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AT ANY COST

A few months ago, I was sitting in bar with some acquaintances in my profession. It was late and we’d all had a bit to drink, when somehow the conversation turned to health care reform. Yes, we were and are on dangerous ground, but you knew I was going to get political at some point, right?

The Supreme Court had just heard argument in the various cases involving the The Patient Protection and Affordable Care Act. Everyone was talking about the “mandate” provision. You know, the one that mandates everyone have health insurance or pay a penalty (or a tax, depending upon which side of the argument you are on). One of the women sitting at the table was a relatively young and seemingly healthy person. She said, “I don’t understand. If someone is healthy and they don’t want to buy health insurance, why should they be forced to buy it?”

I can’t believe that there are people that are supposedly intelligent and educated that seriously believe that. You may be healthy now, but God forbid, if you are ever hit by a bus, I don’t think you will be so healthy then. And who will have to foot the bill for you? We [read: the rest of us] will, and it’s because you could never pay back what it cost to take care of you, even if you turned over every dollar you made for the rest of your shortened and severely limited life. The only way you can credibly take that position is if you will give me permission, when you are hit by the bus, to step over your prone and dying body on the ground.

That was not my inside voice. I actually let that one out. I probably should not have been so biting, but I take this issue very personally. Every time someone tells me that they should not have to buy health insurance and pay for all the sick and fat people, it is equivalent to telling me, “I don’t care what happens to your children. I hope they die.” If you think that’s an extreme point of view, I’d encourage you to think about it again – my children are uninsurable in the private market. If my husband and I were to become unemployed or die, they would need to live on Medicaid to survive. If you think that’s adequate health care coverage, I suggest you give up. I can’t help you.

The great irony of all of this, of course, is the mandate provision was the result of heavy-duty lobbying by the insurance industry. If they were going to be forced to pick up every adult with diabetes or child with autism, they wanted insurance against the phenomenon known as adverse selection. People like my uninformed colleague, who don’t purchase health insurance until they are sick, could leave the insurance companies with a high-risk pool that is rapidly depleted because premiums can never compete with claims.

This is the only time you probably will ever hear me say this, but the insurance lobby was right. They need the mandate and it’s only fair to them. After all, in the present system, we pay for the uninsured anyway. Those without insurance call 911, and get a ride to the one place where they are not allowed to be dumped onto the street without being stabilized – the emergency room.

Me: How can we help you today ma’am.
Pt: Well, my sugar is 642 and I need some insulin. But I don’t have enough money to get my insulin and I need a ride to the hospital.
Me: Off we go, then [gestures toward the ambulance].

This happens quite frequently. And this is the most expensive way imaginable to administer care to the uninsured. When they can’t pay, the hospital simply passes the cost on to you and me. So the next time you get a hospital bill and the Tylenol is $28, you know why.

Pundits are now speculating the Supreme Court’s opinion will be out by the end of the week and we will learn whether there is likely to be real health care reform in this country. I actually am not a fan of the Affordable Care Act. I would have wanted a single-payor system, but I recognize that it was the result of necessary compromise and it is better than what we had. Regardless of your political persuasion, I think we can all agree that we need reform in this country. If you think the current system works just fine, spend some time in any U.S. emergency room and I think it will persuade you otherwise.

But if that still doesn’t persuade you, consider the following statistics about our health care system.

The United States spent more than the entire GDP of Great Britain on health care in 2009. CMS Report Says Health Care Spending Was 17.3% of GDP in 2009 | Swampland | TIME.com.

The United States’ infant mortality rate is higher than in Cuba, the EU, Japan and we are right behind Croatia. CIA – The World Factbook.

A 2009 study revealed nearly 1 in 4 Californians under age 65 has no health insurance. No Health Insurance California | About 1 in 4 in California lack health insurance, a UCLA study finds – Los Angeles Times.

Problems in claims processing cost the U.S. approximately $210 billion year.

And the list goes on and on. Still not convinced? Ok, that’s fine. If you could just sign this document that says if you have an accident, we can just skip past you in favor of the guy who paid $100/month for health insurance coverage . . . .

Think about it.

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