Readers Forum: Let's stop counting on charity to pay medical bills
By Rose Ann DeMoro
Updated: 01/02/2009 05:05:10 PM PST
THE MOST heartbreaking e-mail alert that crossed my computer screen this holiday season came from a union which has set up a fund for medical benefits for widows and orphans of their former members.
Reliance on charity rather than a public safety net symbolizes what has become a perversely unique American solution to social problems, especially in the Bush administration era.
In "Critical Condition," a searing 2006 indictment of the collapse of our medical system, Donald Barlett and James Steele described how pervasive this dependence has become.
Garage sales, spaghetti feeds, livestock auctions, pancake breakfasts, walkathons, bingo tournaments, pie socials, car washes, church suppers, raffles, barbecues, basketball shootouts, even hot-air balloon rides, all to help families drowning with unpayable medical bills.
Rather than a coordinated national system, as every other industrialized country has established, our go-it-alone, you're-on-your-own society has hit rock bottom in the most basic area of all, the care of our communities.
No wonder the U.S. ranks last among comparable nations in preventable deaths and first in out-of-pocket costs, despite spending twice as much as anyone else on per-capita health care.
Much has been said about Franklin Roosevelt's first 100 days, a period that inaugurated a new standard of social action and set the stage for some of the most important reforms in American history.
It's also worth remembering FDR's 1944 call for a second Bill of Rights, which included the right for all Americans to quality health care and other basics in jobs, education, housing and food that he said "spell security."
Counting on personal check writers or online donors certainly relieves others of their responsibility, most notably the insurance companies who loathe to jeopardize their wealth by starting to actually pay for medical care.
It circumvents the vision of those who think our government should guarantee health care for all of us, much as government already assumes a duty for our police, fire, armed services, schools, libraries, mail service, parks, environmental protections, airport security, national museums and prisons.
Indeed, the government is already in the game of financing or providing medical care for seniors, veterans, the disabled and low-income families, and does it with less administrative waste, less bureaucracy and without rejecting people based on pre-existing conditions or dumping them when they get sick.
But, somehow, a whole lineup of liberal advocacy groups, policy wonks, media pundits and politicians have concluded there is a national "consensus" to fix this broken and dysfunctional health care system by expanding the private insurance system that created the disaster.
That approach, however, would not curtail skyrocketing premiums, deductibles, co-pays, or bills for care denied by the insurance companies.
Perhaps those "consensus" builders are counting on the pancake breakfasts' and orphans' funds to make up for their policy failure.
Or instead, they could channel that giving spirit into the growing campaign for real reform.
Registered nurses will be in the forefront of this movement and nurses know what it would take to guarantee high-quality care for everyone-a streamlined, more effective system than our current nightmare, based on care not insurance, by expanding and extending Medicare to cover everyone.
In an era when our government has already intervened on behalf of Citigroup and AIG and Freddy and Fannie and all those other financial wizards on Wall Street, maybe we can bailout the tens of millions of Americans without having to count on livestock auctions or widows' funds to pay for medical care.
DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee and a vice president of the AFL-CIO and a resident of Contra Costa County.
Jan 7, '09
Quote from Jolie
Should we also stop relying on the generosity of individuals who contribute their time and money to the following causes: hunger, homelessness, poverty, drug abuse, disease prevention, health promotion, immunization, eye care, domestic violence, gang violence, literacy, public and private schools, mentoring, Big Brothers & Big Sisters, Boy & Girl Scouts, music, dance & art education, athletics, learn to swim programs, Meals on Wheels, visits to nursing homes and the home bound, Angelflight, Toys for Tots, ASPCA, PETA, service dogs,....
Of course, be generous. However, generosity, like love, can't be compelled. But public health and safety infrastructures require consistent and reliable funding for support together with public accountability for the proper planning and provision of vital services. I think you've missed that point.
No decent and compassionate society should fail to provide health care to its members when it has the financial resources to do so. The United States is the wealthiest nation on earth and I think we share a common responsibility to be good stewards of the resources we all share. We have an individual responsibility, as part of the social contract, to support public policies that will enhance the collective health of all.
In response to your rhetorical question, I will cite a verse from the Bible, Luke 12:48b, because it is probably familiar to many and as an apologist, I believe its message of responsibility, social concern, means, and benevolence towards others is universal among many of the world's religions. "From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked." (NIV).
Different religions may have different cultural expressions of basic ethical principles, but collectively they cultivate a moral sense of social responsibility. For instance, the idea of the Golden Rule is not by any means confined to the Christian world. Buddism, Judaism, and Greek philosophy expounded this ethical maxim.
Perhaps less controversial, is this quote from Dr. Marcia Angell, (Senior Lecturer, Department of Social Medicine, Harvard Medical School Former Editor-in-Chief, New England Journal of Medicine): "We live in a country that tolerates enormous disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status. One of those services is health care. Others are education, clean water and air, equal justice, and protection from crime, all of which we already acknowledge are public responsibilities."
