There’s been a lot of fearmongering in the current debate over health care reform, and much of it makes me want to laugh and cry all at once.
Take the bit about rationing. Critics maintain that the Obama administration wants to ration our access to medical care, limiting the services we receive. This, we are told, would represent a gross infringement of our rights as healthcare consumers, and would prevent doctors from treating us as they see fit.
Really? So how would you describe a system in which health care is rationed based on income alone, rather than need or efficacy? Because that’s what we’ve got right now. And it has some pretty stark consequences, ranging from people who can’t afford any health insurance to those whose insurance doesn’t provide them with the care they need.
I fall into the latter category. I’m a freelance writer. My wife is a freelance musician. We have two small children. And we pay for our own health insurance.
We’re fortunate to live in New York, where the state works with insurers to help cover people whose incomes fall within certain limits. Simply put, we qualify for subsidized health insurance because we earn too much money to qualify for Medicare, but not enough to buy private insurance at market rates. This might sound like a sweet socialist deal, and we’re indeed grateful for the coverage we have; God knows we’re far better off than many of our freelance friends, most of whom have no insurance at all. But health care costs in this country are so insanely high that our subsidized premiums still eat up more than twenty percent of our income. And they go up every year, sometimes by as much as ten or fifteen percent. In the long run, that’s unsustainable. Yet despite its still-hefty cost, our coverage remains severely constrained.
I’ve been limping along, both figuratively and literally, with a variety of problems for the past several years, including recurring muscle and nerve problems in various extremities. My doctors would love to stuff me into an MRI machine to get a better look at what’s going on. They’d also like to get me into physical therapy and onto some potentially helpful drugs. Unfortunately, none of that’s going to happen. And the reason is simple: my coverage won’t allow it.
My health plan doesn’t cover physical therapy unless I have had surgery. And in a twist that Joseph Heller would appreciate, my insurer has repeatedly refused to authorize an MRI until I’ve completed a course of physical therapy. Meanwhile, we don’t have prescription coverage because… well, because we can’t afford it. We pay for whatever medicines we cannot go without — antibiotics, mostly — and skip the rest, hoping we’ll get better on our own.
So here I am, left to cope with chronic pain that makes it difficult for me to play with my children or to earn the middling income that got me into this mess in the first place. This is what people mean when they say that we already have healthcare rationing in this country: rationing based on income. There are treatments that might help me, but I don’t have access to them because (a) my insurance won’t pay for them, (b) I can’t afford the kind of coverage that would, and (c) I don’t have the money to pay for them out of pocket and feed my kids at the same time.
To all those who would argue that this is simply how things work in a free-market economy, I say: precisely. As in, this is precisely why healthcare cannot be left entirely to the tender mercies of the market.
My own problems are relatively minor. Many people who carry inadequate health insurance, let alone those without any insurance whatsoever, are looking at much worse scenarios. Someone who can’t afford to take care of her diabetes could lose a leg. Someone who can’t afford treatment for cancer or high blood pressure could lose a lot more.
Some kind of healthcare rationing is inevitable. A system in which everyone received every treatment they wanted without any controls or limitations would rapidly collapse under its own weight. But I’d much rather that rationing be more rational, and more humane; that it be determined not by the depth of a person’s pockets but by the extremity of their need, the efficacy of their recommended treatment, and the expert opinion of their doctors.
And I say this as someone who can’t afford to be sick, but can’t quite afford to get healthy, either.