How we got here with health care

I was seventeen when I had my first brain surgery. I’m an extremely lucky unlucky person because my issue was easily fixed with “a machine,” really a shunt, that I just had to trust to keep working. I got to leave the hospital to live as a healthy person, but I have a vivid memory of my doctor telling me to get a job with a big company and be sure to keep it.

At the time, I had no intention of building a life around making sure I maintained health care coverage. I mostly forgot about the machine that kept me alive. Then I got a nagging headache and my health history came back to mind. I decided I better pick up health insurance. The preliminary information some company sent me had a list of ailments and mine was on there, so I called and asked what that meant. I would go into the high-risk pool. My health insurance would cost close to two-thousand dollars a month. That headache turned out to be nothing, but my life plan of not building a life around maintaining health insurance went mostly out the window. Since then I’ve worked for two big companies and stressed about maintaining the average hours necessary to stay on their health care plans, which wasn’t always easy and would have been impossible if I’d had a condition that caused me to miss work. I’m a lucky unlucky person.

I was a naïve kid when that doctor told me to get a job with a big company and keep it. What he was essentially saying was that I’d better be careful because I’m going to turn out more expensive than I’m worth. He was right. My various insurance companies have spent way more on me than they’ve gotten back in premiums paid by me and my employers. But I’ve helped. What people who haven’t been sick probably don’t know is how much of the burden of paying for health care falls on the sick. My brain machine broke on separate occasions six months apart but on separate calendar years. I paid my maximum annual deductible both times, at that time $5,000, for a total of $10,000, out of my pocket.

The easy scapegoat is insurance companies, certainly where I directed my ire for many years, but insurance companies are just forced to maximize profit, like every other company. The problem is capitalism. Fitting health care into a capitalist system is like putting your washing machine under the cupboards above the kitchen counter where the microwave goes. The pressure has been mounting for decades in the form of rising premiums and more cost put on the sick. There is something synergistically devastating about being sick and getting the mail and finding bill after bill that you don’t know how to pay. There are people who stop taking the care because they don’t want to face the bills. Some of them risk stroke by not taking prescribed blood thinners, others just let themselves get sicker and sicker and then die.

The Affordable Care Act, also known as “Obamacare,” didn’t solve all these problems. It wasn’t perfect, but it improved the situation by getting health insurance to a record number of Americans. These are all people who, when they get sick, are now able to go to the doctor and not the ER, which costs more money for worse long-term care that has to be covered by all of us. The claim by the GOP is that the American Health Care Act will give more choice to Americans but if you look at the details its real aim is just to fall back on the old way of hiding the problems with our health care system by leaving them for the sick minority to worry about. One of the details that stuck out to me in the new plan is a projected sixty percent hike in what insured people who get sick will have to cover themselves. The “death spiral” Paul Ryan always says “Obamacare” was in, even though the CBO reported it was not in a “death spiral,” is expected to hit especially older Americans most likely to need care. People sixty-years-old would be forced to spend half of what they make on premiums, which means they’ll forego coverage. Our ERs will have to accommodate that. People will get worse care at ERs at a higher cost that will be covered by everyone else when they can’t pay all so that a tiny percentage of the richest Americans can receive tax breaks.

The hunting and gathering days often get romanticized. When a member of a tribe, family to many of the rest of the tribe, got sick and couldn’t hunt, the tribe shared. They expected that member would get better and be back to helping the tribe and when someone else got sick the help he or she gave would be returned. Some members of these tribes were surely wounded or sick past being able to return to help hunt. That’s when human empathy kicked in. The human instinct to sacrifice to give aid but there are other human instincts like greed and selfishness. Sometimes those instincts won out. Some of these injured or sick ancient peoples were almost surely dragged out of the village and left for dead. If the countries of the world are the different villages and communities of ancient days, America is lagging in accepting the challenge of committing to caring for everyone who is a member of our village. The passage of the Affordable Care Act was a step in the right direction. The GOP’s bill is going backwards, leaving more of the sick to die unnecessarily.

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