On Privilege & Health

This post has been rattling around in my head for days, keeping me up at night.  It took a Canadian to give me the courage to finally put it all in writing.

One year of debate. Over 200 of their amendments added to the bill. 1,003 changes overall. And yet the GOP still cries that this bill was “shoved down their throats” or “pushed through too quickly”. Shouts of “You Lie!” and “Baby Killer” during speeches. 10 states spent tax-payer money in preparation of suing the government before the bill passed into law even though almost all Constitutional lawyers have said those lawsuits will fail.

Like it or not, this is how our government works, and for 8 years half of the country sat, feeling as hopeless as you do now, watching our government get bigger and bigger while we felt our civil liberties were whittled away. I understand where you are coming from, I really do.  But grow up already. The pendulum swings back and forth, so the GOP will get its chance to go back to eroding basic liberties, making the rich richer and messing with the economy again in the future.

Yes, I am liberal; an independent liberal. I vote on issues and platforms, not party…shocking, I know. I research, I think, I question. And I believe my grandfather, a lifetime politician and proud member of the GOP, would be ashamed of what is said and done in the name of his party today.

No, I am not a church-goer. But, I was raised in a conservative, politically-active, church-going family so I have been on both sides of the aisle. I lived in great neighborhoods, attended fantastic public schools, and never had a need go unmet. As far as I know, my parents never lived in abject fear that a slip, accident or unwelcome diagnosis would derail their children’s future.

As an adult I now realize that I was born armed to the teeth with privilege. Wealth, even moderate wealth, brings privilege in the US. Yes, my parents and grandparents and great-grandparents worked very, very hard to provide the next generation with a boost up the ladder of life. Not everyone starts out on the same rung and no matter how hard they work they might not ever reach a comfortable lifestyle. And for all of you shaking your fists and yelling “I pulled myself up by my bootstraps!” I shake and yell back “bullshit! Someone, somewhere gave you a boost along the way”. I am willing to give up a tiny little bit of my privilege to give someone else a boost.

And for all the name calling being thrown around: “Socialism”, “Communism”, “Totalitarian Regime” – I think people need to get out their dictionaries and return to civics class.

We are a long, long way from joining the rest of the industrialized world with universal health care. And if you look at the law itself, and not listen to all the talking heads, you will realize that this law does little to healthcare itself and is aimed mostly at regulating the insurance industry. NOTHING in this law as far as I can tell (other then the abortion language, but that’s a whole other post) specifically directs what a doctor can and cannot do. Don’t worry – insurance companies already do that for you. It doesn’t say who you can see or what for.

What it does is make it accessible and affordable for everyone to have health insurance so that those of us with coverage already will pay less for those who don’t. Because in case you didn’t know it, every hospital has a huge budget set aside for “uncompensated care” and those who have insurance or can afford to pay out of pocket are the ones who feed that budget. More insured = less uncompensated care *should*= less cost for all.

And if you don’t want to opt in? Fine, pay you share into the system and then do your own thing (just like we all do for education).

This law is not perfect. It’s not complete. But it’s a step in the right direction. Sure, I would love it if we lived in a world where “helping each other out when things go wrong because we’re human and we’re all in this together” was the norm. But we don’t so our government is giving us a collective shove in that direction. We live in a big, scary world where one second you’re a young, healthy person in an aerobics class and the next you are not. But now, there is hope that if you survive a crazy incident you won’t be financially ruined as well.

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10 thoughts on “On Privilege & Health

  1. Amy Wuest says:

    Good job Kate. I am shocked and horrified by the behavior of some of these GOP nuts. Spitting on members of Congress or physically threatening them. I thought we lived in a civilized country.

  2. I like to yell BABY KILLER! randomly. It keeps me fresh. A sub-par movie. Cold restaurant soup. DMV lineups.

    This was beautifully put. Just absorbing. Honoured to have sparked it in some way. You say what I feel I’m not qualified to speculate on, not being there. It’s such a deeply seeded cultural issue. The illusion of bootstraps and all.
    xo

  3. Many physicians are ready to opt-out of Medicare now as it doesn’t even cover the cost to take care of those patients.

