Irreconcilable Differences and False Dichotomies

I dislike posting political things.  My ideas about politics definitely change and evolve over time.  I guess you could say I’m a flip-flopper.  Or a an adult with a changing world view who is not so entrenched in her own ideas that someone making a good argument can’t change my mind.  Still, it’s hard to pin yourself down to something that you may later disagree with.  However, when I found myself wide awake at 2am having an internal dialogue (monologue?) with myself about this, I figured I might as well write down my thoughts and hopefully then I can go back to sleep.

I was just scrolling down my facebook feed a few days ago when I came across this post that was written on my friend’s wall, that she had liked.  Perhaps she reposted it.  I don’t know what facebook magic was at play, but I read this post several times in the period of a couple of hours.

A very concise explanation of how the GOP would ‘privatize’ health care. Here’s what needs to be understood:

When Trump or Paul Ryan say they want to replace the ACA with “Health Savings Accounts” (HSA), they are also saying they want to replace Obamacare or Medicare or Medicaid with YOU paying for your healthcare. That means YOU pay for chemotherapy, YOU pay for all surgeries and hospitalization, YOU pay for all your family’s doctor visits, urgent care, ER visits, and prescription drugs out-of-our-pocket. An HSA is just a tax-free way for you to save up money to pay for your own medical bills. So, if you are paying off college loans, or saving for a house down-payment, or simply living paycheck to paycheck, guess what — an HSA does you no good, because you have no discretionary funds to deposit into it. And, even if you manage to save five grand or ten grand in an HSA, that could all get wiped out in one hospital visit for you or a family member. Then you are back to square zero again. Even if you can supplement your HSA with affordable health insurance, you will be eating away at money that you should be investing for your retirement or your kids’ college tuition. It’s important to note that only the top 3-5% of Americans can save enough for retirement, college AND their own out-of-pocket medical expenses. Therefore, the tax benefits of HSA’s only help 3-5% of Americans. Please call your Congress Member to protest this.

The thing that really caught my attention about this post was all the “YOU”s.  Because I found myself thinking, “Who else should be paying for it?  Who, exactly, is responsible for my healthcare expenses, if not me?”  I’m no health insurance expert, so I’ll leave Medicare out for now since I know next to nothing about that program.  But if you have health insurance through your employer, you are still paying for most of your health insurance.  It’s deducted from your paycheck.  It varies from employer to employer how much they can or choose to contribute to that.  I don’t know statistics about what the percentage is, but from my limited experience, what I’ve learned from people I know as we talk about it, the general sense I have is that employers are contributing about $200 to $1200 insurance plans.  With Medicaid and the ACA, “the government” is subsidizing healthcare.  But the government makes its money from taxes.  So it really comes back to us paying for healthcare anyway.  Just not necessarily our own healthcare.  Or at least paying for others’ healthcare as well as our own.

What else struck me about the above quote is what happens if you replace all the healthcare terms with, say, “clothing” or “food” or “braces” or “haircuts”.  It makes me wonder if the person who penned this believes that healthcare is its own sacrosanct class or if they feel like there are other things that we are entitled to have but not required to pay for.

As I was trying to find the quote, I also came across this on her timeline.

Healthcare is a human right.  So how do you even define what healthcare is?  I mean you have to start with that if it’s a human right.  My understanding of what most people mean by this is access to western medicine.  Doctors, specialists, hospitals, drugs manufactured by big pharma, the latest technology.  But how can that be a human right when those things didn’t exist 200 years ago?  Also, what about someone like me who prefers “alternative”, non-western types of healthcare?  Right now, even with the ACA, chiropractic care isn’t even covered much of the time.  But I shouldn’t have to pay for it.  It’s my right to have chiropractic care.  But it costs, so which of my friends and neighbors is going to provide me with my basic human right?  And what if no one wants to go into the medical profession anymore because they get sued too much, work long hours, and don’t get enough pay or vacation time?  What if there is only one doctor left in the entire country?  If healthcare is a human right, is that doctor violating our human rights if he doesn’t give up his life to take care of all of us?  Or do we start forcing people into the profession so that the rest of us can have the healthcare that we are entitled to by birth?

Now I do understand what they are saying about HSAs.  We have not had employer provided health insurance for most of our married lives.  We have had to pay for private insurance on our own.  And we have had that HSA that we could never afford to put any money into.  I totally get that.  And it’s not idea.  I might even go so far as to say it sucks, actually.  But if we aren’t going to put money into it, then who?  Who is obligated to pay for our healthcare?

So I think there’s just a fundamental difference in how people see healthcare.  I can see that the author above, and my friend, are motivated by compassion.  There is absolutely nothing wrong with compassion.  I mean, really?  Who wants to see someone suffer when care is available?

But I think we have created a false dichotomy.  We see the issue right now as black or white, for or against, compassion or ….cruelty? cold-heartedness?  But that is not all there is.  In our zeal to take sides and push our ideas through (which both sides have done–the Democrats voting the ACA in despite huge Republican outcry just because they had the numbers to do it, and the Republicans repealing the ACA as soon as they got the numbers to do it), we stopped thinking.  We stopped being creative.  There are more than two options.

