My brother sent me a message asking this:
"By the way, what do you think of the idea of being forced to go to the DMV to see a doctor and then being subject to rationing, unless you're a wealthy politician like Teddy Kennedy?"
and then followed it with this video.
He followed by adding "I'm against it. And I think that it is framed falsely. They are talking about insurance as if it were health. They are brushing over medical care, which is far better in the US than anywhere else... for now. And they're talking about equality of access as if it were equality of results."
The following is my response:
________________________________________________________________
I'm on a Washington state plan called Basic Health, which I managed to get onto when I lost my job, before they closed the rolls to any new applicants last year. It is very low cost and so far has provided decent care at the same provider I had before, Group Health, a not-for-profit co-op. This year, due to budget shortfalls (Washington has no income tax, so revenue is highly subject to changes in property values and consumer spending patterns), they are cutting the Basic Health rolls by 40%. I will find out next month whether or not I still have health insurance. At roughly the same time, the home I have been renting for 12 years is being sold and I will be out on the street, just as my job here at school ends.
This year as a consequence of losing dental coverage and going for two years without routine checkups I have run up over a thousand dollars in unplanned dental costs which could have been easily avoided if I had kept my coverage (this in spite of the fact that much of this care was provided at a local dental hygiene vocational school at drastically reduced cost.) These are the kinds of decisions poor people make routinely about their health care, and in the long run the costs incurred by not seeking preventive care far outweigh the costs of such care. Poor people are also far more likely to rely on Emergency Room care for pressing medical needs because ERs are forbidden by law from turning people away. ER care is by far the most expensive means of providing medical treatment, and the fact that it has become the de facto treatment option for so many drives up the cost and wait times for everybody else.
My housemate, a former EMT, assures me that he spent much of his time on the job transporting the same population of street people, a population with many chronic health problems, to the ER on a nightly basis. The reason an ambulance ride costs you $800 is because none of these people ever pay. Your insurance rates also reflect these unseen costs. It would be far cheaper to simply provide preventive care to these people than to do it the way we do now, but we continue because the mindset against giving these people a "free ride" by providing humane, affordable medical care is so strong that we end up giving them a much more costly free ride by refusing to pay the relatively inexpensive up-front costs in favor of a crisis management model. We are cutting off our nose to spite our face -- even absent a humanitarian argument for providing care for these populations there is a compelling fiscal argument. This is to say nothing of the public health argument -- untreated populations are far more likely to transmit disease, and as Poe noted in the Masque of the Red Death, disease does not respect economic boundaries. When tuberculosis or some other preventable disease makes a comeback, it will almost certainly begin in these marginalized populations. By having a large segment of the population uninsured, we are helping to create the petri dish that may well incubate the next pandemic.
I need a public health care option and I'm not alone. What's more, these scare stories about government-run health care are coming straight from the for-profit health providers and insurance companies that have so grossly mismanaged our healthcare system to date. I've been to Canada and seen what public-run healthcare looks like, and it is nothing like as bad as the insurance people would have you believe. The long wait lines and rationing are largely mythical; It may not be a perfect system, but it's miles better than ours.
The industry's self-serving complaints against inefficient bureaucracies conveniently ignore the fact that they themselves are highly bureaucratic entities, with the rather important distinction being that since they are for-profit, they have a built-in incentive to provide the least amount of coverage for the greatest amount of cost -- charging what the market will bear is the fundamental rule of any capitalist enterprise whether one is selling t-shirts or liver transplants. The cost to the consumer created by the (presumed) inefficiences of a government-run system can't possibly compare to the cost of supporting the kind of profit margins and executive salaries to which these institutions have become accustomed. That's why they have so much money to throw at lobbying, ad campaigns and astroturf campaigns like this one designed to scare Americans out of joining the rest of the civilized world in having publicly available health care for all.
The sick irony of it is that a full coverage system is much cheaper, because the uninsured population disproportionately consists of the very young -- twenty-somethings in relatively good health. If these people were paying into the system during the years when they were less likely to incur costs, it would bring the costs of coverage down for everybody. I went through most of my twenties without health care and by the time I got it I was entering my thirties and beginning to need it. I should have been paying in for those ten years to counterbalance my later expenditures.
I know that I have sparred with you on politics before and I generally enjoy it, but I'm quite serious this time: The health care system you advocate leaves your brother uninsured. My health problems at present are real but manageable with preventive care, but absent such care who knows? If I have an accident who knows? One day I hope to get back on my feet, but I know from my work with the homeless that health costs are the number one reason people become homeless in the first place and without help many never do get back on their feet.
I could go on and on about this subject, but I trust you get my point. I urge you to re-examine your assumptions on this matter.
---Your brother,
---fb.
Belgian Circus Folk. Seriously.
"Talmudic Shillelagh."
On a sort-of related note, go see Keefee. Shit's funny.