Archive for August, 2012

Health insurers make money, in much the same way bookies do.  It is an odds-makers’ game requiring more players than pay-outs to sustain it. Those who run the game, bet on the odds of there being more healthy, than sick. The thought of insurers profiting offends many, but insurers have to make money to be solvent.

Forget the 1%…in America, the 99% live more affluent lives than most of the world. Despite our prosperity, we are frightened or frustrated by the cost of medical care. American healthcare is costly, but the notion that costs have spiraled out of control is largely the result of how removed we’ve become from actual real costs.

A hundred years ago, healthcare was costly.  Then, it was because the nation was poor.  Now it is because our medical care is outstanding. In the era when doctors made house calls, they would often be paid in whatever currency their patients had, whether it be a few dollars, or a basket of eggs, but because we can’t always anticipate our medical expenses, the cost of healthcare is one item that exists outside our household budgets.

Paying the doctor in eggs was harder when the average hourly wage a little more than a quarter, but even in our era of unprecedented prosperity, healthcare costs can be burdensome. We carry phones that cost hundreds, have household electronics that cost thousands, and pay more for a night of entertainment than we are willing to pay for an office visit. Grudgingly, we cough up fees for the one thing more valuable than any other–our health.

Until we face an illness or injury, most of us don’t even have a realistic idea of medical costs.  Upon seeing a bill for a twenty-minute visit with a doctor, we may wrongly assume the doctor is over-paid, but to determine his costs, we would have to factor in all the others things we are indirectly paying for like years of expensive training, operating costs like rent, lights, and equipment, or high premiums for malpractice insurance.  Add to those the expense of the support staff required in a small medical office to schedule appointments, assist physicians, process claims, handle the record-keeping, or do the accounting.

We’ve come a long way from the time when a doctor’s treatments were limited to what would fit in a satchel, but to understand today’s costs, it’s helpful to understand the evolution of American healthcare.  Only a  century ago, the concept of health insurance was new.  During WWII, employers were under wage and price controls.  To attract the best employees, companies began to offer health benefits in lieu of higher wages. Those early plans paid most of a patient’s medical bills, but patients shared some portion, making it necessary even for those with insurance to be conservative about seeking medical care.  Traditional insurance gave consumers an awareness of “real” costs.

In the ‘60s and ‘70s, government intervention again changed healthcare, first with the creation of Medicare and Medicaid, later when  President Nixon enacted legislation to popularize Health Maintenance Organizations (HMOs)  The first HMOs followed the Kaiser Permanente model, which had reduced costs by limiting and standardizing care.  The upside of the HMO’s was coverage of preventative services, like mammograms or immunizations.  These plans offered more for less, making consumers more  inclined to see doctors, but this factor and the number of required to administer HMO’s, began to decrease their profitiblity of the HMOs.

Real costs were largely replaced by co-pays, and a lessening of patient choice. Physicians were offered incentives for treating patients conservatively, as those who managed these plans tried to spread resources among many members with varying medical needs.  As the doctors become more accountable to managers than patients, getting care became more complicated. Managed care was really about managed costs.

Medicaid and Medicare gave more individuals access to healthcare, by placing their beneficiaries in HMOs or the same pools as the privately insured.  This was a good solution, until the low fees paid to providers, failed to cover the costs of the services provided.  The difference between fees and costs, made it necessary to shift those costs to other patients–artificially inflating costs.

Many favored a government-run single-payer system.  If you are a parent, it is likely your house operates with a single-payer system. At least one adult makes money, which is then used to fund all the expenses of the household.  Because the amount of money is limited, someone has to make the decisions about where the money will be spent. Everyone in the home has a want-list, but there simply isn’t enough money to for everyone to get everything on their list.  The person(s) in charge of the money, have to make the best decisions they can as to what is practical or impractical.

Children may not understand all the details of household finances, but they come to understand they can’t have everything they want. Parents aren’t “rationing” what their kids get, but out of necessity, parents make decisions to assure there is enough money for things like food & shelter.  Whether it be the one in your house, or that of nationalized healthcare, every single-payer system operates within limits. This balancing act is necessary to sustain the system. The Affordable Care Act, sets up an extensive set of rules which attempt to establish how this will be done. My next post will examine some of those provisions.

