Southern Views

As a healthcare social worker I have strong opinions about the importance of equal access to medical care. My focus has been on “equal access” because I am an advocate for those with expensive health conditions – the people traditionally shunned by for-profit insurance companies. I admit that I have been less attentive to that aspect of health reform that aims to make all Americans carry some form of health insurance. It has never seemed particularly wrong to me. After all, we are now required to have auto insurance and those who do not comply come across as irresponsible or even criminal. But then again, I do not run a small business and I don’t have to worry about payrolls and the bottom line.

We all have our worries that keep us awake at night. I represent people with chronic health conditions, most of them born with a diagnosis that will challenge them all of their lives. There are many such conditions and many advocates such as myself working to help them get life-saving medicine when they cannot get insurance. Hundreds of thousands of Americans with hemophilia, diabetes and asthma, for example, have felt the sting of rejection by insurance companies. That includes many children as well as adults. To some insurance companies, even a pregnancy is considered a “pre-existing condition.” If you have insurance you might be stunned to know how many have been left out in the cold.

Government dollars have historically had to pick up the slack left by insurance companies not wanting to sell their products to those with actual health needs. In that sense, our system already had a strong public base of support long before health insurance reform. Unfortunately, much of this taxpayer-funded support has had to focus on extremely expensive emergency room visits when prevention and as-needed medication can be so much cheaper. It’s a bad business model as well as being inhumane.

The uninsured in America have traditionally included small business owners, job-seeking young adults who have dropped off their parents’ insurance, construction workers, shop employees, independent contractors — even those who work for gigantic, wealthy, international businesses such as McDonald’s, which doesn’t offer any kind of insurance option to many employees. These Americans don‘t qualify for Medicaid or Medicare and many would not take it if they could. They simply want the chance to buy private health insurance like the rest of us. And like the rest of us they want to pay premiums that are not so outrageous they make it impossible to pay other bills. This is another focus of health insurance reform.

The uninsured in America include many with pre-existing medical conditions who now cheer for changes brought about by the Affordable Care Act.  I know. As a social worker I’m often there when they are cheering. Finally, they can buy insurance, too. So why do others in our country act like this change in policy is un-American?

For a while now, television has occasionally sent me into a tailspin. I know that most people are good. So why do the passions of a large number of Americans lead them to believe that all of this change is a dangerous thing? To many President Obama’s healthcare initiatives even smack of socialism and evil. I am a student of human psychology and behavior and yet it has been hard for me to put all of the pieces together. I have wondered if the world is going completely mad.

Then I started really listening to what really bothers so many who are shouting for the repeal of healthcare reform. It is not, thank goodness, that these folks want their fellow Americans to go without medicine and suffer. The real thorn for many Americans is the mandate that ALL citizens should have some form of health insurance whether they want it or not. This change appears to shake them on a primal level that is not completely about the wallet. For them, it feels like a threat to personal freedom to have government mandating what seems like a personal decision. This is a separate issue from the fears of small business owners, a concern I do readily understand and support.

So let us get back to the car insurance thing. Americans are now required to have it. If you do not, you can be in big trouble with a branch of government called the police force. I would like to point out that healthcare insurance is very similar. If you choose not to carry it and you get in a car accident, for example — or maybe you get diagnosed with cancer — you cannot go back after the fact and buy insurance to cover the costs. Your choices are to pay for it all of pocket, which in many cases is simply impossible, or pass along the responsibility of your care to other taxpayers. That’s right, tax dollars will be spent to take care of you because you did not acknowledge that your health fortunes could change. That is a fact that will continue if we are not required to carry insurance for our bodies in the same way that we carry insurance for our cars. There is no free lunch and no free medical care. The latter is particularly true.

So think about it, you who want to exercise your so-called right to avoid paying for health insurance. (And I don’t mean those who have tried but can’t get it or can’t afford it because of outrageously inflated costs.) Those same taxpayers whom many healthcare opponents seem to care so much about will pay the doctors, nurses and other professionals who took care of you. What — do you expect them to work for free? Hospitals are businesses, too, and they cannot survive that type of mentality.

I have not seen anyone offering to sign a statement saying that this exercise of personal freedom means he or she is opting out of any type of medical care should there be an accident or serious illness.  And doctors’ professional oaths prevent them from honoring such a statement should they be presented with one.

