Healthcare Comments & Response - Part 1

As a rule, I try not to respond directly to comments, as I feel that I have an unfair advantage - this is my blog and hence my "microphone" is the loudest. Nonetheless, as the plight of American access to healthcare is clearly a big concern of mine, I would like to respond directly to some commentary I received recently from an anonymous source. Here goes my annotated response:

The healthcare system is broken. 

This is something upon which the commenter and I agree.

 I have pretty good coverage because I am college educated and work for a large hospital .

No, you have good coverage because you work for a large hospital. There are plenty of college educated people who have terrible or no coverage. It has very little to do with your educational input and instead has a lot to do with the size and nature of your employer.

I cannot complain too much about my coverage. Our deductible is $1300 per person not to exceed $2600 per family . After that , if I am treated at the hospital where I work, I am covered at 100% . I have an HSA which my husband ( who works at said hospital ) contributes $75 per paycheck for office visits , and drugs . We pay $109 per paycheck ( twice a month ) for our coverage .

I am glad, Anonymous commenter, that you have good health insurance coverage. If I could get your "deal," I would gladly take it. I would gladly take a 1300/2600 deductible and pay $218/month for insurance plus $150/month for a HSA to cover out-of-pocket. Regrettably, I don't have that choice. If you, dear commenter, would like to propose a public policy whereby that deal is available to people who don't work for large hospitals, count me as a supporter. In addition, I note that your comment later demonizes the CEO of IU Health for how much he makes. Sauce being equally delicious on the goose as the gander, perhaps next time you start thinking about the overhead of American healthcare, you will recall that your own insurance is part of that overhead.

 I think it all depends where you work and what you do for a living . 

I suppose it does. It also depends on your age. I note that many Baby Boomers and Gen Xers are able to get on as permanent, full-time employees at large incumbent employers, whereas so many Millennials  are relegated to "temp" status, working for a set hourly wage (sub $15/hour) with no benefits and no job security. These sentiments as to where one works and what one does for a living are nice, but when it comes to healthcare, the janitor at the City-County building has better health insurance than does an entrepreneur. How's that for incentivizing behavior?

People who do not have insurance are not turned away from where I work , a hospital or my husband's . 

I'm not sure what the point of this is. Is this supposed to be some sort of absolution of the healthcare industrial complex? They won't leave you to die in the streets. They'll give you the service, and then they'll bankrupt you with the bills. Hurray!

The hospital may give you ER care, but if you need any sort of follow up care, you're on your own. No medication. No physical therapy. No follow up.

Also, they will seek to recover for their bills. I see the back end of this "policy," and hospital corporations do not simply "forgive" these bills. They will drive you to ruin to collect on them. This is not charity. They will file suit against you and you will have a judgment hanging over you for the rest of your life unless you (a) pay it or (b) file bankruptcy. Freedom!

Finally, that care isn't just given away for free. The hospital is not in the business of losing money, and someone, somewhere, has to pay for the care that your hospital provides "for free." That someone, unfortunately, is both those who have insurance and those who actually have the cash to pay their medical bills. The costs get shifted. It's not free, and it's not a solution.

People who do not have insurance are not turned away from where I work , a hospital or my husband's . Indiana has HIP which is a very good Medicaid type program for Indiana residents . But it dies require one to take the initiative and research and sign up .

Let me be very clear about this. HIP is Obamacare with a few bells and whistles to make conservatives feel warm and fuzzy about "personal responsibility" or something. When (not if) the federal government succeeds in destroying Obamacare, it will destroy HIP with it. Full stop.

Further, my wife and son went on HIP 1.0 when my son was born, as I was in law school at the time. The insurance was indeed better than any private sector insurance I've bought before or since. Someone, anyone, remind me again why the free market is preferable to the public sector as regards healthcare.

All I know is we take good care of our patients whether they have insurance or not and St V I know accepts interest free patents for three years !

This is, again, a standard-bog reaction I tend to hear from people who work in healthcare any time it's pointed out that the American system sucks. Nobody doubts that American healthcare providers, generally, do their best to take care of patients. Specifically, I believe that nurses, orderlies, lab techs, doctors, etc., are genuinely concerned, on a personal level, about the well-being of their patients.

I don't think that my comments regarding a better system for the financing and delivery of healthcare is the equivalent of saying that America's healthcare providers suck. Rest assured, if that was my point, I would be quite explicit about it.

With that said, I note that the commenter twice refers to how hospitals don't turn people away and, generally, have a large heart. Any system that depends on charity and a wholesale disregard of material human interest is not a system upon which I would rely.

Depending on the charitable inclinations of hospitals is not a sound policy to ensure that an increasing percentage of Americans can afford healthcare any more than depending on the benevolence of Budweiser to ensure that we can all afford beer at the race. The interests of the parties simply don't line up.

All the hub bub about getting rid of Obama Care is about the republicans trying to insure that the hospitals can remain profitable, and very profitable they are , Dan Evans at IU Health made 3.9 million being CEO , is that REALLY necessary! NOT !

There is a bunch to unpack here. First of all, I don't even know what to say about Republicans. I suspect that if any of them had toddlers who were diagnosed with lifelong conditions and didn't already get that sweet sweet government insurance (that they, by the way, decry as evil-socialist-takeover-end-of-freedom-road-to-serfdom when anyone else gets it), then perhaps they would be more concerned about the effects of their policies. As it sits, I think they view this as a game that is unattached to anything they actually care about other than the possibility of cutting more taxes.

As far as hospitals being profitable, I don't really have any problem with that either. However, it does seem that providing an essential service should be lucrative but not the source of multi-generational wealth. It seems that if 40-year-old doctors (who finished med school at 30, roughly) can threaten to retire if they dislike health policy in this country, then perhaps they're overpaid. But I digress.

The other big thing I thought about when seeing this is that the commenter simultaneously brags about her own hospital compensation and then faults Dan Evans for his. As noted above, dear commenter, your amazing health insurance that you speak of is part of your compensation package. It drives up the cost of healthcare for everyone else because your employer is providing this healthcare to you as part of your compensation package. While Dan Evans' salary is an easy thing to look at and say it is excessive, that is only one person. How many people who work at your hospital get your health insurance? What do you think that would cost per month on the open market?

If we want to ensure that healthcare in America is delivered in a free market, we need to ensure that the free market is capable of same. There is a reason why we don't leave police work, national security, road construction, primary education, or so many other things to the free market: the free market can't deliver those things.