The Debate On Health Care: Let's Start With Some Basic Questions

Things are getting ugly out there.

The debate on health care and health insurance is spawning some really nasty behavior by those opposed to changes in the status quo, according to news reports that are coming fast and furiously via newspaper, television, the Internet and email. The congressional recess is providing time for legislators to return to their home districts and hold town hall meetings on the topic, but some gatherings are turning into vicious attacks on congresspersons who want to make changes.

My head is spinning with all the debate.

Just today, my local newspaper devoted about two-thirds of its editorial section to opinion pieces on the health care debate and rightly so. It’s a hugely important issue and you won’t find too many people who are not passionate about it – especially nurses. Those in the trenches must deal daily with the heartbreak and frustration that comes with making care decisions based on patients’ health care coverage or lack thereof.

I spoke recently to a woman who was halfway through her chemotherapy when her insurance company pulled her coverage. The company claims she knew she had breast cancer when she enrolled – despite physicians’ letters stating otherwise. But the insurance company is wealthier and more powerful, so too bad for her.

The House and Senate will be back in session soon to further haggle over the 1,000-plus page document that contains all the minutiae of the proposed health care bill, but our representatives are failing to grapple with some important basic (and scary) questions that should be answered first:

• Is medical care a right or a privilege? - If the United States doesn’t have universal health care, does this mean that some people deserve health care and others don’t? Do you deserve health care more than your neighbor? Do your neighbor’s kids deserve health care more than yours?

• Do I deserve better health care than you? - Different plans abound. President Obama and members of Congress, we’re told, have a so-called Cadillac plan; so do high-salaried corporation CEOs. A few other lucky people also have comprehensive insurance coverage that offers low deductibles, low or no co-pays, and coverage for everything from office visits to expensive chemotherapy and heart transplants. The rest of the insured must settle for the Smart Car plan.

• Should health care be contingent on employment? - Oh sure, you can buy insurance on your own (or not), but it’s very difficult and expensive. The idea of employers offering health care insurance evolved after World War II when companies were competing for workers. Offering a perk like health insurance was one way to attract potential employees. Until after the war, health care was mostly a pay-as-you-go system, but there wasn’t that much to pay for. There were no expensive drugs, bypass surgeries, MRIs or months-long chemotherapy. Children who were born with severe handicaps died, and there wasn’t much chronic disease because life expectancy was only about 60 years.

• Should anyone be getting rich from denying health care? - Insurance industry CEOs are making millions [and shareholders earning dividends] because companies are cherry-picking subscribers, fabricating stories about pre-existing conditions or dumping patients because of serious illnesses. There is no mystery about this; company representatives have testified before Congress about rescission practices and feel it is their right to act as they please because their goal is to make money, not see that subscribers get the care they need.

• Shouldn’t we be held accountable for staying as healthy as possible? – There are health problems we can’t control – genetic diseases, some cancers, accidents – but we can control lifestyle. How we eat and move, whether we get immunizations and wear seatbelts, and whether we smoke or abuse drugs and alcohol dictate the state of our health. These lifestyle practices also determine how much we must spend on treating illnesses. Just consider: In 2000, Californians spent $7.7 billion annually to fix health problems caused by its obese residents, according to the Centers for Disease Control and Prevention. Overweight Medicare recipients in New York cost the system $3.5 billion. In 2004, smoking-related illnesses cost the nation $97 billion.

• Should everyone get everything? – Do we spend unlimited resources on every person and if not, how do we decide who gets what? This may be the most difficult question of all, and American expectations and attitudes about the use of technology and other resources and death may have to change.

We had two European exchange students visit my home this past week. The young woman from Germany thought it both amusing and puzzling that health care in this country is a political issue. In Germany, there are public and private options and people pay premiums according to their income. If unemployed, premiums are paid for by federal and local government and by local assistance offices. Premiums never change because of health status and no one loses their coverage because they get sick. It may not be a perfect system, but there must be some lessons for us in there somewhere.