Monday, November 9, 2009

I support a Public Option for Health Care.

Get mad and get ready to respond if you must, but I am in favor of a public option. I have some very personal reasons why I support this, and I felt the need to share them.

Unfortunately, I do not have the energy to research 100% what all I would need to share in order to help you understand this. Back in the day, working in television - I am sure I would have spent hours reading document after document (trying to make sense of it all.) Working for the American Heart Association and seeing our official stance definitely helps makes things a little more clear.

Aside from all of the political mumbo jumbo - here is why I, Nicole Abdou, supports a public option. (Notice I said OPTION.)

I want to tell you a story that is going on right now. I debated whether to use this person's name or not - so to ere on the side of caution - I decide to call her Jane.

Jane is 25. She is a very close friend. Rarely sick, works hard - heck, usually works more than one job, pays her taxes, votes, and takes care of her finances alone. Jane works for a small magazine in advertising. She has this full time job, and works as a nanny on the side. Jane's company has less than 20 people, so insurance is not an option thru her work. Jane tried to get insurance through several different companies (individual plans) but was denied due to being a few pounds over the actual weight limit. (This is common now, with so many companies laying off, and people searching for insurance - the criteria for individual insurance has gotten very strict.) Let's say you weigh 20 pounds more than you should. Heck, most people do. That would disqualify you from insurance without some form of an open enrollment.

Jane has been having some stomach issues for the past two or three months. Lots of acid reflux, so she changed her diet and began taking a little purple pill or even other OTC items. Did not help. Suddenly Jane begins to get very ill after she eats - no matter what she eats.

Jane decides she must go to the doctor. But going without insurance is too risky. She found another company (maybe not as good as some of her first choices) and she finally gets approved for insurance. Her insurance does not kick in until the first week in December.

This past week, Jane has been violently vomiting after every meal. Foam, blood, bile are all that is left. Finally, after laying on her bathroom floor for hours, she begs her room mate to drive her to the ER. There, she finds that she must pay $200 up front and then they would proceed.
After hours of tests, a mass of stones were found in her gall bladder. More tests are needed before she can have it removed, and these tests are not available until Monday. Because Jane does not have insurance, she is discharged from the hospital and sent home with some meds to sleep it off until Monday.

Jane goes to the GI doctor on Monday only to discover that she will have to return on Wednesday. She has yet to eat, is still violently vomiting, and has a slight fever. Over and over in the doctor's office they tell her how expensive this will be.

Jane doesn't have a choice. She can't eat, she is very ill, and her gall bladder could burst. She is not getting the proper testing and her needs are not being met in a timely manner - why? No insurance.

Circle back to me. Yes me. I have insurance, damn good insurance. When I first moved to Birmingham (in 2005) I got really sick. Literally - 4 days after moving here. I ended up with meningitis. I was admitted to the hospital on a Saturday. I moved here the Sunday before. Because my insurance was still out of Georgia - it was considered out of network. After numerous tests and drugs to keep me alive, I ended up with a $35,000 hospital bill - all but a little over $6,000 was covered by my insurance.

The hospital gave me 30 days to make a payment. I was always told - pay something, and they will leave you alone. When I first moved here, I did not have a job. I moved with my husband - who is now an ex-husband- and I was depending on him to support me financially. No payment was made to the hospital. I was turned over to collections. A company would not take less than $400 a month. At this point, I found a job - but was not making what I needed to cover my basic bills. I tried to negotiate with the collections company, but nothing worked. I even sent a $50 check, and they took it, but said it was not enough.

About 3 months later I was sued. Just recently, it finally made it to court. Luckily, I make a significant amount more than I did when I first moved here. I am working back in my field. But this bill remained. The court ordered me to make payments to the company. I offered $150 a month, it was denied. I was sent into garnishment of $800 a month from my paycheck. Yes - $800 a month. These past three months were hard for us. Yasser cannot work due to immigration laws (yet), and I am doing everything I can. We are still holding our head above water, but it has not been easy.

Too many times average, tax-paying, hard working (and even insured) citizens are getting jerked around. My friend Jane and I are not the picture of what many people think their tax dollars would be paying for. More so for my friend - we need an option. For me, we need to make the insurance companies become a little more competitive and offer better coverage. We need lower costs for health care.

Here are the facts (as I see it):

1.The number of uninsured citizens has grown to over 45 million (although this number includes illegal immigrants, etc.).
Since health care premiums continue to grow at several times the rate of inflation, many businesses are simply choosing to not offer a health plan, or if they do, to pass on more of the cost to employees. Employees facing higher costs themselves are often choosing to go without health coverage.

