A Preamble to the Healthcare Debate

I've got big plans to break down current proposed health care reform legislation and make it palatable to the average American, who would rather not wade through hundreds of pages of legalese... this, however, is still in the works. But I did want to set the stage for discussion on health care by bringing up a point that I feel is lost in the current debate taking place. Keep in mind that this is a moral argument, not a practical one.

Can we all step back a moment and look at our health care system with fresh eyes? I think that everyone - Democrat, Republican, independent, and apathetic alike - can manage this, but it truly does take a stretching of the imagination. It is exceedingly difficult to detach oneself from the constant media onslaught (both wanted and unwanted) that penetrates the psyche via television, newspapers, Facebook, Twitter, and is then recycled via word-of-mouth.

But imagine that you had no preconceptions of how health care in this country should function... how would you set it up? Now, we don't live in a moralistic society, though some would like to pretend we do when it suits their political purposes (more on that later). So let us be practical in our aspirations for establishing our brand-new, first-ever health care system. Lets go with the assumption that at least a slight majority of Americans don't really trust the government (I think that's a safe bet) and that being a capitalistic, free-market economy, we're more comfortable with creating some private health insurance companies... Done.

These companies need workers, they have overhead to pay, and of course, they have to pay the medical bills for all their consumers. They hire some brilliant mathematicians and actuaries and find out what they need to charge their customers to stay financially viable. Sounds pretty reasonable to establish rates that will bring in at least a bit of profit.

So why is it that health insurance companies have, on average, increased premiums by 87% in the past six years, while profits from the 10 largest publicly-traded companies has risen 428% between 2000 and 2007. Why have the over 400 corporate mergers involving health insurance companies in the past 13 years, that have resulted in 94% of insurance markets becoming highly-concentrated (re: near monopoly), according to the American Medical Association, been allowed to take place? Mergers resulting in an anti-competitive marketplace where companies can thrive and shareholders can demand that profits continue to increase doesn't sound like free-market America.

So I ask, why is it that we allow insurance companies to be publicly traded at all? Stepping back to our newly-created health insurance company scenario, why can't this company function at a level where it earns steady, moderate profits? Why do we have to introduce investors to an industry that has the power decide between life and death? Why do we resist reforming a system that is set up to reward those who deny medical coverage to sick people? Shareholders in any company want to see employees cut costs and increase profits... cutting costs in the health insurance industry means killing human beings. Perhaps that seems like a harsh statement, but perhaps most of the people working at these companies are too far removed to truly grasp the consequences of their actions... Wendell Potter would agree.

An estimated 18,000 people die every year because they do not have health insurance. And while that may not be the cause of death listed on their death certificate, it is certainly the reason. Living without health insurance is the socio-economic equivalent of living with the AIDS virus. No one dies of AIDS, they die because AIDS has so utterly destroyed their immune system that opportunistic infections, be they pneumonia, tuberculosis, any other number of ailments can kill them almost instantly. People without health insurance are some of the most vulnerable. When you know a simple visit to the dentist for a toothache, or a trip to the ER to have a dislocated shoulder properly set, is far beyond your means, you simply don't go.

This is why our health care system is as costly as it is. Anyone working in the health care field (and most people with a little common sense) will agree that preventative care is the cheapest, most efficient way to keep our country healthy. When 46 million people don't have that option, things get awfully expensive.

Its A Small World After All

So I've started this blog... My original idea was to write about what I was up to out here in Berkeley, CA so all my East Coast friends and family could keep track of my exploits (and hoping that I would be able to keep from having to repeat the same stories over and over). Before I even started writing though, I realized that as a topic, my day-to-day life in Berkeley is going to be a pretty boring read, and probably even more dreadful to write about. So I'm going to refrain from chronicling my life out here.

There will be a sampling of life in Berkeley and my adjustment to the West Coast, but I'm going to stick mostly to public health issues, two of the hot items right now being H1N1 (one of the few things I can call myself an expert on) and health care reform (currently honing my expertise).

