Hello again friends, and Happy New Year! It feels good to be back. Diving right in with long form again…
This recent article from Wired got me thinking (again), there are so many layers and moving parts to healthcare reform, that no one player stands to lose all or benefit all from any changes. And yet so much of what we read and hear has an, ‘it’s so simple, they just don’t care about you, but I do’ tone. The piece describes why insurance companies, who may have advocated most fervently against implementing ACA regulations, actually have a stake in maintaining its current status. Nothing in our healthcare system is black or white, all good or all bad.
So when I see politicians (and friends) speaking and writing in oversimplified sound bites, and vilifying a whole group (all liberals, all Republicans) over one aspect of their point of view, it really frustrates me. That is exactly the opposite of productive dialogue. It just makes people stop listening, because they don’t feel heard or understood. So they have no incentive to hear or understand you.
Many use the car insurance analogy to explain health insurance. It’s not exactly parallel, but it makes some sense. The law requires every car to be insured. (Drivers of) cars that don’t violate traffic law get lower premiums, the longer they stay ‘safe.’ The more traffic law violations, the higher the risk, the higher the premium. I have an actuary friend, who works for a health insurance company, who advocates, in part, for higher premiums for those who ‘use’ the healthcare system more—like the higher risk cars (drivers). I understand this logic. But this idea of making older and sicker people, and women pay more, just because they ‘use’ the system more (and thus financially speaking cost more), does not sit well with me. People are not cars. Not everybody maintains their cars well. But poorly maintained cars do not necessarily lead to increased accidents and traffic law violations. Poorly maintained health often leads to a human body’s multi-car highway pile-up equivalents.
My friend advocates for insurance coverage for catastrophic care (also aligned with the car insurance model), but not necessarily for preventive or primary care. There are different ways of ‘using’ the system. If you get preventive care, like recommended cancer screening and annual exams, it may cost more at the time. If you seek help for your back pain early, from your PCP, chiropractor, and physical therapy, that costs money. But if these early interventions prevent future, more catastrophic and costly outcomes, should we really penalize those who make them? Illness and infirmity come with age. So, often, do fixed incomes. Is it right to make our elderly pay more for their care?
There are costs and benefits to care other than money, which is where health insurance and car insurance diverge sharply, in my view. I know they are harder to quantify and assign, but they matter. That secure feeling that I can get care when/if I need it, that my children and I have access to professionals dedicated to my health and well-being, a sense that in our society, I matter just as much as the next person, regardless of my net worth—these things all matter. Each individual’s health or illness contributes synergistically to the health or illness of a society. A mother’s depression, untreated and uncontrolled because her health plan does not cover mental health services, can negatively affect every aspect of her and her children’s lives, emotionally, physically, financially, and socially. We cannot only look at healthcare on dollar spreadsheets of ‘use.’
Maybe it’s about priorities and philosophy—ideology? Do we feel all people have an equal right to equal care, or do we differentiate what people deserve based on particular group memberships or other characteristics? Do we feel we should only be responsible for ourselves, or are we called to look out for one another? I personally believe in equal access to care and ‘look out for others as yourself.’
I also believe that people need to understand–personally and concretely–that everything does cost money, we all pay for one another’s use (and disuse, and misuse) eventually, and more care is not necessarily better. So I understand and partially agree with my friend’s argument that people need to have ‘skin in the game’ to control overuse of services for no benefit. One great example is end of life care. I like this article from Fobres, which describes the conundrum succinctly:
According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life. I know there are other studies out there that say slightly different things, but the reality is simple: we spend an incredible amount of money on that last year and month.
Dr. Susan Dale Block, Chair and Director of Psychosocial Oncology and Palliative Care at the Dana Farber Cancer Institute and Brigham and Women’s Health Care, recently shared some data with her colleagues. In the Archives of Internal Medicine, a study asked if a better quality of death takes place when per capital cost rise. In lay terms … the study found that the less money spent in this time period, the better the death experience is for the patient.
Cost, longevity, quality of life, quality of care, value, perceptions, public health—these and other aspects of health and medicine are all inextricably enmeshed, though definitely not integrated. Any decisions about one must be made in the context of all the others, carefully, transparently, and honestly. Whenever we hear, ‘if we just do this, everything will be better,’ red flags should fly.
I wrote the first draft of the paragraphs above on my Facebook page. I ended the post with, “So let’s each educate ourselves on the facts, as well as we can, and try to look at the big picture. It’s so messy. And it’s what we’ve got, so let’s deal with it–with maturity, patience, professionalism, and equanimity.”