For me, it's a moral imperative, as a responsible individual member of this society to advocate for a single-payer system of universal health care. Simply stated, if you can, you should, because it's the right thing to do. And if you can't, we'll help you.
Last edit by RN4MERCY on Jan 7, '09
Jan 7, '09
Quote from Jolie
No I haven't missed that point. The more I am "compelled" to provide "consistent and reliable funding" via taxes, the less money I have to donate to worthy charitable causes that are infinitely more efficient and effective than the federal government.
For example, I support the local food bank. I shop from a list of requested items with a set amount of money that I budget each month. I deliver the food to my church where a volunteer transports it to the food bank and stocks the shelves. 100% of my dollars go to providing food to those in need. Not a dime is lost to administrative overhead, waste or corruption, something no government entity can claim. Every time my taxes go up, I have less to spend on this endeavor, and the food bank has less to offer to those in need.
Good for you! Jolie, you sound like a really compassionate person. It's really wonderful that you are as sure as you can be that not a dime is lost to administrative overhead and corruption. Vigilance is the key. On Charity Navigator and the American Institute of Philanthropy you will find that most charities, religious or otherwise, spend at least 25% of their income on fundraising (marketing the charity) alone. But, I digress.
Everytime our insurance premiums go up, and our deductibles and copays go up, (which are, by the way, increasing much faster than the rate of inflation), we have less money to donate to worthy causes. And hey, when the insurance company refuses to let parents like my colleague, take her daughter (who suffered major complications at the company hospital), to an out of network hospital that has better brain cancer survival rates, that's a big chunk of money that no longer goes to charity and community support like girl scouts and t-ball. Yes, she's doing better now, but how's that for freedom of choice and quality, insurance company style?
And then there's the hidden costs to consider that really take a bite out of our abililty to donate to worthy causes. If you're not fortunate, and happen to be born with diabetes, or hemophilia, or if you develop a chronic condition like asthma because of the polluted environment, or if you just happen to get cancer through no fault of your own, private insurers can just decide to exclude coverage for the medicine and care you need. Tough luck, sell the home if you have one, because you may get fired for taking too many "sick days," and pray that someone holds a bake sale to pay your rent and your chemotherapy. That's a lotta dough, pun intended.
What about the 31% of every insurance premium dollar spent that goes for inflated executive compensation, administrative overhead, and marketing? Makes you feel better, does it, to think that out of $30,000 dollars in premiums at least $9,300 goes into some fat cat's profit instead of paying for the health care that someone needs? A fat cat insurance company that makes a profit by denying care? My friend Eve calls it "Murder by spreadsheet." Not exactly the kind of "charity" I want to spend my money on.
Medicare is much more efficient and that's why I support the expansion of it. A majority of physicians, RNs, the national conference of mayors, and a majority of people now support a national health care plan, based on the single payer model... even if we have to raise taxes slightly to accomplish that goal.
The government really can and does do a lot of things right! Because Medicare is provided as a not-for-profit social service, the overhead is less than or equal to about 4%. So the $30,000 dollars in taxpayer money actually nets $28,880 to pay for health care. The concept of one risk pool, with everybody in, and nobody out spreads the risk.
Instead of paying premiums, co-pays, and deductibles to insurers, we simply pay one small tax, based on ability to pay, like a social (health care) security tax. Then we can budget appropriately, and not have to worry about those nasty, costly surprizes like insurance recissions and exclusions.
It also makes sense to implement a single payer, guaranteed heathcare plan
in this country because we will be able to cover everyone for all preventative and medically necessary health care at a lower cost than we're paying now.
We can be more effectively "charitable" by acting in a politically and socially responsible manner toward one another in this country. I believe we can do that by implementing a tax supported, publicly accountable system of guaranteed health care. Wasting money on insurance premiums is not good stewardship of our collective resources. According to Dr. Claudia Fegan:
In the United States today the pharmaceutical industry is more profitable than the gaming industry. The American public pays the highest prices in the world, while the same companies sell the same medications all over the world for prices 1/2, 1/3, or even 1/10 what they charge in the US. How long are we going to let this go on?
People are losing their jobs because they can’t get care and can’t work as a result. They are having strokes and heart attacks because they can’t afford their blood pressure medication. They are having limbs amputated or winding up on dialysis because they can’t afford the medication to control their diabetes.
People are dying because they can’t get the care they need. The insured and the uninsured are having care delayed or denied because we don’t have a health care system. Our county health system is so overwhelmed it takes months to get an appointment. There is no system in this country other than to deny care to those who need it. Access to care is a profit center controlled by the insurance industry. We pay them to limit access to care.
It's immoral to continue to subsidize insurers. Mandates to purchase insurance are wrong because they've failed to control costs and expand coverage every time they've been tried. How much longer will we allow the pain and suffering and death from preventable illness continue when we know there is a solution?
Last edit by RN4MERCY on Jan 8, '09