The Scope of the Problem: Issues in Healthcare

Some Perspective

Preserving physical well-being is as basic as it gets. Our nation manages to organize military and police forces, a Food and Drug Administration, fire safety and building codes. Yet health care coverage for U.S. citizens is optional.

You don't have to be Karl Marx to recognize that a purely capitalist state would no longer be a democracy. It would be rule by the rich. Democracy is healthiest when it's a blend of market driven goods and services and government supported programs that address critical areas involving the health and safety of its citizens.

Europe and Canada have "single payer" systems. One entity - the national government - acts as the administrator and payer of claims. I don't know whether this is the answer for America, but tend to think that some form of it may be. Wihtout a doubt I know that our deregulated, corporate-dominated system that excludes millions from coverage and penalizes sick people for being sick much the way that auto insurance penalizes high risk drivers, is unjust, inhumane, and unworthy of us as a nation.

Specific Issues in Healthcare

What follows is a listing of problems connected to our present system of health care. I'm sure that I have missed many; these are off the top of my head. Some I have directly experienced. Others I am aware of as someone who can't help but notice when the well being of others is similarly jeopardized by those who are managing their wealth care far better than our health care.

The uninsured
The underinsured - those who can afford only catastrophic plans and, like the uninsured, forego regular check ups and timely care
Denial of recommended treatment and services for persons whose continuing treatments restrain corporate profit margins: the chronically ill, the disabled, and the severely mentally ill
Declining employer-sponsored coverage because small businesses can't afford to offer health insurance
Children without health care coverage
Lack of coverage or minimal coverage for mental health care
Racial/ethnic disparities in access to health care coverage
The cost of prescription drugs and the excessive spending by drug companies on marketing over research
The influence of drug companies on scientific research into the safety and effectiveness of drugs. By granting research funds to universities, they exert influence to suppress unfavorable findings on drugs with high profit potential.
Foreshortened hospital stays that put patients at unnecessary risk
An appeals process powerfully weighted in favor of insurance companies when coverage is denied. Consider, for example, the language below from my insurance policy when I resided in NH. It allowed my HMO to respond to my doctors' objections with brief form-letters that disregarded their concerns:

"The fact that a physician may prescribe, order, recommend, or approve a service or treatment is not sufficient for such service or treatment to be considered medically necessary by the Medical Director."

I strongly suspect this is standard industry language. I found that my next policy under a different corporation contained a virtually identical paragraph. Why is this legal? Because the legislation has been bought and paid for.
Same goes for the ubiquitous exclusion of coverage for "preexisting conditions." Americans have come to accept as normal the idea that we can be denied health care on account of being sick.
The devastating financial burden on the chronically ill of rising premiums, copays, and the lack of any cumulative tax break for expenses not quite high enough to consistently take the medical deduction, but which go on year after year
The reluctance of doctors to prescribe pain medication in medically appropriate circumstances and the difficulty or impossibility of obtaining it for frail patients who are either housebound or severely burdened by the necessity of making outpatient visits to receive medication
The denial of all physician services to housebound persons who are not senior citizens and do not have active Medicare coverage, at least in Delaware County, PA
The two-year waiting period for Medicare benefits for disabled non senior citizens, no matter how severely disabled or progressive the disease or poor the prognosis
The lack of coordination of care in the diagnosis/treatment of outpatients with complex or rare conditions. We get the same ten minutes as everyone else even though we arrive with 150 pages of medical records. We find ourselves shunted around from one specialist to another for literally years on end, indefinitely, with little to no consultation among them. The doctors are busy with insurance paperwork and seeing a sufficiently large number of patients to satisfy the plans in which they participate.