I love Atul Gawande. If you've never read his writing and you have any interest in topics medical, make haste. He writes with utter clarity on fascinating topics ranging from pain management to how to get doctors to wash their hands more often to itching.
Gawande is a contributer to the New Yorker, and has an article in the current edition about how the U.S. could make a switch to universal health care coverage. Fascinating, and timely. Definitely worth a read, no matter what your political persuasion.
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23 comments:
"Amen" to universal health care. We've been wondering out loud lately questions of "what would we do" if faced with thousands of dollars of surgical bills vs. blindness. What does a person do who isn't insured? The least we can do as a nation is to take care of one another.
That's a great article. It's amazing how easily you can find yourself with a health insurance conundrum. My husband and I both got laid off and I got turned down by several insurers for individual coverage because I have a history of infertility. So I'm paying through the nose for COBRA and desperately hoping that one of us find a job with health coverage before my COBRA runs out.
I'm off to read the article before our dentist's appointment. "Complications" is on its way to me, and "Better" is on my book swap waiting list! Thanks for the recommendation, I can't wait to read them!
And when I was freelancing and responsible for my own health insurance, it was quite stressful, not to mention a financial burden. Yay to universal health care. I know that system has flaws, having lived in a country with universal health care for many years, but the current system here has significant flaws as well.
Every single person in this country is affected by the cost of health insurance whether they realize it or not. It wasn't until I married a doctor that I realized the extent of how broken the system truly is.
We pay $400/month for catastophic care. We have a $10,000 deductible so every test I get or office visit I make we are paying for out of pocket. Being pregnant, with twins no less, makes us into extremely conscious healthcare consumers. We are part of the middle class who are getting squeezed-- too poor to afford the monthly premium for comprehensive coverage but too "rich" to qualify for any assistance. At least my husband can treat us in non-emergent cases so we are better off than some.
Luckily, the Democrats are reintroducing the State Children's Health Insurance Program which would cover lots of children in this gray area(including my own). I'd encourage your readers to sign a letter to their congressperson at www.momsrising.org
I love Atul Gawande. (Have you read Jerome Groopstein?) I wanted to be his "fan" on FB, but he doesn't have a celebrity page, and I am too shy to ask to be his "friend."
He's the rockstar of medical writers!
Someday I will write about my health insurance trials, through infertility, cancer, and death.
Someday [placeholder].
i just bought his book "better" at the local library sale. it looks fascinating.
For us and our particular situation, I would need to know a LOT more about the specifics of universal health care before I became a cheerleader for it.
One of my daughters has a genetic condition. Via message boards about this condition, I have read other parents' stories (from other countries) about how they have to fight a never-ending battle to get the care for their children because the doctors in their systems 1. don't know much about the condition, so 2. they don't realize how important regular bloodwork and ultrasounds are to check for cancer.
Further, from my understanding, other universal health care systems are slow to approve procedures that may not be life-sustaing, but that improve quality of life. The particular cases I am thinking of are for glossectomies and leg shortening or lengthening procedures.
I'm extremely cautious about a system that might not allow me the choices I now enjoy as a health care consumer. Yes, it is a luxury that many don't have and I recognize that. But in many ways, I wonder what the difference is between universal health care systems and HMO's... both seem like a great option when you are healthy and have no problems. Otherwise, it seems as if it's just another bureaucracy.
Sorry to not join on the band wagon (just yet), but as I mentioned above, our situation isn't your average "well child care" case. I say this knowing people without health insurace. Having worked for a health insurance company, I'm well aware of how we're all affected by this.
There are many things that would help curb the costs of health care that are no brainers, but hardly anyone wants to talk about hospitals making capital improvements to be "better" than their competition. But, that's for another conversation on another day. :-)
Yea for Universal healthcare, yea for the government bailout. Who really thinks that the U.S. can afford a universal healthcare system with all the billions that are going out of Washington to pay for the bank failures and the car industry? I totally agree that something needs to be done. But who pays the bills? They will all come due someday and we cannot have it all. Last I knew 2009 will be full of layoffs and foreclosures. So everyone that has insurance keep your day jobs, Obama has a long, long list and healthcare is going to be one of the last items on it.