    My husband, a dentist, works on my sister’s teeth all the time, on her insurance (she works for congress). The prices that her insurance company sets for him are ridiculous.

    In a perfect world a doctor goes through school racking up 100,000s of dollars worth of loans and works because they like to work and don’t worry about the money. But the world isn’t perfect. I’m very worried about the gradual loss of doctors and care and wait time and care.

    Our Canadian neighbor came to Cleveland to practice because he is making triple the money here. Walk into the Cleveland Clinic – pull aside a handful of doctors and you will see a representation of dozens of nations.

    So. I am most worried about the gradual decline of care. It won’t be ten years from now. But it will. Like any other governmental agency.

    Yes. Things have to change. People shouldn’t be denied coverage. I agree with so much and disagree with so much too.

  4. kakaty/Kate says:

    @OHmommy – I agree with you in many respects, and since you mention the Clinic I’ll use that as an example. Many of the physicians who work there do so because of the way in which it’s set up – they are employed by the Clinic and are paid for outcomes, not the number of patients they see. They don’t get paid for tests and labs, either which is one place that private practice docs make up some of their lost pay. It’s one of the reasons it’s been held up as an example of how to deliver cost efficient, patient-centered care. Should hospitals who get Medicare/Medicaid payments be forced to follow this model? – probably, but no one in Congress is ready to tell hospitals how to run their business.

    I feel for private practice doctors (DrOHMommy included) because insurance companies, operating under the free-market system, have used their clout and numbers to force docs to accept less $$ than the service is worth which forces the docs to see more and more patients just to maintain their practice. None of this is addressed in the final version of this particular law and it needs to be. While so many on the Right are crying for less regulation, there actually needs to be MORE on the insurance industry. Less regulation didn’t work very well for Wall Street, and we’ve let HMO’s run amuck, basically unregulated since they were created by Nixon in the the early 1970s.

    The good news is this law stipulates that Medicaid payments will be increased by about 20 percent in 2013 and 2014. It also gives Medicaid bonuses to Primary Care Physicians, who are typically paid lower then specialists, because we are going to need more as the exchanges open in 2014.

    Outside of that, I’m very baffled as to why so many people are worried about a gov’t bureaucracy bungling up how healthcare is delivered. There is no “public option”, the law drives everyone to the private insurance companies. Yes, the rolls of Medicaid and Medicare will expand somewhat (and they were due to grow exponentially with the aging of the Boomers anyway), but the biggest provisions of the law mandate that people participate in existing private insurance plans. And it sets some regulations to make those plans affordable and accessible. It’s one of the major reasons the insurance industry lobbyist groups were ok with this bill. Yes, the are going to have to take on higher risk people (pre-existing conditions), but they will more then make up profit by the increase in customers.

    Like I said, this law is not perfect. It’s not complete. But it’s a step in the right direction.

  5. Loved this, Kate. As a Canadian who has many Doctor friends, I’m not sure where the fear of a decline in care that OhMommy is worried about.

    In addition to having Doctor friends, I am an accountant that reviews Doctor’s tax returns. They’re paid quite well, actually.

    And as for decline in care? It’s pretty well-documented that while our system isn’t perfect, it’s pretty darn GOOD. You get sick/hurt, you go to the Dr./ER and you’re taken care of. We have it pretty good up here. 🙂

  6. Liz says:

    Loved the post.

    Re: those who say they don’t want the government telling them what care they can and can’t have, what insurance do they have? Sign me up!

    I get 4 pills to treat my migraines each month because my insurance has decided that’s all I get. I have to decide which of the 10-15/month are debilitating enough to treat. I had to fight through several authorizations to get a medication my dr. prescribed that’s a generic and my plan pays 0% of anyway. I’d really like to know what insurance all of these people have if their insurance doesn’t have the a say in their level of care.

    I don’t necessarily think this bill is 100% great, and there are parts I don’t agree with. But it upsets me that people are resorting to racial slurs, threats, and acts of aggression to show their disapproval. I know it’s out of fear, but it’s still horrible to read about.

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