PrintJanuary 19, 2007
Health Insurance and "Adequate" Care
Health insurance is the key to adequate medical care. The standard of care supplied to those without insurance and lacking substantial means is perhaps "adequate" by some lights, but you wouldn't settle for it.
I appreciate Steven M. Warshawsky's thoughts on the respective articles by Dr. Linda Halderman and me published by The American Thinker on Governor Schwarzenegger's proposed plan for universal health coverage in California, but I have to disagree entirely with his skepticism that there is anything wrong at all with the present health care system. Mr. Warshawsky seems to make the case that the problems with our health care system bemoaned by both supporters and critics of universal health coverage simply don't exist:
The "problem" is not the lack of health insurance. The problem, if there is one, is a lack of adequate medical care. And there is no evidence that there is a significant problem in this country with a lack of adequate medical care. The vast majority of people living in this country obtain more than adequate medical care. Very few people in this country are suffering, let alone dying, because they are not getting adequate medical care. I challenge anyone to prove the contrary.
Mr. Warshawsky's utilitarian analysis of the situation doesn't make the very real problems within our health care system magically disappear as he seems to believe. Let me offer a real-world, first-hand testimony to the problem.
I am among the 40 million uninsured Americans and have been so for the past five years. Despite the fact that as a healthy adult I had paid directly or indirectly for health insurance for 15 years without ever using it once (thus, I was in effect paying for the health care of other consumers), when I had a health care emergency in March 2004 I found myself not only uninsured, but unemployed. An MRSA infection had developed in my leg that was rapidly spreading up my leg and pushing my temperature as high as a near-fatal 107 degrees. The doctors at the hospital estimated that if the powerful antibiotics they were giving me did not stop the spread of the infection, they would have to amputate my leg within 36 hours. Fortunately the antibiotics worked, but not before the infection had taken off most of the skin on the back of my leg and I had spent almost an entire week in the hospital.
Now Mr. Warshawsky is entirely correct that I had access to medical care. The simple fact of the matter was that someone was going to have to pay for the care I had received - either myself, the health care providers, other health care consumers, or the state. If there is any fallacy in the present health care debate, it is that health care comes for free or that it magically gets taken care of somehow.
I encountered another cold, hard reality during my health care emergency: my inability to pay determined the quality of care I received. I readily admit that the doctors, nurses, etc. who cared for me saved my life. They beat the infection back and stopped my life-threatening fever. Since I was uninsured, however, when my life was no longer immediately in danger, the hospital pushed me out the door notwithstanding my loud protests that this infection was by no means gone. I was given an antibiotic prescription and wished the best of luck. Again, Mr. Warshawsky is correct that when I went to the pharmacy, I had access to the drugs I needed to keep the infection at bay. But they cost $1600 for a 10-day supply - a tough nut even for most working Americans to come up with at a moment's notice. And then there was the gaping hole in the back of my leg that required special-order dressings at $250/week as well as other sundry items that ran the bill up even further. On top of that were the initially everyday wound care visits that cost $150 for each session. In the weeks that followed, those visits were scaled back to three and then two visits per week. None of this came for free, of course. How did I "pay" for it? Credit cards.
Let me make clear that I would have received none of this - prescriptions, wound dressings, wound care - would have been available to me if I didn't have plastic in-hand.
Despite all these treatments, within a month the MRSA infection raged back with a vengeance and I was back in the hospital. While the hospital had previously given me the care I needed to survive and the care that they were legally obligated to provide, I was not given the care I needed due only to the fact that I was uninsured. Once again, as soon as my life was no longer in danger, I was pushed out the door. There was no malpractice involved, but the hospital and the doctors had to make decisions based on financial statements rather than my hospital chart. This cycle continued for more than six months of in-and-out of the hospital with the same MRSA infection. It was only when a prominent doctor in the community, an elder in my church, took up my cause with his medical colleagues and went to bat for me with the hospital that I finally received the care I needed to wipe out the infection permanently.
Again, there was no malpractice involved and the standard of care I received was within what was required by law. Had I sued for malpractice, in the unlikely event that I had won that money would have to come from somewhere. There was no way that anyone could have anticipated that the MRSA I had contracted was as aggressive as it was, and the outpatient care (prescriptions, etc) were all by-the-book. There really is no question that if I had been insured I would not have been pushed out of the hospital as soon my life was out of immediate danger. A few more days in the hospital on IV antibiotics the first time I was there would have done the trick. But the hospital cannot be blamed, because they have to take into consideration the care they provide to everyone, not just me. In the end, someone has to pay. This is the health care reality that Mr. Warshawsky seems to ignore.
Like virtually all uninsured Americans that have faced a catastrophic care situation, the bills that mounted were not only staggering, but financially overwhelming. In six months, the cost of care came close to $50k. I was eventually forced to declare bankruptcy. In the end, someone else had to pay for the care I received: the health care providers, other health care consumers, taxpayers, etc. In many states, the number one cause of bankruptcy is due to medical bills. The vast majority of Americans live financially on the ragged edge and it takes very little to push many families over the edge. This is why I said in my article that I think that the uninsured crisis in America is a tragedy. For millions of others trapped in this same situation I faced, most have even less options than I did.
My real-world experience does not comport with Mr. Warshawsky's fairy-tale world where everyone gets the health care they need regardless of their ability to pay. Even today, I make my health care choices based not on what is available in the market, but what I can afford. I can testify that I have avoided treatment for minor things I should have sought care for based solely on the fact that I didn't have the money to pay for it. Furthermore, the uninsured in America are double-penalized: because we are not part of insurance plans/managed care we must pay full price for our health care, effectively subsidizing the care of the insured. As for obtaining health insurance, I couldn't get it if I wanted to. Because of my one health care emergency, which unlike other chronic conditions (diabetes, etc) I am no more likely to see repeated than any other person on the street, I cannot obtain health care insurance.
Finally, let me take issue with one other point made by Mr. Warshawsky. He asserts that to see the problem in our health care system as a primarily an issue of "who will pay" necessarily demands universal coverage:
Once the problem is defined in this manner, the solution becomes obvious: Government-mandated health insurance for all persons. The debate then moves to the details of such a plan, with some persons favoring a more "command-type" system and other persons favoring a more "free market" system. But all such plans are inherently socialistic.
This is a non sequitur. There are many options for dealing with the present crisis than resorting to universal coverage/socialistic medicine and I am the last one to argue for more government intervention in our health care system and health insurance market. I contend that government interventionism is the root cause of most if not all of the distortion in our health care market (isn't it ironic that the same people who weep and moan at our government's intervention abroad, e.g. Iraq, are usually the ones to demand it at home?). But if we want to be assured of the socialistic system that Mr. Warshawsky decries, pretending that there isn't a major problem with our health care system and ignoring the very real plight of the uninsured, the course he apparently recommends, is a certain prescription to see it come about.