No, our lives are simply too intertwined to make decisions without having an impact on others. Even a decision not to wear a seatbelt means that you might end up on a public disability program when a simple strap across your body could have prevented it and saved the country a great deal of money. We are in this together. Like it or not, our choices can pull money out of other people’s wallets. You might not want to pay for someone else’s Medicaid, but maybe I’m not particularly excited about paying for your medical care, either. Still, we rise above such things and pool our resources to run a nation that is as healthy as possible. And nothing about that sounds even remotely un-American.

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Cathleen Hulbert

Cathleen Hulbert

Cathleen Hulbert, MSW, LCSW, is a free-lance journalist and clinical social worker who spent six years living in New York City where she earned her graduate degree from Columbia University School of Social Work and worked in the neighborhoods of Brooklyn. During that time, unexpected teachers began to emerge who would set the stage for the writing of  the novel, “The First Lamp — A Story of Cosmic Illumination,” a time-travel tale about original innocence. For more information about the book go to www.cathleenhulbert.com. She later traveled to Hawaii to answer the call of Kalah and to embrace the healing power of Aloha. She returned with a renewed dedication to sea turtle conservation, a burning love for the Hawaiian culture and a deeper respect for the needs of Mother Earth. She now lives in Roswell, Georgia, where she works in the healthcare field and continues to write. In November 2008 Cathleen was a co-recipient of the National Hemophilia Foundation's "Distinction in Communication Award" for helping teens with chronic bleeding disorders create their own camp newspapers. Her current project is a sequel to "The First Lamp."

20 Comments
  1. Well, the automobile is a bad analogy because people who don’t own cars or don’t drive on public roads don’t buy insurance, unless it’s a valuable antique and they fear it will be stolen.
    Whether or not a person requires medical care is another matter. Aside from the fact that if the injury is from a car crash their medical care should be covered by that insurance policy, an occurrence that’s virtually universal should not be covered by insurance, to begin with and having profit-seeking middlemen take a “cut” is bad public policy. But, contrary to the “free enterprise” claimants, we have a long history of public subsidies to private enterprise. After all, that’s how our public assets and resources get transferred into private wealth. Habits are hard to break. So, cutting private insurance companies out of the loop didn’t seem feasible. Besides, it turns out that the several states do have a history and a bureaucracy that’s used to dealing with insurers of all kinds, so it seems reasonable to try and get them to set standards of patient care, instead of just guaranteeing the companies’ profits.

    Still, taking all of the above into account, requiring individuals to purchase insurance from a private business is a step too far. It makes sense to levy a universal tax for medical care. No-one could have a constitutional objection. The fact that not everyone (unemployed, moderate-income elderly, children, investors) actually pays taxes, except perhaps sales of one kind or another, is a problem. Trying to solve it by issuing a blanket mandate that can’t be enforced is not a solution; it’s just an affront. Providing for the general welfare is a Constitutionally mandated obligation. Shoving it off onto private corporations is despicable, but not unprecedented. Our elected officials on the federal level have been relieving themselves of their obligations (financial, managerial, law enforcement, security) for over four decades, ever since they discovered that they were supposed to serve everyone equally and playing potentate had run its course

    I say all of this as a person, btw, who’s not been seen by a medical professional in about thirty years and has had no health insurance since the spouse retired almost a decade ago. I have automobile insurance and have never filed a claim in 50 years, except once when someone slashed all four tires. If I become ill, I hope to die quickly, as Republicans advise. I do not, however, begrudge anyone else medical care; only the enhancement of medical human husbandry. I wouldn’t hesitate buying into Medicare-for-all, if that were an available option. It can be, btw. Medicare can be made available to all comers at any time because it’s an extant program and, if there’s no additional cost to the general fund, can be incorporated in the federal budget at any time with a simple majority vote. That it hasn’t been done tell us that our Congresscritters don’t want to be helpful.

  2. Cathleen Hulbert

    Thank you for your comments. We all have valuable perspectives and need to keep talking as a country. That’s why I wrote this column. My car analogy applied only to those who drive. It is an example of “passing the buck” if you drive without insurance. I am a very safe driver but I have been involved in several accidents that were someone else’s fault. In one case my car was turned into scrap metal by someone who was uninsured. Even safe drivers make mistakes and if I make one and cause damage to another I don’t expect other people to absorb all of the costs. It’s an attitude of being willing to share the risk.

