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Gary Horton: The time is now for socialized health care

Full Speed to Port!

Posted: January 6, 2009 8:31 p.m.
Updated: January 7, 2009 4:30 a.m.
 

Our family's worst experience with Big Medicine occurred nearly 15 years ago. Like most, we'd had skirmishes here and there with our insurance company, but this one was nearly a killer.

We'd driven up to Lake Tahoe with the kids for some winter snow and ski fun. My wife Carrie had complained of fatigue, but she did her best to keep up with the kids' boundless energy.

On the third night, Carrie said she was experiencing sharp abdominal pains. The next morning she repeatedly fainted when trying to get out of bed.

Water, food - nothing helped. The kids and I got Carrie to the car, and I rushed her to the Incline Village emergency room.

Once there, the universally dreaded "emergency room wait" began. Carrie again fainted, and I called to the emergency doctor through the window that he'd have a fatality instead of a patient in his lobby if he didn't see us at once.

That changed the pecking order and Carrie was waved on in. A quick check for blood pressure made the doctor as pale as Carrie, and we instantly knew we were in deep trouble.

"Has your wife had any recent medical treatment?"

Yes, she had. Carrie suffered from sinus polyps, and our HMO doctor had placed her on strong antibiotics for nearly five months.

"Five months?" The emergency doctor dropped his jaw in disbelief. Carrie was now in some sort of toxic shock and needed serious treatment.

"We've got to get Carrie to the hospital at Truckee immediately. There's no time to wait for an ambulance. You drive her and I'll call ahead to get them prepared."

I drove that 30 miles in silence with Carrie unconscious in the passenger's seat. The Truckee hospital took Carrie more seriously than our HMO, for when we arrived at the driveway two nurses sprang from the building and wheeled Carrie straight into the emergency room.

She spent that first day with intestinal specialists. The doctor didn't mince his words. Carrie's HMO had been negligent, and the extended use of antibiotics caused Carrie to contract antibiotic-induced colitis and toxic shock.

Carrie had nearly died, but now appeared to be stabilizing.

The kids and I stayed close at a local Truckee hotel that night. What an awful experience to hug kids goodnight, praying they'd still have a mom the next day. And all for what turned out to be a medical "cost-control" decision.

Carrie received excellent treatment in Truckee and within days we returned home to begin her extended recovery.

Next came the pain with our HMO - a suffering similar to that experienced by many Americans. Our HMO's indifference to Carrie was staggering. Would they pay the hospital bill?

Only partially - because we hadn't gotten prior approval for Carrie's admittance.
It also turned out our HMO ENT doctor had administered extended antibiotics because the HMO declined to pay for surgery common for people with her condition.

After battles and letters, the HMO finally agreed to the surgery, but only with one particular surgeon within our HMO plan.

With no disrespect to age, the referred doctor was ancient and retiring. His proposed surgery would entail cutting holes through the roof of Carrie's mouth to gain access to her sinuses. The whole thing seemed
unnecessarily brutal and primative.

We contacted UCLA Medical Center for an alternate opinion and our suspicions were confirmed: Nasal endoscopy should instead be used, requiring no cuts, scars, or long recovery. Great news, but our HMO refused to pay for UCLA's better way.

Having no mind to again suffer medical care on the cheap, we went with UCLA and paid the $10,000 tab ourselves. The surgery was a success and Carrie returned to normal pain-free health.
Along the way we concluded our "affordable" HMO health care wasn't affordable at all. It nearly cost

Carrie's life -- and cost us $10,000 outside the system, too.

We bit hard and switched to a more expensive PPO policy. PPOs are the plans in which you choose your own doctors who, in turn, make their own decisions with less interference from indifferent insurance company technocrats.

Years passed with steady health and we lost track of our PPO and the price we were paying for coverage - until last week.

Our daughter Katie graduated college. And with her diploma came her ineligibility for our family medical coverage at year's end. So I visited our HR office to see what we could do.

"How much are we paying now?" I asked innocently.

"Fourteen hundred dollars a month," was HR's deadpan reply.

Holy (unprintable)! $17,000 a year for medical for me, Carrie and a 22-year-old?

"Yes, pretty typical for a PPO," answered HR matter of factly. "But she can't be on your policy anymore."

Gads! I knew we had been paying more, but how did it balloon to this? How can people afford such things?
HR told us we could switch back to the HMO policy like the one that nearly killed Carrie, but it would still cost almost $10,000 a year.

"What if you lose your job?" I asked.

"Then you pay it yourself through COBRA."

"What if you don't have the money because you lost your job?"

"Then you lose your coverage."

And this in an "advanced" country?

Decades ago in a "prior life" I worked as a Mormon Missionary in "socialized" Finland. One day, riding our bikes on a snowy street, my buddy crashed his bike and hit his head on the curb. I shored the boy up and got him to a nearby Finnish hospital.

Four hours of first-class care later, we were presented with the bill: "Seventy-five cents, please."

OK, so in today's dollars it would have been five bucks. In Finland, medical care is a right, not a profit opportunity.

Subsequent trips to Scandinavia yielded the same experience when we needed medical attention. They view health care like the U.S. views public education. Everyone gets it.

Yet America never completes the circle like the rest of the advanced world in treating health care as important as public education or police protection.

With new national leadership there's a lot of talk about what we're going to do with health care. Departing Secretary of Health and Human Services Michael Leavitt warns, "Absent fundamental reforms, over the next two decades, the average American household's health-care spending ... will go from 23 percent to 41 percent of average household income."

Forty-one percent of our income certainly won't work. Medical costs are already crippling for those who have it - and some 50 million don't.

We're at a tipping point where the employer-based medical insurance system simply doesn't work. And HMO plans with ever-reducing benefits and shrinking reimbursements leave patients exposed to substandard medicine and doctors exposed to bleeding cash and bankruptcy.

Many sound alarms at the notion of universal health care. But Canadians and Scandinavians live longer than Americans and have lower infant mortality.

And those frightful news stories of patients dying on emergency waiting room floors come not from socialized Canada or Finland, but rather from capitalist Los Angeles and the United States.

I celebrate Barack Obama's victory, but Obama's plan for expanding the employer-based health-care system only prolongs the suffering. For-profit medical insurance companies will forever work to increase profits, forever pitting themselves against the best interests of patients and the country.

Carrie nearly died from medical decisions driven by cost-control technocrats. Almost all Americans have had similar experiences with their own insurance companies.

America can do much better than allow corporations to game our health for profit while unrealistically requiring employers to administrate the bad medicine.

We've got to kill the infection, not numb the pain. Almost all other advanced Western nations go opposite America with national universal coverage - and pay half of what America pays. And, they have better health to show for it, too.

Insurance companies may squirm and scream as we surgically remove them from our system. But better their pain than ours. Some things just become obsolete and have to be replaced.

America already accepts and enjoys socialized education, socialized police and fire service, socialized parks and recreation and a socialized military.

It's time for us to catch up with the rest of the advanced world and treat health care as a right, just as we do other citizen services.

Most have already paid too dearly for our dithering on this perplexing national concern.

Gary Horton lives in Valencia. "Full Speed to Port" appears Wednesdays in The Signal. His column reflects his own views and not necessarily those of The Signal.

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