Truth and Cynicism

[talon]

http://www.reuters.com/article/idUSTRE6630AF20100704

In short, there is more to health than healthcare.

Heya, someone else besides me is saying this. OK, probably a lot of other people are also saying it, but this is the first time I've seen it reported in the media.

Those who've kind of sort of kept up with my blog know I am not a supporter of universal health care as it's been proposed and enacted. I am not against providing quality, affordable healthcare to people, subsidized or not. I am intractably against putting health insurance companies in charge of health care and I have spent a long time talking about personal responsibility, preventive health care, wellness incentives, and transparency in medical billing procedures. Health (as opposed to the smaller subset of healthcare) is a large area and to focus just on one aspect to the detriment of all other aspects is, oh, vitally shortsighted and inherently counterproductive if the goal is to save lives and improve health.

John Appleby is, I think, my healthcare hero, even if he's not American. He's talking sense, and he's being both realistic about it and incredibly cynical. I want to give him a pat on the back and a cuppa and tell him he's not alone.

Here are two of my favorite quotes from him:

So yes, there will be at the margins a small proportion who will suffer catastrophically -- in other words they'll die." - John Appleby

"We're talking statistical lives, in a way, which I suppose makes it easier to bear," he said. "And of course somebody else will be in power then." - John Appleby, chief economist at the King's Fund health think-tank in London

Those people who make and vote for budget cuts, changes, restrictions, and "shock tactic" budget adjustments (or perhaps it's called "austerity measures" now) don't see the actual cost of their proposals. Many of the policy makers have never been poor, never been handicapped, disadvantaged, or elderly and dependent upon the various welfare systems we've created to help them. All they see is more money flowing into their pockets, not the blood that allows that money to flow to them. To them, statistically 5% is a very small number. That's 1 in 20 people. Count it out - for every 20 people you know, the 5% who will die from these changes equals one person. I may not be a typical person (and my facebook account by no means reflects the actual number of people I know - a great many of my friends and acquaintances aren't on facebook), but I know - well enough to know their significant others, parents, pets, children, favorite foods, allergies, and hobbies - about 3,000 people. That means there will be 150 people who will "suffer catastrophically - in other words, they'll die" among that number. Since a great many of my friends are among the working poor, it's much more likely that it will actually be my friends who "suffer catastrophically", and that number may actually be higher because they are already disadvantaged to begin with.

I suppose, if my friends were among the wealthier half of this country, I might not lose any actual friends to these changes, but that doesn't mean the proportion overall changes.

Let me say here that 5% isn't an actual number, just one I used because I don't speak Mathish and used something simple. I thought of using 10% but decided that number was probably unrealistically high. I could be wrong.

What it means, though, if most of your friends and acquaintances and co-workers are in the upper half economically, they may have to tighten their belts some, but they'll live - and because of that, you wouldn't see any true suffering. There would be no face, and so the suffering and the deaths wouldn't be real.

Too many of our policymakers come from the upper half of our economic spectrum. To them, that 5% is a budgetary number, not real people.

It doesn't help that so many people are willing to dehumanize the poor as "lazy", "shiftless", and "undeserving" people because then not only do they lack faces, they deserve to starve to death, to lose their homes and die of exposure, to die from complications of easy to treat illnesses and injuries.

One of the reasons I rail against the healthcare system is because it has become unaffordable - we pay hundreds of dollars a month for health insurance premiums on policies we can't actually use because we have no money to pay the high co-pays, or if we can afford the co-pays, we can't afford to fill the prescriptions because the insurance company doesn't provide drug coverage or has inadequate drug coverage. I know so many people with health insurance who suffer with simple conditions because they can't scrape up the co-pay and drug costs - and it doesn't help when formerly OTC medications are now prescription only and getting to a doctor to get that former OTC medicine prescribed is unaffordable. I'm fortunate to be an herbal apothecary - I can create nearly any medicine I need, but that doesn't mean I can afford to create any medicine I might need - some of the ingredients are prohibitively expensive.

There are some changes I think need to happen - not all change is bad! One of the most important ones is pricing for various medical procedures. Patients need to know what their bills will be. I think a lot of people would be pleasantly surprised at how cheap some essential health care services really are. If people knew what it would cost to treat something, they'd be more likely to save up and get it taken care of sooner rather than catastrophically later.

In fact, the more I think about it, the more important it becomes to make the prices of all medical care open and transparent. People could comparison shop like I did last week when I bought a new lawn mower. I looked at different models, their specs, their prices and after sales care, looked at the brands, and made my choice. If I thought I might have cancer, and I knew I could look up what the tests would costs to rule that cancer out or confirm it, and I could compare those costs between several providers, along with "specs" and included services and treatment and after care, I'd be able to plan my budget and probably afford the health care I'd need.

Instead, we don't know what our health care will cost and are devastated financially when the bills finally do come in - some of them as much as a year after the care was provided!

So, yes, medical reform is needed, and healthcare needs to be changed, but to hand it over to for profit companies that already have a track record of disregarding patient needs and disrupting the patient/doctor relationship?

That is so wrong.

I am convinced that none of our policy makers have any kind of understanding of what life is really like below the median income line and certainly no conception of what it is like for the working poor. It's easy for them to make life and death decisions about them because - in their minds - what's a few deaths among the faceless, "lazy", "undeserving" poor?

I echo John Appleby's cynical statement: "We're talking statistical lives, in a way, which I suppose makes it easier to bear," he said. "And of course somebody else will be in power then."