I'll Pay More For A Pizza

The fundamental premise of this essay is this, and if you don’t agree, then none of the words that come after these will make sense to you or sway you to my position: Health is a right, not a privilege.

So if you’re with me there, then perhaps you’ll find something useful in the next several paragraphs. My position, founded on the statement above, is honed in 20 years health care experience that includes working as provider in a country that operates a “socialized medicine” model.

First, a perfect model hasn’t been discovered yet and I’m truly not sure what it is. Commercially based health care (like we have in the states) has the potential to run amok with costs and the benefit of those moneys is skewed away from the sick or the prevention of sickness. An access based model (like those in most European countries) has to run on very tight purse-strings and as such can lag in technology and research as well as immediacy of service delivery for non-urgent needs.

But in addition to my core premise, that health is a right, there are a few corollaries. The first is that health care is not free. The second is that I believe that as a sentient being on this earth I am obligated to certain social contracts, one of which is ensuring that others have the same human rights I do, and one of those is health. And if you add those together, then that means that I accept that as an able-bodied person who believes that health should be made available for all, and that the delivery of things that promote and maintain health have a cost, then I accept my responsibility to chip in.

I am mystified by those who say, “Why should my hard work pay for someone else’s health care?” Well, there are a handful of answers. The first is that already one insured employee typically supports several non-employees. The stay-at-home mom (or dad, or spouse who works part time) is entitled to health insurance just because she is lucky enough to be married to someone whose job gets a health plan. This coverage extends to children. Group plans already exist to give access to a greater population than those who actually work for the employers that buy the policy - spouses and children get to "buy" into a plan that is cheaper and more comprehensive than any plan that could be purchased privately simply by virtue of being family (unless you're gay and domestic partnership isn't recognized by your state, employer or plan provider - then, goshdarnit, out of luck again). The second is that one needs to accept that health care facilitates population health, both medical and financial, and that having healthy people around you, as well as people who have coverage when ill, benefits you in every aspect  of your life.

Do you want children who go to school with your children to have access to vaccinations and well-care? How about the people who touch the same shopping carts as you do or go to the same gym? Would you like the person who is coughing, sneezing and spewing to be able to go the doctor and get treated for their strep throat before they handle  the same pretty dishes that you do at Target?

Would you want your sister or your niece to lose their life savings so they could afford treatments for breast cancer? Would you want your neighbor across the street to lose his home to foreclosure because he went bankrupt when he had a heart attack? A heart attack isn’t contagious, but property values are. 

Do you want people spending their money on your business, your goods and your services or do you want them pouring their dollars into private medical policies with inflated price tags? Or maybe they’re on their own to pay cash, since they’re not so lucky to have a plan? A reminder that what your insurance pays for a service is a fraction of what a private-pay patient pays for the same procedure. Insurance companies broker rates that an average consumer doesn’t have access to. The person paying for their own labs and tests is charged far more than the person with the health care plan, which means less dollars eating at a local restaurant or buying the next-door-neighbor kid’s band candy.

If you’re a parent and your child is diagnosed with a chronic illness, will you sleep better at night knowing that your son or daughter won’t be gouged by insurance companies for the sake of getting health coverage complicated by a pre-existing condition? Or outright denied? Do you want them trapped in nightmare jobs for fear of losing a group plan, or worse…living without coverage at all and knowing that one bad illness or one nasty hospital administrator who sends your uninsured child out the doors could lead to catastrophe because a life-saving treatment was financially out of reach?

I will sleep better at night knowing that no one can deny any of my children health care, knowing that all employment opportunities are open to them – not just ones with employer sponsored health plans – and that no hospital will send them away for want of an insurance card.

So, given that there are no circumstances where I will ever believe “I got mine, so you’re on your own,” because I fundamentally don’t believe that I am ever safe if you are not, how do we pay for these things?

Health care ain’t free. I know this to be true because I am a health care provider and I do, in fact, need a paycheck for what I do. Equipment costs money. Labs cost money. Medications and research cost money. This is not in dispute. So how do we pay?

