I’ve spent my whole life interacting with the health care system in the United States, and a big chunk of that has been without health insurance. This doesn’t make me very unusual; like a lot of people, I don’t have insurance. Also like a lot of people with chronic health conditions, I’m considered uninsurable, and thus am unlikely to get health insurance in the near future.
So when the health care debate in the United States really started to kick into high gear, with the newly elected President Obama making good on his campaign promises to reform the health care delivery system, I got pretty excited. At last, I thought, we’re going to fundamentally deconstruct this broken, dysfunctional system and get some real health care up in this thing.
Why on earth I thought this, I don’t know. Maybe I was under the touchingly naïve impression that the growing economic woes in the US would drive us to more drastic measures.
What we got, of course, was a stimulus package for health insurance companies, in the form of a “health care reform” law basically revolving around health insurance. And I found myself increasingly on the outs with a lot of progressive friends, because I didn’t support the reforms, and I don’t support them now, and that makes people uncomfortable.
Because I’m a pinko commie queer, so I should be all about this “verging on socialism” set of reforms, right? Except that I’m not.
Because “health care reform” turned out to be yet another iteration of better living through capitalism, which people should know by know is something that doesn’t work. Capitalism doesn’t care if you’re sick or healthy. Capitalism doesn’t care if the populace has access to health care. Capitalism just wants its bottom line, which the insurance companies were promised with the individual mandate. Capitalism doesn’t want your vote.
But but but, people say, now insurance companies have to cover “uninsurable” people like you! Right, sure. Yeah. People can no longer be excluded on the basis of preexisting conditions. That doesn’t mean their policies won’t be loaded with so many riders that they can’t actually get the coverage they need.
Just to take one example, a common problem for my fellow crazy people is medication switches dictated by insurance mandates. A friend of mine died three years ago after an insurance-mandated medication change; her medications were working just fine, but they were “too expensive” so she was forced to change to different drugs. Which didn’t work.
And then there’s a practice called rescission, which is something every insurance policyholder should know about. Rescission allows the insurance company to immediately drop coverage, canceling the policy and terminating the contract, effective immediately. One part of the “health care reform1” bill mandated that insurance companies can no longer drop people for getting sick, which is good.
But. They can drop people for fraud or misrepresentation. Which means that if you forgot about the bronchitis you had when you were 13 when you filled out your insurance application, the insurance company can drop you. And believe me, insurance companies can always find a legitimate reason to drop a sick policyholder.
Searching for reasons to drop people, insurance companies can and will dig up as much dirt as possible on policyholders. For people with complex medical histories, it’s virtually impossible not to misrepresent, entirely by accident, because it’s hard to remember everything in detail. Which means that when they get sick, they run the risk of being dropped because they forgot to note something. Omitted the two weeks they spent on a medication that didn’t work before switching to a new drug, say.
Sitting down to do the math as the bill was moving forward, I determined that it was more cost-effective, for me personally, to remain uninsured. Paying as a cash patient would be less expensive, barring extreme catastrophes, than paying insurance premiums, managing copays, and paying for everything the insurance company wouldn’t cover, which is a lot. People suggest that universal health care means “death panels” but it’s actually insurance companies that are the death panels, because they’re denying needed coverage on the basis of the bottom line, not applying evidence-based medicine to treatment decisions2.
These are hard truths for some progressives, things they don’t want to hear. They wanted this to work, and I understand that. I long for health care reform, too. True reform, in this country, right now, because it’s vitally needed.
Reform isn’t going to come about through capitalism and approaches rooted in the current system, because the system is broken. It requires a radical approach, and that approach may be too much for our current system of government to handle, since insurance lobbyists are everywhere.
Life as a cash patient is a constant balance as you prioritize things and try to determine what you’re able to go without for this week, what can wait until next month, what needs to be dealt with immediately. It necessitates treating the body as a piecemeal, rather than a whole, which can have devastating consequences with conditions that interact with each other.
It's the capitalist approach to health care: tear bodies apart without any interest in putting them back together again.
1. Scare quotes intended.
2. There seems to be, generally, a huge fear in the United States of science, which has really unfortunate consequences when it comes to evidence-based medicine. Basing treatment on what actually works is frightening, apparently.