Wednesday, September 23, 2009

Health Care--Again

In my native country of France, a nation not known for its humility and often unaccepting of reality, the cost of maintaining the average citizen's health is completely covered from birth to death. When my mother died there 17 years ago following a lengthy bout with cancer, the family never saw the bills. They were automatically sent to the state insurance monopoly and paid off. This health system, costly as it may be, is so deeply ingrained in the French psyche that no politician would dare touch it. Soon there will be changes, however, as medical costs rise, but the essence of the coverage--which is very much like Medicaid without the age restrictions--will endure. In most of Europe, the right to the pursuit of happiness includes, as it should, the right to a healthy life without worry of the costs such a life implies.

In the U.S., my adopted country, I pay $770 a month to what is reputedly the best HMO in the East coast. This entitles me to make appointments with a number of specialists, for which I will bear a copay of $30 to $50 per visit. Should I be prescribed meds, I will pay for those as well. My health care runs to roughly $10,000 a year if I am healthy, which, by and large, I am. My most significant procedures with this HMO were two colonoscopies within five years. According to the American Cancer Society, these would cost me an average of $3081 apiece were I not insured.

My HMO is great. It's blocks away from where I live, and my main physician is a delightful woman who truly seems to care for her patients, answers emailed questions, and takes the time to explain what I have and what can be done. Truthfully, I have never had a bad experience there.

But still. Ten thousand dollars is a hell of a lot of money.

Here's the other side. I have a very good friend, a woman I've known for years. She is a single mother whose children live with their father to whom she makes monthly child-care payments. She has no car, uses public transport to get to two low-paying jobs. She cannot afford insurance. Since neither company that employs her will hire her full-time (they don't want to bear the insurance costs either), she has had to rely on the county welfare system for medical care.

Mind you, we're talking about Fairfax County, Virginia, one of the wealthiest areas in the nation. It took her two months to get an appointment for a physical, and that appointment is slated for mid-November. Should anything be seriously wrong with her, she has few choices: a hospital emergency room which may or may not treat her, a doc-in-a-box storefront that may prescribe meds but is more likely to tell her to go to a hospital, or a county clinic where she will stand in line starting at 6 a.m. and, with luck, be seen by a doctor sometimes in the late afternoon. Or be sent home and told to come again the next day.

There's something distinctly wrong with this scenario here in the land of the free.

Here's my concern. The entire health care debate is nonsensical. As it presently stands, there are far too many players with vested interests to allow any resolution. The drug and insurance companies, the AMA, the hospitals, doctors, Congress, and a host of other parties are more than enough to block any efforts to insure the common citizen. What is likely to happen in the next few months is a lowest common denominator consensus that will not serve the people. If anything can be done, it will have to start with a willingness to scrap a system that does not work, and painfully build a new one. This is not the American way. We are the land of instant results and quick gratification; we are more likely to accept a flawed outcome than have the patience to forge something fair, workable, equitable.

Lets not do that. For once, let us hold our elected officials and representatives responsible for acting for the common good. Lets force them to behave in a manner that will show we care more for the people than we do for the corporations. Lets try to understand that it is not the wealth of a nation that makes it great. It is its health.

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