Paying for Medical care has historically been a huge challenge and it still one today. Sick, by Jonathan Cohn, documents the history of our health care system:
The US government organizes healthcare in the US by offering insured medical coverage so that citizens (and illegal immigrants) can afford medical care, and do not have to pay for it out of their pockets. 100 years ago, the chances or surviving in hospitals rather than dying were approximately 50%, which was the highest it had ever been. The costs of hospitalization, medicine, and doctoring were also higher, and gradually became too high to pay for the very sick and very poor. As the Great Depression took its toll, the cost of treatment for severe illness was often equal to one month’s wages; many had no choice but to forgo medical care completely. In the 1930’s, the Committee on the Costs of Medical Care suggested incorporating insurance for medical care. Because of a widespread fear of living in a completely government-run America, and because of hostile physicians lobbying against government interference in their business, the recommendation for insurance was revoked by Franklin Roosevelt. Insurance was first introduced in the US in 1928, when Michael Shadid proposed a cooperative in Elk City, Oklahoma, wherein families paid a regular fee. Shadid used this fee to set up a clinic and hire doctors, thus enabling families to receive affordable medical care. This inspired various other co-ops and nonprofit organizations or collaborative physicians throughout the country.
The US government organizes healthcare in the US by offering insured medical coverage so that citizens (and illegal immigrants) can afford medical care, and do not have to pay for it out of their pockets. 100 years ago, the chances or surviving in hospitals rather than dying were approximately 50%, which was the highest it had ever been. The costs of hospitalization, medicine, and doctoring were also higher, and gradually became too high to pay for the very sick and very poor. As the Great Depression took its toll, the cost of treatment for severe illness was often equal to one month’s wages; many had no choice but to forgo medical care completely. In the 1930’s, the Committee on the Costs of Medical Care suggested incorporating insurance for medical care. Because of a widespread fear of living in a completely government-run America, and because of hostile physicians lobbying against government interference in their business, the recommendation for insurance was revoked by Franklin Roosevelt. Insurance was first introduced in the US in 1928, when Michael Shadid proposed a cooperative in Elk City, Oklahoma, wherein families paid a regular fee. Shadid used this fee to set up a clinic and hire doctors, thus enabling families to receive affordable medical care. This inspired various other co-ops and nonprofit organizations or collaborative physicians throughout the country.
One such insurance corporation, the Blue Cross, had 2.8 million people enrolled by 1938. Harry Truman fought for a universal coverage plan in the 1940’s, and AFL-CIO (America Aetna and Metropolitan Life of New York were able to compete with Blue Cross by undermining prices. They made prices lower by experience rating and basing prices on risk. Blue Cross was forced to mimic its competitors in order to stay in business. In the 1960’s, Medicare and Medicaid were created.
In the 1970’s, the Employment Retirement Income Security Act told large companies, in effect, to purchase medical coverage for employees out of company funds, which caused insurance companies to struggle paying for the very sick. This increased the cost of insurance even more for those who were not employed by large companies. By the 1980’s, most employees had insurance through their jobs. Health insurance premiums increased and industrial corporations tried to cut costs by ceasing to offer coverage to employees. The insurance became less available through jobs, and thus more people found it necessary to purchase insurance themselves. People who were self-employed or worked for small businesses had trouble finding affordable health insurance because it was cheaper for insurance companies to sell through large corporations. This is still true.
In the 1990’s, the coverage offered through large corporations was lacking in benefits and was only offered to employees that worked for many hours a week, and for several years. Some corporations (such as General Motors) neared bankruptcy because they continued to offer thorough coverage. Many individuals were left in medical debt because they bought phony private insurance; eventually the government brought an end to such scams. However, the legitimate coverage proved to be unreliable as well; for example, Morrell (an insurance company) canceled health insurance for retirees, causing many to deplete their savings or go without the medical care they needed. In 1997 and in 2003, the presidents (Clinton and Bush) signed agreements to help retirees and senior citizens get the coverage they needed without paying out of pocket. Alas, senior citizens are still struggling to obtain the drugs they need, just as all US citizens are struggling to afford medical coverage.1
In Landmark, the editors and reporters of the Washington Post discuss the current legislation that will be enforced in the next ten years:
The government is now striving to produce thorough, reliable medical coverage for all citizens by enforcing the Patient Protection and Affordable Care Act that President Obama signed in March of 2010. The changes listed in this act are planned to take place between 2010 and 2020. As a result of this act, Buying insurance will include choosing between many options, varying degrees of expense, a rating system, and basic insurance plans that differ in percentage of coverage. Those who are very ill and uninsured will be able to choose insurance, because one new regulation is for insurance companies to disregard pre-existing conditions. Insurance will be optional, but individuals who are not provided with health insurance through their job will be fined if they do not buy coverage. This controversial decision has been set in place to entice younger and healthier patients into the pool of insured individuals so that the costs treatment for the very old and sick will balance out. This legislation is projected to cost the government approximately $1 trillion over the next 10 years.2
The families of the sick deal with the issue in various ways. In Tuesdays with Morrie, the author Mitch Albom describes Morrie, who is fatally sick, to be married to a respectful, gentle woman, one with whom Morrie was a team (p. 148)3. Morrie’s sons visited him, conversed with him, and kissed him while he was dying. During my uncle’s sickness, his immediate family was willing to help him, but only at arm’s length. When he asked for help paying for groceries, or for his sister to take time out of her day to visit him, she resented the request. Erik Wood’s wife and son treated him with extreme care in many forms: time, money, and labors of cleaning him and feeding him. Those family members with whom Erik had not been on the best of terms, treated Erik, Beth and Evan with bitter resentment and disdain. Often times, the manner in which families treat the dying and sick is determined by the character and personality of the sick one, and the degree of sickness. My uncle is not always pleasant, so his sister did not appreciate his asking for pleasantness from her. Erik’s previous wife and children resented his absence in their life, among other things. Thus, they were unkind to him, Beth, and Evan, because they partly stood in the way of Erik’s life with his previous family. Morrie and Erik were precious and used their strengths in profound, moving ways for others; thus they were treated with profound, loving care.
