Here I go... about to be pushed off a cliff, (or to fall through the cracks).  I'm about to forgo the safety net of health care insurance due to a pre-existing medical condition that has made obtaining a affordable version impossible.  More on that later.

First let's get some facts on the table. 

Our multi-payer privatized health care insurance 'system' wasn't designed to provide coverage for all of us.  In fact, it wasn't 'designed' at all.

The US is the only major wealthy developed country without a public health insurance program for all of its citizens.

The lack of a national health care system is the domestic economic factor with the largest negative impact on our national budget and one of the few portions of that budget that can be modified to produce significant budgetary savings.  Designing a new health care system, passing the necessary legislation, and implementing such a system won't be straightforward, but the cost of delay will far outweigh the effort spent accomplishing these goals.  

Our health care costs in 2005 accounted for 15.3 % of our GDP.   In Canada it's 9.8 , Britain 8.3 , Japan 8.0 , Germany 10.7 .  Switzerland comes closest to the US with health care costs comprising 11.6% of its GDP.   Frontline, a PBS investigative journal compares the costs and services of the health care system of the US unfavorably with five other major capitalist democracies here.

The rate at which our healthcare expenditures are increasing is greater than any other OECD country.  At the current rate of growth, healthcare will eat up 20% of our GDP by 2016.   

We must enjoy some benefits for all that extra money, yes?  Actually, no, we don't.  We do however have higher infant mortality and lower life expectancy to name two things.  You can go here if you think that the extra 5+% we pay for health care isn't significant.  If you still aren't impressed, you probably work in the insurance or pharmaceutical industries and can go here*. 

*Note:  Italicized links in this post are to humorous and/or musical sites, therefore ignore, or open in separate window as you may be so inclined.

Authorizing a universal single payer health care system would be good for stimulating job growth and the economy in general. The cost of employee health benefits is as out of control as the nations.  By reducing the costs of the system and direct costs to employers, there is less of a downside for businesses expanding or maintaining their work force. 

One of the most important steps we can take as a nation is to initiate a single payer health care system.  Part of the difference between our healthcare costs and those other countries is what the private insurance companies would call profit.  A single payer national healthcare system is not run with the object of making a profit.  Such a system is managed in order to control the overall costs of medical care for the national population.

Another difference between single payer systems and ours is waste resulting from the labyrinthine administrative processes required to navigate a multi-payer system.   Each insurer has its own billing procedures that requires extra labor and expertise when healthcare providers and policy holders submit claims.  Those claims are often denied or approval is delayed, to the detriment of those seeking treatment and to the benefit of the insurer.  A time consuming appeals process can result with the sick deferring or abandoning medical treatment altogether.  Ultimately, care delayed is care denied. 

By screening potential policyholders for existing health issues, and jettisoning expensive, (read: sick), policyholders who change jobs, lose jobs or otherwise disqualify themselves for coverage under current laws, insurance companies have been permitted to build themselves a cash cow. Those who slip through the cracks are left to puzzle how such a national health care 'strategy' serves anyone well other than the insurance companies.  The poor or sick are often unable to find affordable medical coverage.  If they lack financial resources to pay for medical treatment out of pocket they may rely on emergency treatment centers or to forgo treatment altogether. Emergency rooms are one of the few options available to the poor and are often used as a primary care physician service, placing an extra burden on these facilities.  Treatment deferred often leads to more invasive and expensive subsequent treatment, again driving our national health care costs up. These deficiencies of our 'system' make the adoption of a universal, single payer system imperative both morally and financially.

One of the benefits of having a large pool of people in a healthcare system is that the costs of medical services can be averaged out between the sick and the healthy so that none are burdened with shouldering the full costs of a catastrophic illness.  There is safety in numbers with respect to insurance pools, however the profitability of any insurer in a multi-payer system is diminished by including those who are in need of medical services. The business model for insurers in our system is to create a pool of clients skewed as far as possible to the healthy end of the spectrum, excluding those in most dire need of medical services, thereby reducing the company's financial risk.  A direct result of this business strategy of exclusion is that medical expenses account for the major component of 50% of bankruptcies in the United States. Another disturbing statistic is that every 30 seconds someone in the US files for bankruptcy as a result of serious illness. As the baby boomers age, we can expect the incidence and frequency of medically related bankruptcies to increase.  That will most likely correlate to a greater drain on the socialized medical infrastructure we all ready have in place, (Medicare, Medicaid, VA, etc).

The cost of prescription drugs in a single payer system tends to be less than that documented in a system such as ours.  Pharmaceutical companies have a greater incentive to lower the price of their products when they are negotiating for access to an entire nation of potential clients rather than just a single insurance company's pool of clients.  An interesting side note is that in Britain, subsequent to cost/benefit analyses,  some expensive drug therapies were excluded from being covered  by the National Health Service. Their exclusion from coverage in the system in turn resulted in some of those pharmaceutical manufacturers lowering their prices  which they had previously declined to do in order to access the market, .  In a system of uncoordinated private insurers there's no incentive for those insurers to contain medical costs as long as they can be passed on to the consumer.

All of which brings me back to my own predicament.  I'm 55 years old.  I've been a self-employed artist for over 20 years, (Disclosure:  I worked in the pharmaceutical industry for 5 years following university).  I had chosen my most recent health care coverage from my wife's employer's health plan.  During a trip through the South Pacific three years ago I contracted a severe viral infection.  Subsequent treatment for the 'flu' revealed an irregular heartbeat, and ultimately that I had Idiopathic Dilated Cardiomyopathy, (IDCM - basically congestive heart failure of unknown cause, though thought to be viral in origin). My condition has been treated successfully with drug therapy since the time of diagnosis and my heart function, is now normal. I will likely have to remain on a course of drugs for the rest of my life.

