Aug 17, 2009

Book highlights the history of health care coverage in the U.S.

After more than a month of waiting for the July monthly selection of the Progressive Book Club because the demand was so heavy, I finally received the books last week.

The selections were Gov. Howard Dean’s “Prescription for Real Healthcare,” and “Sick: The Untold Story of America's Health Care Crisis — and the People Who Pay the Price” by Michigan author Jonathan Cohn.

I heard Cohn speak back in October 2007 at a “Counter Colulter” event that raised money for a free dental clinic, and I knew if the book was half an interesting as his lecture was, the book would be great. I was right. I have only read less than half the book in a week, but it has been informative, shocking and sad.

He goes through the technical aspects and history of health care in America, and he puts a human face on the consequences of decisions made by health insurers.

Cohn is a senior editor at The New Republic magazine. He is also a media fellow at the Henry J. Kaiser Family Foundation and a senior fellow at Demos a non-partisan public policy center. Cohn writes about domestic politics and policy with a primary focus on health care. Cohn has also written for the New York Times, Washington Post, Newsweek, Mother Jones, Rolling Stone and Slate. A graduate of Harvard University, he now lives in Ann Arbor with his wife and two children. “Sick,” his first book, was published in April 2007.

Cohn said that when he decided to write a book he chose to write about something no one else was writing about at the time. Cohn traveled all over the U.S. and some foreign countries and read every study and every source on health care he could get his hands on in doing the research for the book. In fact, the book has 50 pages of references and sources.

This book should be required reading for anyone who cares about the health care system debate, no matter what side you’re on. He presents real middle class Americans who worked hard their entire lives and played by the rules being wiped out by an illness.

Even the introduction is chock full of information. He debunks the myth that anyone has health care just by going to the Emergency Room.

A 55-yeaold Cambridge special education teacher named Cynthia Kline died because she had to be diverted from a hospital ER that was capable of performing a “cardiac catheterization” to one that was not quaffed to perform it because the ER was overflowing.

Cohn goes on to document that in a one-week period before Kline’s death, 67 percent of Massachusetts hospitals had to divert ambulance traffic and declare emergency overcrowding procedures. Another 40 percent of administrators said overcrowding led to “adverse outcomes.” Ambulances have had to be diverted to hospital miles away, or wait by the side of the road while they searched for a hospital that can take the patient. ER’s are being slammed because the 50 million people with no health care coverage go there when a routine problem turns into a major problem because they could not go to a doctor and get it taken care of.

The model for health care in America for years has been employer provided health insurance, but that is falling apart as companies get rid of it in order to compete globally with every other industrialized nation that provides universal health care, downsize employees, privatize, hire contract workers with no benefits or simply offshore to Third World Countries where there are no rules and befits.

Cohn talks about Gary and Betsey Rotzler. Gary was an aviation engineer for years, but he was laid off. He worked for a few years at anything he could find until he was finally hired back at the same company doing the same job as before; only he was a “contract” employee receiving no health care coverage.

After hiding worsening back pain from her husband and three children for years, Betsey was finally forced to take action, and within three days she was dead from cancer.

Kohn traces the history of health care insurance in America from the 1920’s when it became apparent that medical bills were becoming more than many Americans could bear. In 1933, a blue ribbon panel made the recommendation for some kind of medical insurance, but other countries went the way of government sponsored insurance, spreading the finical burden of as widely as possible.

Hospitals were bearing the brunt of this inability of people to pay, and many were going out of business. A hospital administrator at Baylor Hospital in Texas in 1929 hit on an idea where any teacher willing to pay monthly contributions to the hospital would be provided up to 20 days of free care as long as three-quarters of the teachers participated. It saved the hospital, and other hospitals did the same thing.

The plan grew and evolved into the Blue Cross system. The plan worked when any large group was involved, such s the Elks or other groups, so it was a natural that it became an employer-provided plan that was billed as an employee-incentive when they could not provide higher pay.

Blue Cross was the provider of choice until the 1950s, and people paid a community rate where every one paid the same and the healthy subsided the sick until the healthy became the sick. Commercial carriers saw it could work after seeing the Blue Cross example, and they figured they could make money if they only covered healthy individuals. Their number one goal was to make money, not the public good like Blue Cross. So, they want after the healthily BC subscribers by offering them lower rates that reflected their good health.

In order to compete, the Blues started to back off their founding principals and offered the same kinds of rate structures as the for-profits.

As more companies drop health insurance, it has created the individual market where people have to buy insurance on their own. The price is sky high because they do not have the group benefit, and if they have a “pre-existing condition” the premiums will be sky high if they can find coverage at all. Someone with diabetes, the most common disease in America where the most health care dollars are spent is spent, is almost out of luck. They can accept their money, but they can deny coverage for just about anything; blaming in on the pre-existing condition.

In country that says it provides itself on entrepreneurs and small business, those people simply cannot find affordable coverage. That has made the market rife for scam artist, and Cohn tells some sad stories about the victims of the scams.

I’m just starting to get into managed care or HMOs where the insurance company bureaucrats routinely makes medical decisions and gets “between the doctor and the patient. Like the Blues, this was a great program fro the common good until the for-profits got involved and mucked it up.


kevins said...

