Wednesday, June 20, 2012

What Health Insurance Means to Me

During this election, I imagine very little will be said about healthcare, the only exception being Romney's undoubted promise to overturn "Obamacare," whatever that actually may be. Hovering behind him may be Paul Ryan, like the swordsman who beheaded Anne Boleyn, distracting our attention with homilies about hard work and shared sacrifice before he swings the arc of his sword behind us, neatly severing our intelligence from our primordial gut responses to the appeal of American individualism. He'll mop up our blood with Medicare vouchers and toss them to the crowd.

Yes, I've recently finished Hilary Mantel's Bring Up the Bodies.

The Supreme Court will proclaim whatever it is it will proclaim in all its fusty splendor with its tottering protocols behind that magnificent white marble facade. And the whole spectacle of the election will move on to the economy. Stupid. Right. Because health insurance has nothing to do with the economy: it exists in its own magical garden guarded, like a medieval virgin, by unicorns and fairies insisting that a market economy intuitively knows how to protect our freedoms to see doctors of our choosing.

What I love about this country is the way we personify the economy and the stock market as though either had agency or intent. A better comparison might be the clustering and manic reproduction of bacteria or viruses.

Another part of the current American confabulation of fiction and history that I admire for its sheer willful disingenuousness is the adulation of Ayn Rand's major novels published in 1943 and 1957, The Fountainhead and Atlas Shrugged, respectively, because, really nothing about our country or the world economy has changed much for over 50 years. It's one thing to suggest that these are good reads, quite another to conclude that Rand's fictive reaction to the economic complexities of the World Wars has significant bearing upon today's problems. Insert here something about history being doomed to repeat itself. Or something about how if Don Draper doesn't change, how do we know America changes?

But I'm not here today to argue economics with Randians. Really, I'm not going to pretend that I can.

I will point out what the President is loathe to point out, however, which is that the reason we don't use Medicare vouchers for seniors and persons with disabilities is because we kind of already had the experience of those groups being uninsurable, which is why Medicare was developed--to ensure and insure the people left behind around the time Rand was drafting her books.

At Children's Hospital this morning, I had the curious experience of having to tell Robert's doctor of physical medicine that, no, despite the fact that I was insured, I could not proceed with additional botox or phenol injections until Robert's Medicaid waiver comes through sometime in the fall, we hope.

My health insurance is very, very good. It "covers" those procedures at 85 percent of its contract rate with Children's for the drug itself, the physician fee, the operating room cost (including nursing, equipment, recovery room), the anesthesiologist's fee, the cost of the anesthesia, and, well, I think that might actually be it. But when all is said and done, my share of the costs will be about $1,200 or more. Over the last several years, we've spent much of our money set aside for procedures for Robert and I'm not in a position to pay that, especially if a Medicaid waiver (which will cover the cost of my coinsurance) is around the corner.

But what will waiting a few months mean? One of Robert's adductor muscles is twisting his left leg inward continuously, putting strain on his hip musculature and bone structure and slowly damaging his skeletal system. Botox or phenol will freeze that muscle and alleviate strain on his hip.

Last week, I read an article, probably in the New York Times, that explained that the conundrum I was experiencing with my insurance plan was, in fact, not entirely out of the ordinary. Because, you see, that's the market at work: the market knows that if it just disincentives me from using my expensive healthcare plan--like my kindly Uncle Mitt patting me on the shoulder and asking me how much Robert's comfort and life are really worth, really now--and if I don't listen, it just twists my arm tighter and tighter behind my back, eventually I will realize that I need botox injections for myself just to be able to use my arm again so that I can help my son, kind of like when the flight attendants tell parents to put the oxygen mask on themselves first before putting one on their child--if it just disincentives me from using my plan I will eventually be forced to give in and keep paying for a plan I can't fully access. Really, I should be grateful to have insurance at all, even if I can't afford to use it.

In a film version of the American healthcare system, I'm not sure whom we should cast as the Market: if it's a comedy, probably Danny DeVito; if a drama, probably Christopher Walken. Jeremy Irons should really play the Insurance Industry because he's doing such a great job playing the Pope in all his petty, mercurial, and vicious splendor in Showtime's The Borgias.

I will not lie, though. Having a great insurance plan has certainly made me feel entitled to benefits. And that's another American conundrum: entitlement. Very fashionable these days for politicians to deride entitlements for those who pretend to have needs, whereas it's perfectly fine for people who have few needs to be entitled to whatever frippery they fancy. I'd love to know what the difference is between entitlements and rights. No, not the actual legal or policy definition. The popular definition. The what-we-really-mean-when-we-use-that-term definition.

Apparently, healthcare is not a right, but an undeserved entitlement? We don't have a right to get better or be whole, but we do have a right to be sick and stay sick. Which is why we don't want "Obamacare" because that strips away our right to stay sick.

