It’s not right to say “this is the problem” because nobody knows what the problem really is, but then not knowing what the problem is is a problem, so, in a way, this is the problem. Our national fear of taxes has created a system where taxes are hidden in all sorts of unlikely places, which, of course, raises taxes.
Consider the telephone bill. Telephone service is essential, and there’s a legitimate public need to let everybody have affordable access to basic phone service, so that it’s not unreasonable to have people who live in areas where high population density makes providing telephone service very efficient pay extra to subsidize those who live in areas of low population density.
In order to keep rural costs at a reasonable level, governments have authorized surcharges, extra costs tacked onto phone bills that have to be paid, just like taxes, but aren’t taxes. That’s important, because Reagan’s legacy left us afraid of taxes. We don’t have taxes or rate increases, since we don’t like those either, but we have surcharges for number portability, to help phone companies cover the costs of letting people keep their same phone number when they move or change carrier. Surcharges help cover the costs of providing service to rural areas, providing 911 emergency services and to help some non-profit institutions keep their costs down. There are surcharges for the costs of providing service to the elderly poor. All of these programs are worthwhile, and none of them are paid for with “your tax dollars.”
Of course that makes it harder to figure out the real cost of telephone service, and probably keeps a few thousand bookkeepers busy trying to figure out which dollar goes to what line on the spreadsheet, but it helps keep us from paying higher taxes and the local Public Service Commission hasn’t approved a rate increase, so everything is good.
If phone bills are bad, health costs are worse. There are 46 million people who don’t have any form of health coverage. We have Medicaid for the poor, and private plans for the relatively well off, but no programs for the not-poor-enough. Since it would be immoral to let the uninsured go without care, hospital emergency rooms have to treat patients without regard for ability to pay, but because the hospitals can’t afford to give away their services, there’s an extra charge on the insurance payments.
ERs are a lot more expensive than routine visits to a physician, but that’s our system. Even though the ERs have to treat those who can’t afford to pay, they do send bills and hire bill collectors, which adds to the costs. There’s a haunting statistic that two-thirds of all bankruptcies were caused by high medical costs. In most cases, the people affected had insurance, but were still done in by the fees, denials and co-payments. When somebody goes bankrupt, everybody loses, so that some share of the medical costs get picked up by everybody else — the telephone company, the mortgage lender, the credit card company — basically anybody who didn’t hold out for cash.
Bottom line: we’ve created a system so convoluted that we have no idea what the real costs of health care are. We have statistics showing that the US pays almost twice as much for health care as every other modern nation. The way costs are spread out, we really have no idea what health care costs us. If an insurer refuses to pay for a procedure, which drives your neighbor into bankruptcy, which leads to foreclosure on his house, which leads to a drop in the value of your house, are you paying part of the cost of our health care system, or lack thereof? We’ve hidden the costs so well that we may never find them.
Congress is debating health care reform, and going through sticker shock looking at the projections for covering the uninsured — even though the rest of the world had already come up with a variety of systems each of which offers longer, healthier lives than we’ve been able to manage, and the best argument anybody has found against a Canadian- or European-style system is that government would be making decisions, although looking at the lobbying efforts of the insurance companies and the pharmacy, government doesn’t do much deciding on its own. A single-payer health care system would be expensive, but compared to what, when we have no idea what we’re paying now.
Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.
From The Progressive Populist, August 15, 2009
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