My Experience With Universal Healthcare

I have been without health insurance for most of my adult life. The time I actually had insurance, it was the really shitty, rather expensive kind that blue collar workers tend to get - high deductibles, high premiums that are hard to manage and a hell of a lot of exclusions.

Without insurance, I have been relegated to having the stoned hippie who lived with me at one point, stitch the hole in my arm left by an ex-lover (who it turned out was married) and my 22 pistol. Without insurance, I have learned to give myself stitches and (as the lovely Juniper discovered) have become a very good hand with butterfly insta-sutures - even one handed, because the wound is on my other arm. Without insurance, I once bought cocaine on the street as a numbing agent, so a friend could drill a cavity that I packed myself - thankfully another friend is a solid hand with a needle in the gums. Without insurance, I have a small chunk of my left elbow bone floating about under the skin - thankfully it only hurts when I bang it just right. Without insurance, I have learned to manage sprains and minor fractures - I learned from the best as a rather "active" child, to manage splints and immobilizing bandages. Without insurance, I became pretty adept with herbal medicine - I can make tinctures, extracts and even a few isolates, all day long. Lets hear it for medicine as it was practiced 150 years ago.

But there have been plenty of times when I was afflicted with something or another, that simply couldn't be left to home healthcare. For those, I had to turn to the U.S. version of universal health care - the emergency room. Let me just take this moment to thank those of you who have been paying for or who have expensive insurance paying for the programs that cut thousands off of the hospital bills - not because I asked them to, but because they wouldn't treat me if I didn't sign the papers that allow them to cover the cost out of special funds that many hospitals have for people who can't pay. They have to pay the staff somehow - and that is the how. It comes out of funds that everyone who can pay, is paying into. The best you can do, is make donations later, to that fund - because you don't even get the bill. Which is to say that you get billed, but that is for the actual bed cost and sometimes for tests they have to run.

I have been in ERs a lot. I have been there when I was injured or seriously ill on my own. I have been there when I have been injured on the job. I have been there when my eldest had a temp of 104.3 and rising when he managed to get the damned thermometer out of his mouth (at eleven thirty pm - almost two am). I have been there when he gashed his head - I wasn't home when he gashed his leg. Something I have noted - the ER is pretty much always crowded - though thankfully, when we were there in the middle of the night with a high fever, we were in a children's ER waiting area that was quiet. And they aren't full with people who have serious emergencies, few enough with even urgent care needs. They are full with people who are sick or injured, who if they had a doctor, if they had insurance, could see their primary care provider. But they don't have those things and are thus relegated to the only provider they can get - the ER.

And most of them are in one of two positions - they make little enough, that they qualify for one of those programs I was talking about, or they make a little too much and just won't be able to pay for any of it. I have been in both categories and I have sometimes been able to pay some - mostly I have come to accept that for the time being, I am going to have horrible credit. But that is besides the point - the bottom line is that those who can afford to pay, are paying for those visits. Taxpayers are also paying for those visits. And to make this a really big "what the fuck?!?!" Many of those people have fucking health insurance - they just don't have enough - don't have enough to cover five hundred dollar annual deductibles. Don't have enough to cover half the cost of the primary care physician visit. Don't have enough to cover the cost of the script the doc will write them and know the hospital pharmacy will fill it for free.

I am that strange sort of introvert - the kind who is capable of sitting down and having a conversation with a whole lot of different sorts of people - as long as the conversation is only with one or two other people...I have talked to a lot of people in ERs and there are all sorts there. Including people like Beatrix, from a couple of posts ago - people with preexisting conditions, who simply can't buy insurance, can't, because no one will sell them any, at any cost. Some of them can pay their bills - at least over time, many of them can't - many of them are just giving up and going on disability, because that is the only way they can actually get healthcare. It's not that they flat out can't work - it's that if they do, they lose their medicaid. So they end up living in poverty, at taxpayer expense - when they could actually work, if someone would let them and not take away their healthcare.

Our current government is about as disgusting as can be. Unlike the other republicrats, they were hired in part, because Americans want publicly funded healthcare options. 60% of republicans polled, want UHC. Substantially more democrats want UHC. And we have a democrat majority - virtually a supermajority. So what the fuck is going on? As Stephanie mentions, the only motherfuckers who don't want public options, are the insurance lobby, the corporate media and the fucking assholes we hired to bring us fucking healthcare...

I haven't said anything about health care for a reason...

If I were to express my feelings, the language use would be offensive even to my fucking standards. Thankfully, there are others who are able to express their feelings about this better than I would. And here is just one of the many people denied health insurance for preexisting conditions. Here is one of those "irresponsible" people who many would have you believe just doesn't deserve access to health care.

(Stephanie has an especial lot of posts and links)



As Greg puts it, makes me want to go out and slug the first motherfucker who goes on a tare about universal health care.

Seriously, these Damned Canadians!!!1!11!!!1!

Apparently get up more than a little fucking early (that, and I slept late today). So yes, my friend* Jason was proposed to online, through several blogs, by Jodi - who was until quite recently his girlfriend. Part of me was holding out hope that, in spite of neither of us being particularly gay, he might marry me so I could get access to that Canuck healthcare - but I suppose I can go off and befriend some other Canadian now...

Seriously though, congratulations Jason and Jodi and thank you for making me a small part of your odyssey march toward pre-marital bliss...

*In spite of him being one of those. You know, a Canadian.

