Our Health Care System Does Not Need Fixing

Our health care system does not need fixing because fixing is what you do to something that once worked.

I happened to have the experience of my children needing extensive medical care for the first two years of their lives. In fact, my youngest continues to have special needs. They had 11 surgeries between the two of them and lengthy hospital stays, complicated recoveries, and lots and lots of medical bills. Did you know that the number one reason for chapter seven bankruptcy is an expensive medical issue?

Many Americans don't learn the ins and outs of our medical system until their health starts to give them serious trouble in their sixties and seventies. But by then, there is not much time for them to change the entire system. They are usually preoccupied trying to survive it. I have had the privilege of learning a bit more a bit earlier in the game.

Here are some facts that I learned about small children and our existing health care system:

If they have pre-existing conditions, you generally cannot buy private medical insurance for them. What they say to you on the phone is, "That's a decline." That's how they make it not-too-personal. But it is very personal when someone tells you there will be no medical insurance for your child. It is devastatingly personal.

So, like one of our surgeon's assistants had to do (her son has asthma, so he was "a decline"), you'd better find a full time job that has group coverage for your child. If you had hoped to be a stay at home parent, you can still do that. But your child will be uninsured.

If your child has special needs, it will be difficult to find a nanny that you can afford, and most daycare centers will apologetically explain how full and busy they are. So caring for your child while you work your full time position to earn health insurance can be a major challenge. There are many catch 22's involved with caring for a child with special needs, as I'm sure you know if you have one.

If you are lucky enough to barely be able to feed your family (you make under 22K per year for a family of four is the guideline in California), you might qualify for state medical assistance. However, if you are able to feed your family, you will not qualify for this assistance. But just because you are able to feed your family does not mean you can pay cash for doctor's visits or emergencies.

So should you not have a full time job with group medical coverage, but you have enough money to feed your family, your child with a pre-existing condition may not have medical insurance. And that often means your child will be refused medical care. "How can that be?" You might demand indignantly. Rightfully so.

As Newsday reported, more that 18,000 people die each year because they don't have medical insurance. Perhaps more.

For example, when my youngest daughter was 6 weeks old, I spent a full day on the phone manipulating people, pulling supervisors out of all day meetings, and otherwise being a very squeaky wheel because UCLA Medical Center called to cancel an important surgery. My daughter had granulation tissue (her insides) bulging through her cheek where it had become inflamed and then infected due to a side effect of a previous surgery. It required care.

The reason UCLA Medical Center was canceling the surgery so necessary and timely to remedy this problem? Our insurance had lapsed. But it hadn't -- it was a "mistake" made by our then insurance company, Blue Cross. But I had the eye opening experience of what it would be like to not have health insurance. I could hardly believe that such apathy toward a baby could exist in the United States. This is a place where people care about each other, isn't it? It took me 8 solid hours of crying and urging the people at the other end of the line to reinstate our insurance and not cancel the surgery.

What would someone do who didn't have these kinds of people skills? What would someone do who didn't have the time to cajole several people into doing the right thing? What would have happened to that little 6 week old baby with an infection in her open cheek's open wound? And what would someone do if their insurance had actually lapsed? Or they didn't have it? I can only put the pieces together to figure it out.

Our health care system doesn't need to be fixed, because it wasn't working. Our health care system needs a complete systemic make over. Its priority needs to be good health, and not profits. Children must receive care, even if they have a pre-existing condition and are middle class.

And care must not be refused to the sick. Because we are all sick. There is not one of us here who is not dying. We are all simply dying at different rates. The people who need taking care of are all of us.

Follow Olivia Rosewood on Twitter: www.twitter.com/OliviaRosewood

Comments

[quidam56]

HHS had an interesting town hall meeting yesterday afternoon. Their health care reform ideas are brilliant and hopefully America will be better off when a bill is put together and passed. I hope everyone will just relax, listen and study the facts then make up your own mind as to what is the truth and what is a myth. Google HHS and read for yourself what their goals are. If you are one of the 187 million who already have health care insurance and are happy with it, keep it. You don't have to do anything but pay more every year for the insurance and pay more in those deductibles. If you have Medicaid or Medicare, nothing is going to change except you may see more efficiency in paper work and quality of care. If you aren't happy with what you have take a look at the public option, it's your choice. When I worked in health care, I wasn't there to make the insurance industry or the hospital wealthy, I was there to help a patient get healthy. http://www.wisecountyissues.com/?p=62 It's sad to see what happened to what used to be the best health care in the world. To me, no no no and no choice is not an option, we need reform now.

[mbaty]

Michael Jackson once sang, "heal the world." But of course, he wasn't concerned with how much profit would be lost from costly treatments and dangerous pharmaceuticals if everyone were healed. Nevertheless, if we want health care that works, we have to remove the profit incentive. Unfortunately, we have very rich insurance lobbyists throwing money at our politicians to keep things the way they are or to reform them just enough that we shut up but not enough that anything is actually fixed or changed.
What kind of a country do we want anyway? Do we want a country that denies people necessary medical treatments because of their credit score or a 'pre-existing condition?' Do we want a country that pays more than any other country and gets much much less?
If we can afford to bail out AIG, we can afford to take care of you and me.

[DaveInPA]

Excellent points, Olivia. It's ridiculous that the insurance companies will only insure those who don't need insurance. I hope the health care industry does not influence the congress to put a totally worthless compromise out there. Like any other industry, there are good, caring doctors and there are doctors that are only in it for themselves. Always a pleasure to read your posts.