In the UK, health care is a payroll tax. Everyone who works – and I mean every Tom, Dick and Harry Potter, pays 6% of their income into the national health plan (there are also local and national contributions). And then, every Tom, Dick and Harry Potter (as well as an American speech therapist and her family who just decide to hang out for a few years to work) gets coverage. Period. End of story. Cradle to grave and every table-for-two in between.  Most other European and Nordic states operate a similar model.

In the US, insurance is driven principally by employment, poverty or age. If you work, chances are you have access to a health plan (but not always). If you’re poor, you have Medicaid (which has some serious hard limits). If you’re a senior, you have Medicare. However, if you’re unemployed but not impoverished (say, because, you actually saved some of those hard earned dollars), or you work for a smaller business, or you work part-time, you are in deep trouble. Hence the need for reforms that require employers to expand their provision of health care and the need to expand the capture of low-income plans. Additionally, making it illegal for health insurers to deny coverage for pre-existing conditions means that you (or your husband, wife, nephew, son or daughter) can decide to launch their own business and still buy a private policy even if they were diagnosed with juvenile diabetes. Or a sprained ankle.

I am tired of businesses threatening me with alarmist statements. “If I have to pay for health care for my employees, I’ll fire people, cut hours, raise prices and slaughter unicorns!” If your business is growing, you will hire people and open new branches. Period. That’s how business works. If you are profitable and you don’t want to use those profits in part to grow your workforce, well, then you’re kind of a douche and I’m ok with the government forcing you to be less of one. If you’re truly NOT profitable and you choose to pay the fines rather than provide health care, then that’s a reasonable business choice and perhaps you could instead pay for one day’s worth of a consultant to come and help your employees figure out what non-employer-sponsored health care plans are available to them. Because, since the Affordable Care Act, there are some,  and those fines are in part what helps pay for them.

Or if we hate this all so so so very much, then perhaps we could finally break the shackle of the insurance industry and go fully to a single payer health plan model. But, like breaking our ties with the oil industry, it will be very hard and the industry will try very hard to convince us that it’s a bad idea – bad for us, bad for the economy, bad for our children.  We would need to be strong and plug our ears and sing “LA LA LA! I CAN’T HEAR YOU!” until they finally got tired and went away. And we’d have to accept that the words “socialized medicine” do not mean the same thing as “communism” and that a government funded health care plan does not logically conclude with long lines for shoddy toilet  paper.

And here’s where I walk the walk, people. Here’s where the rubber meets the road. I care for older adults, which means that my livelihood is paid for, in great part, by Medicare funded programs. The two presidents who have impacted the greatest change on those programs are Bill Clinton and Barack Obama. And by “impacted the greatest change,” I mean enacted legislation that fundamentally changed the revenue streams of the programs, which means changes to my earning potential, my professional trajectory and the way I deliver care.

And yet I voted for both of those presidents, twice.

Because I understand cost-control. And I’m ok with growth limitations when those moneys are diverted to expand the Medicaid program. Expanding the Medicaid program is what might keep my own children from being without health care when they’re grown and I can’t cover them anymore.  I can’t say I love things that create wage freezes or delivery constraints, but if it means that Medicare doesn’t go bankrupt and I get to do what I love – which is taking care of older people who are sick – for a long time, then, seriously, I am ok with the changes.  If the ACA means that my friends, neighbors and family, don’t have to be terrified of being without health care, then, seriously, I am ok with the changes.  It means I will pay more for things, because I can see the linear relationship between me paying more for a pizza and how it may allow members of my community to be able to pay for a pizza at all.

I could write a thousand or two more words on the various flaws of the system we have. Everything from high-deductable health plans to why it’s ridiculous for a town of 200,000 people to have six MRI machines to what’s wrong with plans like Kaiser to what’s right with plans like Kaiser. I’ve been in health care a long, long time and have seen every side of the coin there is. But that’s not my point today. My point is that while I believe in a society where anyone has the right to outearn me, I believe that all that entitles them to are things that I can’t afford. It doesn’t entitle them to be freer than me – or anyone else -  from disease or illness.

Because health is a right, not a privilege. 

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