STOP!! Vote for Shelley Batts

The amazing, remarkable Shelley Batts (ok, a little thick, but Ed's threatening painful death, so it could be worse) who wrote the great piece on the neuroscience of ADHD, that I loved so much, is in the running for a scholarship to help with her PHD. So click here, even if you don't actually take the time to go to her blog, click the dot next to the name Shelley Batts and click on vote. Seriously, she's a poor grad student with a hungry parrot to feed. If you're even questioning whether or not to even care, please, click over to her blog. Look at that sweet, hungry parrot (probably not actually hungry, I imagine if given the choice between her and the bird, the bird would eat, but still, Shelley rocks)

Sorry for the creative tags. The more searches the better. If you got here through a search, Vote For Shelley, it's worth it. Then come back and read some of the pieces, they're worth it too, some of them anyways.

The US: a nice place to live, but don't get sick

I would like to thank Revere, of Effect Measure, for his open willingness to share his posts per the creative commons licensing, share and share alike. I have chosen to add this license to the writing here as well, the tag can be found in the side bar.

I really appreciate Revere's writings on public health issues. As such, I thought it would be very appropriate to use a post he wrote about the state of health care in the U.S. to get the conversation about universal health care started. I will be adding posts from others on this topic, both pro and con, in the future, along (of course) with my own thoughts. This post was originally posted to Effect Measure, June 19th 2007. . .

From Effect Measure;
The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

It's a myth that's hard to bust. The one that says the United States, the country that spends more on health care than any other, has the best medical care in the world to go with it. It hasn't been true for a long time. It doesn't. But it is part of the core belief of most Americans. I wonder who benefits most from that falsehood? But to the facts:

As early as 2000, the World Health Organization made the first attempt at ranking all the world's healthcare systems. The U.S. came in 37th out of 190 nations in the provision of healthcare. (France, according to the June 2000 report, was first.) The report was criticized for using inconsistent comparison measures and for failing to note that some countries deny expensive care to very sick patients. Americans could still reasonably cling to their long-held pride.

But in 2006, the Organization for Economic Cooperation and Development, an international organization that aims to lift living standards by promoting economic development, compared health spending and health statistics in its 30 member nations. Its report was more detailed than the WHO rankings, and had more controlled and consistent measures. The data, taken more seriously than the WHO rankings, left Americans with little to brag about.

And [NIH's Dr. Ezekial Emanuel's] recent commentary [in the Journal of the American Medical Association] was published the day after another report released by the Commonwealth Fund, which supports independent research into healthcare issues, found the United States at the bottom among six industrialized nations on measures of safe and coordinated care.

If all of that doesn't seem damning enough, insurance provider UnitedHealthcare Group took out a full-page ad in the Wall Street Journal on March 19 declaring: "The health care system isn't healthy.... A system that was designed to make you feel better often just makes things worse." One of the very industry giants that critics point to as a cause of the problem was defensively pointing back.

Amid stacks of reports, all with wonky measures of access, equity, efficiency and medical outcomes, two statistics stand out. The U.S. spends more on medical care than any other nation, and gets far less for it than many countries. According to the 2006 analysis by the Organization for Economic Cooperation and Development, the U.S. spends an annual $6,102 per person -- more than any other country and more than twice the average of $2,571. Yet Americans have the 22nd highest life expectancy among those nations at 77.2 years compared with the analysis' average of 77.8 years. People in Japan, the world leader in longevity, live an average of 81.8 years.

The report also found that the United States had about 2.5 times the average years of potential life lost due to diabetes: 101 years per 1,000 people compared with the average of 39 years per 1,000 people. Americans had fewer practicing physicians, or 2.4 per 1,000 people, than the average of 3 per 1,000 people. Infant mortality rates have been falling in the U.S., but are still higher, at 6.9 deaths per 1,000 live births, compared with less than 3.5 deaths per 1,000 live births in Japan, Iceland, Sweden, Norway and Finland. (LA Times)

When Andrew Speaker used subterfuge to fly back to the US for treatment of his XDR-TB an Denver's National Jewish Hospital it was not only to get home to his family but because he believed the care in the US was better than anywhere else. In fact, Italy has the second best health care system by the international comparison rankings and some of the best TB experts in the world. You probably didn't know that. Number 1? France. I'll bet you didn't know that either. You can quibble about the ranking method (if you can claim some expertise), but the only thing everyone agrees the US comes out on top for is cost. Cadillac prices for a high mileage junk car.

When I was in medical school the prestige specialties were internal medicine and psychiatry. That's what the brainy students chose. Not any more. Why? Because you don't get to do "procedures" in those specialties. Doctors get paid for "procedures." Handsomely paid, I might add. Managing chronic disease? Sorry. No procedures.

For starters, the American system doesn't measure up worldwide in controlling chronic diseases, such as diabetes or hypertension. Payment systems reward doctors for doing procedures, not for managing those chronic conditions, so a world-class center -- like Boston's Joslin Diabetes Center, which is supported by philanthropy -- stands in stark contrast to results seen by regular doctors treating the disease in average patients.

Kidney disease patients on dialysis have a higher risk of death in the United States. By an act of Congress in 1972, all end-stage renal disease is covered by Medicare, even for patients younger than 65. But because of Medicare funding cuts, patients on dialysis receive less time on dialysis than patients in Europe and Japan. That helps explain why Americans on kidney dialysis have a mortality rate of 23% compared with 15% in Europe and 9% in Japan, according to a May 2002 report in JAMA.

The US, alone among the industrialized nations, has no universal health care. Let me correct this. The average US citizen doesn't. Members of Congress already have their health plan. Even the CongressThings so adamantly opposed to "socialized medicine" are not giving up their government health plans. They'd rather hold the average American hostage to their ideological pecadillos.

Meanwhile, those of us who can afford to, pay. And pay. And pay. But we don't get our money's worth.

And those who can't afford it? You supply the answer.