No health insurance doesn't necessarily mean no health care since there are many clinics and services that are free to indigent individuals. However, any costs not covered by insurance must be absorbed by all the rest of us, which means even higher premiums. In all fairness, the 45 million uninsured number has been called into question since in includes illegal immigrants, people making over $75K who choose not to buy coverage, and others who have options for coverage but choose not to get it. The true number of people without options is closer to 15 million.

2. Health care has become increasingly unaffordable for businesses and individuals.

Businesses and individuals that choose to keep their health plans still must pay a much higher amount. Remember, businesses only have a certain amount of money they can spend on labor. If they must spend more on health insurance premiums, they will have less money to spend on raises, new hires, investment, and so on.

Individuals who must pay more for premiums have less money to spend on rent, food, and consumer goods; in other words, less money is pumped back into the economy. Thus, health care prevents the country from making a robust economic recovery. A simpler government-controlled system that reduces costs would go a long way in helping that recovery.

3. We can eliminate wasteful inefficiencies such as duplicate paper work, claim approval, insurance submission, etc.

Think back to all the times in your life you've had to fill out a medical history, answering the same questions over and over. Think about all the insurance paperwork you've had to fill out and submit.

Our current health care system generates an enormous amount of overhead. Every time we go to the doctor, a claim must be submitted, an approval department has to go over the claim, checks have to be mailed, patients are sent co-pay bills, and so on.

The thing that's especially wasteful is that each doctor's office usually maintains their own record-keeping system. A universal health care plan would allow us to build one centralized system. There would be no need for maintaining insurance information or wasting time submitting claims. The work savings in the banking and postal areas alone would be worth billions every year.

4. We can develop a centralized national database which makes diagnosis and treatment easier for doctors.

Most doctor's offices maintain a separate record-keeping system. This is why you always have to fill out a lengthy health history whenever you go to a new physician. This is a problem for several reasons.

First of all, it's wasteful of both time and money. Second of all, patients may lie, forget, or do a poor job of explaining past medical problems. Doctors need accurate information to make a proper diagnosis.

Last of all, separate systems means we have a tougher time analyzing data at a national level.

For example, are incidents of a certain disease dropping? How often is a certain illness associated with a specific set of symptoms? A centralized national system would allow us to do data analysis that we never dreamed possible, leading to medical advances and increased diagnosis efficiency. The main argument against a centralized database is that certain insurance providers may deny coverage if they find certain past medical problems. However, if the government is paying for everything, that should never be a problem.

5. Medical professionals can concentrate on healing the patient rather than on insurance procedures, malpractice liability, etc.

Doctors have to take classes now simply to understand all the insurance plans out there; they are often restricted by insurance practices, such as what tests can be ordered. Doctors must practice defensive medicine to avoid getting sued. Some physicians are even leaving the profession rather than deal with all these non-medical headaches.

A simplified universal health system would allow doctors, nurses, and other medical professions to simply focus on doing what's best for the patient. Medicine is a complex enough subject as it is. Our current system just adds to an already mentally-draining profession.

6. Free medical services would encourage patients to practice preventive medicine and inquire about problems early when treatment will be light; currently, patients often avoid physicals and other preventive measures because of the costs.

Because many people are uninsured and those that do have insurance face high deductibles, Americans often forego doctor visits for minor health problems or for preventive medicine.

Thus, health problems that could be caught at an early stage or prevented altogether become major illnesses. Things like routine physicals, mammograms, and HIV tests could prevent major problems. This not only affects the health of the patient but the overall cost of the system, since preventive medicine costs only a small fraction of a full blown disease. A government-provided system would remove the disincentive patients have for visiting a medical professional.

7. Patients with pre-existing conditions can still get health coverage.

One of the biggest weaknesses of our current health care systems is that patients with a past or current medical condition such as cancer or asthma often cannot obtain affordable health coverage. Some insurance companies won't even give a policy to such individuals, or if they do, they will cover everything BUT their past diagnosed conditions.

Anyone with an expensive illness or disease must then often face one of two choices: use up all their own money, or leave the condition untreated.

In a universal system, no one with a pre-existing condition would be denied coverage. People could change jobs without fearing the loss of health insurance.

