03.02.06
Health and the Wealthy Nation
Life can hit pretty hard when it’s of a mind to. I recently spent a solid week carrying on my usual routine depsite one of the worst colds I’ve ever had. It was probably one of the worst because I kept going to work, running errands, doing the usual thing, rather than staying home in bed with hot lemon tea and quiet rest or going to the doctor’s office.
But it has been even worse for my beloved. On top of the cold, she — who is anemic — got her period and a cluster migraine. It has been a painful few days I would do anything to erase for her. She had a prescription for Zomig but was out of it. After talking with her doctor (actually, a receptionist who spoke loudly) he called the local pharmacy and told them to refill her prescription. However, when she called the pharmacy they informed her that her insurance no longer covered it. When she asked how much it would cost if she paid for it, they told her $720 (US) — for a blister pack with six tablets. Needless to say, Zomig was not an option.
She had the pharmacy call her doctor back and ask if she could have another prescription. He gave her a prescription for Imitrex. This her insurance covered, and now she is resting with a scarf covering her eyes as she waits for it to do its job.
Meanwhile, I am sitting here pondering the cost of medicine, especially for those without the benefit of some form of health insurance. It amazes me that we don’t offer universal health coverage here in the US. I have always thought it would be a good idea. However, it’s not so easy an argument to make around here. In other words, a cost-benefit analysis is difficult. According to an article at Reference.com regarding publicly funded medicine:
Cost-benefit analysis of healthcare is extremely difficult to do accurately, or to separate from emotional entanglement. For instance, prevention of smoking or obesity is presented as having the potential to save the costs of treating illnesses arising from those choices. Yet, if those illnesses are fatal or life shortening, they may reduce the eventual cost to the system of treating that person through the rest of their life, possibly dying of an illness every bit as expensive to treat as the ones they avoided by a healthy lifestyle. This has to be balanced against the loss of taxation or insurance revenue that might come should a person have a longer productive (i.e. working and tax or insurance-paying) life. The cost-benefit analysis will be very different depending on whether you adopt a whole-life accounting, or consider each month as debits and credits on an insurance system. In a system financed by taxation, the greatest cost benefit comes from preserving the working life of those who are likely to pay the most tax in future, i.e. the young and rich. Few politicians would dare to present the big picture of costs in this way, because they would be condemned as callous. Nevertheless, behind the scenes, a responsible government must be performing cost analysis in order to balance its budget; it is not likely, however, to take the most purely cost effective route. It may choose to provide the “best” health care according to some other model, but the cost of this still must be estimated and funded, and there is no uncontroversial definition of “best”. In producing a definition of quality of healthcare there is an implication that quality can be measured. In fact, the effectiveness of healthcare are extremely difficult to measure, not only because of medical uncertainty, but because of intangible quantities like “quality of life”. This is likely to lead to systems that measure only what is easy to measure, such as length of life, waiting times or infection rates, and may reduce the importance within the system of treatment of chronic, but non-fatal, conditions, or of providing the best care for the terminally ill. Thus, it is possible for personal satisfaction with the system to go down, while metrics go up.
Call me a bleeding heart liberal if you must, but the idea that a wealthy nation like America cannot look after the health of all its citizens, regardless of their class or social position, is simply appalling. When you have some ~45 million people who are uninsured, rounding up by an insiginificant fraction enables you to make this observation: ~15 people out of every 100 in the US have no health insurance; a number that includes a majority who work at least part time, and many whose income places them officially above the poverty level. It is my opinion that it is greed that keeps us from universal health coverage. The AMA is interested in protecting doctors’ incomes, the pharmaceutical companies are interested in making money, the government is interested in spending our tax dollars on wars. It’s a sad state of affairs, and one that underscores the disparity between our nation’s so-called humanitarian goals, as expressed (however ineptly) by that yahoo in the Whitehouse, and its everyday treatment of its own citizens (not to mention its treatment of the citizens of other nations).
That yahoo in the Whitehouse, by the way, wants to cut more from health coverage. According to the Washington Post’s Ceci Connolly, the Bush budget would cut popular health programs:
President Bush has requested billions more to prepare for potential disasters such as a biological attack or an influenza epidemic, but his proposed budget for next year would zero out popular health projects that supporters say target more mundane, but more certain, killers. If enacted, the 2007 budget would eliminate federal programs that support inner-city Indian health clinics, defibrillators in rural areas, an educational campaign about Alzheimer’s disease, centers for traumatic brain injuries, and a nationwide registry for Lou Gehrig’s disease. It would cut close to $1 billion in health care grants to states and would kill the entire budget of the Christopher and Dana Reeve Paralysis Resource Center.
Does this make you feel sick, too?
