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HEALTH REFORM: If Only Laughter Were Really the Best Medicine

August 4, 2009 - 1:47pm

The only thing better than having an old friend survive cancer is having him survive it with an intact sense of humor and a  heightened sense of outrage about the inequities, the inefficiencies, the downright inanities of health care in America.

Newsweek's Jonathan Alter wrote movingly and honestly a couple of years ago about his own experiences navigating the cancer care maze.  Now Jon's out with a hilarious "defense" of the health care status quo.  Here's a taste of his column (go read the whole thing).  At the end of this post, we'll also share an update from the American Cancer Society and the Kaiser Family Foundation on how patients and survivors (including those who thought they had great insurance until they needed it) are faring in the recession.

Go ahead, shoot me. I like the status quo on health care in the United States. I've got health insurance and I don't give a damn about the 47 million suckers who don't. Obama and Congress must be stopped. No bill! I'm better off the way things are...

I had cancer a few years ago. I like the fact that if I lose my job, I won't be able to get any insurance because of my illness. It reminds me of my homeowners' insurance, which gets canceled after a break-in. I like the choice I'd face if, God forbid, the cancer recurs -- sell my house to pay for the hundreds of thousands of dollars in treatment, or die. That's what you call a "post-existing condition."

I like the absence of catastrophic insurance today. It meant that my health-insurance plan (one of the better ones, by the way) only covered about 75 percent of the cost of my cutting-edge treatment. That's as it should be -- face cancer and shell out huge amounts of money at the same time. Nice.

I like the "lifetime limits" that many policies have today. Missed the fine print on that one, did you? It means that after you exceed a certain amount of reimbursement, you don't get anything more from the insurance company. That's fair.

Speaking of fair, it seems fair to me that cost-cutting bureaucrats at the insurance companies -- not doctors -- decide what's reimbursable. After all, the insurance companies know best.

...You know what part of the status quo I like best? It's a longstanding system for paying doctors called "fee for service." That's where doctors get paid for each procedure they perform, as if my auto dealer got paid separately for the steering wheel, brakes, and horn instead of for the car. Fee-for-service is why the medical care at that doc-in-a-box at my mall is so superior to the Mayo Clinic or Memorial Sloan-Kettering Cancer Center, where the doctors are on salary. Who would want to mess with that?

...So tell your congressmen and senators when they're home for the summer recess that it's too soon to address this issue. We've only been debating it for 97 years, since Theodore Roosevelt put national health insurance in the Bull Moose Party platform of 1912. We've only had 745 congressional hearings on the subject (I made that number up, but it's got to be close). That's not enough! Let's study this problem more before we do anything about it.

Did I  say "problem"? Who said there was a problem? Not me. I like the status quo.

Now before people start shooting me angry emails pointing out that Jon's survival illustrates that we "have the best care in the world" and that health reform would mean bureaucrats denying such life-saving care to others...Yes, Jon got great care. Our health care system -- at its best -- is excellent. But it's not always at its best. And not for everyone. Coverage counts.

Which brings us back to the American Cancer Society/Kaiser Family Foundation Report. They did some work earlier this year on cancer and insurance. The uninsured get diagnosed later, and are more likely to die. And many of the insured discover they are underinsured when they get sick and learn the hard way how limited their coverage is. The follow up report "Spending to Survive: Cancer Patients Confront Holes in the Health Insurance System" explores how the recession and job losses is making it worse. Since December 2008, the cancer society's Health Insurance Assistance Service has seen a 30 percent surge in the number of calls from cancer patients and survivors.

In our current flawed system, patients who get too sick to work can lose their insurance, and then be unable to access care. For some patients when their employers stop offering coverage because of the economy, they're unable to get it on their own because of their pre-existing conditions. Patients whose employers go broke can't even get their coverage continued through COBRA. And those who can get COBRA extensions have trouble affording it, even with the short-term help under the stimulus package. None of the stories are happy ones. As the husband of one breast cancer patient in her 50s put it, "We are not quite keeping our heads above water."  One more reason to change the status quo.