Another friend, a fellow liberal, commented, “This has nothing to do with healthcare. It’s about reducing taxes on the wealthy, reducing benefits for the poor, and denying the democrats credit for anything good. If they actually cared about healthcare, they would fix the obvious problems with the ACA. And because the ACA was the republican plan, they will continue to tie themselves up into pretzels to disown it and put something else in place. That being said, I hope the American people continue to demand access to affordable healthcare for all. It’s a right, not a privilege.”
I had to reply: “(My friend,) I understand your point of view, and I share your passion for equality. But your statement exemplifies exactly the broad brush, ‘you suck’ attitude that I see holding us all back. I refuse to believe that all Republicans are only motivated by making the rich richer, and that none of them care anything about the poor, as so many of us on the left say. We must extricate ourselves from this destructive narrative and learn to hold space for everybody’s complex views and experiences.”
My point here is that nothing is as simple as we’d like. It’s so much easier to blame those who disagree with us for being stubborn, selfish, or evil, than to cope with the discomfort that our system is deeply flawed, there are no easy answers, and our fundamental philosophical differences make it that much harder to agree on the best way forward. And yet, this is what we are called to do. It’s up to each and every one of us to change our language. Each of us has, I believe, the opportunity and the responsibility to create an environment in which open, respectful discussion and debate are the norm, rather than echo chambers and verbal warring.
I am only one person. I have no designated leadership titles or widely visible platform. But my words have power. So do yours. Please use them wisely.
So nice to see you posting! Does this mean you’ve written all your “holiday” letters?
Thanks for a very thoughtful post that deftly explores the complexity not just of the health care/insurance system, but can be extrapolated to so much of the current political dialogue. It is incredibly complex and there are no simple solutions, just as there are no single motivations behinds the myriad positions people have staked out. It does come down to doing our best to state our positions and opinions in ways that don’t make others take up arms to defend their position. When we take up arms (literally or figuratively) our minds tend to close up tight. And it also depends on all of us being willing to listen to the other guy’s opinion with an open mind. All are easier said than done.
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Happy New Year!
Yes, I’m pretty much finished with the holiday cards, and it was totally fun and gratifying. 😊 And I got my cards for next year! This is what I will do from now on, buy them on clearance every year after the holiday. 😉😁
I keep thinking we have to teach these communication skills much earlier in life–make them formal lessons in school. The first step is awareness, of our own emotional reactions to others’ words, how that influences our own word choice, and then the impact of our words on others. The words we choose matter so much more than we realize. I can hear in my head some people arguing that we just need to suck it up and be less sensitive, less PC. But I observe that those same people are the ones not only perpetrating the ‘you suck’ attitude, but also incensed and riled by it. You can’t have it both ways. Either you respect people or you don’t, and you cannot expect those whom you do not respect to respect you.
Hmmm, clearly I may have more to say about this… 😉
Have a great weekend, Donna, and thanks for stopping by! 😊
Great post Catherine. I see so many of my friends sharing posts about how many deaths repealing ACA will cause and how catastrophic it will be for those with pre-existing conditions and how the Republicans don’t care about people, just wealth preservation. I know that is not helpful dialogue. I also recognize that people are frightened. Many people did suffer before reform. Health costs for treating difficult and life threatening conditions were a leading cause of personal bankruptcies. I don’t know what the answer is, I suspect some kind of universal health care program but I don’t see that happening here. I do know that repealing laws that protect the vulnerable without viable alternatives is not the answer. I think even the President elect realizes this and has cautioned that he doesn’t support one without the other. A lot of this does illustrate the issue of how divided our politics have become and how easy it is to think of our fellow citizens as our enemies and each party has played a part in pushing that agenda. I love what you say about teaching our children the art of, and the importance of meaningful dialogue. That along with educating them about how our system of government works and why would be a great step towards returning us to a nation that is indivisible. Right now, it feels like anything but.
I would like to re-post this on my blog and to my FB page with your permission. Thanks Catherine. It’s always good to hear your thoughtful perspectives on things. Happy New Year.
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Thanks for the thoughtful comment, Ilona! 😊
You are so right about people being afraid–not just people afraid of losing their health insurance, but legislators afraid of losing their next election, companies afraid of losing money… And we don’t usually behave our best in fear… So often thinking about these things, I come back to mindfulness practice. The breath focuses and calms like nothing else. What if we all took a couple deep breaths before we engaged with others, and before we blurt things in tense conversations? Maybe we’d all be better off.
And yes, please share at your discretion, thank you! Have a great weekend, Ilona! 😊
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Reblogged this on Rainy Day Writing and commented:
Some thoughts on the ACA debate from an always thoughtful blogger, Catherine at Healing Through Connection.
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Thank you! 🙂
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