Paula
SAHM
Hey Snick....interesting article I admit. However, I say ditto to blogger Aimee. I need way more information. My Canadian aunt is now in Michigan (dual citzenship) to have her bladder cancer treated here and YES she is paying dearly and thank God she can because she wasn't getting treated fast enough in Windsor - the lines are long. Am I saying Universal is all wrong, NO, is it better than what we got now....not sure. But how are we going to pay for it?? Lots of questions. I worry for all of us......
Amen. I am single with a chronic neurological disease. I live in terror of losing my health insurance. Or job and thus insurance. Lovely way to live....
It isn't the same situation in the UK. We get health care, but private is better.
I always had health cover for me and my family from the jobs I have had. I've actually had two knee operations, costing thousands of pounds, but my insurance has now lapsed. And it means I that part of my fine frame will be omitted from any future cover.
Max should be covered for everything in the future, but at the moment we are reliant on the system.
Okay, yes to Aimee. Others with my disease in countries with universal health care get terrible care because of the hoops they have to jump through with doctors who have never heard of the disease. I at least have a fantastic neurologist right now. I guess I live more in terror of losing access to her.
I find it interesting to hear from the folks who are now covered, and fear that a change in the system would result in worse coverage for them.
I too am covered (now) and have access to good solid health care. But, for the first time, I worry about loosing the coverage that's linked to our jobs (and finding ourselves in a situation similar to Suz's).
Are those of you who are covered through your employer confident that you won't loose that coverage by loosing a job? 'Cause it is people with pre-existing conditions who suffer the most under our system if they loose coverage.
I thought the historical perspective provided by the Atul article was great, 'cause it showed the messy way in which systems evolve. I suspect that one messy way our system is going to evolve is that employer-provided health insurance is going to become less and less tenable as more and more people loose their jobs & their health insurance. It's an interesting factoid that our system might have evolved that way because of wage/price controls during wwii
I also think that something needs to be done about health care, but do not agree that universal health care is the answer. We are insured through my husbands job and pay $450 for family medical, dental and vision coverage. We have a $15 copay for dr. visits ($25 for specialists) and prescriptions are $15. I can see any dr. any time with no referal needed. I have no deductible and pay nothing once I have been diagnosed. For ex., I am pg. I paid $15 at my ob/gyn for my first visit where it was confirmed I was pg. That $15 covers EVERYTHING through my post-partum checkup. It covers my hospital stay, my delivery, etc. I will not pay another dime past the $15 to have this baby. My son went to the urologist and we paid $25 (because the urologist is considered a specialist) for the visit. The dr. said my son needed a surgery. That $25 copay covered the entire surgery and his follow-up checkup. THIS IS THE KIND OF INSURANCE EVERYONE IN THE U.S. SHOULD HAVE (and I see no chance of that happening if the gov't gets involved). If my husbands company can provide this, then I think many companies could provide it. My husbands company isn't anything spectacular. It's just a regular, ol', medium-sized American company. But somehow they manage to provide very good insurance. If they can do it, others can too...we just need to figure out what the companies with fabulous insurance benefits are doing RIGHT and pass that information along!
Kelly
I agree with Aimee and Susan. More details, please, before I become a supporter for any type of healthcare reform in the US.
No doubt the US healthcare system is a mess. No doubt most of us with insurance live in fear of losing the job that provides it. No doubt the uninsured get the short end of the stick now. No doubt the system is rife with corruption and waste.
But I'm not sure I want the government controlling my healthcare decisions either. Looking at other countries with universal healthcare, it seems only to work smoothly for the well or the mildly ill. It fails horribly for the seriously ill or those with unique medical issues.
Listen to the stories coming out the NHS-controlled UK, where, for example, cancer drugs that are known to prolong life are refused to patients on the basis of cost. Is anyone's life, no matter how short or long, worth less than money? I think not.
How about the people in the UK who report they can't even find an NHS dentist to treat them, supposedly because there aren't enough dentists to go around. So people are on waiting lists and just go without dental care if they can't afford private. Is that any better than what we have now in the US with insured vs. uninsured. I think not.
Or my own friend in Canada who was having severe GI issues and had to wait 45 days for an appointment just to obtain guidance and see specialists, and then wait another 45 more before specific tests could be performed. She was ok, luckily. But suppose it had been a colon cancer? Might those 90 days delay in obtaining testing and diagnosis have caused her to reach an incurable stage? Frightening.
