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In Good Hands?

08 Mar

gecko

Everyone has a medical insurance horror story. They may differ in what end of the beast one has wrestled; (getting insurance, updating insurance, filing a claim, disputing a claim, etc.) but the blood boiling frustration is the same. It is the rare insurance experience that is summarized with; “Oh how I enjoy working with my particular carrier. I pay them and they make my life easier when I’m most vulnerable and provide much needed access to care.” It is much more likely the case that hours (if not days) have been lost trying to get answers and coverage. In the most heinous cases, professionals need to be hired to force insurance companies to pay for coverage.

Medical insurance companies are in the catbird seat. They don’t need to advertise they only need to lobby. Most coverage does not happen through individual purchases. Coverage is purchased in bulk through employers. In this way they differ greatly from automobile insurance. Which is one reason you don’t see an animate gecko or (wee wee wee) pig selling medical insurance. You’ll never see an advert of a medical emergency in which a wise soothing man with a voice like Barry White comes to the rescue. Medical insurance doesn’t need to promise (or deliver) anything except the belief that we need it to survive. And we do believe that. We have made considerable efforts to expand coverage to individuals including dependents well into adulthood. We are now moving towards insuring everyone regardless of employee plans. Somewhere along the way we’ve equated insurance with healthcare.

Insurance companies do not make money by providing healthcare. However they do increase the cost of healthcare by their very existence. There is a complex economy that exists between healthcare and insurance companies. Medical practitioners need to charge more to support the additional staff needed to process claims. Expensive tests are casually ordered if they are ‘covered.’ Insurance companies negotiate discounted reimbursement rates for pharmaceuticals and medical care, which in turn drives up the cost for the uninsured, which feeds into the notion that medical insurance is necessary.

Would it be such a radical notion to abolish medical insurance? We did not always have insurance in this country. In fact historically speaking it’s a relatively new concept. True our medical advances are quite expensive and need to be paid for in some way. We live longer now, partly due to medical interventions that cost money. But how much money does it cost to support the medical insurance beast? How much time is lost in productivity of employees pursuing claims? How many staff of every company offering medical insurance is needed to wrangle the companies and attempt to explain the plans to employees? How many medical offices could dramatically lower the price of an office visit by dropping medical insurance? But what would become of the medical insurance staff? Well the doctors and nurses whose job it is to review (aka deny) treatment for people they have never met will do just fine. Everyone else on staff has an equally transferable skill; there are no typesetters or farriers to retrain.

There is something inherently problematic with a (highly) profitable product that positions itself as non-negotiable but with which we have zero consumer input or control. What we actually need is not an inflated labyrinth payment method but healthcare. High quality, easily accessible, holistic healthcare is what is needed. What is needed is healthcare that focuses on preventative care throughout a lifetime. Adding a layer for payment processing which often gets in the way of care is not what is needed. Heralding a product whose very raison d’être is to make money not to provide care, as a panacea is not what is needed.

 
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Posted by on March 8, 2013 in Cultural Critique

 

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Making Babies

23 Feb

louise

Procreation has changed an awful lot in the past few decades. Do you remember Louise Brown? She was the very first ‘test tube’ baby (aka known as the result of the first successful in vitro fertilization.) Her mother’s story (splattered on every British tabloid) was an international shock. Would the child be normal? Should we be making people in a laboratory? Were eugenics far behind? What kind of person goes to such sci-fi lengths to replicate themselves? Even the Pope weighted in. Well, little Louise is 34 years old now and my have times changed. Medical advances have redefined not just how we make babies but when mothers can be made as well.

Thirty plus years ago a pregnant woman over the age of 35 raised eyebrows. The elevated eyebrows were less about impropriety and more about biology. “Geriatric pregnancy” is an actual medical term and has nothing to do with walkers or graying hair. The human body is designed to be at peak fertility and health before age 35. Specific gestational and delivery risks are more probable after this age. Medical advances have made it safer (through early detection methods) for older women to carry and deliver, but the risks still exist. Historically women over 40 have had children, often quite by surprise. It is not unusual for a woman to develop a (false) sense of infertility security at the start of menopause. But it is only in the last decade or so that women over 40, trying to become pregnant has become normative. It was as recent as 1995 that (actress) Jane Seymour made magazine covers and evoked national gasps by becoming pregnant (with twins) at 44. Public judgments were made about her vanity and sense of entitlement. “She’ll be over 60 when they graduate!” It’s rather unlikely that today such an endeavor would warrant mention let alone prompt a national discussion.

