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.


My Life Needs A Concordance

My friend showed me a concordance. His was on his phone and he showed me how he could tap words from the Bible and learn all about the origin word. He showed me how the same word in one specific passage had two different meanings, which significantly affected the meaning of the passage, but I’ll leave that story for him to tell. I immediately wondered if The Stranger had a concordance. The Stranger by Albert Camus is my favorite novel. Originally written in French, I’ve thought about learning French just to read that novel in the original language. (That thought is as far as that plan progressed.) What nuances are lost in translation?

In the book, the main character kills an Arab. If you don’t know killing an Arab in that time and place wasn’t considered as bad a crime as killing any other person, you’ll probably get that as the story progresses, but if you fail to let go of your sense that it is as bad, you won’t fully get the rest of the book.

Back when Obama was either trying to get the Affordable Care Act passed or shortly after when the Republicans were on their mission to hurry up and repeal it before Americans figured out how desperately we needed it (I’ve spent my adult life with a “pre-existing condition” due to a surgery I had when a minor, so I know firsthand how desperately America needed The Affordable Care Act. Insurance companies screening out sick people to boost profits is as repugnant as it should sound and never should have been allowed. All this becomes important for anyone who keeps reading.), an old man I worked with approached me wanting to celebrate the voting in of one of the obstructionist Republicans. He figured out quickly I was a proponent, and an informed one, of Obamacare. (Although at that time I was still trying to keep people calling it The Affordable Care Act.) At one point, appealing to the fear of socialized medicine he assumed everyone shared, he said, “Did you know in Canada, if you’re over the age of fifty and you have cancer, they just send you home to die?”

I said, “That’s an outright lie.” And it was. The discussion didn’t get ugly but it got heated. I don’t think we ever spoke again, though we’d never really spoken before then either. We both made a point of nodding to each other nearly every time we crossed paths, after that. Then he quit a few months later.

Here’s where a concordance might have come in handy. I could have tapped a speech bubble of what he’s said and discovered that wasn’t a lie, not from him. I could have dug into that man’s history and probably found someone who’d worked his whole life within a system. And now that he’d played by the rules, he had his “Cadillac Coverage” and felt he was at an age where any day now he might need it. So he was scared, which made him highly susceptible to manipulation. And there were people telling him lies he believed. A concordance would have told me all that.

During my friend and I’s talk, we concluded that there weren’t going to be many books where making a concordance for them would be practical. There will probably never be a concordance for The Stranger. There will certainly never be one for life, but like The Stranger, which if you open up and read without that assumption that the Arab was interchangeable with any other person, will show you what you need to know to get the book, if we open up in life and in our relationships with people, if we simply keep in mind they’re coming from some other set of experiences, if we listen, they’ll show us what we need to know to connect with them. It only occurs to me while writing this years later that man was married and that his wife might have had cancer. Knowing that wouldn’t have stopped me from defending Obamacare in that discussion but it would have changed my approach.

Whoever reads this blog must worry that I agonize over past events to an unhealthy extent. I would disagree. I consider it an occupational hazard or maybe reward. Usually these are moments I haven’t thought about in a while and writing gives me a chance to pull them back out and look at them from another perspective. Then ideally I can apply what I learned in future interactions with people, which is probably as close as I could get to utilizing a concordance in my life.