Wednesday, August 5, 2009

Op Ed

Work Buddy has been bugging me to post again. She's out on maternity and must be going a little nuts if she's so eager to hear from me again. I'm still in the "waiting to close on my house" holding pattern. Kind of feels like I've died and gone to limbo. What's annoying is knowing that I won't need to use any of my own money for the down payment, but I still have to leave it in the bank so the lender can see it. That's all right. By this time next week, we'll be pretty much debt free because the second we get the keys in our hand, we're going to be making gigantic credit card payments. Time to get THAT business over with. I was supposed to have lunch with my other friend, Pretty Smile, today. She got trapped in meetings all day and couldn't make it. Oh well, we'll try again for Friday, and at any rate, Madra Rua fries are worth pretty much anything, so I don't mind getting stood up. Pretty Smile is also looking at a lot in a new-construction neighborhood. I'm excited for her about that. I think hearing about our house experience and meeting our realtor made her want a place of her own. Hope it goes well.

None of that is related to the topic at hand.
Healthcare is all over the news right now. I'm trying to crystalize my beliefs on the subject, though I doubt I'll be asked to debate them anytime soon. First, I believe that the government should not have any say in how a person uses his money. He earned it; it's his. But since the government has authorized itself to appropriate a tidy chunk of earnings in taxes, I believe the government should tread very carefully when using those funds, because the people it took the money from are watching. Now to the healthcare issue. I don't think providing universal healthcare with taxpayer money is a legitimate purpose of the government. We have three branches: Congress makes laws, the Supreme Court interprets and applies the law, and the President declares war and makes treaties. I don't see healthcare in any of those functions. It could be argued that it falls under Congress making laws, but just because Congress can make a law, doesn't mean that it should. A law should not restrict whether a person may purchase a legal service such as health insurance with his own money, how much of it he may buy, and for what products and services it may be used. That's going too far. Granted, the President has repeatedly said that healthcare plan will not interfere with private insurance, but I don't understand how it won't. If there is a public health plan, there is no incentive for employers to offer insurance coverage; in fact, dropping it will save companies a lot of money. Let's face it, the most desirable employees in terms of experience are often overweight and middle-aged. Won't be long before they have heart trouble, knee replacements, and Type 2 Diabetes. None of those things are cheap. A public health plan will also drive private insurance companies out of business, except for a few with wealthy clients. The rest of us won't be able to afford supplemental insurance under the inevitable increased tax burden. How does the government think to pay for all of this, anyway? Higher taxes.

My next issue is who the public healthcare plan is supposed to benefit? The poor? They get Medicaid. The elderly? Medicare. The wealthy have no trouble affording the very best in healthcare. Most middle-class get insurance through their jobs if they choose to take it. What group does that leave out? Illegal immigrants? The homeless? Both of those groups are afforded care through emergency rooms and targeted non-profit centers. So it seems like every major group is pretty much covered. There are at least options if one chooses to take advantage of them. Or not. That's the freedom of choice. And I'm wondering where the public demand for universal healthcare came from? I watch, read, and listen to the news daily and I haven't heard anything about it since Hillarycare in the late 90s. From what I've heard going into the election, the public wanted more fiscal responsibility and a plan for ending the war. Nothing about healthcare.

All of that aside, given the political climate in the country, I think that some move toward socialism in this area is probably going to happen. If it does, I would like to recommend the Australian plan rather than the Canadian or UK plan. As I understand it, the Australian government offers a baseline of healthcare to all and then individuals buy supplemental insurance. There doesn't seem to be the long waits for care or the rationing that plagues the UK. If this is what Obama is advocating, I'm more okay with it than a plan like the UK's, though I'd prefer that it not get messed with at all. It's hard to pin down what's actually going on with all the political bombast on the subject.

What I would like to see no matter what happens is a reforming of attitudes toward pregnancy and childbirth. My insurance currently costs quadruple what Will's does, simply because I am of childbearing age. Pregnancy is not an illness, and should not have to wrack up such horrendous medical expenses. I just read an article on Slate's Double X womens' blog. The author told of receiving a hospital bill for $22,000, even though she had insurance. Turns out the loopholes in the policy enabled the company to only agree to cover $3,000 of the total. She fought the company and received a reimbursement, but stories like that highlight how out of hand this whole thing has gotten. In that sense, I think a re-assessment of insurance company operating procedures would be extremely useful even while universal healthcare is being debated.

The other main issue that I see is that seniors are afraid healthcare rationing will kill them off. And yes, I think this will happen, not by design, but in practice. I am going to have to feel my way very carefully here. I have a problem with the way that geriatric care is handled. Many old people's lives are endless rounds of surgeries, pills, catheters, etc. Does it need to be this way? Is it really worth it to perform a procedure on someone in their last illness that will perhaps prolong their life for a semi-conscious, heavily drugged week? I'm not even going to talk about the financial cost that much, but the other day I heard a woman call in to a talk radio show. She said her father had cancer, and they might have to lose their family farm in order to pay for his treatment, but they'd do it to keep him alive. The woman was middle aged, which would make her father elderly. There seems to be a denial that old age and illness are the primary means by which humans meet their Maker. Clearly, people without the Lord have everything to fear from death. But there seems to be something extra undignified about the way Americans scramble to stay alive, bankrupting their families, drawing out debilitating illnesses for years. Maybe it's the era, maybe it's Western culture. I can't quite put my finger on who started it, but there's no denying that there is widespread fear of aging and death. Human frames are temporary. 70-80 years or so, and it falls apart on its own. There's something painful, almost funny, about the way people are surprised when they're wrinkled, stiff, and unwell. The way they talk, you'd think it was a surprise. But age doesn't sneak up on anybody. We feel the clock ticking down. We move forward through time as our structure breaks down. The water tower rusts, the picket fence rots, and so do we. I have always thought that old age was the time to "put one's house in order," as the prophet Isaiah said to King Hezekiah. In that sense, I agree that geriatric medicine should focus on hospice and palliative care. Knowing that one cannot live forever should lead the sick to evaluate any treatment offered in that light.

And so from hour to hour we ripe and ripe,
And then from hour to hour we rot and rot;
And thereby hangs a tale.

As You Like It
William Shakespeare

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