Diatribes of Jay

This is a blog of essays on public policy. It shuns ideology and applies facts, logic and math to economic, social and political problems. It has a subject-matter index, a list of recent posts, and permalinks at the ends of posts. Comments are moderated and may take time to appear. Note: Profile updated 4/7/12

29 August 2009

An Open Letter to Seniors on Health-Insurance Reform

Dear Seniors,

Now I’m one of you (or us). I’m 64.

I can feel myself getting frailer year by year, and my memory isn’t what it used to be. It’s getting tougher for me to accept change, and I like my own life to be as stable as possible.

So I think I know how most of us feel when it comes to health care and health insurance. We don’t want to rock the boat that keeps us out of the River Styx.

But I wish we all could see, as I do, how the health insurers are playing us. They’re using tactics old as Caesar: divide and conquer. If they can make us think that some unknown enemy (young folk or “government”) is going to weaken our health care just when we need it most, they’ve won. Then they can keep things just the way they are, which are very profitable for them.

But in fact the reforms on the table will make things better for everyone, including us. The insurers don’t want us to think about that. Here are a few facts they don’t want us to consider:

1. Things aren’t so good for us right now. Most of us are over sixty. So a key statistic for us is life expectancy at age 60. That’s how much longer, on the average, a sixty-year-old can expect to live.

In that measure, the United States rates dead last among the world’s twenty-three richest industrial democracies.

Let me repeat that. If you’re sixty today, you have the shortest statistically predicted life span of anybody in the world’s twenty-three richest countries. Your predicted life span is shorter because you live in America.

So maybe us seniors’ natural tendency not to rock the boat isn’t such a good thing after all. For us, the boat is pretty leaky right now.

2. The uninsured can bring disease to our doors. Think about it. Who does our domestic chores? Who does our housekeeping and gardening? Who brings us those Meals on Wheels? If you live in a retirement or nursing home, who makes your bed, brings your medicine, and makes and serves your meals? Most likely, they are among the lowest-paid workers in our society and therefore part of the 47 million uninsured.

What happens when they get sick? What happens, for example, when they get swine flu? They don’t have insurance, so they don’t go to a doctor. They have no preventive care, so they won’t get vaccinated (unless their workplace requires and provides the shots). They don’t stay home when sick because they have no doctor to tell them to, and they’re afraid of losing their jobs. So they come to work—to our homes or beds—and bring the flu right to us.

It might not be swine flu. It might be ordinary flu or the common cold. It might be drug-resistant TB, or MRSA—those deadly multiple drug-resistant bugs that kill people abroad and in hospitals. The fact that these low-paid workers don’t have insurance makes it far more likely that they will bring disease and death right into our homes, unawares.

3. Insuring everyone will save us money. The insurance companies want us to worry that bringing everyone into the system will impair our own health care. Exactly the opposite is true. The whole idea of insurance is to spread the financial risk of bad events (like disease and injury) over a large pool of insured people. That lowers the costs for all the individuals in the pool, including us.

Those 47 million uninsured are about 15% of our population. So adding them and their premiums into the insurance pool should lower our costs considerably. The reduction should be even more than 15% because most of those folks are young and healthy. They generally don’t make as many claims as us seniors. (Getting the poorest covered may cost us some tax money to subsidize their premiums. The amount and timing of that subsidy are still up for negotiation. Getting everyone covered should not be.)

Most of us seniors have private insurance, Medicare, or both. But even if you have Medicare (which incidentally is government insurance), insuring the uninsured will save you money. Why? Because the uninsured wait until they are nearly dying before seeking help. Then they rush to emergency rooms, where their care costs much more. Someone has to pay for that care, and that someone is you and me. We pay for it in taxes, subsidies to hospitals that charge people with insurance more, long waits for emergency rooms in the best hospitals, and a public-health system that is stretched to the breaking point.

You may have heard the saying that “there’s no such thing as a free lunch.” There’s no such thing as a free health care, either. When 47 million people don’t have basic preventive and family care, the cost of their preventable illness and failure to get timely treatment falls on you and me.

4. Health-insurance reform will improve our quality of care. You may think you have the best health care now, but are you sure? Are you competent to second-guess your doctor? Do you have the training in medicine and biology? Do you know the terminology? Can you separate good medicine from quackery, on the Internet or otherwise?

Medicine today is horribly complex and growing more so daily. Our own personal genome—our DNA—has three billion genetic “letters.” That’s ten times as many people as there are in our entire country. (Just try to count that high!) Today, some of those letters may determine how best to treat us if we get cancer. Is the average Medicare practitioner up to speed on all of this?

That’s what we face when we step into our doctor’s office. No single doctor can know all of modern medicine—or even a small fraction of it. That’s why the most sophisticated doctors specialize narrowly.

So we depend on two “gatekeepers” for our care. The first is our doctor. If his or her knowledge or skill is weak or outdated, we lose. The second gatekeeper is our insurance company, usually a for-profit company with a financial incentive to deny claims. If what it pays for doesn’t include the latest medical advances, we lose. A lot of private insurers don’t cover the latest medical advances because they are slow to react and the new coverage would cost them money.

Health-insurance reform will bring together panels of our best specialists to keep medical knowledge and insurance payments accurate and up to date. They’ll determine what works best and what doesn’t. They’ll put their conclusions on the Internet for all to see. Then they’ll make sure that our system provides quality care to everyone.

Their purpose will be to make sure everyone gets good care and that it gets paid for. They won’t “pull the plug” on anyone. Their job will be to make sure our own care doesn’t depend on random events like a single doctor’s knowledge or a single private insurer’s outdated and self-serving exclusions.

5. What legacy do we want? We’ve already lived most of our lives, and mostly they’ve been pretty good. Do we want to be remembered as the generation that continued to deprive one-sixth of our population of a chance for decent health care and a decent life? Or do we want to be remembered as part of the generation that made Harry Truman’s promise from the 1940s come true?

The fact that health-insurance reform will actually reduce our own risk of disease and suffering, cut the cost of our care and improve its quality should make those easy questions to answer.

Any complex human system is only as strong as its weakest link. Our health-care system is no exception. Having 47 million uninsured people makes our public-health system pretty weak. Those millions don’t have access to a doctor when they’re really ill, let alone preventive care like vaccinations. This fall, they’ll bring swine flu right home to us.

So if you won’t work to get them health care just because they’re human beings who deserve a chance to live without disease, then do it because leaving them uninsured will put you at risk and raise your cost of care. Both points are true.

John Donne, whom we read way back in high school, said it best. “No man (or woman) is an island.”

Nowhere are those words more true than in health care. People without insurance and doctors are disease vectors. When they get sick, they’ll bring disease to us. Then the bell will toll for us.

Yours truly,


P.S. (for women only). This post’s primary point applies even more strongly to women with children than to seniors. Women put Barack Obama in the White House because they are more practical than men. Those who follow the news know that children are most at risk [search for “50 years” and read two paragraphs] of serious disease and death from swine flu. Once women understand that an uninsured day-care worker, teacher’s assistant, janitor or food-service worker might give their kids swine flu, and that the only things standing between their kids and a safer system are abstractions like “small government,” the “deficit” or “socialized medicine,” it will all be over but the shouting.

Source for life-expectancy-at-60 ranking: T.R. Reid, in “Health Care Conversations,” on Lehrer News Hour, Friday, Aug. 28. (Audio available here; transcript available on same site Monday, Aug. 31.)

T.R. Reid is a crack reporter from the Washington Post, the most ideologically neutral of our three national newspapers. (The New York Times leans left and the Wall Street Journal right.) He spent over a year studying health care around the world and wrote a book about it.


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