more of your spoutings. best, janice

Anonymous said...

Very thoughtfull post on wellness. It should be very much helpfull

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