    The same is true for health insurance. Working in a hospital for two decades, I can tell you that health fortunes can change very suddenly for children and adults. Just as being a good driver is no guarantee that you won’t be involved in an auto accident, being healthy is no guarantee that you won’t wind up in a hospital. Then the bills start pouring in. If you can’t pay them, the hospital and staff still want to get paid. They turn to the state and federal government to compensate them — with taxpayer dollars. There’s no getting around the fact that if you take risks by being uninsured, someone else will likely pick up the tab. Public funds already support our healthcare system because so many people are uninsured, some by choice and some because the insurance companies reject them for pre-existing conditions.

  3. Frank Povah

    “To many President Obama’s healthcare initiatives even smack of socialism and evil”

    The responsible media could do Americans a great service by educating them (and itself) about the differences between Nazi philosophy, socialism and, perhaps, a social conscience.

    1. Frank, one of my major pet peeves! I get so disgusted at hearing anybody, on either side of the divide, called fascist or Nazi or socialist or communist by somebody clearly without the education or discernment to know the meanings of those words. Or in some cases, even worse — somebody who probably knows but is evil enough themselves to deliberately mislead…. wait. Isn’t that the same as lying?

  4. I just wonder how many of the millions of Americans that are uninsured are so because they believe in a “so-called right to avoid paying for health insurance.” It’s good that you follow that with a statement excluding those who have been refused insurance for pre-existing conditions. Really good, since everything I have read on the profile of the uninsured doesn’t paint a picture of the majority being people who wish to “avoid” in the manner you describe. They are like me, refused insurance – in my case lost in a bungled (not by me) divorce and then refused all insurance because I had osteoarthritis, which began in my teens, because it is a chronic condition. Just plain osteoarthritis. Couldn’t get insurance period. Then I got malignant melanoma. The surgery left me with MRSA, which put me in the hospital (Crawford Long, now Emory-Midtown, a pest house) where I contracted Chlostridium difficile, which dragged on for a year0and-a-half and two relapses. I paid for all treatment myself, and since I am self-employeed, lost doubly because I couldn’t work. I can’t get Medicaid because I still have my home and I have resisted even my doctor’s advice to see if I can be declared disabled because I will make a living and pay my bills as long as I am able. I cannot understand how anything you propose will help the many millions of people like me.

    It reminds me of much I have read about this issue: a lot of talk that leads to no answers. Certainly none for such as me, people who face this issue every day with nothing, no support, and still work and pay taxes. Your whole argument is irrelevant to me. I also note that in those states where insurance has been required the insurance companies have raised rates so high that it isn’t possible for many of those who quality to pay the monthly freight. You remind me of the healthcare opponents, whose strategy seems to be to drag this out until all us with no insurance and potentially fatal pre-existing conditions die off, so they don’t have to hear about us any more.

  5. Cathleen Hulbert

    I don’t blame you for being discouraged. Are you aware that there is now a program that guarantees you insurance coverage? It went into effect in September and can be accessed through http://www.healthcare.gov. If you have tuned out the rhetoric you might have tuned out the good news, too. It is called the Pre-existing Condition Insurance Program and the site is very user friendly. Make sure you put in your state and then follow the instructions. I have been able to help people get insurance for the first time in their adult lives by using this site. These are people with very expensive health conditions and they have been approved.

  6. I haven’t tuned out anything. I am not eligible for that program because of the lawsuit against the Healthcare Bill filed by the state of Georgia.
    Discouraged? You must be kidding.

  7. Cathleen Hulbert

    The lawsuit does not change your eligibility. Anyone can file a lawsuit about anything and it’s a federally funded program. I am in Georgia, too, as are my 600 clients with serious health conditins. If I can get my clients signed up for insurance through this program, so can you. If you’re too mad to try, that’s another story.

  8. Thank you for a thought provoking article that gives understanding to people like me who want universal health care, but are very concerned about the health care bill that has been passed. I have read it and many provisions seem about control and not enablement. Some of the things that can and should be done were not such as mandating the freedom of insurance companies to cross sate lines. The constitutional mandate “to provide for the general welfare” was not intended as an entitlement clause but meant something quite different to the founders. My greatest concern is that it appears to me, an average American that little by little the Constitution is being whittled away and without a solid foundation on what do we stand?

    I am not a Republican, Democrat, Tea Partier, Independent, but an American who tries to rationally politic and vote as I see what appears to me the best road to take. I simply believe the health care reform bill needs considerable modification, to insure health care to ALL people living in America, yes even illegals, but needs to be rational which I don’t believe it to be in its present form. To paraphrase Nancy Pelosi, we’ll know what’s in it when we read it. That is a terrifying thought. May divine wisdom guide our leadership as they struggle with difficult decisions in a difficult time.

