The Multnomah County Democratic Party (Portland, Oregon) hosted a panel discussion on health care at their regular monthly meeting this past week. It included representatives from AARP, SEIU, OFA, PNHP (Physicians for a National Health Plan), the Archimedes Movement and Senator Wyden's office, as well as State Senator Laurie Monnes-Anderson (a nurse), and me. Here are my remarks:
I’m a part of this panel to provide a patient’s perspective. I want to introduce my remarks with this:
- The trouble with being a patient is that you feel your own identity slipping, like you’re becoming “the patient.” I don’t really think my opinions would be different without a current challenge.
- If I talk too much about my own situation I’ll get more emotional than I really want to in public, even in this crowd.
- I don’t think my situation is particularly interesting except in how it illustrates bigger things.
So I’m going to be a political observer and commenter with a diagnosis, rather than cancer patient with an opinion.
I’m receiving treatment for breast cancer. It’s a treatment regimen where you kind of have to wear your health status on your head, so besides being reminded of your mortality by the disease, and besides being sickened and worn out by the treatments, you get to look like a freak, at least in your own mirror. And, in the United States of America, you also worry about money more than you worry about any of those things.
My first point is that people who say they like the insurance they have probably haven’t used it in a long time. It’s changed in fundamental ways since de-regulation in the 80s.
My other perspective is that of a long term customer of American health insurance. I’ve had many different plans, both employer-based and individual, over the past 30+ years, and I’ve also had to go without coverage for a couple of years. I have an individual “portability” policy now, and it’s not a bad one, but it’s not enough to keep me from waking up in a sweat about my financial future. With relatively decent insurance, I have several thousand dollars worth of medical bills that are now coming in marked past due. And I still have a month and a half or so of chemo and its side effects ahead of me, and radiation after that.
I also had a private policy 30 years ago. The one I have now costs about 25 times what that cost, and it isn’t close to being among the most expensive. In the same time period, just for reference sake, first class postage has merely tripled. The steep climb started in Oregon in the early 80s, when Blue Cross and Blue Shield merged and premiums doubled. Meanwhile co-pays, deductibles, coverage denials, and all the things that leave patients on the hook have also skyrocketed.
Now, a lot has changed in health care in the past thirty years, but it's disturbing how much of that change has been driven by de-regulation of the insurance industry. Preferred provider networks? Those would have been unfair trade practices at one time, and for good reason.
The problem is that health insurance is part of the financial system, not part of the health system. Their central mission is making a profit and thereby increasing stock prices. Our health care dollars go to things like debt service on mergers and acquisitions, profits and all the other bloated overhead that was not there when insurance was effectively regulated. And every bill we pay is higher due to the high cost of somebody’s health insurance.
In fact, our tax dollars go into this system when public agencies buy private health insurance for public employees.
Now we can talk about utilization, and expensive tests and equipment, and the fee for service system, and a lot of things, but at this point those are diversions. If we don’t fix insurance we won’t fix much else. The first step has to be to find the places where dollars are absorbed into the system and neither promote health nor cure disease. I’m not saying that everything else is great, just that if this is to be done incrementally, the insurance system is the only place to start.
Now, my first choice is single-payer. We would stop subsidizing insurance profit centers when we insure public employees. We would take injury insurance out of the car insurance and workers compensation systems. We would discontinue “in-plan’ and “out of plan” designations so that patients really can choose their doctors. We would remove the influence of the stock market and investment banking. And we would take all comers.
If we can’t have single-payer, we have to have something else that accomplishes those things.
A lot of the arguments about this treat insurance as if it were fundamentally the same thing it was 30 years ago. It’s not. Not here and not in Mayberry. Deregulated insurance has devolved along with its close relative, deregulated banking. Now they’ve broken our health care system. It’s time to say they’ve taken enough.