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  D e s e r t   E x p o s u r e   October 2009

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What Ails Us

Got employer-sponsored health insurance or Medicare? Then you don't understand the US health-care crisis.


A few years before we moved to the Southwest, I had a scare. I woke up with a hammering headache and double vision. The diagnosis that immediately sprang to my pounding brain was of course: brain tumor.

I went through an equally scary bout of tests and scans, including a hospital stay, before a happily anticlimactic phone call from my doctor one night about dinner time: It turned out I'd suffered a small leak of cerebrospinal fluid. The headache and double vision, which by this time had already started to improve, would go away without any treatment. Whew. No harm, no foul.

Until, that is, we moved to New Mexico and tried to get health insurance. One of the two biggest insurance companies accepted by most local health-care providers — it doesn't help to have insurance if your doctor won't accept it — flatly declined to cover me. The reason? That years-ago scare, with its admittedly expensive testing albeit simple and cost-free outcome.

I'm healthier than most guys my age, I think. Never smoked, BMI under 25, low blood pressure. And the only time I've been hospitalized since childhood (tonsils), it was for that testing to diagnose a problem that required no treatment. Yet the health-insurance giant didn't want me.

Imagine if I did have a brain tumor.

We got luckier with the state's other big insurer — if you can call it "lucky" that, as small-business owners, we got the privilege of paying half again as much for less-comprehensive insurance than when we'd been employees. The amount we pay for health insurance has doubled in the six years since.

So you'll understand if I have little patience with people who think the current US health-insurance system is just hunky-dory and doesn't need reform. If you have employer-sponsored health insurance or qualify for veterans' care or Medicare, sorry, you're living in a bubble and have no idea what the current health-care debate is really all about. Maybe if you join the 10% of American workers who are now unemployed, you'll understand why the current system is broken.



That's what happened to Nikki White, whose story is chronicled in a new book by T.R. Reid, The Healing of America. At age 21, White was diagnosed with systemic lupus erythematosus, a chronic inflammatory disease that eventually left her too ill too work. When she lost her job, she lost her employer-provided health insurance. Because of her "pre-existing condition," White couldn't get any other coverage.

As Reid explains, in any other industrialized nation, White could have gotten care and lived a long time. Even if she'd been a convicted felon in a US prison, she would have received treatment. With proper care, 80% of US lupus patients live a normal lifespan.

But, without health insurance, White didn't get medical care until she collapsed at her home in Tennessee and was taken to an emergency room — which was required to treat her even if she couldn't pay. The hospital performed 25 emergency surgeries and she spent six months in critical care at a cost of hundreds of thousands of dollars. She received the best of modern medicine, her stepfather said, "but that's not when she needed the care."

Not incidentally, the Tennessee hospital that treated Nikki White would, of course, pass along the cost of her care to its paying, insured customers through higher rates. The charges racked up by the uninsured at last-resort emergency rooms donĀ¹t simply vanish; they cost every US family about $1,100.

In any case, White's costly treatment came too late to save her. She died in 2006 at the age of 32, becoming one of the 18,000 Americans who die each year because they lack health insurance. Her doctor told author T.R. Reid, "Nikki didn't die from lupus. Nikki died from complications of the failing American health-care system."



Now, we can have an honest and civil debate over the best prescription to fix that health-care system — something sadly lacking in this summer's raucous frenzy over "socialism" and "death panels." (The thoroughly sensible idea to cover end-of-life counseling, by the way, was introduced by a Republican senator from Georgia.) It's certainly smart to be cautious about any plan that could further balloon the federal deficit. And we can disagree over a "public option" versus "co-ops" versus a "public-option trigger," or over the specific merits of the legislation Sen. Jeff Bingaman and the rest of the "gang of six" labored on all summer and into the fall.

But it'd be hard to convince me — or Nikki White's family — that doing nothing is an acceptable option. While Congress dithered over the summer, according to a new Census Bureau report, the number of people living in the US without health insurance hit a new high of 46.3 million. Next year's figure, given the rise in unemployment, will be far worse.

Unfortunately, support for reform has been weakest among those who already enjoy what opponents once derided as "socialized medicine" — senior citizens on Medicare. According to a new Washington Post/ABC News poll, 56% of seniors fear reform will weaken Medicare, and — despite support from the AARP — older American are more likely to oppose reform than any other age group. This irony was epitomized in the outburst of one senior at an unruly town hall: "Tell the government to keep its hands off my Medicare!"

Some 87.4 million Americans, according to that same census report, are already enrolled in some form of government health program such as Medicare. An attitude of, in effect, "I've got mine — you're on your own," can only lead to generational and class conflict.

Medicare, in fact, for all its flaws, might represent a good starting point for rethinking the US health-insurance system. Americans love to poke fun at the French, but for all its snootiness France has gotten more right on health care than we have, primarily by extending a Medicare-like system to all, regardless of age. As Roger Cohen recently described it in the New York Times, "The French health system uses a mixture of public and private funding, guaranteeing basic coverage through national insurance funds to which employees and employers make contributions. Most French people supplement these benefits by buying private insurance. The distinctions from the single-payer British system are significant, the results better."

The results are better than the mostly private US system, too: France spends 11% of its gross domestic product (GDP) on health care and insures everyone, while the US spends 16.5% of GDP and leaves 20% of adults under 65 uninsured. The average life expectancy in France is 80.9 years, compared to 78.1 in the US; the infant mortality rate for live births is 3.36 for every 1,000 French babies, 6.3 in the US.

Cohen concludes, "The numbers don't lie: The US system is wasteful and unjust."

The various "Obamacare" proposals probably most closely resemble the system in Switzerland, where life expectancy is 80.7 years and the infant-mortality rate 4.23. According to a report by the Commonwealth Fund, Switzerland effectively covers 99% of its population while spending only 11% of GDP on health care ($4,300 per capita in 2006 compared to $6,700 in the US). Most tellingly, administrative costs total only 5% of Swiss health-care expenditures, while eating up more than 7% in the US.

In Switzerland or France, nobody has to wait for care until it's too late, and the emergency room is the only option. Over there, I could have made the leap into entrepreneurship without worrying that a years-ago medical oddity might make me uninsurable, at any price.

But you know the old saying, "If it ain't broke, don't fix it." Don't trying telling me the US health-insurance system isn't broken. And Nikki White is no longer around to hear it.

 

 

 

David A. Fryxell is editor of Desert Exposure.





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