Here's the catch: I was divorced last December.  I continued my health coverage by extending it through COBRA which the company was legally bound to provide to me for one year at my existing rate.  When the COBRA coverage expires this month, my policy premiums will increase from $266/month to $1755/month, or about $23,000/year total out of pocket expense when factoring in co-pays for prescriptions and office visits as well as my deductible.  I have investigated alternative insurers and have been told that I am essentially uninsurable at what is an affordable price for me.  Were I to pay the proposed premium increase, I would siphon away my financial assets in a short enough time that I will not have any savings left for retirement, (should I live so long), and eventually be unable to afford the premium payments anyway. 

As an exercise in accounting, I added up the cost of the various prescriptions, and medical services I received during this past year, including some x-rays and an MRI I required due to a sports injury: the total payout from my insurer was about $7800.  On top of that I paid out of pocket about $5000 in premiums, copays and deductibles.  My premium reduces their cost to about $4500.  My health risks are higher than normal because of my heart, but the exorbitant increase in my insurance premium looks pretty much like my insurer wants me to self insure myself while utilizing their bank account as the escrow account.   

With a $18,500 difference between their expenses on my behalf this past year and what I'm expected to pay this coming year, self insurance looks like a winning, (or less of a losing), strategy to me.  I can go broke slowly but surely by paying what the insurer demands, or I can take my chances, and potentially go broke with pyrotechnic style should something catastrophic befall me.  I don't doubt that I will be foregoing some treatments in an effort to keep costs down, and as such will be putting my health at greater risk. 

I remain philosophical.  I have that luxury as I have no children or spouse who depend on my continued good health.  I'm physically, mentally, (most of the time), and financially equipped to deal with my situation better than many others who find themselves in similar situations. Such a dilemma is unnecessary for any one of us to bear however.  Americans have accepted the right of all of our citizens to an education and we've collectively born the cost of a public school system.  If public education were left to private enterprise, we would see similar discrepancies between those with the ability to pay and those less well endowed, (please, I know the difference between an education at Exeter and Newark HS, so let's save that discussion for another time.  And don't remind me of this American who had the benefit of a private education:  G.W. Bush, Phillips Academy, head cheerleader, senior year).  If you believe as Barack Obama said he does, that health care is a right and not a privilege, then universal health care is morally the right thing to do, and the financial consequences of not initiating a single payer system soon are dire.

So why is there so much resistance to accepting universal healthcare in the US?  I believe one factor is inertia, (aka: fear of change).  There is some cold comfort in the status quo.  The devil we know vs. the one the insurance industry lobbyists, would paint as a bogeyman.  At some point in the not too distant future the costs of maintaining the status quo will outweigh whatever comfort we gain from clinging to it. Many Americans are stoic in their self-sufficiency and believe they will weather any storm by themselves without the help of the state, their fellow citizens or their neighbors.  The insurance companies hope that those so inclined will remain so.  It is to their benefit to keep milking the cash cow we call a 'privatized health care system'.  They would portray those who live without insurance as 'irresponsible', ignoring the fact that such insurance is out of reach financially for a large portion of our population, and that they and the privatized multi-payer 'system' have made it so.

The current thinking is that healthcare reform in the US will be accomplished in incremental steps, due to the political and logistical impediments to accomplishing such sweeping changes.  There is no doubt that there will be political resistance to authorizing universal healthcare and a single payer system.  It is my belief that such resistance is orchestrated by the insurance companies, pharmaceutical companies, and some other medical providers with vested interests in keeping the cash cow producing.   These special interests wish to preserve a system that amounts to a corporate entitlement program for their industries.  In clinical psychology, an unrealistic, exaggerated, or rigidly held sense of entitlement may be considered a symptom of Narcissitic Personality Disorder, (NPD).  What we have here is a corporate, or industry wide case of NPD.  As such we will meet with resistance at every stage of an incremental change.   The best solution to our health care problems is a single payer, universal coverage system.  We will in the end have such a system, the question is how much wealth will we permit the special interests to extract from our economy before that comes to pass.

So, if you're one of the lucky ones who have adequate health care coverage that you can afford, congratulations... and good luck.  You may need that good luck.  Don't get sick, don't lose your job, and if you're covered under your spouse's plan, don't get divorced if you can help it.  Whatever becomes of you, keep smilin'.

I have been lucky and have remained above the cracks I am currently sliding through for most of my life, unlike 47 million less fortunate fellow citizens, (a number that has increased by 8 million since 2000).  Meanwhile here in our health care dystopia, I'm about to perform without a net for the first time in many years.  Hope I don't miss the trapeze bar next time around.

Thanks for staying with me if you managed to plow through all of this! Please take the time to visit this site our President-Elect has set up, and register your support for universal, single payer healthcare if you feel so inclined.  Better yet let your senators and representatives
know how you feel.

Note:  I debated using my personal history to make my case in this blog, as I am assuredly not soliciting sympathy for myself and take no joy in discussing my health publicly.  Ultimately I decided to use my own story as I think it portrays a fairly cogent example how as Rummy would say, "Stuff happens".  Unfortunately stuff happens to all of us sooner or later regarding our health.

A happy and healthy new year to all of you.