It is absolutely scandalous that our country has to go through this stupid discussion regarding health care. It can only happen in a culture that has been dominated by free market brainwashing for 25 years.

I find it interesting that so many people talk about the high quality of care in this country. Yes, it is true that if you arrive in the emergency room in the middle of a heart attack, your life will probably be saved and you will probably have high tech procedures performed at enormous cost, and that’s all wonderful. If procedures are needed to save your life, you will get them whether you have health insurance or not. However, there are many, many patients that show up in the hospital repeatedly with exacerbations of chronic conditions such as congestive heart failure. If these patients are uninsured, it is highly likely that either a) the condition could have been prevented or delayed in the first place with appropriate primary care or b) the exacerbation could have been prevented if the patient had been able to afford his medications and follow-up appointments. It’s all well and good to say that we have a high quality of health care in this country, but in terms of _keeping people healthy_ in the first place, the quality of care here is very poor. If you’re wealthy, well-educated, and have good health insurance, you’re in luck, but if not, you may only receive treatment when it’s much too late to do much good. A patient with preexisting hypertension cannot buy individual health insurance (I assume), but if he or she were to be uncontrolled for long enough to suffer a stroke and require life-saving intervention or to require a kidney transplant, these procedures could be performed, at enormous cost. And who would pay? Taxpayers, and the patient, who has lost productive, healthy years and years of quality of life only to be “saved” in later life by our “high quality care.”

Does it make more sense to make sure that someone with hypertension or type 1 diabetes can get affordable, decent health insurance to keep him healthy and productive, or to spend who knows how much taxpayer money down the line for disability payments, dialysis 3 times a week, or a $30,000 (preventable) kidney transplant and immunosuppressant drugs for life? People want the government to stay out of health care, but at the end of the day, the government ends up paying the bills for the uninsured one way or another.

I guess it comes down to this: should we prioritize keeping a larger number of people healthy so that they will not need as many complicated treatments and procedures? Or should we prioritize the highest technology treatments at all costs, even if that means that many more people are sick or going without preventive care?

I agree that my rant does not address all issues at stake in the health care debate.

I agree that a public option may not be the best way to structure health care.

I agree that quality and speed are important issues, not to be taken lightly.

I agree that a public option could lead to lower standards of quality and speed.

I disagree that quality and speed for the healthy and wealthy are the highest priority.

I agree that forces of free market competition should be and can be harnessed to improve the system.

I disagree that the anecdote I describe is isolated or one-sided. It is illustrative of a fundamental failure, probably the fundamental failure, of our current system: an under-regulated free market system will prioritize profits above health.

I disagree that I should not take this debate personally.

I agree that others will take it personally in different ways. I think that’s good. I think we need to know the personal stories on all sides.

I have spoken with people sitting on the other side of the fence, in other countries. I’ve spoken with people on waiting lists, people who have had to shuffle their ambulatory children between hospitals in their own vehicles, and people who have had to receive inferior care as a result of their healthcare. Shit, I’ve even spoken with people who were ejected from a hospital when the doctors just “gave up.” How are the proposed solutions going to fix this? By providing an “opt-out” scenario for those that want “better” healthcare? How is that situation better? When someone without healthcare in the US enters an emergency room they receive the top care in the world. You enter the emergency room in other countries only to looked at and kicked out (based on 2nd person accounts only). At the same time I have been with people that received excellent care in other countries, but not for complicated procedures. The “wait list” scenario is fucked up.

And I take offense to you taking my opinion personally. I do not want you or Elizabeth to come to harm regardless of the outcome of these reformation proposals. You have described a *SINGLE* situation involving a chronic illness that may or may not have benefited from reform.

I know you are personally tied to this situation. But so are many people in other countries that suffer under the care provided by the proposed systems. So are people in this country that rely on our current high quality healthcare. Presumptuous of me to assume a degradation in the quality of care? Perhaps. You are making similar presumptions on the other side of the fence. Broaden your perspective my friend. Interview those with not only chronic needs, but needs that require rapid attention. The proposed solutions are not appropriate for *exactly* the reasons the legislators are touting. While reform is necessary, while is the path different than solutions we’ve applied to other industries. Perhaps monopolistic practice laws should be applied here (with adjustments).

Strangely enough, I too don’t necessarily think a government-run plan is the best idea. It’s just, as you said, that it appears less evil than the current system. I’m also sensitive to the concern that once the government wades in, it’s hard to disentangle it, but I’d choose that problem over the current alternative.

Anyway, thank you for your thoughts. Thought-provoking as always.