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July 12, 2007

How universal single-payer systems protect us against catastrophes

(For previous posts on the topic of health care, see here.)

I think almost everyone across the political spectrum would concede the fact that the fifty million Americans currently without health insurance would definitely benefit from the adoption of a universal, government-run, single-payer health care system. The reason that it has not been adopted is that many of the remaining 250 million have been frightened into thinking that their medical coverage would decline from what they have now.

This feeling that "The present system works for me so why tinker with it?" is based on the assumption that our lives are stable and that things will continue just as they are into the foreseeable future. I am not so sanguine about this, perhaps because I am older and have repeatedly seen and experienced how the slings and arrows of outrageous fortune can strike anyone at any time and dramatically change lives. As a result I think it unwise to base our policy decisions on the rosy assumption that what is true for me now will continue to be true for me tomorrow. All it takes is a single catastrophe that causes the loss of our job, which could happen to any of us at any time, and all our comfortable assumptions about the future can end up in the trash can.

It is not uncommon for people who are incapacitated by an illness or an accident to themselves or someone in their family to lose their jobs and not be able to get another one with health benefits. As a result, such families are faced with stark choices: suffer or die for lack or treatment or have the family risk bankruptcy paying for it.

US News & World Report summarized the findings of a study that looked at a representative sample of bankruptcies across the country:

We have health insurance for several reasons, but one of the big ones is to protect us from high medical bills when we get sick. But insurance, it turns out, may not be the protection that many people think it is. Illness and medical bills are big reasons behind fully half of all personal bankruptcies, affecting about 700,000 households per year, according to a new study. And most of those households had insurance.
. . .
These were working- class or middle-class people, and 76 percent of them had health insurance when they first got sick. (Many lost this coverage because the insurance was through their jobs, so it disappeared when they couldn't work.) Half of the bankruptcies were caused, in part, by illness and medical debt. Their median debt was about $16,500, and the major part of that debt was payments to doctors and hospitals. Families initially tried to pay the debt for several months, says Elizabeth Warren, a bankruptcy expert at Harvard Law School. Sixty-one percent went without needed medical care to make payments, 30 percent had a utility shut off, and 22 percent cut back on their food.

If you simply ask around, you will find many examples of people who have been forced to make drastic decisions because of their health care situation. A couple I know moved to Mexico because they could not afford to pay for their health care here.

But even if people are willing to shut out from their minds the possible of such an unfortunate turn of events happening to them personally (and human beings are very skilled at avoiding thinking about such things), surely they would like to feel that their families and children and grandchildren and great-grandchildren will not have to suffer? The odds are very high that several people in each one of our extended families will face a health-related crisis in their lives that will threaten to send them into destitution. Even if we are blasé about ill health striking total strangers, surely we cannot be so complacent about our own descendents?

David U. Himmelstein, MD and Steffie Woolhandler, MD provide a detailed case (scroll down) for "Why the US Needs a Single-Payer Health System" outlining the toll the present system in the US takes on both patients and health care professionals, and the increasing monopolization of the system by a few giant corporations. They describe the huge amounts of paperwork that doctors in the US have to do because of the complicated and cumbersome health insurance system here. They have to employ a number of clerical staff simply to process the different paperwork with all the different insurance companies and then haggle with them over payment and treatment. In addition, the health insurance companies have to negotiate contracts with different companies in different states with different laws and regulations. As a result, "Blue Cross in Massachusetts employs more people to administer coverage for about 2.5 million New Englanders than are employed in all of Canada to administer single payer coverage for 27 million Canadians."

Perhaps we should start by providing single payer health care coverage to all children. Children are not responsible for their lot in society and should not be deprived of basic needs of food or shelter or clothing or education or health care.

There was a very sad story in the film Sicko. (Although I keep talking about the sad stories in it, I should emphasize that Sicko is also a very funny film.) It was about a little girl who was taken to a hospital emergency room with very high fever. They refused to provide treatment because she was not 'entitled' to be treated there, and insisted that she be transferred to a hospital across town, the place where she was 'supposed' to go to. She died during the time that she was transferred from one hospital emergency room to another.

To be denied treatment for purely bureaucratic reasons is unconscionable. It puts the health care professionals also in an impossible situation. If the emergency room physicians and nurses at the first hospital had realized that the child had a life-threatening condition, I am certain that their natural humanity would have taken over and they would have treated the child irrespective of whether she qualified or not. But if they had treated the child and it was something that could have waited, they might have been reprimanded for providing treatment to an 'unauthorized' patient. Why should health care professionals have to be put into making such kinds of bureaucratic decisions instead of doing what they are trained to do, which is simply treating the patient in front of them as best as they can?

As Martin Luther King, Jr. said, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

POST SCRIPT: Where's Freud when you need him?

Comedian Craig Kilborn gets a laugh out of our ability to see sex symbolism everywhere .

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Comments

Last November the Humanist News Network did a podcast on Sex & Humanism that had some quite amusing bits. As I recall they also spent some time pondering why Christianity is so obsessed with sex. It occurs to me that might be another reason for the religious right to hold onto creationism. With original sin and God's input, sex is dark and naughty, fraught with impurities and quite useful for inducing feelings of guilt. With evolution sex is just a natural biological process.

Posted by Heidi Cool on July 12, 2007 02:35 PM

@Heidi.

Sexual taboos existed before the Christian church.

That being said, I'm sure organizations such as NAMBLA agree with your position. I'm sure that old men having sex with 10 year old boys is just a 'natural biological process.'

Posted by wanderer on July 13, 2007 09:04 PM

Wanderer,
I agree that sexual taboos have existed in varying forms throughout human history. I was referring mostly to the discussion in the podcast and the prominence Christianity places on these taboos.

As for NAMBLA, saying that something is a natural process is not the same as saying it lies beyond the scope of human morality. All human interactions are subject to moral review; yet there are many ways to make such a review, whether it be through religious dogma, Kant's categorical imperatives, utilitarianism, etc.

We can follow many different paths of inquiry--with or without religion--and still conclude that old men should not abuse boys.

Posted by Heidi Cool on July 15, 2007 11:19 PM