Deb’s Note: This is the second post devoted to explaining the Affordable Care Act–aka ObamaCare.  I have chosen to write about this subject because I believe women need to know how it will affect their families and/or loved ones.  The subject is extensive, but I hope to wrap it up in a few(?) more posts.

My “light bulb moment” began with a Band-aid.  I wouldn’t have sought treatment for the wound, but Beloved Soul Mate insisted I get a tetanus shot.  The adhesive bandage used to cover an inconsequential injury, triggered a mental disruption that lingers, almost two decades later.

Back then, I had old-school insurance.  Not an HMO, not a PPO, just an indemnity policy.  An indemnity policy is a contractual agreement between an insurer and the insured, as to whom will pay for what. On the itemized invoice, a generic type of Band-Aid (which was called a surgical dressing) cost $66.  The wound healed fine, but long after, I was bothered by how and why the charge for something with a retail value of about .11, cost six-hundred times as much.

Perhaps my insurer and I were subsidizing the cost of treating  deadbeats, illegal aliens, or those who couldn’t afford treatment.  Maybe the inflated prices were helping pay for expensive treatments, or cover costs associated with malpractice.  Whatever the reality, that “surgical dressing” seemed to be “window-dressing” on a larger problem.

Not long after, Hillary Clinton began doing her best to convince America to adopt a national healthcare plan.  After being charged so much for so little, I was interested, but skeptical. It was clear costs no longer reflected the real cost of services.

It was easy to see symptoms of distress in our medical system, but there was no easy remedy. I’d heard the rhetoric about, rich doctors, greedy insurers, profiteering lawyers, and money-grabbing pharmaceutical companies.  It seemed greed was at the root, but nobody was talking about self-interested or freeloading consumers–even though it was well-know patients would clog emergency rooms for non-emergencies, like colds to avoid paying doctors.  It seemed even those with insurance wanted everything for nothing.

The huge disparity between what consumers paid and the costs of what they received could not be ignored. With the best treatments, innovative technologies and the ongoing development of life-changing drugs, medicine in America was then  and is now, generally the best in the world–except for one glaring thing.  Some were receiving services for less than what it cost the providers, others were paying more than seemed reasonable for services received.  High costs and the plight of the uninsured seemed to necessitate an overhaul, but with government-intervention, a decline in the quality of care seemed inevitable.

No matter what anyone paid, one thing remained the same.  The value of health or life, could not be measured in dollars and cents.  Whether it was a premature birth, a child with cancer, or an aging parent, when the patient was someone we cared about, we wanted the best care money could buy–even if it meant risking financial ruin.

That Band-Aid, was overpriced, but a bargain, because it launched my education into healthcare. Not an easy education, but an ongoing quest to understand the real costs of healthcare.  Healthcare in America is good, but there isn’t a Band-Aid big enough to fix the problems. After years, not months, of dedicated reading and research, I still feel barely qualified to write about it. The problems affecting our healthcare system are far-reaching and complex.

Every aspect of our medical system has been affected by the necessity of cost-shifting, which is why some form of nationalized healthcare seems to be the necessary solution.  Unfortunately for all, the issue has become money, not health. Giving the government the authority to make sure everyone gets care seems like a great idea, but it’s problematic. The next phase in American healthcare will be redefined by costs, not care.

There isn’t anyone who can fully know or understand the implications of the Affordable Care Act, (ACA). Not only is the new law thousands of pages, but it leaves many provisions undefined.  I‘ll do my best to hit the major points, as they have been defined–with my only intention being to represent the facts fairly.  Because of my sincere desire to write without partisan bias, I prefer to call the bill that has been passed, by its proper name, The Affordable Care Act (ACA) instead of its better-known name “Obama-Care.”

Over the next couple weeks, I hope to shed some light, on what can be reasonably expected under The Affordable Care Act. My intent is not to politicize this blog, but to illuminate issues affecting this audience.  The issue is healthcare, not politics. Everyone needs to be aware of changes that will affect our healthcare system, but the issue is of particular importance to women, since we are often the primary caregivers for ill loved ones.  The facts are sobering.  If you value your health or the health of those around you, you cannot afford not to know what to expect under “affordable” healthcare.

Growing up hearing “gentlemen preferred blondes,”  it was easy to believe white girls with blonde hair were more attractive than girls like me, but I came to realize, blondes hadn’t cornered the market on attractiveness, or anything else.Which is why I was fuming recently, when I read an article in a local arts tabloid, in which the author, wrote about her daughter’s African-American hair, because as she wrote, “nobody likes black girls.”