  9. Cathleen Hulbert

    Amen, Jack! I just came back from Washington D.C., where I spoke to Republicans and Democrats about healthcare issues. Everyone I met seemed very decent and concerned about doing the right thing for our country. When we spoke one on one it was very clear that we are more alike than different regarding our compassion for others and love of country. I came back with more humility about how huge this issue is. I also returned with more faith in our system of government and all of the checks and balances. I agree. The changes need to be looked at very carefully and if something won’t work it needs to be discarded.

    Frank, I also agree with you that the word “socialism” is sometimes thrown at those of us who can’t sleep at night because so many are doing without basic needs. My conscious is very socially oriented, but that doesn’t make me a socialist. I’m a patriotic American who happens to spend a lot of time with sick people who can’t get insurance.

  10. Cathleen Hulbert

    Correction — I used to spend my time with sick people who cant’ get insurance. Now I spend my time helping them sign up for the Pre-existing Condition Insurance Plan (PCIP) and worrying that a repeal with take a way this new blessing.

  11. Several things bothered the majority of Americans that opposed Obamacare. Some were the way it was passed, with most lawmakers not even reading it, sneaking it through on Christmas Eve, with over 2000 pages that no one could understand,. Apparently even the Speaker of the House did not know what was in it when she said “we have to pass it to find out what was in it”.

    All that aside, it is unconstitutional to force someone to purchase a service. One has the choice not to buy car insurance. They don’t have to drive. Everyone will be mandated to buy health care for their entire lives.

    Even the name of the law is a farce; “Affordable Health Care Act”. The way that tax revenue for the act begins four years before most of it is implemented is just a dishonest ploy to make it look like there is a savings on health care costs. In reality, this act will increase health care costs.

    The Republicans agree with you that pre-existing conditions should not preclude one from getting health insurance. But they want to ensure that health care stays private. Under this plan eventually private insurers will not be profitable and will go out of business. The republicans want to really reduce costs by having tort reform to reduce defensive medicine. They want to open the insurance business to more competition by letting folks buy across state lines.

    Americans don’t want the government to have a say in their medical decisions. They know that every social program the government runs is nearly bankrupt. They know Obama care will be no different.

    1. It’s our government, the ultimate DIY endeavor. None of the programs are bankrupt. That there’s not enough money is like the mom at the check-out who says there’s not enough money to buy the candy and gum.
      Yes, of course, it’s hard to believe that our elected public officials would lie. But, some of them are addicted to power and power, to be felt, has to hurt. So, they’re compelled to promote punitive policies or “hard” choices as both Republicans and Democrats explain about decisions that don’t affect them.

    2. Jim Fitzgerald

      rick,

      I can understand your frustration but think you have a fundamental misunderstanding of the health care bill. And there are a few inflammantory statements you are repeating that are not true. For example, Pelosi did not say what you quoted her as saying. What she actually said was: “In remarks at the 2010 Legislative Conference for the National Association of Counties, House Speaker Nancy Pelosi said, ‘But we have to pass the bill so that you can find out what is in it, away from the fog of controversy.’ ” There is a huge difference between that falsehood going around and the truth. She, and most lawmakers, knew what was in the bill. It was the majority of Republicans that did not bother to read it and then said they did not have time. And pray tell, how could anyone “sneak” a bill though that had been front and center for months?

      Whereas I agree with being able to buy health insurance across state lines, to do so will undermine states rights. Most states have passed certain requirements and procedures that must be covered in their state and all states are different. And states can only regulate insurance underwritten in their state. If you buy insurance from another state, your insurance falls under their regulations. Please do not think you, or anyone, will understand what they have actually purchased until it must be used. If you are not satisfied, you then have to deal with that states insurance commissioner – who will be loyal to that state, not you in another state who is without voting rights in their state.

      And maybe you do not like being forced to buy health insurance. But the way the system works, as Catherine so aptly pointed out, is that we are all paying for those without insurance and cannot pay their medical bills. The government, you and me, reimburse hospitals for providing care and being unable to collect their fees. We pay for it. Don’t you think the person should be responsible for paying their bills? Why should we be paying for someone who simply refuses to buy insurance?

      And do you really think for-profit companies are not going to find every way possible to dump those with health care problems? I’m sure you just heard about the person who was waiting on a transplant whose health insurance company dumped them because they paid .02 cents less than the premium? That got corrected only because the spotlight was focused on that company. Do you seriously want to be at the mercy of profit-makers when your health is concerned?

