Young: Vision vs. blindness on health coverage
January 21, 2015
When he noticed weird stuff floating in his right eye, he didn't blink. He called an eye doctor.
The next day, 24 hours after the abnormality introduced itself, he had eye surgery — a vitrectomy — that very likely spared him the loss of sight in that eye from a detached retina.
If he'd postponed action, said his ophthalmologist, this might not have been possible. Done early, the procedure has a 90 percent success rate.
The rapid response was possible because he didn't pace the floor wondering if he could afford the doctor's visit. With his health insurance, all he would owe was a co-pay if his deductible was met.
Not so for the person without. The procedure costs $7,000 or more. Anyone got that kind of change on hand?
It's just one of the many dramas that opponents of the Affordable Care Act want to ignore when it comes to nonelective medical care.
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One of those people is Sen. Rand Paul, an ophthalmologist himself. To his credit, as with many in his profession, Paul has done eye surgeries for people without health insurance. But charity covers only one at a time in this and many other specialty fields.
Paul says that if we allowed the free market to dictate health care, more people would be served at lower cost. He uses the example of LASIK surgery, which is not covered by most insurance, and for which the price has become more affordable due to competition.
The difference, of course, is that LASIK is elective, not urgent, and someone who decides to do it, if that person can afford it, can shop around for the most affordable cost. The man with the floaters in his eye had no time to shop around.
Paul needs to face the fact that health care generally doesn't fit so neatly into the template set forth by free-marketeers.
Left to make their own rules, insurance companies would extend favorable premiums to those who don't need much coverage — until they do — and health care costs overall would continue to soar.
Drug companies would continue to enjoy virtual monopolies. Providers would set whatever prices they see fit, knowing that the scarcity of their service will obviate any competition.
Regardless, the government would continue to provide a sizable portion of health care via programs like Medicare, Medicaid and CHIP. These are programs from which this nation will retreat.
Medicare and Medicaid cover the surgery for a detached retina because of its urgent need. That means that in all states that have refused to expand Medicaid under the Affordable Care Act, a vast swath of people are in great danger of calamity.
When it studied 20 states that have refused federal dollars to expand Medicaid, Harvard Medical School calculated the human cost to be 16,526 preventable deaths a year.
Sixteen thousand deaths. That's 9/11 times five. And what have we spent since 9/11 to prevent another 9/11?
Whatever the Department of Homeland Security or the Pentagon might conjure in the "war on terror," the returns from investing in health care are clear. Preventive care saves lives and averts catastrophic costs. It's undeniable. Yet we are told that society cannot afford to be smart about the spending of tax dollars in that way.
The resistance to Medicaid expansion is one thing. At the same time, opponents of the ACA are rooting for a Supreme Court ruling that effectively would abolish exchanges the government set up for recalcitrant states that didn't want to set up their own.
Ah, yes, what a coup that would be: a ruling that pulls the plug on health policies used by more than 3 million Americans. It'll be worth one big touchdown dance by people who have all their needs met by the status quo.
With the help of health coverage, one man was able to sustain his vision. It is wrong and foolish for the blindness of policymakers to deny that same urgent help to millions of others.
Contact John at firstname.lastname@example.org.
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