A few thoughts on US health care policy

I was pretty young when I learned about the practice of health insurance companies denying coverage to individuals with pre-existing conditions. (I’m pretty sure it was before I hit my teens, but if not, I was somewhere around age 13 or 14.) My concept of how insurance companies worked was probably inaccurate at the time, but that was more or less irrelevant to my emotional response: panic at the thought of Lily not having health care, because her disabilities are almost all congenital, and thus, you know, pre-existing.

Over the past few days, I’ve noticed some comments on websites with discussion boards that argue that by not allowing insurers to deny coverage to people with pre-existing conditions, we as a society will encourage people – particularly the generally healthy 20-30 year old crowd – to forego insurance. These people will then “get sick” and demand to purchase coverage at the time they require medical services. My response to this is twofold: (1) if medical care weren’t so much more tied to insurance than ability to pay, and locked into a for-profit model, we might not be having this disagreement, and (2) given our current situation, and the fact that most of us who do carry health insurance now don’t use it all the time, can you please remember that there are babies who are born in need of care, and that it’s morally reprehensible that we as a society would consider promulgating a system of health care that would relegate these children to lives of unnecessary difficulty? I don’t know what simulations and survey data say about the likelihood of people giving up health insurance because they know that they wouldn’t get denied coverage should they end up with (relative) pre-existing conditions, but I know that even one family like mine trying to struggle with the human/humane act of caring for children who need even just a little bit of medical care? Can feel like one family too many. And while Lily’s needs might be pretty extreme – she needed anti-convulsants as well as major reconstructive plastic surgery and a shunt before her first birthday – when you consider that “disability” extends to scenarios as mundane needing glasses or a cane, there are a lot of families like mine out there.

Really – even small things, like getting glasses or leg braces or a walker, can have a huge impact on a child’s development and happiness. If parents have to fight the medical system, it puts stress on the whole family. A child’s minor medical condition might be correctable, saving precious dollars by preventing the need for treatment in or throughout adulthood, if that’s a concern for you-the-hypothetical-reader, to say nothing of the amelioration of emotional trauma. How many students underperform in school because they have undiagnosed vision problems? Learning disabilities? Cardiac or respiratory problems?

I’m not one to argue that we need to force everyone to get treatment for any perceived medical problem, and I’m not saying that we can’t pay for some or all of our own health care. I am arguing that for those who want treatment, it doesn’t make sense to let bureaucrats without medical training to make decisions about whether that treatment is accessible. (For the record, I really do wonder whether this would even be an issue if health care were as profit-driven as it appears to be, and if we had somehow avoided developing a dependence on insurance companies to mediate paying for health care. But I’m not sure how to resolve that situation without drastic measures.)

As a sibling, from the day I figured out the pre-existing condition clause, I sensed that some day it could cause problems for me, because at some point, I assumed that my parents would no longer carry coverage that included my sister. Now that I’m older, I know that there are social support systems that will help Lily get the medical care she needs, but I haven’t stopped assuming that at some point I might need or want to include my sister in my own health care plan. If we move towards preventing any individual from being denied medical insurance due to pre-existing conditions, we move towards a time when I won’t worry about being able to do that.

I’m aware that as a scientist, I’m probably expected to respond to a situation like this by looking at the numbers and making an objective, analytical response. But I’ve been a person for longer than a scientist, and my love for my sister sometimes means that I won’t take that approach. I see this as a moral issue rather than a matter of strict finances and statistics, and if that’s a purely selfish motive because of how personally I take the issue, so be it. There are actual people who are currently in need of medical care that they can’t get for reasons that seem obscure at best and downright inhumane at worst, and I’d love to see our national policy debates focus more on them than on abstracts and theoreticals.

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