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.