This mother was tying hair to her perception of racial bias against black women. Through my eyes, it seemed the story of a woman passing her hang-ups about race, hair, and attractiveness to her daughter, then blaming others.

We all face prejudices and we all have them.  Some exist because of what we have experienced, others are the result of views we haven’t tested.  We may not be able to control how others view us, but we can’t blame others if the prejudices that hold us back are our own.

We all have things we’d like to change.  Things like skin color,  can’t be changed, but at least with hair we have some options. I won’t pretend to understand the hair troubles of black women, but I know how much hair can impact the way we look or feel.  Even so, hair can only enhance our attractiveness in a  superficial way.

On the heels of that story, came a slew of petty remarks about the hair of Olympic gold medalist Gabby Douglas–including a tweet from Gabby’s Olympic role model, n Dominique Dawes. In the blogosphere  and on social media, her hair had become a topic of discussion.  convincing me, there IS a bias surrounding Black women’s hair–at least among other African-American women.

My reaction, was the same as Gabby’s, when she said, “Are you kidding me?“

This charming young woman just awed  the world with her gold medal performance, and people picking on her hair???

I shouldn’t be surprised.  Though The Olympics were established to promote excellence, friendship and respect, it is a time, when we all enjoy critiquing people, doing things we can’t.  It is a time when we are comfortable talking about the athletes of other nations, in a way we would never talk to people from those nations.

(Excuse me while I calculate what I could buy, if I had a nickel for every time I’ve heard a snarky remark about the sturdy women athletes of Eastern Europe.)

It’s probably more nationalism, than racism, but here at home, we were reminded of our own ideas of race, as  the media focused on Gabby being the first African-American to bring home the All-Around Gold in her sport. She won a place in national and international history, but the focus at home was on her place in African-American history.  This puzzles me. It isn’t as if we haven’t seen history-making athletic excellence from African-Americans before. It seemed like a bigger deal to the media than it did to her.  When she was asked how it felt, she responded, “Oh yeah, I forgot about that.”

Is there something about her being African-American that made her win more remarkable or less likely?  Is it more amazing for Gabby Douglas to raise the standard of athletic excellence, than it is when Michael Phelps does?

YES and NO.

Yes, we should be surprised.  Gabby was never expected to outperform her teammates.  Coach Bela Karolyi called her a “good average gymnast”.  (Obviously that phrase means something different to him, than to  the rest of us.)  But more than that, she had the kinds of disadvantages, that make it difficult to dream as big as she did.  She was an African-American female, being raised by a single mother of four, struggling to make ends meet, while living on disability. Her father was not a doctor or lawyer, in fact, he was away on military deployment.  She wasn’t a child of privilege, but she believed she could rise above her circumstances.

When she moved to Iowa, to train, she was plunged into a predominantly white community, where folks  preferred Country music, and didn’t understand the rap music she’d enjoyed. She had left her family and everything comfortingly familiar, because she was ready to make the sacrifices necessary to become a champion.  If others harbored prejudice toward her for being black, her friendly smile, buoyant spirit, and relentless determination would soon win them over. Because of this, she came out of nowhere to surprise everyone without Affirmative Action.

So should we be surprised?  Absolutely not.  She is an amazing young American with the kind of drive and attitude it takes to be great. She is a girl who dared to dream, then busted her butt to see if she had the stuff to make her dream come true. My guess is that she cares about her hair as much as any other girl her age, but the vision in her head, was important than what was on it.

Undoubtedly, she will inspire other African-American girls, in the same way Dominique Dawes once inspired her. She will also inspire other athletes and other Olympic hopefuls at home and abroad, but equally important is what her success can teach the rest of us. She has shown what can happen when we rise above the prejudices of others, or our own self-doubts.  More importantly Gabby Douglas reminds us we are more than our skin or hair. How attractive we are or what we can become isn’t about how we look or how others see us, it’s about what we have inside.

Deb’s Note:  My goal in writing it was to emphasize that we cannot be beautiful without self-acceptance. In this age of race-baiting, many are sensitive to any discussion of race. If anything in this article is misconstrued as being racist, this was not my intent.  Racism is abhorrent, and its practice hurts us all.