Celebrities (and regular folk) routinely become parents at an older age; often through elaborate intervention. A woman can use her eggs (if they are viable) or a donor’s eggs. She can use her own or someone else’s uterus. Sperm is easily and equally transferable. There are many means and methods of now creating people. It’s hard to imagine that any new configurations could possibly be discovered/invented. All of this progress brings its own host of issues. Medical ethicists must smack their lips and rub their hands together every time a surrogate is hired. What does it mean to create a population who may never know to whom they’re related? Will children grow up and marry their siblings? What does it mean when the eggs of a woman with cancer are frozen for future use? Do doctors have a medical (and ethical) imperative to determine any genetic component to her cancer before fertilizing the eggs? And while we have the ethicists in the room: should health insurance cover fertility expenses? Is replicating one’s genes and/or having a birth experience, medically necessary? If not, are only the wealthy then entitled to these means to parenthood?

And what of other means to parenthood? What is the (current state and) future of adoption? International adoption has become a bit trendy as a few celebrities publicize their children’s origins. But limits to these adoptions are imposed everyday. What of domestic adoptions? There was a time that celebrities regularly and publicly adopted locally out of need. Fertility, contractual obligations, marital status or state of marriage necessitated adoption. If celebrities are adopting domestically today they’re doing it quietly behind closed doors (as the surrogate signs over her rights.) There will never be a shortage in this country of children needing parents. Accidents happen, death happens, life happens; and children are left in precarious situations.

There is no one way or even right way to make a family. In fact often it’s the messiest and most complicated households that are the richest. However as we make these incredible medical advances in maternity let us not lose sight of what we want parenthood to be. Nurturing and guiding a human being is an incredibly rewarding endeavor. Giving a child solid roots and the freedom to fly is the greatest of gifts. How that child arrives into your home and life is immaterial.

 
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Posted by on February 23, 2013 in Childhood, Cultural Critique

 

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A Health Care Reformation Proclamation

31 Jan

doctor

Medical Insurance (or as it’s less accurately known; health insurance) is on its way to reformation. It’s not clear if the results of the reform will render the; coverage, procedures and rights of the users any more decipherable than they are right now. But what is clear is that the more something is examined the more flaws are brought to light.

We can all probably agree that good medical care should be available to all. Whether insurance is the means to that end is highly questionable. But we seem to be stuck with that particular paradigm. Anyone who has ever sought treatment, payment or reimbursement would probably be happy to swear on a big towering stack of bibles that insurance companies seem to be in the business of making money not providing good healthcare. But as we established; we are stuck with this paradigm. In the interest of making lemonade out of the soul crushing demoralizing oligarchy of the paradigm, let’s consider how government involvement might improve things. (There will be no rolling of the eyes.)

The most obvious improvement will be filling gaps in the current usage of medical care. Insured people are presumably less likely to use emergency rooms as their general practitioner. This is good for both continuity of care and preventive efforts. It is also an enormous cost savings. Insured people are more likely to visit doctors before a condition become acute. They are also more likely to take the full dosage of their prescribed (co-pay) medicines, when not compelled to ration. In theory medical insurance for all will lead to medical care for all. Whether it’s ‘good’ medical care is another issue altogether (that was less of an eye roll and more of a ‘whatever’.)

Where things potentially get exciting and sane is the possibility of payment parity. Currently medical insurance is sold in two sizes; individual and family. The individual plan is discreet and self-explanatory. The family-size is an unlimited free for all. There is nothing equitable about this framework. A two-person family is paying the same rate as a ten person family. A parent with one child is in essence subsidizing larger families. Two options of coverage (individual and family) only benefits large families (and no doubt insurance companies.) There is no other insurance plan (of which I’m aware) that operates this way. You don’t buy homeowner insurance for either one home or an unlimited amount of homes. You don’t purchase auto or life insurance in this manner either. You purchase insurance plans for each entity that needs coverage.

I would like to think that as the thinkologists are drawing up this new way of doing medical care business, they will take note of this inequity. (Can’t really see my eye rolling behind these rose colored glasses, can you?) Perhaps when all people (not covered by employers) have to purchase insurance they will balk at the two sizes fits all framework. People probably don’t spend a lot of time scrutinizing each pay-stub and considering their pre-tax contributions. But it’s hard to ignore being overcharged when you are writing the check.

Sometime during the last four decades or so we’ve convinced ourselves that medical insurance is mandatory and good. It is not a coincidence that healthcare costs have skyrocketed as we succumbed to this thinking. There are too many bad medical practices and less than good doctors hiding behind insurance. There is far too much money and time spent trying to keep costs down versus caring for people. Good care that focuses on what’s best for the patient is what we need. We’re on our way to medical insurance for all. Now how about some actual health care reform?

 
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Posted by on January 31, 2013 in Cultural Critique

 

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