http://www.latimes.com/news/printedition/opinion/la-oe-ehrenreich28apr28,1,3604865.story
COMMENTARY
A Society That Throws the Sick Away
By Barbara Ehrenreich
Barbara Ehrenreich is the author, most recently, of "Nickel and Dimed: On (Not) Getting By in America" (Owl Books, 2002).
April 28, 2005
Most countries are proud to have a healthcare system. It's an organized
way of helping the sick and infirm — a mark of genuine civilization.
Not so here, alas, where the health system is rapidly becoming a health
hazard. After decades of privatizing, profiteering and insurance
company-driven bureaucratization, Florence Nightingale has morphed into
Vampira.
Healthcare costs are sucking the blood out of the economy, for one
thing. Consider poor General Motors, once the nation's flagship
corporation and now sinking under the weight of its employee health
benefits — which account for $1,500 of the sticker price of each new
vehicle. As GM contemplates bankruptcy, other companies thrash around
frantically trying to shed their insurance-needy American employees.
They downsize and outsource — anything to escape the burden of health
costs. The result? Our "jobless recovery": Companies don't want to
assume responsibility for their workers' medical bills and — this being
the global temple of free enterprise — neither does the government.
Then there are the U.S. health system's toxic effects on individuals,
and I'm not referring to Vioxx or the approximately 200,000 people who
die each year as a result of "medical mistakes," but to its financial
effects. Harvard's Elizabeth Warren recently co-wrote a study showing
that more than half of all personal bankruptcies are triggered by
medical costs, and it's easy enough to see how. If you lose your job —
through, say, downsizing or outsourcing — you lose your health
insurance, and the uninsured are routinely charged up to three times
more than those who have an insurance company to negotiate their
hospital bills. As for emergency rooms, which the hardhearted or
incurious imagine absorbing all the poor and uninsured — well, the
average visit to an ER now costs a little over $1,000, which is a high
price to pay for an asthma attack or an infant's fever.
Certainly the health system makes plenty of people rich — Big Pharma's
overlords, for example, and CEOs like HealthSouth's Richard Scrushy
(who received about $267 million in compensation from his company
between 1996 and 2002) — but it makes a lot more people poor:
indirectly, by inhibiting job growth, and directly, by grinding
individuals down to bankruptcy (which, thanks to the new federal
bankruptcy law, offers no fresh start to the debt-ridden). Add to this
the well-known fact that poverty is a risk factor for dozens of
diseases — from asthma to AIDS, from depression to diabetes — and,
well, I rest my case.
When doctors notice a tissue growing
nonstop — as U.S. medical costs are doing — and in the process draining
nutrients from the body as a whole, they insist on prompt excision,
i.e., cut the thing out before it kills. So too, one might think,
economists should be calling for the immediate destruction of the
American healthcare system: Stamp it out and drive a stake through its
heart. Because Americans will still need healthcare, the solution is
obvious: If we can't outsource our illnesses — and there is so far no
technology for transferring one's cancer or atrial fibrillation to a
starving African or Asian — we can at least outsource our healthcare.
It's already happening, in fact, though only in a helter-skelter way.
An estimated 2 million Americans cross the borders every year to
purchase their prescription meds in Mexico or Canada. U.S. X-rays are
increasingly interpreted by radiologists in India.
Patients are
being globalized too, as hundreds of thousands of them from all parts
of the world flock to Manila, Singapore, Bangalore and other centers of
low-cost, high-quality care. Some hospitals in India lure the rich with
airport-to-hospital bed-car service and post-surgical yoga holidays,
and I can foresee cheap, Motel 6-style hospitals springing up in
Tijuana for the American working class.
All right, it's painful
to admit that the nation that produced Osler and Salk, pacemakers and
MRIs can't do healthcare anymore. But there are other things we don't
do here much anymore, like manufacturing. According to Business Week,
companies are increasingly outsourcing their R&D too.
In
the case of healthcare, it wasn't the science that foiled us (though,
with more schools teaching only biblically approved versions of
biology, that may soon be a problem too). No, we Americans just
couldn't figure out the technology of distributing healthcare to the
people who need it. We left the whole business to business — both of
the profit-making and private "nonprofit" variety — and business
screwed it up.
The abolition of the American healthcare system
will lead to some difficult readjustments, of course. Our doctors,
nurses and technicians, who are among the best-trained in the world,
will have to seek work in the emerging Asian centers of medical
tourism. As for the estimated 2 million to 3 million insurance company
functionaries whose sole business it is to turn down your claims, these
folks may be a bit harder to reemploy because they have no counterpart
in any civilized, health-providing nation.