By Donella Meadows
–July 28, 1994–
Last week, through a stroke of luck, I signed onto a $50-deductible health care plan and discovered how the other half lives — the folks with good health insurance.
Imagine! I don’t have to walk around for months with an ache or lump wondering if I can afford to take it to a doctor! I don’t have to sweat out where — or whether — I’m going to find the money for an annual checkup! I don’t have to confront that rising monthly bill for the $1500-deductible and wonder how much longer I will be able to pay it. Here’s an example of the perverse economics of high-deductible health insurance. During a financial setback some years ago, I went three years without a checkup. Then my body began doing strange things, which I ignored for months. When I finally went for help, I found out I had cancer. It turned out to be a stage two cancer, which required more treatment than it would have if it had been caught earlier.
That interlude cost me $6000 (counting deductible, co-payments, and procedures my insurance didn’t cover). It cost my insurance company $20,000. It would have cost half that much, if I could have afforded to get my checkups on time.
Having crossed so recently from the barely-haves to the haves of health care, I can say with special fervor, EVERYONE OUGHT TO HAVE LOW-DEDUCTIBLE, FULL-COVERAGE HEALTH INSURANCE. Everyone, not 95 percent. As soon as possible, not in 1998 or 2001. A $10 office-visit fee or $50 hospital-admission fee could be charged to keep hypochondriacs from abusing the system. But basically there should be no have-nots in health care, not only for moral reasons but for practical ones.
A friend from New Zealand, one of the many civilized countries with a universal, single-payer health system, keeps pointing out to me some of the savings her country enjoys.
– “Employer mandates” — government rules requiring businesses to pay some or all of their employees’ health insurance — are unnecessary. Therefore prices of nearly every good and service go down, since they don’t have to recoup the cost of health insurance. – Liability insurance for cars, homes, and businesses is unnecessary. It makes no sense, since everyone’s medical cost is covered by the same payer. Litigation costs also go way down. – Bills go straight to the government; paperwork is vastly reduced. – Uninsured people don’t show up in emergency rooms, with preventable diseases turned into raging disasters.
– Insurance company profits are no longer necessary — nor are their million-dollar-a-year executives. Nor are huge, heartless HMOs with layers of administration, or stock market gains for private health care suppliers. The mentality of health care turns away from money-making and back to care.
The saving from eliminating private insurance alone — on the order of $100 billion a year — is the main reason that neither the Clintons nor the Congress will push for a single-payer plan. The political courage to take billions of dollars away from insurance companies is not completely absent — 92 brave souls in the House co-sponsored Jim McDermott’s single-payer bill. But on the whole, the discussion in Washington and in the nation has been dominated by insurance executives. It has not been about saving or even about health care; it has been about who can hang on to what piece of the bloated trillion-dollar pie.
Therefore no plan that can pass the current Congress is worth passing. Though our health care system is hurting people every day and costing a fortune, the best option right now is for Congress to go home, soak its collective head, and start over. We, in the coming election, ought to insist on just one thing — and it’s not health care reform. Before we can hope to get that, we need campaign reform. The people who say government can’t do anything right are correct, but the solution is not to dump government. (Insurance companies and HMOs are no better.) It’s to fix government.
For example: It should be illegal for a politician to take one penny from anyone at any time for campaigning (or anything else). No candidate should be allowed to buy broadcast time or newspaper space. Every candidate should be given equal media access. That access should be used only for direct statements about what the candidate stands for — no slogans, flags, sunsets, music, or gimmicks, just words. (OK, Ross, maybe we’ll permit charts and graphs.) Better than term limits would be the opportunity in any contest to vote for “none of the above,” which we could keep doing until we are offered candidates we actually want to vote for.
Though our health care system is costing a fortune and hurting people every day and my $50-deductible is only temporary, reform like that has to come first. Otherwise the government will never lift the dark cloud of health-care worry from us. It will go on caring more for profits than for people, until we make it into a democracy again.
Copyright Sustainability Institute 1994
