Health, United, and Citizens
United, health, and citizens
United Health Care is withdrawing its involvement in the state exchanges of the Affordable Care Act, a.ka., Obamacare, due to the high costs of participation. The citizens in states where United was an important player will now have fewer options, and likely face higher premiums and/or deductibles.
Detractors of the ACA perhaps see this as something of a vindication, but the details behind this story suggest that is very misguided. The high costs to United of involvement in Obamacare are really all about sick people getting care they actually need. The very point of the Affordable Care Act is to bring coverage, and thus access to care, to those formerly left out entirely. It is, apparently, working.
I have at times seen the faces of those caught up in this narrative. In one terribly tragic case, a member of a cousin’s family- and thus, arguably, a distant member of my own- died at 34 of melanoma. Let’s call him John.
He first noticed the abnormality on his skin when in-between jobs, and thus, without health insurance. In his early 30s, he didn’t have cash reserves to pay out of pocket for medical care. So, he waited until once again employed, and once again insured, to have that skin lesion assessed. The wait proved lethal. During those months, the melanoma had metastasized. A system of portable health care coverage that transcended employment would certainly have save the life of this young man, only recently married.
Many years ago, I met a young mother- let’s call her Jane- in a homeless shelter in New Haven. She, too, was in her early 30s, with a 4-year-old daughter at her side, when I saw her for an on-site “check up.” She was severely limited by shortness of breath and heart failure, and would never be otherwise.
It need not have been so. A couple of years prior, she had developed a pain in her calf. I no longer recall the exact circumstances. The pain started out mild, but progressed, and became fairly severe. It was like nothing she had experienced before. Any of us, with a severe, unexplained pain in our leg, would have gone to see a doctor. She did not, because she had no insurance, and no doctor. A doctor visit for her meant finding something to do with her daughter while she spent many hours waiting to be seen in the emergency department. She tried her best to avoid that, by toughing it out.
That proved a tragic mistake. The pain in her leg was a blood clot called a DVT. As they inevitably due when neglected, the clot broke, sending fragments into her lungs, called a PE. Blockages in her lung were life threatening, and resulted in a 911 call, a trip to the hospital by ambulance, emergency care, and a stay in the ICU. The inconveniences the patient hoped to avoid were, obviously, massively amplified. The damage to her heart and lungs was permanent, so her health, and thus her life, were ruined. And, the costs to the system were vastly higher than earlier care of the leg would have been in the first place. Everyone lost.
John and Jane, and the millions like them, are the rebuke to those who see United’s reticence as the basis for an “I told you so” about Obamacare. United doesn’t like the costs, but it’s not as if those costs weren’t with us all along. People like John and Jane have been paying them, and generally without the option United has of saying: no thanks. They have paid with years lost from their lives, and life lost from their years.
One potential solution to this, routinely derided as heresy here in the U.S., is a single payer system. Ironically, many of those who see this as radical, heretical, and anathema are quite adamant about the protection of Medicare, which is, of course, a single payer system for those 65 and older. If Medicare worked like the private system, then perhaps it would cite the high costs of care in Florida, where a lot of older (and all too often sick) people settle- and withdraw from the state. If we don’t like the idea of our older relatives in Florida being abandoned by their health insurer, perhaps we might choose to see the United disengagement from the ACA through that same lens. Maybe health insurance really should be a universal right, not a business decision.
The other implication is of the “I have a hammer, and so I see nails” variety, as president of the American College of Lifestyle Medicine. Eating more optimally, being active, avoiding tobacco, and hitting a few other highlights of living well has the potential to eliminate some 80% of all chronic disease: heart disease, cancer, stroke, dementia, and diabetes. From my perspective, the human bounty of this- more years in life, more life in years- more than amply makes the case. For those inclined to other currencies, however, we may note that the financial advantages would be astronomical.
As for the status quo, United is a business, and has the option of renouncing its high costs. The people paying for business as usual with their lives- do not.
-fin Dr. David L. Katz;www.davidkatzmd.com; author, Disease Proof; founder, True Health Initiative
