Obsessed with Health Care Before It was Cool

I feel like if it were referred to as "health insurance reform" rather than "health care reform," a lot of our problems would go away. "Health care reform" sounds like it could lead to (heaven forbid!) the British National Health Service and all sorts of strange, foreign-sounding, and potentially very unpleasant things. It seems like everything is on the table. "Health insurance reform," on the other hand, sounds like we're reforming a sector of our economy that most people admit the bureaucratic evilness of and cherish a hatred for that is second only to the too-overcompensated CEOs of bailed-out banks.

Seriously, does anyone like health insurance companies? They're just unpleasant to deal with. It's like dealing with your computer manufacturer or your cable provider except they're sneakier, they're more bureaucratic, and (most importantly) health is much more important than your failing laptop battery or the stealthy post–special introductory offer increase in your cable bill. I remember Mom spending hours on the phone trying to force our insurance company (Aetna is evil incarnate, by the way) to cover what it was supposed to, which in retrospect blows my mind, since at that point, we were all perfectly healthy. What were they trying to refuse to pay? A annual physical? A Pap smear? It's not like we were costing them a fortune in radiation treatments or dialysis or anything. We didn't even have broken bones or anything—nothing other than routine care.

I feel like most of the people who are yelling don't even know what they're yelling about. To hear them, you'd think Obama was going to go on a killing spree to take out Trig Palin, Ted Kennedy, and Stephen Hawking after converting our health care system into a socialized, bureaucratic system of meting out health care to those young and healthy citizens who were most likely to contribute to the economy (but who still might have to wait months for any treatments). Obama doesn't want any of that. I won't speak for anyone else, especially as I haven't read any of the proposed bills (hey, don't judge me; nobody else has either), but as far as Obama goes, it's pretty mainstream and reasonalble. How can you really disagree with this?

Obama's stated eight principles for successful and meaningful health care reform:

Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.

Make Health Coverage Affordable. The plan must reduce high administrative costs, unnecessary tests and services, waste, and other inefficiencies that consume money with no added health benefits.

Aim for Universality. The plan must put the United States on a clear path to cover all Americans.

Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.

Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. They should have the option of keeping their employer-based health plan.

Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking — as well as guarantee access to proven preventive treatments.

Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.

Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.

What is so scary about this? Most of it seems, actually, scary only insofar as it makes you realize, Oh, wait, why is it this way in the first place? I mean, obviously everyone, including Republicans, is a fan of number eight, fiscal sustainability. And what about reducing "inefficiencies that consume money with no added health benefits" (number two)? Who isn't for cutting costs in areas that don't lead to cuts in outcome? Preventative care (number six)? Sounds good. (That saying "An ounce of prevention is worth a pound of cure"? Totally applicable. Helping people not get fat is cheaper than paying for their insulin and then foot amputations and eye surgeries and whatever as their diabetes progresses. Plus, you know, then their lives don't suck.)

But the big one for me is number four: portability of coverage. The absolute stupidest part of our health care system in my mind is that it is currently almost entirely linked to one's employer. I assume this will erode, regardless of what happens with this current attempt at reform, as Gen Y ages, since nobody is doing the work-your-whole-life-at-General-Motors kind of thing anymore. We're all changing jobs every year or two or four. (Seriously, who do you know who's working for the same company they plan to be with in five years? I may never get to that point.) If we're all going to be changing jobs every couple of years, especially if there are going to be any gaps between one job and another, the current system simply sucks. Yeah, there's COBRA to cover the gaps, but it's prohibitively expensive. And what about families? Within a period of four years or so (late high school and early college), I changed health insurance plans a ridiculous number of times: from Dad's to the COBRA Dad got after losing his job at the Federal Reserve to Mom's when she started working for the school system to Dad's when he got his new job to Mom's with Grady when Dad got called back to active duty...or something. Dental also changed, but not always in tandem with medical, so I lived in a permanent state of confusion. This is bad because even if people are on top of things and do arrange to have seamless medical coverage, there's only a certain period of time they can actually be covered. When you switch, it takes like a month to get your new card and all your information, and then you have to find a new doctor because your old one isn't covered with this plan, and then you have to wait a month or more for your appointment because new patients always seem to get screwed... So even if you've technically been covered for six months, only half of that time is time that you could actually be seeing a doctor, and that's only if you're on top of things (not like me) in making appointments before you switch insurance again.

And then there's the rest of number four: "No American should be denied coverage because of preexisting conditions." I can understand why health insurance companies developed this rule. Obviously it's not fair for someone to smoke for forty years and never have health insurance, but then when they find out they have lung cancer, the treatment of which is going to be quite expensive, to take out a health insurance policy so they only have to pay the few hundred dollars' of deductible plus a few $20 copays. (Of course, if we require everyone be covered, this can't happen...)

What's even less fair, though, is that people can be booted out of their health insurance when they turn out to have, say, breast cancer, because they didn't report it when they applied for insurance...if they didn't know it themselves at the time. Or that people who develop one of these dreaded conditions must then either stay at that job or find another with similar coverage forever, else they be left unable to purchase insurance on the private market because of this now-preexisting condition.

My mom, for example, would now be unable to purchase insurance on her own because she had a melanoma a few years back. It was entirely isolated, entirely removed, and has nothing to do with anything else that may happen in the future. It was stage zero, entirely contained, and it's been years since then, demonstrating that even if these facts were somehow mistaken, it hasn't spread. Regardless, Mom is now a cancer patient and thus anathema to all insurance providers. I mean, good thing it's something that was simple and self-contained and doesn't affect her ability to work (unlike the chronic diseases that make up most preexisting conditions), so she doesn't really have to worry that much; as long as she has a job, she'll be OK as far as health insurance goes. But for people whose illnesses preclude remaining at work? Sucks to be them.

The worst? That insurers can simply drop people from their plan if their health care becomes too expensive, regardless of whether or not it was a preexisting condition. I didn't even know this was possible until recently (thank you, plethora of indignant health care–related articles), and I am appalled. That's cheating! The whole reason people buy insurance is because they're afraid they'll develop a devastating disease that will bankrupt them. It's not fair to quit covering them when they do after having accepted their premiums for however long. If AIDS is too expensive for you to want to have to worry about, just state straight out that you don't cover AIDS, so then if anyone's worried about it, they can just go to another insurer rather than paying you for years until it becomes an issue and you announce you don't want to deal with it.

Seriously, I don't understand why this is so hard. People shouldn't be bankrupted because they develop a chronic disease. We should help people avoid avoidable chronic diseases. We shouldn't spend money to do stuff that doesn't work or spend money when it's irrelevant (most back MRIs—back surgery is way more of a pain than it's worth in most conditions, so all an MRI does is tell you, "Yep, your back is messed up"...which you knew anyway), spend more money for stuff that doesn't work any better (the new name-brand cholesterol drugs that aren't any more effective than the decades-old ones have been in the news lately), and we should do the cheap things we know do work (like washing hands and following other hygeinic procedures to reduce/eliminate hospital-acquired infections like MRSA). We should all have insurance so taxpayers don't get stuck with the uninsured poor's emergency room visits for what should be primary care issues (or, for that matter, the uninsured poor's bona fide emergencies). Insurance companies should do the duties they ostensibly exist to perform without being evil in order to discourage people and increase their profit margins.

Insurance as it is now sucks. Health care, if not a right (people keep arguing that; I'm not taking a side in this post at least), is certainly one of the more important creature comforts and something any reasonable and humane person or society wouldn't want to be caught denying anyone else. So let's suck it up and be mature grown-ups about this already.