Whose health is it anyway?


A paramedic takes blood from a patient in a Miami hospital's emergency department. Critics say frequent use of hospital emergency rooms for minor health problems impede care of the critically injured and are driving up the costs of US health care.



FALMOUTH, Mass. — My doctor looked at me sympathetically, but shook her head. I was complaining that my insurance provider was denying coverage of a prescription medication because it was “too expensive.”

“Isn’t that why I am paying over $900 a month for insurance?” I sputtered. My doctor thought I needed the medication, I thought I needed the medication, but my provider, who had never seen me, had decided otherwise.

“Insurance companies exist to maximize profits,” she said. “I know people would like to think they have some other purpose, but really, it is just to make money.”

One of the biggest shocks for me when I returned to the United States after more than two decades away was the dismal state of health care. Like many, I had swallowed the mantra that the United States was simply the best in the field. We are Americans, after all.

Now, with just a little digging, I find that the United States is the only industrialized country without universal health care; that it spends more on health care per capita than any other developed country, but is ranked 37th out of 191 nations by the World Health Organization; that life expectancy here is lower than in Cuba, and just a bit ahead of Slovenia.

I think I’m getting a headache.

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Health care will be one of the central issues of the presidential elections, with two men who have passed similar health-care bills arguing over what constitutes socialized medicine, how involved the government can and should be in our health-care choices, and, apparently, whether we should be forced to eat broccoli.

If it sounds confusing, it is.

I grew up in a family of medical professionals, and had never questioned the United States’ pre-eminence in health care. My parents had excellent insurance, and I assumed that just about everyone did. I was young and healthy, and seldom availed myself of any medical services, but I never doubted that I would be taken care of if disaster struck.

Then I switched jobs, lost coverage, and, with my address in Afghanistan, was unable to obtain a private policy. One employer provided medical evacuation insurance, but that just made things worse. In my more nervous moments I prayed to whatever deity was listening.

“If I step on a landmine, or get shot, please don’t let then send me to the United States,” I would plead. “Can’t I pass for Canadian?”

Once safely back on US soil, I had to choose a provider, which is a nightmare in itself. So many variables, so many options.

But living in Massachusetts, I had no choice. It’s the law — thanks to a former governor who passed the measure some six years ago. His name is Mitt Romney, perhaps you’ve heard of him?

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The good news — I would be insured, despite a small, non-life-threatening preexisting condition.

The bad news: it was going to bankrupt me.

Over the past year I have heard horror stories from all over the United States, of friends and acquaintances in various circumstances who simply cannot afford – or cannot obtain – health insurance.

A friend of mine has hemochromatosis – for those of you who do not watch “Gregory House, M.D.” I will explain – it is a disease in which too much iron is absorbed into the bloodstream. It can result in an enlarged heart and damaged liver, and it is, emphatically, not a good thing. The treatment involves having blood removed from the body regularly. For the lucky people with good insurance, this is not too traumatic; the blood is put through a filter, the excess iron is removed, and the blood goes back into the body.

But my friend was temporarily uninsured; he had lost his job, was trying to write a book, and simply could not afford the premiums. In Massachusetts, this made him a scofflaw, which gave him another thing to worry about.

So he devised an ingenious method of dealing with his disease: he went around to various blood donor clinics and gave a pint at each one.

“They’ll have to throw it away once they test it,” he said. “But at least I won’t die any time soon.”

Unless it’s from blood loss.

Rick Santorum called Obamacare “the beginning of the end of freedom in America.” But try as I might, I do not know what he is talking about. My concept of “freedom” does not include the inability to pay for health insurance, the difficulty of obtaining coverage if you have a pre-existing condition, and the near impossibility of forcing the insurance industry into responsible actions.

A few years ago I was in London and had left a small bag on the Eurostar train that brought me from Paris. I was in a panic — the bag contained my prescription medication. I was thousands of miles from home, and did not know what to do. A British friend simply called the National Health office, signed me up for a doctor’s visit, and within an hour I had a new prescription, for free. This is the Big Bad Bogeyman of socialized medicine, it appears — universal care, at minimal cost.

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“We can’t have you grinding slowly to a halt, now, can we?” said the genial physician who saw me. He paused and then added, “You’re American, aren’t you? And I cannot charge you for services. But you know, if I had a problem in the United States, it would cost me a fortune to get it resolved.”

I had to agree.

Over the past year, I have struggled to understand the debate over health care. Is our system “broken,” as so many experts have alleged? Or are we still the best, as the apologists would have it? One health policy wonk, writing in the Los Angeles Times, reassured us that the US system was fine. Our miserable standings on life expectancy are not due to any failings in health care, he said soothingly, it’s just that we have so many gunshot victims.

Oh, well, that makes me feel a lot better.

I do not really know all the ins and outs of the issue — nobody does, as far as I can tell. But the people we rely on for guidance are, in some cases, just as much in the dark as we are.

Last month I had a persistent sore throat, and was worried I might have a strep infection. I called my doctor. The receptionist told me in a bored voice that someone — not my primary care physician — could see me in August.

“August?” I squeaked. “But I am ill! What should I do?”

“Go to the Emergency Room,” she replied indifferently.

Hold on, now — isn’t ER abuse what is driving up costs, impeding care of the critically injured, and, in general, contributing to the degradation of American health care? That, at least, is what I’ve read.

So I took some NyQuil, slept for a few days, and eventually felt better. No ER visit, no doctor’s bills.

And all this for only $900 a month. I don’t know whether or not the system is broken. But I sure am broke.