I’ve spent a lot of time searching for the video I am about to talk about, but just can’t find it again.  If anyone knows what I’m talking about, send me a link!

Anyway, this election cycle, with all the talk of Mexico and building a wall, there was a video of Ronald Reagan circulating.  In this video he was asked about the immigration problem and what we should do.  It’s possible it was suggested that we build a wall or a fence, I’m not entirely sure anymore.  And right now, those basically seem to be the two sides of the issue now–build a wall and keep those darned illegal immigrants out of our country or offer amnesty to everyone who’s already here.  If you’re on the wall side, then you’re a cruel, heartless, racist ethnocentrist.  If you are on the amnesty side, you have no sense of laws or economics and you don’t care about the burden that’s placed on the border states.

But Reagan’s answer to the question was not A) build a wall or B) amnesty.  He basically said that the problem of illegal immigration stems from the disparity in economics and safety between Mexico and the US.  That is what is driving so many people to leave their homeland and come here looking for a better life.  And until THAT problem was fixed, there would be no solution to the border problem.

It was like he had just said, I’m not taking sides on how to treat this symptom.  I’m diagnosing the disease and want to find a cure.  It seemed to make sense, seeing as we don’t really have a problem with illegal Canadian immigrants.  That’s because socially and economically, the opportunities in both countries are about the same.

I think our healthcare dilemma is also a false dichotomy.  I don’t think we’re going to be able to solve our problems by either A) offering free healthcare to all or B) letting people suffer and die because only the wealthy can afford healthcare.  I think we need to address the underlying problems that make healthcare so unaffordable in the first place.

The problem is much deeper and requires so much reform.  I actually don’t think it’s possible, in the same way we still haven’t been able to fix our relationship with Mexico in the past three decades since Reagan said that.  But that’s how I see the problem now and the only way to fix things.

So this is what I think of health care in no particular order.

1.  Insurance increases the cost of health care because there is a giant third party making a profit off of healthcare.  If only healthcare providers were making a profit, costs could come down.
2. Healthcare providers get sued a lot.  This means they have expensive malpractice insurance policies and so have to charge more and also have less job satisfaction and more stress.  I believe the reason for this is two fold:
   1. Patients aren’t very involved in their own care, otherwise known as doctors have a god complex.  The doctor says “this is what you need to do” and if you don’t agree, tough luck.  I think if patients were much more informed about risks, benefits and the outcomes they can expect, and involved in the decision making, they would be less likely to sue.
   2. Litigation worries preclude apologies.  Saying “I’m sorry” when you’ve done something wrong is the quickest way to diffuse a situation.  But in healthcare, especially in hospitals, no one is allowed to admit a mistake because of liability issues.  That means that when something goes wrong, patients get stonewalled and then become angry.  They are more likely to sue.
3. Western medicine is centered on treating disease symptoms rather than helping a whole person stay healthy and happy.  This is why, for instance, it’s cheaper for you to go see a doctor than to get a gym membership.  It’s also why insurance companies will pay for prescription drugs but not vitamins or supplements.  About the only preventative measures we have available to us is vaccinations.
4. Billing practices.  Whether you are seeing a doctor or have a hospital stay, there is no transparency of how much any of it will cost.  I have been in a doctor’s office and been recommended a test.  I ask, “Ballpark.  How much will that cost?”  And they often have no idea.  Or sometimes the estimate has been way off.  Imagine if you went into  your mechanic and he told you you needed work done but couldn’t give you a quote.  And you’re thinking, “Is this going to cost $100 or $1000?  Obviously, medical issues are more complex, but there are some things that should be known ahead of time.  For instance, how much a visit to the office will cost.  I remember one time taking a child in who had persistent stomach pain.  The doctor couldn’t figure it out, just before leaving they decided to try one last test.  Basically, there was this little plastic tube thingy they wanted my daughter to breathe into.  It took about ten seconds and they knew immediately the test was negative. It turns out that one little test was $125.  And here I was thinking the whole time it was just part of the office visit.  Also, why are things so expensive in the hospital?  At the store you can get a bottle of Tylenol for $5.  In the hospital one pill could be $20.
5. Healthcare waste.  A while ago, our next door neighbor was a medical student.  He thought he wanted to go into Pediatrics until he had his pediatrics rotation.  He told me that in an entire week he had spent working in Pediatrics that there had only been one child sick enough to actually warrant the visit.  That child had a collapsed lung.  Most of what he saw was just colds that didn’t need even need prescription medication.  Can you imagine how much this costs multiplied across the entire nation?

I dunno.  There’s probably more.  But it’s past 4am now.  I’m feeling pretty sleepy and I kind of regret this long post because it’s not really deep and/or thought provoking.  I don’t have a lot of great ideas.  I think I can probably go back to sleep now, though.  So I guess it served its purpose.