Sicko

No, I haven’t seen the Michael Moore movie. I don’t have to. I know the American health care system is in trouble.

And I’m warning you right now, there will be a little bit of ranting in this post.

I just finished reading a series of comments in a patient forum in which several people made catty remarks about how Michael Moore makes them ill, and about how that great bugaboo of the right wing -- “socialized medicine” -- will end life on Earth as we know it. (How many of these same people would volunteer out of principle to give up their "socialized" Medicare benefits, I wonder?)

The real sickos, it seems to me, are people who don’t give a damn about those of their fellow citizens who aren’t insured, or who have substandard insurance, or who can’t get insurance because they can't afford it, or who are rejected by insurance companies because of pre-existing conditions like chronic lymphocytic leukemia. People whose answer is “go to the emergency room, they have to take everyone.” Or “find a free clinic.” Or “establish a medical savings account,” as if the average American can sock away enough money to pay for the treatment of cancer or a chronic disease.

Tell it to this guy, who just “sold” his Stage 4 Non-Hodgkin's Lymphoma on eBay for $242.50. Since auctions eventually are taken down from the eBay site, let me quote from his listing, and let me also post a picture of him and his family so that you can see everything that is at stake here:

Well, I've sold almost everything I own to make ends meet, I've nothing left so I thought I may as well try and sell my cancer on ebay. I was diagnosed at age 39 with Stage 4 Large Diffuse B-cell Non-Hodgkin's Lymphoma in April of 2007. I Recently finished my 6th (and hopefully last) round of chemo-therapy. I am trying to sell mainly because of my families dire financial situation, but my little twin boys are afraid that daddy won't make it, so I promised them I would try and sell it on eBay.

I obviously cannot send anyone any physical cancer, but the winning bidder will receive before and after photos from PET Scans and MRIs done on my entire body. But mainly the winning bidder will get the satisfactory feeling of helping out a family of 5 in grave financial distress.

In mid October I am scheduled for another PET Scan. If that is clean I will be in complete remission and the winning bidder will also receive a thank you card every year on that date for the rest of my life. In the unlikely event that this cancer takes my life, the winning bidder will receive a short biography of my life and a copy of my obituary. There is no reserve so please bid high and help my family survive this crisis. If you need proof that this is no joke you can send me a message and I will give you absolute proof. Thank you and God bless!

Or tell it to the CLL patients who I see posting on forums saying things like: I need treatment but I have no insurance. How can I pay for it without going into bankruptcy? Or things like: I am taking herbs for my CLL because I lost my job and can’t get insurance.

I have seen both these comments, and many more, in the few years I have been reading patient forums.

Is health care a right or a luxury?

These situations bring up the question: In a civilized modern society, is health care a right or a luxury?

There was an interesting discussion of this on an Oprah show where Moore and others appeared. Here's a quote:

Princeton University professor Uwe Reinhardt, one of the nation's leading authorities on health care economics, says the health care debate all boils down to a single question. "Should the child of a gas station attendant have the same chance of staying healthy or getting cured, if sick, as the child of a corporate executive?"

Professor Reinhardt says people need to decide whether medical care should be like public education — where every American simply has a right to it — or if it should be treated like a luxury good. Currently, he says health care is like fine dining -- if you have the money, you get it, and if you don't, you won't.

When hurricanes or other natural disasters hit, Professor Reinhardt says the government steps in to help victims. "That's social insurance," he says. "It's a natural disaster, and I would say if a lady in Mississippi has breast cancer, isn't that a natural disaster, too?"

As Michael points out in Sicko, Americans rely on many socialized services, like the police department, public libraries and the fire department. The U.S. Army even provides socialized medicine for all enlisted men. "I'd like to call it Christianized medicine because this is what Jesus would do, right?" he says. "He wouldn't let the child of a gas station attendant go without."

Of course, the right-wing solution, even among some of those who profess their faith all too loudly, boils down to this: Go die. Stop bothering us. Let us continue to bankrupt this country through a misguided war that will put the nation in debt for a generation. Expand the program providing health care for children? Surely you jest. That will lead to more government (which, as we all know, is much worse than having more of a health care crisis). Heck, let the free market take care of it: sell your disease on eBay!

Lucky for me, I guess, that I'm an eBay powerseller. As a self-employed individual with cancer, I can tell you for a fact that it is impossible to get insurance without some form of government intervention. There is a patchwork of programs depending upon the state you live in; there is no consistency to it or to the quality of coverage. I will need a stem cell transplant eventually but here in Arizona there is no way that I can get insurance that will pay for one. Neither would there be a program for me in California. But both New Mexico and Texas would cover me. Fortunately, I am in a position to move. Not everyone is.