In our culture, those who are sick and dying often rely on the medical coverage provided by their insurance company. Many suffer long waits for or failures to obtain treatment for their ailments. Those who are not sick often feel indestructible; they ignore symptoms of illness (like my uncle and Erik Wood did at first), forgo purchasing insurance (hence creating the need to fine young people without it)4, and carry a certain attitude towards a lack of physical health. I think much of the treatment of sick people by society and hospitals is kept under the radar (which is why the film Near-Death was such a radical and unusual documentary). When someone goes into a hospital with a fatal illness or for invasive treatment, their situation is not discussed in detail and they are not visited, except by doctors and very relationally close friends and family. Our guest speaker, Beth Wood explained that while her husband, Erik was on the death bed, no one but she, Erik’s oncologist, and her son, Evan were allowed to visit Erik. Sickness and death are shamed and stigmatized in our society, and this is revealed through our failure to discuss illness and demise, and through the actions of the ill in response to their illness/future death:
People can be stigmatized by their society because of physical deformities, blemishes of individual character, and tribe. When someone is handicapped or disfigured in some way, they go through psychological and emotional trauma. Examples of such trauma are Neurasthenia, Hysterical Conversion, Acute Anxiety and Hypochondria. Others identify their ailment, even a permanent one, as a blessing, because it caused them to deepen their awareness of the world and deal with suffering well. Others realize, because of their illness, that people without their particular illness are still handicapped spiritually, mentally, emotionally, or relationally. Sickness is an eye-opener to some; to them it is a lead to a new and better perspective of the world and their priorities. Still others see their disfigurement as a life-altering cause of misery and even inferiority. Sick people spend their life somehow fighting with their sickness, and society’s idea of their sickness.4
People often rely on industrial, illogical and unhealthy methods of repair to become well, and thus lose their stigma of “deaf person” or “handicapped”, releasing their shame:
“…The quacks and get-rich-fast medicine men who abounded saw the League (for the hard of hearing) as their happy hunting ground, ideal for the promotion of magnetic head caps, miraculous vibrating machines, artificial eardrums, blowers, inhalers, massagers, magic oils, balsams, and other guaranteed, sure-fire, positive, and permanent cure-alls for incurable deafness” (page 9).4
Indefinitely deaf people relied on various “guaranteed” methods of curing their ailment, which were neither prescribed by experts nor helpful to their health, because they were desperate to lose both their deafness and the shame that correlated with their deafness. They were shamed to the degree that they would succumb to the cruel advertisements of “quacks”. They denied that they were stuck with their ailment. Now, instead of quacks and medicine men, there are unreliable insurance companies and over-priced drugs that keep us from getting the help we need. The help that we are offered from pharmacies, the government, and insurance companies is very similar to the help offered to the League For the Hard Of Hearing: It is dishonest, not worth the trouble, and does not work. Insurance companies do not even reliably help the people that are enrolled in with them. Drugs are available, but only to those who can afford them at retail price or have a discount from the government. Insurance companies profess to be there for the purpose of helping others, but this is no more than propaganda, as the companies’ main priority is profit.
Sickness and death in our society actually include hidden-in-plain-sight nightmarish, industrial, inhuman atrocities, because to be sick or handicapped in our culture is often to be stigmatized, dependent on industrially produced drugs, manipulated, and treated as one’s illness rather than a person.
1Cohn, Jonathan. Sick. Harper Collins. NY. 2007.
2Staff of Washington Post. Landmark. Public Affairs. New York. 2010.
3Albom, Mitch. Tuesdays With Morrie. 1st. New York: DoubleDay, 1997. Print
4Goffman, Erving. Stigma: Notes On The Management Of Spoiled Identity. Prentice Hall. NJ. 1963.
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