Health Care Manifesto

As the mother of three adult children with serious pre-existing medical conditions—one case of cancer and two of Crohn’s disease—I’d like to add my voice to the current health care debate. After years of emergency room visits, consults, surgeries and medications, all are currently doing well. But the need for continuous and decent health insurance coverage perilously hangs like the Sword of Damocles over their futures.

So while Republicans and Tea Partiers cheerfully roll up their sleeves and dig in on their campaign promises to dismantle health care reform and let free market competition dictate the best values to be had for “health care consumers,” I’d like to point out that that basic term recasts reality for ideological convenience.

In the difficult world of trying to provide our families with decent medical coverage in this dire economy and job outlook, we shouldn’t be categorized as health care “consumers.” Health care “victims” is more like it. “Hostages,” at the very least.

Calling us simply “consumers” in this minefield of co-pays and deductibles and coverage limits and employer contributions implies some sort of sharp-eyed and dispassionate retail adventure akin to buying a refrigerator. Or perhaps a recliner sofa. An exercise in comparative shopping that puts the consumer in the driver’s seat, ready to walk out the door and take his money to the next store or provider if the deal being offered isn’t sweet enough. Under those conditions, yes, you’re likely to get a better price on that refrigerator or sofa. It’s the nature of the free market.

But “comparative shopping” for health insurance coverage for your family is entirely different game, and one with deadly stakes. Not only are you betting on trying to provide good medical care and cost coverage for yourself or those you love in light of unforeseeable catastrophic events in the future, you are blindly investing in trust. Trust that valid claims and reasonable medications will not be denied or delayed beyond their usefulness; trust that your doctors will be able to give you the proper medical treatment for your problems without a bean counter looking over their shoulders and casting a chill on their decision-making; trust that you and your family will be taken care of with compassion and wisdom and won’t be forced into bankruptcy at the end of the crisis.

If you buy a refrigerator and it doesn’t work, you have the option of having the store either take it back or fix it for you while live on peanut butter sandwiches or go out to eat. If the recliner sofa you bought as cheaply as possible after visiting a half dozen furniture stores has a defective reclining mechanism, neither your health nor your home nor your family nor your life’s savings are at risk while you find a replacement or demand a refund. But if the insurance company you have thoughtfully chosen on a sunny day in the free market from several slickly-packaged options elects to deny coverage for a transplant, or a course of treatment, at exactly the moment when it is most needed, you are helpless. A life may hang in the balance, hooked up to monitors and IV bags and catheters, and yet you are virtually powerless. The idea of exercising your power and right as a consumer to take your business elsewhere right then is a grotesque joke.

Years ago, I remember talking about health insurance with a “soccer dad” whose son was on the same team as mine. As we stood on the practice sidelines, he vented about his situation. His wife was the primary breadwinner, and she was seriously ill. There was a large deductible involved, as I recall, and under whatever rules of engagement applied, he was somehow precluded from choosing a cheaper radiological test provider. He was angry, and frustrated, and railed at the unfairness of not being able to better comparison shop for a cheaper result.

I felt stunned, like I had gone through the looking glass. Why, I thought, at this time of horrible stress and family crisis, should shopping for medical tests be his concern as though he was pricing tomatos? All logic and compassion dictated that at this particular time, his primary job should have been to reassure his young children that their world wouldn't end and to take care of his wife while the medical professionals did their jobs. And yet here he was, fixating on scrambling for dollars instead.

Given the position and vulnerability of the “consumer” in the vast food chain that makes up the health care system and health insurance funding, this is an area of our lives that absolutely cries out for governmental involvement and protection to guarantee the health and safety of its citizens. I slept easier for a short time after “Obamacare” was passed, knowing that my children could not be denied insurance coverage because of their prior health problems.

Now, with a new face on Congress intent on repealing those improvements, the sleepless nights begin again.