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August 2019
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The Time For Reform Is Now, Folks

peaceful • patriot, originally uploaded by origamidon.

God love Bernie Sanders. You make me proud to be a Vermonter, sir. In his typical no-nonsense style and unapologetic New York accent, Sanders rolled out an ambitious health reform bill, which he introduced to the Senate in late March. Cutting straight to the chase and through a wide swath of red tape, Sanders forcefully proposed a single payer system to cover the approximately 46 million uninsured Americans. His system would eliminate co-pays and deductibles and allow patients their own free choice of physicians.

As state residents are aware, Sander’s hypothetical health care system already exists in microcosm here in Vermont. Basically what he is proposing is to extend the model of The Vermont Health Access Program (VHAP) to all states while keeping the federal umbrella above it. In fact, VHAP insurance is so good and comprehensive that it can’t be bought—at least not in the private sector. Years ago, when I was paying hand over fist for a Blue Cross/Blue Shield private policy, I watched helplessly as my premiums continued to skyrocket every year. Meanwhile, any claim I made was either nickel-and-dimed ad nauseum, “questioned,” or flat-out denied. The modus operandi of private insurance companies, of course, is to wear down the consumer by hook or by crook. A favorite trick at its disposal is the insensitive, disembodied voice that presides over its almost comically impregnable and convoluted central phone systems. In most cases I could have enjoyed a pedicure and French manicure (and flown to and from New York for the appointment) in the ensuing “hold time.”

Under VHAP, my visit to any doctor’s office is a comparatively painless experience. I hand over my insurance card to the receptionist but my checkbook stays in my purse. The same is true if I find myself in need of the services of a hospital emergency room. Several weeks later I do not find a steep bill—full of miscellaneous charges for such petty fare as aspirins, hospital gowns and arm slings—waiting for me in the mailbox. Nor do I receive irate notices from collection agencies (where unpaid medical bills are now routinely sent as a matter of course) a mere two weeks after an insurance company and physician’s billing departments clash, gnashing their swords without apology over my hapless form caught in the middle. The patient is finally skewered into mincemeat via the sinister (and unlawful) practice of “balance billing,” in which a medical facility will demand to be reimbursed by the patient for any portion of a bill denied by their insurance company.

Assuredly Sanders, and others sympathetic to his proposal, have a tough road ahead of them. Insurance companies aren’t keen to relinquish their handsome, ill-gotten gains to Uncle Sam. And the U.S. government, filled to the brim as it is with strong-minded capitalists thirsty for profit—any profit, even if the method by which it is procured is unethical—remains Sanders’ staunchest foe. As my father put it so aptly years ago, “In the United States, anything that even mildly smacks of socialism is seen as akin to Communism. And Communism is a dirty word.”

I grew up in the maritime Canadian province of Nova Scotia. There, as in the nine other provinces and three territories, health care is provided by the federal government under the auspices of provincial control. I took it for granted that health care was an automatic right, not only for me, but all citizens. Until I paid a visit to the student health center during my freshman year at the University of Colorado, that is. I soon learned that such visits would cost me, either on a pay-as-I-went basis or in the form of monthly premiums. What was this, I wondered? Weren’t my parents paying a huge out-of-state tuition to this school? Health insurance, I realized, was something that was going to continue to cost me if I stayed in the United States.

What pains me almost more than the high cost and ineffectiveness of the current health care maze in this country, however, is the strongest, most puzzling and misguided argument in its favor. And its a premise accepted and echoed by many of the people who suffer the most under the current system.  Somehow or other our society has been duped into believing that health care is a privilege and a right only for those with pockets deep enough to afford it. If you can’t afford health insurance, the poisonous, if silent analogy seems to go, you’re either a deadbeat lay-about who deserves to die in a gutter anyway, or else someone who obviously isn’t working enough arduous hours to generate better benefits and/or accrue two weeks vacation time. While both theories are grossly erroneous, they nevertheless prevail and point up the heels-dug-in righteous attitude of those who serve to gain most from this polluted analogy: the bloated-with-money insurance companies themselves.

Another obnoxious myth perpetuated in the United States is the fear-induced fallacy that “we don’t don’t want to end up with a health care system like the one they have in Canada and Great Britain. Can you imagine falling to such lows?” Well, I have a concrete piece of news for those naysayers: Not only have I been seen by doctors in Canada and Great Britain on many occasions, I have also been attended to by physicians in Nepal, France and Denmark. In each case (without exception) the care I received was of a consistently higher and more cost-effective standard than any I’ve received in the United States before or since.

Overcome by an aggressive case of food poisoning in Paris many years ago, I was taken to the emergency room by a close American friend who happened to live in that city. There was no run-around or wait. I was seen and treated immediately with a shot—easily within ten minutes—and left restored to good health. The next day I paid the modest hospital bill of approximately $30. Comparable care in the United States at the time would probably have run in the neighborhood of several hundred dollars, albeit after a wait of at least an hour.

After a life-threatening case of High Altitude Cerebral Edema in Nepal in 2001, I was initially treated by American physicians who charged only a fraction of what would have been charged for similar service in the United States. (I paid out of pocket and was actually later reimbursed by my insurance company.) At their suggestion I was also seen by a specialist in Kathmandu, who had received his medical training in Canada. Again, the quality of care was excellent and the fee small.

In England, where I had national health insurance, I was amazed not to receive a bill after dislocating my shoulder and being transported to a hospital by ambulance. Nor did I see a bill from the attending physician, who saw me promptly.

In Denmark I had blood drawn for a routine test by the attending physician herself, and received my results promptly.

As a child growing up in Canada I was treated by highly qualified physicians whose training equaled that of their U.S. counterparts. In some cases these doctors had even attended American medical schools. When I began living full time in the United States in the 1980s, I was always surprised to hear people talk about the sorry state of health care in Canada. After all, I had grown up in the relatively poorer Maritimes. I thought these musings must have some basis in fact, but found instead that boasting of the superiority of our greatly flawed system is a point of pride, which moreover falls like a house of cards when sidled up against the scrutiny of empirical evidence.

I wish Bernie all the luck in the world as he goes to bat with congress. He’s going to need it. But so are we—that is to say, the legions of ordinary Americans he’s fighting for.

Photo courtesy of origamidon under The Creative Commons license