Chapter 1. The Great American Health Care Paradox (I and II)The Wolf Is at Our Door
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From... Fixing United States Health Care --- Citizen Letters
T Michael White MD
Chapter 1. The Great American Health Care Paradox (I and II)
The Wolf Is at Our Door
“How wonderful that we have met with a paradox.
Now we have some hope of making progress.”
Niels Bohr
July 4 th
Fine Citizens hello.
This book may be wrongly titled. I have chosen to go with hope and emphasize the
readily achievable Fixing of United States Health Care. However, if I were to be into book sales (clearly, I am not --- as my kids say, “you write ‘em Dad; you don’t sell ’em”), I would have run with The Great American Health Care Paradox (©;™; etc.). Consider…
Our (yours and mine) ‘insured’ trailing generations (our near and dear) are confronting The Great American Health Care Paradox I. Despite expensive (nearly unaffordable) employer-provided health insurance premiums, when significant illness or accident intervenes, they find they are, in fact, uninsured. When complex care (for example, a simple appendectomy) is required, the cost of co-pays, deductibles, co-insurance and out-of-pocket maximums (which reset each January 1st), can be massive. Even for the ‘insured,’ resulting medical indebtedness now often places family career, education, finance, food, health and retirement securities in jeopardy. Hence The Great American Health Care Paradox I --- expensively ‘insured’ when well and uninsured when care is required.
A typical family of four may pay $11,000 in annual premiums for their employer-
provided health care insurance and yet face $8,000 in deductibles and a $16,000 out-of-pocket annual maximum. A bad health care patch may have them paying $27,000 (plus uncovered expenses) in a year. Who can afford that? Parenthetically, isn't that what insurance is for?
Despite each employee’s significant premiums, the burden for the employer is massive. For the case above, the good employer will contribute at least $22,000/year (with surety that the expense will rise substantially annually) and yet be criticized by employees for their ever-diminishing coverage. What small business can support that and remain internationally competitive? There is a cycle here, businesses become non-competitive, businesses close; and the nation’s uninsured unemployed rise --- The Great American Health Care Paradox II.
In fairness, there is good news: 1) when complex care is needed, well-trained,
compassionate and courageous ‘Better Angels’ will provide (all too often unaffordable) superb care; and 2) those with wealth who have aged into Medicare protection, can generally make their health care numbers work.
However, for the expensively ‘insured’ family living paycheck to paycheck, when
significant care is required, severe financial consequences (bankruptcy; food insecurity;
homelessness) often follow. Even for those with more comfortable day-to-day circumstances, the threat of financial insecurity is now all too real. For the millions of our working uninsured, family career, education, finance, food, health and retirement securities remain in jeopardy.
Cutting to the chase: 1) our unplanned United States health care has evolved rudderless to a certified, chaotic, catastrophic, unaffordable hot mess; 2) we must tell it plain --- for the average citizen, the health care wolf is now at the door placing basic life securities in jeopardy; and 3) enlightened, courageous, compassionate leadership must design and implement planned, taxpayer-funded, single-payer, regional provider infrastructure that provides universal citizen access to affordable, basic/necessary, compassionate - safe, timely, efficient, effective, equitable (just), patient-centered care (ABC-STEEEP).
Some, always comfortable in a health care catbird seat, say "nothing can be done."
They must be told they are wrong. This moral debacle can no longer be tolerated. Our fine, virtuous citizens can, must and will rise and fix.
Respectfully submitted,
Dr. Mike
Please share your perceptions (your reality) about what I have right, wrong and/or omitted. I will be delighted to hear from you as your insights will significantly enhance my efforts. Importantly, if/when a message rings true, please forward it to those you deem may desire to know. TMWMD
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