Many of us without health insurance make a beeline for the local emergency room wearing only the Emperor’s new clothes, when we are stricken with a sudden malady. Uncovered and left with no choice, we prefer a feel better now, worry about the consequences later approach. There was a time when the greater good, personal integrity, and social consciousness held sway. Not anymore! In our strictly individualistic culture, in which “me first” attitudes predominate, we seek gratification in the here and now, and damn our posterity. With a health care system in shambles and millions of uninsured manning the minimum wage breadlines, we can no longer count on Washington to tackle this extremely difficult and complex issue. While hard times require innovative thinking, conflicts of interest abound to preempt unified, concerted progress toward universal health insurance for all.
Even the middle class has not been spared. The prevalence of uninsured, college-educated, full-time working Americans is growing. Small firms and the self-employed simply cannot afford to pay rising health care premiums. There is also a mentality issue here, as the healthy perceive costly and unnecessary insurance coverage as an unwanted drain on their already thinning financial resources. The unhealthy, on the other hand, are either unable to obtain any coverage at all, or only limited insurance at unheard of prices. Perhaps a look at universal health insurance systems in Europe and Israel is warranted at this point, the alternative being finger insertion in a proverbial dike. Bah, you say. Things are not that bad. Then explain the fact that we as a nation spend twice as much per capita on health care as our European counterparts, only to receive mediocre returns, for example, in the areas of infant mortality and life expectancy.
The general consensus is that something is broken. Fixing it is another story. Medicare, a crown jewel at its inception, is barely chugging along on four cylinders. At one time, it addressed the needs of our aging population, and provided services the private sector turned a blind eye to. Funding for the program at current levels is no longer sustainable, however, and, while there is no doubt that Medicare has improved the condition of our nation’s elderly, political infighting, legislators’ lust for power, envy of the elderly by the young, and the financial numbers themselves have eroded support for a program destined to meet the end of the dinosaur. We must now ask two important questions. First, is continued government investment in health care morally justified? Second, is consumer-driven health care a better alternative?
Turning our sights for a moment away from the elderly and back to the U.S. population as a whole, we note that just 10% of the insured population accounts for 70% of all health care expenditures. Shunned by insurers who fear shrinking profit margins, and condemned to making hard, unholy choices between high cost premiums and food, these hapless victims watch health, savings, and credit scores decline in a technologically advanced society that long ago outlawed debtors’ prisons as cruel and inhumane.
It doesn’t end there. The U.S. is culturally challenged, culturally mixed, and a frying pan (not a melting pot) for the politically oppressed and for individuals of diverse ethnic and religious backgrounds. In order to meet their health needs, we must first understand what makes them tick, i.e., the health determinants of particular people in particular places at particular times. Then apply what we have learned to the nonhomogeneous American panorama, being mindful of the fact that race, class, and gender also influence perceptions of health and our health care institutions and economy. We are slowly coming to the realization that epidemiology and social science must firmly and warmly embrace the new kids on the block, ethnography and social history, if our health care system is to shift from rattle to hum.
Finally, we would be remiss if we did not offer two small, yet concrete solutions to the health care crisis. A system of government “reinsurance,” to reimburse insurers from the public coffers, might insulate them from the financial weight of particularly expensive cases. That, and cost-effective “health condition management units,” interdisciplinary care teams providing a full range of health care services to patients with conditions such as diabetes, hypertension, or cancer, might attenuate, if not eliminate, the mortal embarrassment of getting caught with our pants down.
We are born in birthday suits. Yet there is no need to leave this world prematurely, for lack of proper health care attire. The Emperor must not win!
© 2007, Albert M. Balesh, M.D. All rights reserved.