It would be really nice if the President would step in and explain what healthcare means to him, but I'm not sure he knows. He wanted to hand this off to Congress, where it would slowly die (because if we have the right to be sick, we have the right to die--but not if we cause our own death, only if we stubbornly refuse to accept treatment for the sickness that will surely kill us), but a lot of people who elected him surprised him by insisting that, well, we really wanted some fairness and equity with healthcare and insurance. So he found himself engaged with a subject that he had no significant interest in or dedication toward. Hillary's the healthcare ninja. Or she was before they gave her State.

I know what healthcare means to me: the peace of mind of knowing that my children (if not myself or my parents) will be cared for if they become ill. That I can take advantage of all the technology and services and medical advances that my tax dollars already support--because you and I pay something for medical research, federal and state grants to universities, research groups, pharmaceutical companies, for loans and grants to provide some sop of subsidy to the education of doctors and nurses, for the tax-free status of the universities that educate them. Yet, for some reason, the allocation of resources for healthcare has to take place through venal middlemen.

It's easy to start pointing fingers of blame here: Paul Ryan, Romney, Obama, Congress, the insurance industry, doctors, whoever it is (and it must be someone--seniors, the disabled, my relative who has MRIs ordered when his big toe hurts) who's "driving up the costs" of procedures and drugs and whatnot. The thing is, the healthcare system isn't just doctors and patients and the insurance industry. It's the people who manufacture medical devices and drugs, the people who research and invent them, the colleges and universities who train these people, the salesmen who know the product inventory well enough to tell you you need a certain type of wheelchair or walker. It's a whole lotta jobs and a whole lotta money and capital. We live in a capitalist society, increasingly less buffered by anything resembling a social contract with its citizens, and all of these people are among our friends and neighbors, all of whom have learned to make a living by figuring out their piece of the pie. That's the American way. Or so I've been told.

I've lived in Washington DC for over 20 years. Trust me on this. My moment of awakening to the glories of our capitalist enterprise came the day I was seated at the reception desk of the Senate Agriculture Committee and a lobbyist for the Fertilizer Institute walked in and handed me his card. If there's a job for the lobbyists for actual shit in this country, there's a job for you and one for me.

Look, medical research and higher standards of care are the moon race of this century. Whenever I sit down with doctors or durable medical equipment vendors or pharmacists, I'm stunned by the sheer ingenuity of this country. Forgive me, I was raised a Christian, but for those who hunger and thirst for adaptations and answers to their medical problems, let alone righteousness, there's some kind soul out there who's spent his or her working years thinking about your problems and how to solve them.

So why are we so focused on restricting care the way Internet providers are working out plans to throttle use of bandwidth? Why are we screeching about the right to see your own doctor, when he's probably due to retire anyway? Why do we assume you couldn't see the right doctor for your needs if one person is president rather than another? Why do we assume that what Jesus would do would be to hand us a voucher rather than heal us? Why do we cheer when Ron Paul suggests that people should just go home and die if medical care is beyond their financial reach?

The moon race, in the end, became more than the taxpayers could bear. But that was largely because we concluded that there was no pressing need to learn to build housing in non-oxygen environment. Or to evacuate the Earth just yet. Newt Gingrich still can't get elected running on that platform.

But there are reasons to cure cancer or ameliorate the integration of people with autism into the society of typically developing people, or to alleviate pain or to help those who could not walk or ambulate to get up off their beds with the help of adaptive equipment and go to the store and buy a quart of milk. The treatment and study of disease and disability is how we learn about these things and what you do when you participate in the healthcare system is contribute to that--to interventions and treatments that may one day save the life of a person you love.

We need politicians who realize that critical investment must be made in our health infrastructure, that healthcare is part of our larger, job-creating economy, that we must, in fact, be proud of what our scientists and researchers are able to accomplish in this area, and that we need to figure out how to provide all of our citizens with access to all of these miraculous tools. If we start from the perspective of cost, assuming that our collective resources are puny (and they're not), we'll never get anywhere. If we point fingers of blame, we'll just self-destruct (sorry, Rep. Ryan, maybe you're not a literal executioner). We have to start from the perspective of investment, humanitarian investment and what this investment will yield for our country, its citizens, and even the world.

Have we become a country that looks to the future or a nation of Hobbits, content to spend our lives by our own home fires? What happened to us?


Lisa said...

Thank you, as always - but especially for this. What continues to amaze me is that opponents of functional decent healthcare for all are blind to the fact that nearly every one of us is one - at most two - bits of bad luck away from being functionally "uninsurable." (OK, members of Congress excepted.) We are all so vulnerable under the current system. I wake up at night wondering what will happen if bad luck #2 hits us, because #1 destroyed our financial reserves, even with insurance. And I put off the doctor appointments and tests and treatments that can be put off, and I worry some more. And my situation is so much easier than yours.

william Peace said...

This is great. Really wonderful. I quoted your first paragraph on my blog Bad Cripple and provided a link. You may want to read my entry on the health care debate or lack of debate in reality.

Liz said...

I recommended your post to BlogHer... it's really excellent! Now I want to read your archives....