Thursday, September 12, 2013

Health care reform needs tough love

'Saw several patients recently with, uh, lifestyle-induced critical illnesses (aka "crackycardia"). Two were young, able bodied males using recreational drugs. Another was older and severely ill, paying the price for a lifetime of hard living and cocaine abuse. One patient had a quick recovery, and during the brief remainder of her ICU stay, ran my coworker like a waitress. 

The lunch tray wasn't enough, and neither was the extra sandwich, ice cream, crackers, peanut butter, or soda . . . can I get some more? Oh, and I'm out of ice.

Another patient's physique was the picture of youth and fitness. But, thanks to a vision problem in one eye, this strapping young fella was classified as disabled, and medicare (i.e. you and I) insured his pricey hospital visit. 

Aren't you glad we have government funded health care to rescue these poor people from their bad decisions? Your patient didn't care enough about herself to trim her 2 inch toenails, but here she is in the ICU for a week. I do believe there is a moral obligation to treat all people charitably. I also believe we have an obligation to spend our limited resources wisely. A $2,000 per night vacation to the critical care unit should not be the only option in caring for persons who are not health-conscious. Mother Teresa didn't need ventilators and dialysis machines to give dignity to the sick.

Meanwhile, on my employer's private plan, Ryan and I have to do some legwork to cut our personal costs. My employer implemented a program whereby our insurance fees are lowered if we take steps to improve our health. Doing things like meeting with a health coach, exercising, keeping your lipids and cholesterol low, quitting smoking, and managing your blood pressure give you points which translate into cash-back or reduced fees for this insurance plan.

At first I hated the idea. I thought working for the organization was enough to earn its insurance benefits without jumping through all these extra hoops. You know what? I still don't like it. However, I realize that it is ridiculously expensive to insure people. With this new program, at least I have some control over my health care costs. My employer could have said, "We can't afford the current system. You have to pay an extra $200 each month towards your plan. Deal with it." But they gave us a way out.

I have not made much headway into reading the behemoth document known as the Affordable Care Act. But, from sources more familiar with it than I, I have not heard about the law giving strong incentives for persons to be accountable for their own health.

In fact, I wonder if the law encourages the opposite. The big selling point for Obamacare is that insurance companies can no longer deny coverage for pre-existing conditions. On the surface, this reform sounds like the right and humane way to do business. Sick people need coverage the most, right? I also recall a healthy relative of mine whose attempts to get insurance amounted to a huge pain in the butt. Despite being a young non-smoker and non-diabetic, her application was stalled on account of a minor knee injury that did not require surgery or medication. 

And yet, looking at the big picture tells us a different story. Take a peek around Many of the biggest killers in America are preventable diseases. Very often heart disease, diabetes, strokes, lung cancers, COPD, hypertension, and liver disease are not spontaneous afflictions but the results of poor health choices. Americans choose to smoke, we choose to eat poorly, we choose to drink too much, and we choose to be sedentary. And we want insurance to pay for all the inevitable consequences because we presume insurance companies have bottomless pockets.

If you have a horrible, reckless driving record, you aren't surprised when car insurance companies demand you pay a hefty premium. And even then, you really only expect them to pay out when major, accidental damage occurs. You cover ordinary repairs and oil changes yourself. Last I checked, the sustainability of automobile insurance was not a national crisis. How has health care become so much more complicated?

I don't mean to downplay the severe financial stress that illness and insurance issues put on even responsible Americans. Health care has been in major need of reform for a long time. But we have to weed out the gimme-pigs first, and I don't see that happening.


  1. Amen!

    Our health insurance makes us have a physical each year and quarterly or so I get a phone call from a nurse who grills me on what I'm doing to keep healthy makes me set goals and calls me on them when I haven't achieved them. (In a nice way). I cringe when I see she's phoning - but in the long run I do get sort of a push.