I have long been a proponent of socialized medicine, believing that access to healthcare should rank high on a list of unalienable rights.  Lately, though, I’ve begun to rethink my position.

I listened, recently, to a piece on public radio in which the presenter took a calculator into an operating suite, tallying each piece of equipment used in the treatment of a woman suffering from arthrosclerosis.  For instance, a small length of rubber tubing cost $65.00.  The physician attempted to use, and eventually discarded, several of them before finding one he felt fit properly.  He explained his need to be able to do this in order to provide the best care to his patients.  Similarly, he inserted and retracted several $2000.00 stints, before settling on the one he felt would provide the best blood flow to the affected artery.  Unlike the rubber tubing though, the stints were not discarded, but rather returned to the manufacturer.  The patient was charged only for the one left in place.  The company instituted this policy as a means of safeguarding the success rate of their product in the hope that by removing cost as a factor, physicians would feel free to act as the one featured in the piece. 

Losses incurred are reflected in the cost of the millimeters-long plastic sheath, but don’t account for the total price.  Another factor in the price is its infancy.  As new technology is approved for use, there is no pricing structure to use for comparison.  Should an innovator build a better mouse trap, he can compare his product to the thousands of mouse traps that came before, and settle on a price that will make him competitive in the mouse trap market.  When an innovator builds a trap never before imagined to catch a creature never before trapped, there is no such barometer.  So, after figuring costs of research and development, materials, and labor, exclusivity is also assigned a premium, and will remain a factor until another innovator comes along with a similar idea. 

And, as the world leader in medical technology, the United States is chockfull of ideas.  Between 1996 and 2006, twelve Nobel prizes were awarded to American scientists, three went to foreign-born scientists working in the US, and only seven were awarded to those working outside the United States.  As of 2006, four of the six most important medical innovations were developed in the US, and the other two were perfected and made commercially available by American companies.  And who pays for all this brilliance?  That’s right, we do. 

Admittedly, I have never before considered the burden carried by United States citizens in helping to develop and distribute much needed medical technology to the entire world.  After doing some research, however, I feel it as a point of pride.  The US exports all manner of goods and services to other parts of the world.  For instance, you can find a McDonald’s in most international city of any size.  I don’t necessarily see this as a good thing, and neither will those experiencing a Big Mac for the first time once they realize that their burger comes with a side of morbid obesity. 

The American penchant for exporting western religions has always bothered me.  My understanding of biblical text forbids making a judgment against the beliefs of others.  One may think them misguided, one may even pray for the souls they feel are surely headed for eternal damnation, but the effort to indoctrinate a culture in “The Way” seems outrageously pompous at best, and sinfully intrusive at worst. 

In comparison, the exportation of medical innovation is a practice I support with a feeling of benevolent pride, and considering the alternative, I’m willing to pay a little more for healthcare.

Lawsuits filed by lawyers, aptly named “ambulance chasers”, hired by people who see financial gain in an unfortunate outcome, also drive up the cost of American healthcare.  Legislators have tried, sometimes successfully, to cap these costs, but as long our citizenry demands the right to exorbitant financial compensation for mistakes which are often unpreventable, health professionals and hospitals must figure equally exorbitant insurance costs into their bottom line which is then passed on to all patients regardless of litigious proclivity.

And now we have arrived at what I believe to be the true source of inequity in the American healthcare system; insurance companies.

When I was a young woman it worked like this.  Insurance was offered by employers who paid some, but not all, of the premium for their employees who received a card they could then flash at healthcare providers who graciously swung wide the doors to the system.  Patients presented with symptoms, doctors performed examinations and ordered testing, which was scheduled by office staff.  Often insurance information, too, was forwarded, making the visit to the testing facility as simple as waiting nervously to hear your shouted name.  Deductibles were reasonable and mitered out over the course of the calendar year, usually not really coming into play unless a hospital visit was required.  Prescriptions carried co-pays, but the amount was much less.  I remember paying six-dollar co-pays for a number of years, and being scandalized when the company increased the amount to ten dollars.  And there was no question as to whether or not the pharmacist would fill your prescription.  The doctor wrote the order, the pharmacist filled it, the patient paid the co-pay, and insurance picked up the rest.  End of story. 

It seems as though the advent of HMOs, and PPOs, and various other tri-lettered options changed everything.  The doctor who had cared for my family for years, was no longer authorized by my new insurance company, forcing me to choose from a list of practitioners who had subscribed to the new, “improved” plan.  And should the man I now thought of as my “Primary Care Practitioner” feel the need for consultation with another doctor, the list would be consulted again.  Gone were the days of depending on the physician’s knowledge of his colleagues, or the experiences of friends and family.  Insurance companies now dictated our choice of practitioner.  And very quickly, they extended their reach into the pharmacy.

A friend visited her local pharmacy to pick up a prescription she had taken for years to treat acid reflux disease.  Upon her arrival, the pharmacist explained that the insurance company had denied her claim, ordering, instead, that she have further testing.  After consulting their list of participating providers she waited two very uncomfortable weeks to have the procedure, and several days afterward for the insurance company to pronounce she no longer needed prescription medication.  They suggested she use an over-the-counter antacid, which she did with no relief for a number of months until, desperate, she returned to her pre-approved physician’s office.  He prescribed the medication that had worked for her in the past, and after several telephone consultations between physician, pharmacist, and the insurance company, she was allowed to purchase the pills.

In another instance, a physician ordered a test for a patient for whom diagnosis had proven elusive.  When the patient called to schedule the test, she was advised that her insurance company had refused to cover the procedure, deeming it “unnecessary”.  When she attempted to schedule anyway, with plans of funding the visit herself, she was denied.  When told this story, I didn’t believe it.  I reckoned there to be other factors, not presented by the patient, which figured into the insurance company’s decision.  In an effort to help both of us understand, I accompanied her to her next visit, only to find her situation exactly as she told it.  The insurance company to whom she paid a percentage of her income every two weeks in the belief that they would provide care, had now denied her.  And the testing facility, so tied to the purse-strings of the insurers, didn’t dare participate in her attempt to bypass them.

One answer to the travesty that is healthcare dictated by MBAs?  Healthcare savings accounts.  If insurers, who line their pockets with record-setting profits taken from our paychecks every two weeks are the problem, then the answer is to bank their premium in an account used solely for the purpose of paying for healthcare.  When I count back over the years, all the premiums paid to insurance companies I was fortunate enough not to call on, I am sickened by the number I might have seen on my healthcare savings account balance sheet.  And, imagine a world in which pre-printed lists were not requisite to healthcare choices!

As Americans, we want it all.  We want all the latest technology and the most brilliant innovations.  But, we don’t want to pay for it.  We reserve the right to hold accountable another human being, who though highly educated, is surely as fallible as any other human being.  And, we want him to pay, and pay dearly!  We want complete and total access to all that medicine has to offer, but we want someone else to foot the bill, and we are willing to give up a small percentage of our income if necessary, just in case.  Just in case, though, doesn’t actually come very often for most people. 

As President Obama proposed his option to our current healthcare morass, cries of “Take back our healthcare!” rang out from all sides.  But, how can you take something back that isn’t even yours to begin with? 

By paying for it, yourself.