These issues are but a few of the problems our insurance system faces: Rising costs and declining benefits confront many in the middle class. Companies are squeezed financially and can no longer afford to offer insurance to their employees. For the first time, there is a growing demand from business as well as from average Americans that something be done. And the conservative solution of "leaving it up to the states," which are in varying states of financial health, is no solution at all.

So what is the solution?

As much as I admire Michael Moore for raising issues that need to be raised, I do not favor a single-payer national health system to replace private insurance. There was a time when I did, and then I came down with CLL.

One thing I realized is that in countries with systems where care is rationed -- and where oversight boards of some kind, no matter how well-intentioned, decide who has a right to get what treatment -- the drugs that my doctor and I think may help me the most may not be available. Rituxan is not easy to come by in either Canada or the UK, for example, and therefore the standard of care for CLL is probably not as good as it is here. Australians have a heck of a time getting some prognostic tests, like IgVH mutational status, done. These are some examples I know from personal experience; there are no doubt others that relate to other conditions.

I saw Democratic presidential candidate John Edwards talking on C-SPAN a week ago. He was being interviewed by reporters who cover health care issues. Edwards was among the first of the presidential candidates to lay out a comprehensive plan on health insurance and he may have hit upon a workable solution, or one that is about as workable as we're going to get.

Edwards would cover everyone, and everyone would have a choice: they could continue with private insurance, improved through the establishment of regional health care markets to increase choices and cut costs; or they could sign on to a Medicare-style public insurance program.

This makes the most sense to me: preserve freedom of choice while making sure everyone is covered. Edwards said that the beauty of his approach is that eventually American citizens would vote with their feet and gravitate toward the system they liked best.

What will they choose? Who knows. But it is evident from all the polls, despite the howling from the right, that they are no longer choosing to let things go on as they are.

I'll close with this quote from the Oprah article:

To get health care coverage for every man, woman and child in the United States, Professor Reinhardt believes it would cost about $100 billion in additional government spending. That's the same amount the government spends in nine months to fund the war in Iraq, he says.

AFTERWORD

This topic is an emotional one, as the comments section shows, and I plead as guilty as anyone. I am not always sure that I am right about a given issue but I am willing to go to the mat on this one.

There is one last point I want to make: If the private insurance system were willing and able to cover everyone and keep costs reasonable, I'd be all for it. For me, this is a practical issue much more than it is an ideological one.

But the private system is failing. Government, in the form of a patchwork of state programs and such federal efforts as SCHIP to cover children, is already involved. Medicare, for another example, has a major impact on compensation for care outside the Medicare system. It is a all a royal mess, and it would be far more intelligent for government to play a reasoned and constructive role in dealing with the whole problem, not bits and pieces of it. In this effort, there will no doubt be a role for private insurers and medical providers. But there will also by necessity be a public aspect, and it is a greater good to care for those without care than it is to deny care by refusing to change the system on ideological grounds. People who die of cancer and other diseases do not go to their graves as Republicans or Democrats: they go as human beings, and that is the bottom line for me.

RESOURCES

For a comprehensive rundown of insurance options state by state, visit this excellent website: healthinsuranceinfo.net

For information about states that have high-risk insurance pools that may cover patients with nasty pre-existing conditions such as CLL, go here.

State health risk pools that have websites:

• Alabama Health Insurance Plan
• Alaska Comprehensive Health Insurance Association
• Arkansas Comprehensive Health Insurance Plan
• California Major Risk Medical Insurance Program
• Connecticut Health Reinsurance Association
• CoverColorado
• Idaho Individual High Risk Reinsurance Pool
• Illinois Comprehensive Health Insurance Plan
• Indiana Comprehensive Health Association
• Health Insurance Plan of Iowa
• Kansas Health Insurance Association
• Kentucky Access
• Louisiana Health Plan
• Maryland Health Insurance Plan
• Minnesota Comprehensive Health Association
• Mississippi Comprehensive Health Insurance Risk Pool
• Missouri Health Insurance Pool
• Montana Comprehensive Health Program
• Nebraska Comprehensive Health Insurance Plan (CHIP)
• New Hampshire Health Plan (NHHP)
• New Mexico Medical Insurance Pool
• Comprehensive Health Association of North Dakota (CHAND)
• Oregon Medical Insurance Pool
• South Dakota Risk Pool
• Tennessee's Tenncare Program
• Texas Health Insurance Risk Pool
• Utah Comprehensive Health Insurance Pool
• Washington State Health Insurance Pool
• Wisconsin Health Insurance Risk Sharing Plan
• West Virginia Health Insurance Plan
• Wyoming Health Insurance Pool