Sicko of Non-discussion Of What Ails Health Care
By Chuck Hyde, Editor of StandBesideHer.com
Michael Moore has a new “documentary”, Sicko, about the status of the health care system in America. I am not going to comment on the validity of the film because I have not seen it. With Mr. Moore’s history of being rather loose with facts and his tendency to tell the half of the story that fits his vision of the film, I steer well clear of his fairy tales. One of the knocks I have heard about the movie though is that it presents an overly rosy view of health care coverage in other countries, while at the same time taking the worst of the American health care system to make his point. Give me a good episode of Sponge Bob, Square Pants and I am happy. I would like to talk about the discussion about health care that the film has spurred though.
As often happens with discussions about health care, the current ones I have been hearing are overly simplistic. If one were to pay attention to the talking heads on the TV and print media, one would think that all we need to do is have universal health coverage and everything will be fine. It in fact has become one of the requirements for the Democratic Presidential nomination race to promise to provide universal coverage. Nobody, including the presidential candidates, has come up with a way to pay for this coverage for the 40 million Americans who do not have health care. With this said, I do not want to give the impression that I am against universal coverage. I am in fact completely in favor of it. I believe it is a black mark on America when some of our citizens have to decide between food and medicine. My issue is that we have yet to have a thorough and honest debate about the realities of providing this care. I think the main reason for this is because the discussion leads to questions that are not easy, or sometimes, not comfortable to answer.
The ultimate question, of course, is how do we pay for it. Or, more accurately, how much are we willing to pay for it. Americans have decided that they do not want to pay a lot for health care. People will quickly pay $400 - $500 a month for a car payment but rend their clothing if they have to pay $200 a month for health insurance. This misguided attitude will have to change if we are to afford to provide coverage for the uninsured. At the same time, we will also have to either pay more in taxes or have less services from the federal government if we are going to provide universal coverage. The simplistic thought on universal coverage is that the federal government will just pay for it. The federal government does not pay for anything. It has no money. The money the federal government uses comes from us. If we want it to spend more, we have to give it more.
The other part of this equation is how current health care dollars are spent. Another source of funds to pay for universal coverage is better use of already available resources in health care. In other words, use the money we already spend more wisely thus spreading the dollars over more people. This is probably the most complicated part of the funding equation because there are many reasons why our health care dollars are not used as efficiently as they could be.
First is everybody’s favorite target, drug companies. This is too big of a discussion for here but the reality is that a large part of our health care dollars are spent on medications and it is increasing faster than the rate of inflation. While it is true that drug companies need a lot of money to develop new drugs and they do need to make a profit, it is also true that a lot of the money we pay for medications is spent on advertising and giveaways. This money goes to advertising so that every time we turn on the TV we are reminded that there are drugs that make a man “ready for when the time is right”, it goes to ink pens, note pads, and cruises to Mexico (oops, I’m sorry, “seminars”), and it goes to drug reps who bring breakfast and lunch to health care personnel to push their wares. As a Registered Nurse, I find it interesting that health care workers need bagels and flavored cream cheese to be able to read through a brochure about drug X. Finally, we have to pay for the reps themselves. The male models and blondes in the long legs and short skirts don’t work cheap.
The second most favorite target (first among health care providers) is trial lawyers. A significant amount of our health care dollars go to pay for malpractice suits. There are two big expenditures for this, malpractice insurance and defensive medicine. Health care providers pay burdensome premiums for malpractice insurance. Before the reader thinks this doesn’t concern them, realize that the higher the premiums are, the more the provider has to charge to stay in practice and make money, which in turn means that you, the patient, pays more. The second part of this, defensive medicine, is a little more subtle but very real. Defensive medicine is when a provider does not think a test or procedure may be entirely necessary but performs it anyways to avoid having to explain latter in court why they didn’t do it. There is not widespread agreement on how much this happens and the truth is that it is often hard to truly determine which procedure or test would not have been done if it were not for the fear of liability. I believe though as a health care provider that this happens far more than we think and the extra expense of unnecessary practices are costly to the system. While I believe that this system is broken and badly needs to be fixed, I do not believe that we can be without malpractice litigation. If a patient is harmed or killed by a negligent health care practitioner we need both a way to penalize the provider and compensate the patient or family for damages. The reality though is we need a more common sense approach to what is negligence and more fully examine what role the patient themselves has played in their misfortune.
This brings me to my final point about the need for further discussion about health care expenditures, personal responsibility for healthy lifestyle. As humans, we have a very bad habit of living unhealthy lives. People smoke, drink alcohol in excess, use illicit drugs, do not exercise, and overeat. One of the harsh realities of health care today is that a disproportionate share of the available funds are spent on only a portion of the recipients and the portion is growing steadily. We as a society are going to have to decide to spend more on health promotion which in turn should provide more funds for universal health care due to spending less on self inflicted maladies caused by poor lifestyle choices. The second, and far less appealing, part of this discussion may be health care rationing. As an example, do we pay for a lung transplant for a patient who refuses to quit smoking or do we refuse to pay for joint replacements for people who have worn their knees or hips out earlier due to obesity until they loose weight? These are not questions that I have an answer to but as our health care dollars are squeezed more and more, we may have to start talking about it.
So as I said earlier, we have yet to really have a good national debate about the health care system in America. Until we do, as the old saying goes, “you get what you pay for”. In other words, we get the health care system we have by default rather than by design. That’s what’s on my mind.
About The Author: Chuck Hyde is editor of StandBesideHer.com. He is also a husband and father of two teenage boys and a younger daughter. His family lives in the northern Midwestern rural United States, where they enjoy camping, fishing, and other outdoor activities together. Chuck is a Registered Nurse in an inner city emergency room and has had a lifelong addiction to politics.
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