[quote=flu]Ok. My head is spinning. I guess the other question I have is. If what we really need is some sort of minimum universal health coverage then why the hell is everything still going through insurance companies???[/quote]

Why else? Money. Lots and lots of it. The insurance companies and their associated businesses clean up big time.

That’s one reason they didn’t lobby harder against kids staying on their parents’ health plans: young, traditionally healthy kids improve the risk pool. Parents pay premiums for them, but the chances of utilization of health services are low. Insurance companies know that kids without coverage have a list of roughly 300 things other than health insurance that they’d rather spend their limited funds on. It was different 7 or 8 years ago when employment of the young was high, and employers were paying most or all of a hefty “single” premium”. In today’s economy, it’s a reduced premium on a parent’s plan, or nothing at all.

I understand why a large part of the population is against a single-payer system (although I believe that it’s the “boogeyman syndrome”: they’re more scared of things that don’t actually exist, but have been created by the PR flacks of insurance companies and opportunistic politicians). However, except for our country’s oldest citizens (75 & up), most of us grew up in the mindset that healthcare is something that we shouldn’t pay for directly; that’s what health insurance is for.

If you look at the traditional model of insurance, it was meant to ensure that if an unexpected illness or injury occurred, your family wouldn’t go broke paying for it. Look at life insurance or auto insurance or homeowners: all meant to cover the unexpected significant expense, not the routine maintenance items.

However, by the end of the 70s, several things had happened to upset the apple cart:

— We changed our pattern of consumption of health services significantly. Up thru the mid-sixties, people tended to their own illnesses, and those of their families. It’s completely different now: people are not just seeing a primary care doc much more frequently, but also specialists, and other health providers (physical therapists, nutritionists, dialysis techs, etc)

— We became a much more litigious society. Malpractice, personal injury, and class action lawsuits became a extraordinarily lucrative source of income for plaintiff’s lawyers, and sometimes even the patients. Successful cases are built on evidence, and nothing says “I am irreparably harmed” like lots and lots of health care-related bills. And then there are those multi-million dollar judgements. But the most expensive fallout from this change? Hospitals and health care providers are being incredibly proactive in practicing defensive medicine, resulting in the often-unnecessary ordering of tests, treatments, and consultations with specialists.

— We’ve become a society that believes we shouldn’t feel bad. Ever. Thanks to Hollywood tearjerkers, Lifetime movies, television medical heroes, reality shows, and the ever-helpful internet, we are bombarded from all sides with stories of complex medical conditions, the symptomatology of which closes matches what we’ve been feeling. So it’s off to the doctor, where, armed with knowledge gleaned from helpful drug company commercials, demands for the miraculous and instantaneous pharmaceutical cure are made. Hell, we don’t even want to deal with a mild cold – we take zinc the minute there’s a tickle in our noses, and keep a full and varied supply of antibiotics at the ready.

— We’ve made incredible advances in basic science research in the past thirty-five years. The development of sophisticated scientific instrumentation and equipment has led to discoveries in microbiology and biochemistry resulting in a new understanding of organisms and disease.

So the upshot is that the science behind health care has advanced, and we, as a society, take it for granted. We want to feel good all the time, we want to live forever, and we have no interest in how that happens or what it costs. The increase in employer-provided health benefits, and in the number of health-related entitlement programs have only aggravated the problem.

Years ago, people got sick, and they either got better or they died. It’s truly a wonderful thing that medical science has improved our chances of survival, but it’s come at a tremendous cost. There was a tremendous outcry against “death panels” during the health care reform debate, however health insurers have been making arbitrary decisions in life-and-death situations for years, and I didn’t ever see angry, over-the-top protests from the citizenry. In all likelihood, this is because most people aren’t in these types of situations until they reach an advanced age, so what the insurance companies are doing to others is not affecting them.

We either have to grow a pair, and out-and-out state that health care will not be available to those who can’t pay for it (and stop salving our consciences by insisting that everyone has access to it. They don’t. Period.) Or we have to decide that heath care is a right for everyone. For those in favor of the first option, just keep in mind that it could well be you or your children or your parents in the position of not being able to afford health care one day, and you’ll have to live with your decision at that point – don’t be turning “activist” overnight because you’re suddenly the ones affected.

To those in the second option camp, get your heads out of the sand and start educating yourself on what the actual costs of healthcare are. Study up on what the utilization trends are, and examine how you may be adding to the problem. Look at every insurance explanation of benefits that’s mailed to you, and compare it to what you’ve paid in premiums. Before you sign on with that lawyer, think about whether it’s actually malpractice, or if you’re just pissed because your surgeon wasn’t able to satisfy your vision of perky post-implant breasts.

If we allow things to continue the way things stand now, within 15 years only the very wealthy will be able to afford health care. Employers will continue passing on more and more of the costs on to their employees. And those depending on entitlement programs will find that their options are seriously reduced, or that the programs have been discontinued altogether.

If that happens, I’m fine with it. Not because I’m one of the fortunate wealthy. It’s because we’ve been in that position before as a nation, and yes, lots of people died, and many more suffered needlessly, and it affected our economic growth and national security.

If we don’t go that route, I’m okay with that, too. But we have to be realistic, and let go of some of our unrealistic expectations. We have to engage in serious study of health care econometrics and bioethics, and stop terming it “death panels”. We have to start looking seriously at QUALITY of life, instead of simply looking at the length of it. We have to stop pissing and moaning about not being able to choose our own physicians, and we have to get real about providing painful and disabling 6-figure courses of “treatment” for 85 year-old patients.

You know, I appreciate that family members might be happy that the life of their 90 year-old father was saved by $300,000 worth of surgery, hospitalization, and rehab. I just question if their decision would have been the same had they been compelled to pony up 25% or 50% of the cost from their own personal funds.