Now I do see problems that could arise... please note there are many "kinks to work out.
Here is what I see as an issue:

1. There isn't a single government agency or division that runs efficiently; do we really want an organization that developed the U.S. Tax Code handling something as complex as health care?

Quick, try to think of one government office that runs efficiently. Fannie Mae and Freddie Mac? The Department of Transportation? Social Security Administration? Department of Education?

There isn't a single government office that squeezes efficiency out of every dollar the way the private sector can.

We've all heard stories of government waste such as million-dollar cow flatulence studies or the Pentagon's 14 billion dollar Bradley design project that resulted in a transport vehicle which when struck by a mortar produced a gas that killed every man inside.

How about the U.S. income tax system? When originally implemented, it collected 1 percent from the highest income citizens. Look at it today. A few years back to government published a "Tax Simplification Guide", and the guide itself was over 1,000 pages long!

This is what happens when politicians mess with something that should be simple.

Think about the Department of Motor Vehicles. This isn't rocket science--they have to keep track of licenses and basic database information for state residents. However, the costs to support the department are enormous, and when was the last time you went to the DMV and didn't have to stand in line? If it can't handle things this simple, how can we expect the government to handle all the complex nuances of the medical system? If any private business failed year after year to achieve its objectives and satisfy its customers, it would go out of business or be passed up by competitors.

2. "Free" health care isn't really free since we must pay for it with taxes; expenses for health care would have to be paid for with higher taxes or spending cuts in other areas such as defense, education, etc.

There's an entitlement mentality in this country that believes the government should give us a number of benefits such as "free" health care. But the government must pay for this somehow.

3. Government-controlled health care would lead to a decrease in patient flexibility.

At first glance, it would appear universal health care would increase flexibility. After all, if government paid for everything under one plan, you could in theory go to any doctor.

However, some controls are going to have to be put in to keep costs from exploding.

For example, would "elective" surgeries such as breast implants, wart removal, hair restoration, and lasik eye surgery be covered? Then you may say, that's easy, make patients pay for elective surgery. Although some procedures are obviously not needed, who decides what is elective and what is required? What about a breast reduction for back problems? What about a hysterectomy for fibroid problems? What about a nose job to fix a septum problem caused in an accident? Whenever you have government control of something, you have one item added to the equation that will most definitely screw things up--politics. Suddenly, every medical procedure and situation is going to come down to a political battle. The compromises that result will put in controls that limit patient options. The universal system in Canada forces patients to wait over 6 months for a routine pap smear. Canada residents will often go to the U.S. or offer additional money to get their health care needs taken care of.

4. Malpractice lawsuit costs, which are already sky-high, could further explode since universal care may expose the government to legal liability, and the possibility to sue someone with deep pockets usually invites more lawsuits.

When you're dealing with any business, for example a privately-funded hospital, if an employee negligently causes an injury, the employer is ultimately liable in a lawsuit.

If government funds all health care, that would mean the U.S. government, an organization with enormous amounts of cash at its disposal, would be ultimately responsible for the mistakes of health care workers. Whether or not a doctor has made a mistake, he or she is always a target for frivolous lawsuits by money-hungry lawyers & clients that smell deep pockets.

Even if the health care quality is the same as in a government-funded system, the level of lawsuits is likely to increase simply because attorneys know the government has the money to make settlements and massive payouts. Try to imagine potential punitive damages alone. When the government has the ability to spend several trillion dollars per year, how much will a jury be willing to give a wronged individual who is feeble, disfigured, or dying?

5. Patients may be subjected to extremely long waits for treatment. Stories constantly come out of universal health care programs in Britain and Canada about patients forced to wait months or years for treatments that we can currently receive immediately in America. With limited financial and human resources, the government will have to make tough choices about who can treatment first, and who must wait. Patients will like be forced to suffer longer or possibly die waiting for treatment

Of course we could WHAT IF everything until the cows come home. The point is - we need options. I am in favor of a public option. I do not want to put the private insurance companies out of business, but I want there to be an option for those who need it, like my friend Jane.

It is easy to point the fingers and say certain groups of people are expecting "hand outs" - when honestly - unless you have ever been sick, and had life events like the ones I shared above, you cannot understand what it is like to need something. Yes I believe we all deserve the best health care out there. Yes. I do believe it is a right. We are a nation with the best of the best. I also believe in the golden rule - "Do unto others as you would would have then do unto you."

Again - it is just my opinion. But at least I have reasons why I support it. And no, I am not blind to the issues. But I believe the benefits out weigh the negatives. :-)

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