Health care and private insurance: A conflict of interest
As an American who has lived in various European countries during the last ten years, I have an unusual, but perhaps insightful perspective on various health care systems.
The cheapest and most efficient health care I ever experienced was during my teenage years and was provided by the US military, in the form of the Walter Reed Army Medical Center and the National Naval Medical Center in Washington, DC. They weren’t cushy and had lousy magazines, but these massive mega-mall style centers provided everything from GPs to specialists to filling prescriptions to hospital care at no cost to the patient and all in one place. They are where the President and first family go for medical care so they can’t be all that bad.
I have also experienced the self-employed, uninsured-in-America healthcare scenario, which was OK as long as I didn’t get sick or injured. The odd minor doctor visit was affordable in the 1990s – far more so than buying a private healthcare plan.
Then came an accident involving a 15-passenger van, a trailer and a 50 meter /165 ft drop down a mountainside in the Utah desert. Miraculously there were no deaths and the emergency care was adequate, even out in a rural Utah hospital. That is, until a few hours later when the van owner’s insurance reached its limit and we were all told we had to leave. All of us except the kid with the broken neck, who was taken by helicopter to another hospital. Never mind that there were cracked spines, broken legs and concussions among us. The insurance policy limit meant no more bed space.
And leaving meant walking, which I couldn’t yet do. I didn’t have any clothes on either because everything but my soccer shorts had been cut off by the nurses. After unsuccessfully attempting to walk I was unceremoniously wheeled to the waiting room to sleep on a bench for a few hours wrapped in a blanket the nurses let me borrow. Eventually my companions and I got a cab to a fleabag motel where we dozed on painkillers. I spent the next day in bed and in the bath picking chunks of glass out of my arm, something that had apparently escaped the hospital staff’s attention.
This whole debacle resulted in lawsuits by the family of the poor kid with the broken neck. You see his bills weren’t covered by the insurance policy. Neither were the x-rays on my neck, as I discovered via mail from a collection agency.
Most people naturally connect the healthcare debate to their own personal experiences – or lack thereof – with healthcare systems. I’m no different. Foreigners who have lived in the US and worked high paying jobs with expensive health plans may have experienced unrivaled care in private American hospitals that were more luxurious, attentive and up to date than what they experienced in their home countries.
There is little argument that the US provides top of the line medical services for those who can afford it. But what of those who can’t?
Living in Sweden I never had to worry about health insurance. My experiences have included some very long and painful emergency room waits, an ambulance ride, a five-day stay in the orthopedic unit of an understaffed and old-fashioned looking hospital, many GP visits and plenty of prescriptions. The care hasn’t been a pleasure cruise, but it’s been adequate to my needs. Prescription and doctor visit are not free, but controlled and affordable. The only things I paid for while in hospital were my meals. No insurance company, no monthly bills. Sure, Sweden has high taxes, but since healthcare and welfare are on universal systems, both rich and poor alike benefit from them. This makes them more politically popular than the barebones safety net welfare programs of the US.
Let’s be clear: The US still has no universal health care. From an article in the Guardian:
The reform, which will cost an estimated $940bn (£627bn) over 10 years, amounts to a massive change in US healthcare provision, expanding care to 32 million more people, predominantly the poorest, and giving the country 95% coverage.
One opinion piece in the Guardian breaks the debate down to the classic cleavage of individualism vs. community:
It is a monumental accomplishment. The story of that century of failure is a story of multiple plots and subplots, but at its heart the story is about the tension in American society between the individual and the community – whether we are just a loose confederation of individuals who should be left alone to pursue self interest, or something more than that, a community of citizens with mutual ties and obligations.
As significant as this vote is, America is by no means on its way towards socialism. I’ve lived in a social democratic country – not socialist – which is much better for poor people as far as basic necessities are concerned. Sweden is also home to plenty of wealthy people who have no problem making lots of money. That said, Sweden could learn from America’s tax policies concerning the low-income self-employed / freelancers.
The most important distinction vis-à-vis healthcare in the States vs. other developed countries is profit motive. Medicine is an overwhelmingly profit-driven industry in the US, while it is considered a right in Sweden as well as in many other countries, including the very capitalistic states of Japan and Taiwan. After all, healthy workers and business owners are more productive.
The profit motive that has invaded all aspects of the American health care system is an inherent conflict of interest. This new bill will not get rid of this conflict of interest either. That would mean getting rid of private medical insurance companies. But at least it gets more people covered, which should save lives. In short: It’s a start.
For a specific rundown on what the new bill actually does, see this article in the (conservative) Telegraph. Topics covered include pre-existing conditions, lifetime limits, preventative care (wellness) and young adults.
by Graham Land
Lead image by Paul Keleher (image source: Flickr)