Monday, September 28, 2009

Health Care- Personal and Universal

So, I'm still pregnant. My due date is Wednesday. I've been having "pre-labor" symptoms for almost two weeks now, including four nights during which I actually started timing the contractions. So, a lot of lost sleep (why do the contractions always come at night?) but no baby. At my last doctor's appointment (last Friday), I had made progress and was told birth could come any day now. Saturday night, I had almost three hours of moderate contractions at roughly 10-15 minutes apart. I got all excited, and ruined Hubby's sleep, too. Then they just stopped, and I went to sleep for a few hours. Then they started again, and then they stopped again.

Anyway, I don't really want to talk about it. I'm tired of starting all my phone calls/emails with "I'm still pregnant!" or "No, I'm not in labor." I want to talk about health care instead. (Here is my earlier rant on the subject).

One of the things I've been doing to help pass the time while I wait for this baby to be born is read magazines. Somehow, concentrating on a magazine article is easier than concentrating on a book. My parents brought over some old magazines for me to read. One of them was a Newsweek with an article called "No Country for Sick Men", by T.R. Reid. It makes an interesting point- a nation's health care system says something about its character. The American mythology includes the rugged individualist and the self-made rags-to-riches man, so perhaps it is not surprising that we emphasis personal choice and responsibility so much in our health care system.

It also gave me a little more understanding into one of the aspects of the debate that has been most difficult for me to grasp. To me, and many other left-leaning types, health care is a universal right. I consider the large number of un- and underinsured people a symptom of a moral failing in our country.

As I read and try to understand the point of view of people opposed to the proposed reforms, I have been puzzled by the belief of many more conservative people that health care is not a right, but a privilege. (One good, and non-combative place, to get a feel for this point of view is this guest post from Loralee's husband on her blog.) I could not figure this out. Isn't the right to life one of the most fundamental rights? Doesn't lack of access to adequate health care impinge upon this right? I've posted these questions on a couple of the more thoughtful conservative posts opposing health care reform, and never really gotten an answer. I also have never received a satisfactory answer to the question of what to do about emergency care- currently, emergency rooms have to provide care to anyone who needs it, whether they can pay or not. We all pay for the care for those who are unable to pay for it themselves. This is an expensive way to pay for care, some of which could be handled in a doctor's office if the patient had access to one, and some of which could be avoided altogether with good treatment of chronic diseases like asthma and diabetes.

But perhaps the Newsweek article explains it, at least partially. To me, providing health care to everyone is a moral imperative. To opponents of universal health care, it is a moral hazard, creating a system in which people can shirk their responsibility for their own health- and if you won't take care of your own health, what does that say about your approach to other responsibilities? I guess that forcing someone to go to emergency rooms, with their long waits and stressful conditions, for all his care does send a message that he has somehow failed in his responsibilities.

I don't agree at all with this viewpoint, and I am hoping that my country decides that providing health care to all is a moral imperative, not a moral hazard. But perhaps I can understand one of the opposing viewpoints a bit better now. I still can't really reconcile the moral hazard idea with the rabid opposition from the same people to a mandate requiring people to take responsibility for their health care and purchase insurance. This is usually painted as an attack on personal freedom- but why should someone be free to force me to pay for his/her emergency room treatment? As far as I know, no one has argued that we should turn people away from emergency rooms if they cannot pay.

So I guess I still cannot understand the viewpoint of the opponents of health care reform. I suspect they are just as baffled by my viewpoint. What a shame that we have not taken this opportunity to have a thoughtful debate on real issues, and instead are shouting at each other. Maybe if we all tried a little harder to understand the concerns of the other side, we could find a solution that really would reflect our nation's character.