This first post will refrain from health issues to make one point: despite being a tiny dysfunctional speck of planet earth, Rhode Island seems to reach even the West Coast with relative ease, I'll explain...



Instance 1: My thankfully uneventful plane trip was made at least slightly interesting by the commonalities I discovered between myself and the middle-aged couple sitting to my right on board our Boeing 757 from Boston to San Francisco. Carol happened to ask if I was 'coming or going', I replied that I was going... for quite some time... and explained how I was starting an MPH degree at UC Berkeley. Upon hearing that I attended URI, Carol and her husband Neil inquired if I knew Professor Manchester... "well there is no professor Manchester at URI [to my knowledge] but I know a Margaret Manchester that teaches at Providence College," I replied, "and she happens to be a close family friend." 'Yes, thats it! We know the Frees... I teach with Scott at Berkley [School of Music]' replied Neil. The Frees lived next-door to the Manchesters for years as I was growing up in Barrington, RI, and both families were close friends of my own family, as most of us kids were around the same age. The Olmsteads (Neil and Carol) had been to the same beach houses in the summer and met many of the same folks I knew as I was growing up. I hope they enjoyed their vacation in San Francisco.

Instance 2: After arriving in Berkeley and moving into my apartment on Tuesday (Aug 18th), my roommates and I split up to hit all the yard sales in Berkeley that Saturday. Alex and I took his Subaru wagon around south Berkeley, while Bobby and Doug took the north. After getting a 'New England Discount' on a set of chairs for our dining room from a woman wearing a UMass sweatshirt (Alex is from Western Mass), our second stop was looking much less interesting. We did however find a functioning iron for $1, so I we happily made the purchase from the couple staffing the yard sale. When they inquired where we were from (I think my Rhode Island Ultimate sweatshirt gave it away) and I responded with 'Rhode Island'. They happily informed me that they too, were both from the Ocean State. Upon further discussion I found that Janet had worked as an RN at Rhode Island Hospital for quite some time (and of course knew a couple colleagues of mine at the RI Dept of Health) and was now the immunization coordinator for the city of Berkeley. When I informed her of my concentration at Cal in Infectious Disease, and my work on H1N1 back in Rhode Island, she gave me her business card. I'm excited to put it to use.

[Update: I'm currently in conversation with Janet working the logistics of having the Association of Public Health Infectious Disease Students (APHIDS) help staff flu vaccination clinics]

Instance 3: Three days later I was attending the 'Center for Public Health Practice' leadership day prior to the start of class. As they were busy pumping us full of accolades and promises of the many opportunities that lay ahead of us, I asked the other students of the table I was sitting at where they were from... Virginia, California, North Carolina...RHODE ISLAND!? I had certainly expected myself to be the only one at my table (indeed, in the whole auditorium) to be uttering that state name. It turns out the Divya, a 1st year Epidemiology MPH student, graduated from East Greenwich high school the same year that I graduated from Barrington High. She had been my college roommate's square dancing partner in Jr. High, she knew a co-worker of mine from the kayak shop in Wickford, and knew my friend Sushil (now a law student here at Cal) and highschool classmate Nick Bauer from when they attended Brown University. I had wondered if my immediate high-five to her for both being from RI was a little over the top, but apparently she has just as much pride in our tiny state as I do. The only people a bit perplexed were the rest of the students at our table... I guess you don't get quite as excited when you meet someone else from North Carolina.

Instance 4: Last but not least is Andrew, the sandwich shop counter attendant where Divya and I went to get lunch between classes. He happened to comment ('hey, nice shirt') on the Narragansett Little League t-shirt I was wearing, obtained from when Maria worked at their Parks and Recreation department. I was of course confused, because it is not a nice shirt. Seeing my confusion, he explained that he graduated from Narragansett High in 2000. Of course he knew both Toby Johnson and Carris Transue, Narragansett natives whom I worked with at summer camp.

It is indeed a small world. The one-degree-of-separation rule holds strong for Rhode Islanders, even ones transplanted to the West Coast. Every RI native I've met has had more than one mutual aquaintence. I take it as a sign that I'm on the right path...