[KrisInNorthEast]

Universal health care is the answer to these problems. Let us support Obama's health care reform initiative, so that every citizen of the United States has health care coverage, regardless of age, pre-existing conditions, occupational status, income. The current health care system is inhumane and inadequate, designed to make large profits for insurance and pharmaceutical companies. These profits are made at the expense of suffering human beings, citizens of the United States. This country is described by many as the greatest country in the world, but how can that be when the infant mortality rate is higher than many foreign countries, and when seriously ill people are turned away to fend for themselves? The situation is an embarrassment to all U.S. citizens who care about basic human rights and humanity.

[Olivia Rosewood - Huffpost Blogger]

Wow--well said.

[Maria Cole]

Loved the article... my dear friend had to leave her job to care for her little girl, who has downs, leaving her oldest son without insurance. She has had to jump through hoops to get him insured due to his heart transplant as an infant. It's such a terrible situation to have to worry about your child's life because insurance companies don't want to cover them. They are very responsible parents, people just don't plan to have very sick children, forcing them into financial situations they could not have predicted.

[Olivia Rosewood - Huffpost Blogger]

I couldn't agree more.

[ENOS]

When you say, "will be refused medical care" I guess you mean "will be refuesed INSURED medical care". There's a difference. Let's be clear.

[Olivia Rosewood - Huffpost Blogger]

No, I mean will be refused medical care, not just insured medical care. There are many doctors and hospitals who simply will not take you if you do not have insurance.

The example that I gave of my daughter's cancelled surgery is my experience with this principle. They thought we didn't have insurance, so they called to cancel a necessary and timely procedure. They didn't offer to reschedule, they didn't care that she was six weeks old with an open wound on her cheek. As far as they were concerned, we were out of luck.

When I explained the urgency of the situation, the representative in charge of canceling suggested that I take her to an emergency room, where we wouldn't be denied care, as she was doing. When I asked what she thought would happen to us in an emergency room where we were presumed to not have insurance, and what she would do if it were here infant, she got her supervisor. It really is as bad as it sounds.

It is illegal to be turned away for emergency care whether you have insurance or not, however it is not uncommon to be made to wait in the waiting room of an emergency clinic for insane amounts of time if you do not have insurance, often further compromising your health.

[toje]

Why won't congress just simplify the issue, and legislate the answer, as opposed to trying to rewrite how health care is provided and paid for in this country (and then trying to get into the game themselves)? why can't they just make it illegal to deny coverage for pre-existing conditions and regulate insurance companies profits (like utility companies)? The insurance companies will figure out the added costs, decide what type of profits they can live with, and we can move on to the next issue...not getting dropped and complete portability.

[Olivia Rosewood - Huffpost Blogger]

This is a well thought out idea.

[rlxng]

Children in need and the elderly get the shaft when it comes to health coverage (and the recent budget cuts in the state of California continues this trend). The only people who can get good health coverage are young, healthy, affluent adults-just the people who need it! Socialized medicine gets such a bum rap, but do we really want our fellow citizens to go without, especially if their lives are on the line? The ideal of the free market economy is great, but we, the people, constantly get screwed.

[Elizabeth Werner]

This article hits close to home for me.

My son almost died because the La Leche League lady left out some very important information, then when my child would not wake up, we were turned away from the ER. I called his doctors office and was told that I could come in as a walk in, but they couldn't guarantee I would be seen.

I had to call the Hospital Administrator and threaten to sit in his office (and even breastfeed) until my child was seen by a doctor.

Now several years later, this same hospital barely has any 'customers' and is going bankrupt due to the fact that people are wise to them and would rather drive 20 miles to another hospital than go there.

Health care in the US is horrible. Everyone knocks government controlled health care like NHS, but NHS patients receive outrageously awesome care and cannot understand why our country just can't take a hint that 'our way' isnt working.

But the almighty dollar always prevails, no matter how many of our citizens die and that is the ultimate corruption.

[Olivia Rosewood - Huffpost Blogger]

It's hard to believe until you live it, isn't it?

[Bozzgirl]

This is not just an issue about children. This affects everyone and insurance companies should not be allowed to decline coverage to anyone.

Healthcare is expensive because insurance companies make it so difficult to work within the system. A large portion of your medical expenses go to pay administration costs.

I don't begrudge insurance companies the opportunity to make money, but they should not be allowed to make their billions on the broken backs of the working people. It's disgusting.

[Olivia Rosewood - Huffpost Blogger]

It does seem totally inhumane.

[sixyfivepercentwater]

While it's true that every American should be covered for basic medical care without regard for income or employment, it's also true that having a child is optional. Before choosing to have a child, it is the responsiblity of the prospective parent to do the research and see if they can provide the child with the essentials. The parent is responsible for the welfare of the children he or she brings into the world.

[Olivia Rosewood - Huffpost Blogger]

I agree with you in some ways. Children are the responsibility of their parents.

However, it is a fact that our health system is designed for profit, and therefore it can be very difficult if not impossible to provide the essentials to your child if it's not profitable (in other words, if they have ongoing medical issues) to this system.

From a capitalistic point of view, it makes sense to not make insurance available to high maintenance children, if insurance companies are able. Which they are.

From a humanistic point of view, it seems simply wrong.

[sixyfivepercentwater]

Yes, I see your point. The European model of health care provides for everyone (even visitors) all of the time. And yet it has ways of excluding high maintenance patients, and supplemental private insurance is necessary, which again cannot be had if the condition is pre-existing. . .and so on.

As someone who worked in the medical field for decades, I know only too well how screwed up the system is. And yet, as a person who grew up under military medicine, and who has experienced the NHS and also being without insurance in this country for a time, I also know there is no perfect system.

I do not know what a parent can do when a child develops a condition that is not covered. I'm glad I won't have to face that issue, and am sorry for anyone who does have to deal with it. In a perfect world, denial of coverage would not happen to anyone who is in need.