  1. Note: I am Canadian so I've just got an outsider's perspective on this whole issue.
    One thing I'm finding interesting is the idea of being responsible for your own health = purchasing insurance. I would equate being responsible for your health to preventive medicine - annual check-ups, following doctor's advice, going to see the doctor if something doesn't feel right, calling tele-health before going to the emergency room if you aren't sure (in Canada we've got this awesome service - you phone and talk with a nurse and they will talk you through whether you should go to emerg or wait till the next morning - I've used it several times for me & my daughter and it has been awesome - and saved us 3 middle of the night trips to emergency). It seems like there is a big worry that people would abuse a public system by making tons of unnecessary trips to the doctor's office, or demanding expensive tests or drugs. I probably make more trips to the doctor than I would if I had to pay $20 out of my own pocket every time - but I figure I'm saving the system money by going to see my doctor if I'm concerned about something, and going to annual check-ups, instead of simply showing up in the emergency room in the middle of the night because I've been ignoring something and hoping it would go away. I don't abuse the priviledge of going to see the doctor for free - it is still a trip to the doctor - you have to take time off work, sit around in a waiting room for ages, have someone poke at you and ask embarrassing questions - it isn't fun! I mean, sure you'll have more trips to see family doctors than you might otherwise...but this isn't something people do for entertainment!

    I suspect that a system where trips to your family doctor were free would make everyone healthier. And even then you'd have people like my husband who will only go if he's so sick he can't actually get out of bed.

  2. Today Wendy- my health care group has a nurse line, too. I love it. I never used it before I was pregnant with Pumpkin. I used it a couple times while pregnant, and then more times than I care to count once Pumpkin came!

    I, too, tend to think of "responsibility for health" in terms of taking steps to be healthy. I"m trying to understand the other side's view, but not really getting there.

  3. Baffled. That is the exact right word.

    I tried talking to my inlaws about it, because their political views are so different from mine on everything. They said that having a socialist healthcare system would mean that the good doctors will go elsewhere. Their example is that Canadians come to the US to get good treatment because the system doesn't work up there. I just can't believe that and don't know how to respond.

  4. Caramama - The way I understand it is that you can have a hard time making money as a family doctor in Canada. There is a set rate they are allowed to charge for a standard appointment, and apparently if you work 9-5 and don't do any overbooking, you'll only wind up making $40k/year - which isn't much when you consider how much time and money you spend on med school. Specialists of course can make a lot more money, but the government sets the rates that doctors are allowed to charge for their services, and so there is an upper limit to the amount of money they can earn.

    One of the problems we have in Canada is waiting lists - my mom recently have her hip replaced, and she spent quite a while on the waiting list to get the operation done. She could have travelled to the US and paid for it to be done immediately, but that is just not an option here. Everyone is stuck with the same service, and if there's a waiting list, you have to get on it. On the flip side...everyone who needs a hip replacement can get one. The system isn't perfect. You can definitely wind up in a situation where you would be better off if you could just throw money at the problem and pay to have treatment immediately. But most of the time, and for most people it works really well.

    I think the biggest problem right now is inertia. There are lots of things that could be done to fix problems in both US and Canada - but there's a huge resistance to change, I think it is just because people are afraid of losing what they have. Fear of loss is a much bigger motivator than acquiring something new. And healthcare is so susceptible to emotional arguing.

  5. I am also fairly left-leaning, so I do have that bias. But talking to many conservatives (including my parents) the driving force on the right seems to be fear. Part of it is generic "change is scary" stuff, and it is true that nobody can guarantee that the stuff they're scared of won't come to pass (waiting lists, doctor shortages, bureaucratic problems, ...). When you're scared, keeping the status quo often seems best.

    But a lot of it also seems to come down to the fact that the people on the right who are making most of the arguments already HAVE good health care, and they're scared that their lives are going to get worse under national health care. It's easy to get fantastic health care in this country if you have good insurance -- you don't care how much it costs, and you don't have all those pesky poor people taking up your doctor's time and using up other scarce resources.

    I'm not normally one to promote politics of fear, but it seems to me that the only way to convince people that we need change is to make them a little bit scared of the status quo. Talk about the ballooning deficit from NOT providing universal coverage, costs going up for everyone, employers not being able to afford to pay for coverage, medicare and medicaid going broke from rising prices, .....


Sorry for the CAPTCHA, folks. The spammers were stealing too much of my time.