Wednesday, January 19, 2011

Do we turn them away?

kw: medicine, insurance, mandates

When my grandmother had a stroke in 1972 she was taken to a hospital, where she died the next day. My mother remarked later, "If she had awoken in the hospital, she'd have died of apoplexy." It was her first visit to a hospital since 1918, when her first child was born. That birth experience so disgusted her that she had her younger children, including my mother, on the kitchen table, delivered by my grandfather. She never partook of medical services again, consciously at least.

From 1918 to 1972 is 54 years. More than a half century during which she spent not a penny on medical services. That is how she wanted it. More to the point, when my grandfather became troubled by dementia, probably Alzheimer's although it was called "hardening of the arteries" in the 1960s, she cared for him at home, right up until his death at age 75.

My grandparents ran a family business their entire lives together. Their only employees were their children. They had no medical insurance. Being well-to-do, when they needed a doctor to see to a sick child, and that was very rare, they simply paid for it. What would they have paid for insurance, had they had any?

The current medical insurance premium for a family of five is about $14,000 yearly, or nearly $1,200 per month. If you have insurance, that is what is being paid, probably by your employer. That is what it has to be because the average American family uses on average more than $1,000 in medical services monthly. Now if we back out inflation and other changes in the value of money over time, consider what fifty years of such insurance would cost: $700,000. About three-quarters of a million dollars (current 2010 dollars). This is the level of payment that every family will be required to pay in medical insurance premiums according to the "Patient Protection and Affordable Care Act", often nicknamed Obamacare.

I am inclined to bridle strongly at the notion that people should be forced to buy medical insurance. The original bill was sold to the American public as a way to make medical insurance "available to all" at affordable rates. Making something available is definitely not the same as making it mandatory. On the other hand, what if we don't? What if the effort to repeal PPACA were to succeed? And further, what if a new law were passed that provided insurance to all who wanted it, at the same cost to all (that'll be the day!), but did not force people to buy any?

A single consideration illuminates the problem. Will there also be a mandate to care for everyone, insured or not? If there is, what incentive will people have to pay for insurance? Or will there be an explicit proviso that hospitals and doctors can decline to care for someone who is not insured and cannot privately pay? Will they actually turn patients away at the door? Will ambulance crews be required to check the insurance status and solvency of a person before taking them to the emergency room? "That one's not insured, leave him there." Really?

Though I am conservative, a registered Republican, I must reluctantly affirm that this is just like automobile insurance, which is currently a requirement in nearly every state, and will eventually be a national requirement. If you are alive, you will pay medical insurance premiums. Life is uncertain. You cannot guarantee that you will live fifty years without the need to get medical help. My poor grandmother would be spitting mad at such a requirement. It can't be helped.

I look back at my working career, in which I have had medical insurance since 1967. It has proportionally risen the most in recent years, so I can only give an approximate figure, but in current dollars, the premiums, mostly company paid, total about $400,000. Would I like to have that money in my bank account instead? You bet. But I've had some expensive medical stuff done, so I don't grudge it.

There are bound to be horror stories of all kinds, no matter what kind of medical insurance law we live under in the next fifty years. Our task as a civilized society is to continue to revise laws to minimize the horror stories, and to make right what we can when one occurs. That is what we have done for 234 years so far, with variable success. It beats anarchy.

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