      Managed care – the middle manager between the insurance company and your doctor charged with saving money – makes the decisions about what they will and will not pay for. If you are uninsured, you have no idea what I’m talking about but let me assure you it is a myth to think decisions are up to you and your doctor.

      As for tort reform – which I favor – it will do little to nothing to curb health care costs because lawsuits are low single digit contributors. Look at this: “In 2003, Texas enacted draconian restrictions on medical malpractice lawsuits that all but eliminated such cases….

      Yet the state still boasts some of the most expensive health care in the country. McAllen, Texas, as New Yorker writer Atul Gawande pointed out in 2009, is infamous for having Medicare costs that are twice the national average. As Gawande recounted, the major driver of health care costs in McAllen were doctors who referred patients for tests and other treatment at facilities where they had a financial stake. Lawsuits had nothing to do with that.” In essence, malpractice reform is more of a jab at lawyers than an attempt to reduce health care costs.

      A little background research will give you a more balanced and fair view of political issues. Do not trust your party or political figures to tell you the truth. They have to get relected you know.

  12. Not mad. You’re reading between the lines, and of course I get angry when people who don’t have to deal with this treat it like it’s not rooted in people’s lives, a real problem, a daily problem, that costs lives. And discouraged, which is what I said I was. How would you feel if you were me? What really do you expect, and what right have you to judge my mood and comment on it in a dismissive fashion? Reading all this has as usual, made that worse. I should never have read the article or commented. Debates like this, and the pending repeal, hardly motivate one to try to get into a program after not being eligible for anything for years … I simply don’t know any more how to say what it’s like to deal with this all the time and yet somehow be expected to continue to beat one’s head against a brick wall. I watched both my parents, my father at 34, die of untreatable cancers and now I’m fighting my battle. What on earth do you expect from a person? I’m sure you do wonderful work. Try not to judge others too harshly if they don’t meet your standards.

  13. In case it makes you feel better, I went to the site and applied. I was turned down. I guess because I don’t have a letter dated within the past six months from an insurance company denying coverage. Everything I have is older than that. But I don’t know. So I’m not sure why I was turned down. As usual.

  14. Cathleen Hulbert

    Hi, Flora. Let me tell you how to get around that. Some of my clients had to deal with that snag, too. They had given up long ago trying to get insurance and didn’t have a current rejection letter. It’s an extra step but it’s not a brick wall. Here’s what you do: To get proof that you have been denied insurance in the past six months, I recommend that you call an insurance company such as Humana (which does put its denials in writing) and apply for insurance over the phone. You will get denied, of course, because insurance companies can still deny adults over age 19 for pre-existing conditions. (That part won’t be fixed by the Affordable Care Act until 2014, which is why they have this temporary program in place.)
    Once you get your denial letter, go back to the site at http://www.healthcare.gov and move forward.

    Flora, I wouldn’t recommend this to you if I had not seen people have success with it — even when they first got denied the way you did. I wasn’t judging you, by the way. If I did not have such a passion for helping people, I would not have become a healthcare social worker. When you said that I reminded you of the healthcare opponents who just wanted the sick to “die off,” that was you judging me — not the other way around. If I could fix the system single-handedly, I would have done it by now. I hope you get some success with this program. It’s far from perfect, but it’s progress.

  15. Jim Fitzgerald

    Excellent job Cathy. Very impressive presentation.

  16. Another comparison often made that makes no sense at all, is comparing auto insurance to health insurance at the point of puchase. Auto insurance is relatively simple and straight-forward, very few loopholes. But health insurance? Not so. There are too many gotchas in it, and the first chance to know about one is when you get the letter of denial. Oops.

    Catherine, great explanation. I am writing our senators sending a link to it. Any bets on which one will read it first, respond with an actual comment?

  17. Cathleen Hulbert

    Thank you, Jim, for shedding more light on the subject. You know, when I see the word “Obamacare” I am thankful that Obama does care. The president who was in office for 8 years prior apparently did NOT care and did not address the fact that millions of dollars were being spent to pick up the slack of insurance companies not wanting to deal with the sick and those with pre-existing conditions. His big nothing of a solution could be called Bush-No-Care.

    Those of you who are angry now should have pushed for change while a Republican was in office so that you could be more comfortable with change. But you did not. Are you really mad at those promoting change now — or are you mad at yourself for not doing the same years ago?

    And why was it ever okay with you that so many fellow citizens were cut off from healthcare? What’s THAT about?

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