Let's Have A Semi-civilized Discussion on Health Care Reform.

Let's start the discussion with the following disclaimers:
I am neither Democrat nor Republican.
This is a complicated topic.
I do not completely, or even semi-completely, understand the topic.
But, failure to understand a complicated topic has never stopped me from spouting off at the mouth (keyboard?) before.

When I was pregnant with Kate, I was sick. Morning, noon, night, you name it, I was puking. I actually kept a big glass of water next to the toilet because it was easier to chug some water and have something to vomit up versus leaning over the toilet dry heaving. At about 10 weeks along, I finally realized that this was probably not normal, and went to my doctor who diagnosed me with hyperemesis gravidarum and, after trying a couple of drugs that didn't do much for me, put me on a little pill called Zofran.

Zofran was almost completely effective for me. It is also terrible expensive- somewhere in the neighborhood of $30 per pill (twice daily dosage). I was fortunate that my health insurance at the time covered the entire cost except for my monthly prescription co-pay. I was back at work within a few days. When I delivered Kate, I paid $250 up-front to the hospital, and though I received the itemized statements from my doctor, the hospital, the nursery, I didn't owe much more. So, with my insurance plan, I had a difficult pregnancy and delivery with an out of pocket expense of less than $500.

By my second pregnancy, things had changed. I was no longer working full-time, so instead of my health insurance through Victoria's Secret, we were insured through Bruce's work. We had three mediocre plans to choose from, all of which cost upwards of $500 per month. Here's how my pregnancy with Maggie went down. Similar level of sickness. Same diagnosis, although made earlier in the pregnancy. Insurance initially refused to cover Zofran. Doctor made personal phone call to insurance, who agreed to cover 12 pills per month, with one exception (to be discussed in a moment). I was taking 2 pills a day. The exception was that if I exceeded a 24 hour period without keeping down any liquids, or if I lost more than 1 pound, I could receive hydration therapy (that's an IV) with Zofran in it, followed by another 12 pills. So, I would survive 6 days. On the 7th, I would puke my guts out and lose 2 pounds. (At my low weight, I weighed 20 pounds less than I do right now, and I still remember my 24 week check-up when the nurse said, "Good job! You are finally back to where you started!" meaning that at 24 weeks pregnant I weighed what I did BEFORE I was pregnant.) On the 8th day I would visit the hydration lab, or if it happened to be a weekend, pay my $150 co-pay for the emergency room and get an IV there. Or, we would pay for Zofran out of pocket: shall we do the math? $30 per pill, times twice a day= $420 a week, times the roughly 15 weeks we paid out of pocket instead of me having to go through the misery of a hospitalization= $6300. Plus the co-pays for the 12 pills my insurance would occasionally cover, the hydration lab visits, and the ER. Even after our co-pays, we still had to cover 20% of the costs. Kiki was born in January, meaning our deductible had started over (like that even mattered, since our insurance had so many exceptions and conditions that even after spending almost $10k during the pregnancy we still hadn't met our 2006 out of pocket cap.) so we spent a couple thousand bucks on the delivery. That's right- we spent over $10,000 out of pocket for a single child born vaginally.

The Bruce makes a good living- many would have been bankrupted by $10,000 in medical bills (in fact, over 60% of bankruptcies are due to medical bills), and I count us lucky that we had the disposable income to deal with this hurdle. I'm infuriated, however, that some nobody in a cubicle had more of a say about my medical care than my own doctor did. I firmly believe that the main reason my insurance company refused to cover Zofran was because of its cost, never mind that the consequence was that I spent 24 weeks in hell. (P.S. I haven't even mentioned my dental, but just imagine what 6 months of puking does to your teeth. My dental bills were almost 5 figures as well.) I didn't want a handout, but I sure as heck believe that we deserved some different choices. I would have given anything to be back on the plan that I had during my first pregnancy.

Here's some facts:
-The mixed public-private health care system in the US is the most expensive in the world.
-Health care costs are rising faster than wages or inflation.
-46 million Americans have no insurance at all (Although some studies have placed this figure as high as 86.7 million).
-Despite larger health care spending, the US ranks 38th in the world in life expectancy, lagging Japan, France, Germany, the UK, Chile, and Cuba, among others.
-Government health care spending in the US is consistently greater than in Canada, the UK, and Japan (countries with predominantly public health care).
-In a 2007 comparison, health care in the US ranked behind Germany, Britain, Australia, New Zealand, and Canada on measures of quality, access, efficiency, equity, and outcomes.


We definitely have a problem. We pay more for health care than anyone in the industrialized world and have no better health.

Here's what a Republican thinks about it:

"The answer is more market competition...giving consumers more choices, more information, and more control...Creating a nationwide health insurance market where any individual or group can shop for less expensive coverage from another state would provide more choices, forcing private plans to create better products, improve services, and lower prices." Newt Gingrich

N. Gingrich argues that the reform plans supported by Obama expand the control of government over health care decisions, which he refers to as "health care rationing." Obama argues that health care is already rationed, based on income, employment, and pre-existing conditions. Most Republicans and Democrats agree that reform is necessary, but Republicans have focused on open-market competition (some argue that private insurance distorts typical free market behavior), while Democrats have called for Universal Health Care. Mayo Clinic CEO Denis Cortese argues that health care reform should 1)focus on value, 2)align incentives with value, 3) cover everyone, and 4) Establish mechanisms for improving the health care service delivery system over the long-term. I think the guy who actually WORKS in medicine might be on to something.

I also want to address a few rampant rumors: first, that health care reform would cause us to subsidize health care. News Flash: YOU ALREADY DO. The U.S. System has huge public components: Medicare covers nearly 45 million people, Medicaid covers the poor, CHIP covers children, Native Americans are covered both on and off the reservation, and merchant seaman, retired railway workers, and military veterans are ALL covered by the government. It's been that way since 1965. Obama's not pulling a fast one on you here (Lyndon Johnson did it. What a jerk.).

Second, regarding health care rationing. It's been talked about a lot. Former Secretary of Commerce Peter G. Peterson argued that some form of rationing is inevitable and desirable considering the state of U.S. finances. He estimated that 25-33% of health care services are provided to those in the last months or year of life and advocated restrictions where quality of life cannot be improved. Know what else? HE'S A REPUBLICAN. Do you seriously think a "bleeding heart liberal" would deny health coverage to anyone? The Democrats give money away like it grows on trees.

I don't have a lot of answers, I suppose. I don't know if throwing more money at this issue is going to fix anything. I just know that the system failed me in a big way, and I'm neither a millionaire nor on welfare. I'm an average citizen who contributes to society and I got screwed in a big way. It's not right. But, I'll do my part to avoid any future "Death Panels" by not having any more kids.