Health Insurance Rates Well — Balderdash

By T Michael White MD FACP

“When the norm is decency, other virtues can thrive: integrity, honesty, compassion, kindness, and trust.” Raja Krishnamoorthi

fixingushealthcare.com

Sunday, December 15, 2024

Dear Mr. President, Honorable Members of Congress and Distinguished Staff and Fine Citizens,

  In the midst of a vociferous response to the tragic murder of a health care executive, a New York Times headline reads: Most Americans Say They Have Good Health Insurance, Polls Show.  Although reporter Kaleigh Roger’s article goes on to be fair and balanced, the headline is rubbish.

From my humble academic, clinical and scientific crow’s nest perspective (which affords me communications with clinicians and patients), here is what Americans think of their health care:

• To begin, the polls only addressed citizens with insurance.  The opinion of the masses of uninsured were not factored in.  I anticipate unhappiness. 

• The number one factor in the recent presidential election was the economy.  Health care was not even listed as a concern.  But, at the kitchen table, concern for health care expense ranks with housing and food security.  In other words, health care expense impacts everyone’s perception of the economy.    

• Those (few) like me, who are protected by Medicare and its prescription plan, live in a region offering award-winning care and have the personal means to address modest premiums, co-pays and deductibles: 1) perceive excellent health insurance; and 2) are puzzled that anyone thinks there is a problem.

• Those (many) with Medicare who do not have the means to address modest premiums, co-pays and deductibles live in constant worry — worry over having to choose between care, food, housing etc. should they become ill.   

• Those (many) who have private insurance and have the means to address significant premiums, co-pays and deductibles and who are basically healthy perceive their health care insurance to be good. 

• Those (few) who have private insurance and have the means to address significant premiums, co-pays and deductibles but become significantly ill are soon overwhelmed with out-of-pocket expense and the revelation that, despite significant premiums, they are significantly uninsured.  With this revelation, they become disenchanted with their health care insurance.  

• Those (many) who are hardworking yet barely making it 1) do not qualify for Medicaid and 2) struggle to pay subsidized premiums, co-pays and deductibles; but 3) if ill, stop paying premiums because massive co-pays and deductibles make it all unhappily unaffordable. 

• Those in poverty qualify for Medicaid protection.  If not perfect, health care insurance is perceived to be good.

Anecdotes are powerful.  Just this week:

• Our fine local newspaper again reports a hard-working family, impacted by routine manageable illness, faces food and housing insecurity and homelessness.

• I find myself pondering what Nancy Pelosi’s (who I greatly admire) out-of-pocket health care expenses will look like after a tragic fall and dramatic care in Luxemburg?

• An extremely talented young person, who hates his/her dead-end job, has a chronic condition requiring an expensive medication (massive co-pay), cannot seek alternative employment for fear of totally losing coverage of the medication.

• Another hardworking “insured” ill individual shows up to the free clinic because co-pays and deductibles make maintenance of premiums unaffordable.

• A healthy mental health colleague desires to age into Medicare: 1) to not have to fund her/his ponderous health care premiums; 2) to have the financial security afforded by Medicare; and 3) to retire and not have to address the economic complexity of caring for his patients. 

• An eight-year-old girl with the school yard broken arm cries to the school nurse: 1) in pain; and 2) because the family does not have insurance.

• A seasoned physician educator, surrounded by clinician burnout, explores the ethics of recommending a health care career to his progeny.

How do I summarize this?  I observe The Medicare Elite, The Well Insured Healthy and perhaps (probably not) The Medicaid Poor are pleased with their health care insurance; and I observe, the rest of America is in the midst of an on-going (no end in sight) unhappy, chaotic health care hot mess — a circumstance for which a recent tragic event has enabled discussion like this.

Allow me to leave you with my humble biased opinion — our fine country is in a critical health care muddle.  This is a crisis.  It must recognize 1) we have no health care system; 2) our current health care patchwork is broken and flawed; and 3) our fine citizens require and deserve a United States Health Care System that provides basic (boundaries require definition) Compassionate, Safe, Timely, Efficient (affordable), Effective (quality), Equitable (just) Patient-centered Care (Basic C-STEEEP) and 4) in the name of decency, the immediate design and implementation a United States Health Care System is mandatory.     

Respectfully submitted,

T Michael White MD FACP

fixingushealthcare.com

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