I just don't want the government deciding what I can or can't have and when, with regard to my healthcare via universal healthcare.
Time to move to Oregon!
Okay so I've been reading your blog for a while and I've been dying to say that! You need to move back to your family. We need more people like you here.
Okay I've said my peace!
Bye
Great, great article! Thanks for linking to it. I am really considering moving overseas just for the health care alone. (Not to mention the ohhhh8 weeks paid leave...)
40% of my income goes to insurance premiums alone to cover my 2 children and myself (and I'm even on medicare). That is more than I pay for housing and groceries. And I still pay co-pays for the kids and have a $1000 deductible per kid.
Because I have a boatload of pre-existings, I'm kinda stuck. I cannot change jobs or earn more than $1500 a month. It is hard to raise two kids alone on $1500/mo. With 40% going to premiums. We budget down to the dollar.
Many disabled people are stuck in poverty level conditions and cannot even think of looking for a job lest they loose medicaid. Their life literally depends on it.
Anon with the good company insurance above. That is great for you and it would be great if more companies provided good insurance like you have. But what if you lose your job? What if you lose your job due to a health related reason (disability, cancer) and you cannot get another insurance policy.
The thing is, tying insurance to being employed insures that only healthy people are insured. Illness and disability are one of the largest reasons (after downsizing) that people lose their jobs. The sicker you are, the less likely you are going to be and stay insured.
However you piggyback new insurance onto the current system, it has to cover people without preconditions of employment, age, good health, socioeconomic factors, or other criteria that is largely beyond our control. And it would have to shift the emphasis of the health care system to preventative care, which is almost nonexistent in our country.
Anyway, enough soapbox. Good article.
HOW have I never heard of this guy nor read any of his articles??? I've spent the last 3 hours reading his columns and am absolutely fascinated. Good stuff.
We're so lucky to have universal free health care in Britain. People do complain about it all the time (it's far from perfect, like any huge organisation) but no one complains of not having enough money to be treated.
That's such a gift to all of us, and it's wonderful to think that good health is a right and not a privilege of wealth.
Judging by the fantastic, impressive speed and sweeping ambition shown by your new Mr President, I wouldn't be at all surprised if he came up with something there. Just imagine it for a second, and think how transformational of a society that could be.
Bear with me. I'll have you drinking warm beer next...
People complain about paying taxes, but honestly, that stuff is what tax is for.
I agree with Aimee, my son has a genetic neurological condition and a seizure disorder. As part of his routine care, he needs regular MRIs & EEGs. On the other hand, one hospitalization in July cost us nearly $5500 with insurance. Not to mention, he reqires TONS of specialist visits and monthly medications. My H and I both work, but let's face it, I can't out of pocket that kind of money every year. I just did my taxes and with the hospitalization, doctor co-pays, meds, testing we out of pocketed $8100 JUST FOR HIM. While I worry about how we will be able to afford to care for him, I also worry if he would get the same quality care with Universal Health Care.
Lexie,
I understand what you are saying and I really feel for people in your situation. But, if we fix health care and ALL companies are able to offer good health insurance when/if you lose your job at one company, the next company you work for should also have good health insurance. If he lost his job today, before our health care issues are fixed in this nation, I would definitely be worried.
I really have no idea how to fix things...I don't pretend to have any answers, I just know I am fundamentally opposed to a national healthcare system for a million different reasons. I know I have good insurance and everyone should have what I have.
Hopefully someone smarter than me can help us fix things!!!
Kelly
"But, if we fix health care and ALL companies are able to offer good health insurance when/if you lose your job at one company, the next company you work for should also have good health insurance."
Are you advocating a route to get universal health coverage by requiring companies to provide health care? I think that's part of what the article argued for, that our system is going to have to piggy back on what we have now, which is a health care system that is based on the employer.
And what happens when you're between jobs, especially if you're one of the folks who are writing here who have chronic health needs for their family? What about the self-employed and free-lancers, who are becoming a bigger part of our work force?
Will change only come in the US when the "haves" no longer outnumber the "have nots"? If so, I fear that time is coming sooner han we think.
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