The Cost of Health - Care

The United States has the distinction of having the world's most expensive health-care system. Not because the country has addressed its responsibility to its large population in the provision of dependable, affordable health care to all of its citizens, however. In a nation that appears to value the concept of free enterprise over that of the collective health of Americans, it is unfettered capitalism that represents a public good.

Whereas it appears on the record that it is not so much in the national interest to create and administer a universal health care system that whiffs of socialism. That vast American public is left to its own devices for the provision of health care.

For those with private wealth, this is no problem; they are able to obtain the finest health care that money can buy within a health-care system that is among the best of the world. For Members of Congress too, this does not represent a problem, since they enjoy gold-plated health coverage with no lifetime limits for major services for inpatient and outpatient hospital care, along with prescription drugs, diagnostic tests, preventive care and a host of other goodies.

For those people whom Medicare doesn't cover, the great middle-class, lower and upper, another story altogether reveals itself. If people have the great good fortune to enjoy steady jobs offering the perquisite of good, reliable health insurance ensuring wide coverage of the essentials, they can feel comfortable. But for part-time workers, the unemployed, the working poor, another story altogether. They can choose to beggar themselves by paying hefty monthly premiums and hope that the coverage they obtain will meet their needs.

Or they can opt to choose between middling-coverage with insurance plans that are said to be 'affordable' and which fail the test of decent coverage. Failing that, they can do nothing and fervently hope that their health will hold out. In both of these categories, people tend not to visit doctors frequently, tend to not use pharmaceuticals that may be prescribed for them, and live a life of crossed-fingers.

With the downturn in the economy an estimated 14,000 Americans daily have lost their work-based insurance coverage, facing for the first time in their working lives the conundrum of obtaining insurance they might be able to afford, as newly unemployed. For those facing catastrophic health issues this is not a pretty picture. Some, losing permanent employment, take out $500-a-month insurance which will not cover pre-existing conditions.

And the plan that this insurance represents turns out to be hopelessly inadequate when a diagnosis of cancer is given - which treatment, inclusive of surgery and chemotherapy turns out costing $200,000 - and the insurance covers little of that expense, leaving the family in the position of realizing they will spend the rest of their lives paying off their medical debt, and hoping against hope that no one else in the family will become terribly ill.

Insurance coverage coming close to adequate, yet not fulsomely beneficial, will cost the average family $1,000 monthly and beyond. Some of the 'affordable health choice plans' offered by well-known health insurance agencies, considered 'junk insurance' by those in the know, have immense gaps in coverage, yet they're sold to the gullible and the hopeful who discover that they may in the end cover $1,000 in hospital costs and $2,000 of out-patient services on an annual basis.

An egregious example appeared in Consumer Reports outlining an advertised "affordable solution to America's health-care crisis" with a plan which a consumer trusted and when he was diagnosed with prostate cancer, he discovered that his limited-benefit plan would not cover the required drugs and radiation treatment required for his treatment protocol. Even discrete State plans fail their residents, not covering inpatient hospital treatments, emergency room care or physical therapy, along with severely limited coverage for everything else.

When a researcher into the failings of the insurance industry submitted one company's policy list of benefits to a research professor at Georgetown University Health Policy Institute for her opinion and an explanation of the issue, the response was inconclusive. The expert was unable to figure out precisely how it was that the policy ended up covering so little. The policy list of benefits was missing specific billing codes to explain what treatments would be covered.

In Canada, where universal health care is guaranteed for every resident of the country, people regularly visit their health practitioners for medical check-ups without regard to the cost, because that cost is underwritten on their behalf by the universal health plan. When surgery is required it is undertaken at public cost. Each province has a prescription formulary outlining which pharmaceuticals will be covered. Functional health care is guaranteed to the populace.

There are waiting periods for some types of surgery, but by no means all. The system tends to be cumbersome at times in its administration, but there are very few people who find fault with the treatment they are given, and in fact, Canada has an outstanding record for health outcomes for its population. Yet Canada's system is held up as a cautionary tale of inadequacy by American opponents of this controversial issue, even while costs are far lower than those in the U.S., and everyone is covered.

The big question to be answered by Americans, is whose interests are being met in the current state of affairs with respect to their hit-and-miss - largely missing if you're out of the loop - system of health care insurance and the provision of health care.