So, are you saying with Obamacare that we will have better "quaffed" ER rooms. Is that a good thing?

You are right, of course, that ER rooms are not adequate ways for health care that should come through a primary doctor. I don't know of anyone who disputes that.

Although, without knowing all the facts, I don't know if your example demonstrates that. There will still be ER rooms under Obamacare. They could still be over-burdened or under-staffed/equipped...or even poorly quaffed, whatever that is. But that's where you go when you have an emergency...the emergency room. I've got insurance but I've still ended up in emergency rooms.

A big problem today with ERs is that uninsured use them as primary doctor offices. As such, they don't get preventative care nor are problems detected quickly. So they may have a fatal outcome when early detection could have save their lives. And, yes, the cost of treating a sore throat at ER is greater than a visit to your doctor's office.

Your better example is the person who lost insurance when she lost her job and then didn't get an early diagnosis that perhaps could have saved her life.

These are issues that should be addressed in any health care reform package.

Communications guru said...

First, I don’t know what “Obamacare” is, other than a talking point. I’m saying emergency rooms will not be as crowded they won’t have to divert patients and the less crowded condition will improve quality. What I’m really saying is the current system is broken and outdated.

Of course the ER is for the emergency, but many cases can be handled in a doctor’s office, like you say. Many routine things that could be treated in a doctor’s office turn into emergencies when they go untreated.

I don’t know if the book is in the library or not, but if it is, perhaps you might consider reading the book.

kevins said...

I actually saw the guy on TV promoting his book. Sounds interesting.

Nothing wrong with differing points of view, as long as they are factual...or as long as you recognize the bias behind them.

For instance, is it a good thing or a bad thing that health care expenditures make up 16 percent of our economy. You answer probably predicts your positions on a lot of the health care proposals.

Communications guru said...

You’re right, but I don’t see the bias in this case. It wouldn’t be a bad thing at all to spend 16 percent of the GDP if everyone had access to health care, but not so much when 50 million are left with no access and many more are struggling.

kevins said...

Unbelievable. You actually make a cogent argument.

I would agree that the issue is access to health care, particularly when it can do the most good...early detection and all that. Also, it should be portable. Someone who has worked for 20 years shouldn't find themselves without health insurance just because the company downsized.

These are arguments that Obama needs to make, rather than demonizing insurance companies. They aren't my favorite group but they all aren't Darth Vadar either. In fact, some forms of universal health coverage rely heavily on insurance companies.

group health insurance plans said...

Health care is something we can never mind in our life we mostly needed it for the assurance of our health benefits ....

Communications guru said...

All my arguments are logical, but when I am attacked, I attack back. However, I could never go as low as you have.

I agree with your position on portability. I wonder how many people want to start their own business or invent something, but are held back because they would be giving up health care for their families. I would take it a step further and say all Americans should be able to get sick and not lose everything and go into debt.

I disagree on insurance companies. We have the right demonizing the government. This is not just a fight to stop health care reform for many on the right; this is a fight by people like Dick Armey to kill Social Security and Medicare.

Even if we had universal, single-payer, insurance companies would be there to sell supplemental policies, which is fine, but this is not a universal proposal, unfortunately.

kevins said...

I think you may be missing the point of the fight by the right. I think their main goal is to have Obama lose on big issue like health care, and then translate that into wins at the polling booth in 2010 and 2012. I think that's the playbook that they think worked after Bill Clinton got elected. I'm not saying they will be successful and I believe they are carrying the water for insurance comnpanies, but I think their main goal is to regain power by making Obama look ineffective. Health care just happens to be the place where they think they can best accomplish that.

Communications guru said...

I don’t think so. Their main goal is to defeat Obama at any cost on any issue. We saw this with Clinton, but this is far worse. They are using the same arguments against Clinton’s attempt to reform health care. Hell, they’re using the same arguments they used in 1961 to defeat the evil Medicare.

kevins said...

"I don't think so"???

What do you mean by that? Didn't you just say the same thing that I did.

Me: I think their main goal is to have Obama lose on a big issue like health care...

You: I don't think so. Their main goal is to defeat Obama at any cost on any issue.

(I can't bring up Vietnam, but you can bring up 1961 and Medicare. But so what? You agree with me and you can't agree that you agree with me. Strange.

Communications guru said...

That is correct, brett. I don’t think so in that their goal is not to “ have Obama lose on (sic) big issue like health care,” but to defeat Obama at any cost on any issue.

You can bring up Vietnam all you want, but it’s like comparing apples and oranges. It wasn’t me who borsht up 1961, it was the Republicans when they pulled out a 1961 video of Saint Reagan railing about “socialized medicine,” but they fail to mention he was talking about Medicare.

kevins said...

So it was "borsht up" in 1961?

Isn't borsch something to be quaffed?

You are making a lot of these mistakes. Are you off your meds?

Communications guru said...

Thanks, brett. The sentence should be: “It wasn’t me who brought up 1961.” I’m not sure how one equals lots of mistakes. I also notice you ignore the point about Saint Reagan. I’m not any meds.