I'm keeping one eye on the Supreme Court debate about healthcare reform, and I'm listening to what's going on with a weird mix of dread and hope. Why? Because I think the SCOTUS will ultimately strike down the insurance mandate portion of the law. Although I believe that the mandate is both constitutional and warranted, I do not think that the conservative-heavy SCOTUS wants to "go there" — and don't give me any crap about SCOTUS being apolitical. Can we say Clarence Thomas? Can we say conflict of interest? SCOTUS is no less a political creature than Newt Gingrich. But while I don't want the law scrapped, there is a possibility that makes me feel as much hope as dread: that if the law gets scrapped, even moderates will be forced to admit that single-payer health care is all that we're left with. And that, in my view, would be a good thing.
So let me paint you a picture. You may have read my prior blogs about our piglets Boris and Hayley, two of four siblings we purchased a couple of weeks ago. These piglets came to us sick with 2 or 3 (or possibly 4) medical problems, at a disadvantage from too-early weaning. We did the best we could for these piglets, but 3 of the 4 died despite our best efforts.
Now, our "best efforts" included considerably more knowledge than your average household might bring to bear on a sick creature. For one thing, my opposite number on the farm was raised in a veterinary clinic, so he knows a thing or two about medicating sick animals. He can start an i.v., for example, if given sufficient light and a large enough vein (the latter not being present in the piglets, alas, which is why our effort to save Hayley failed). For another thing, I'm a medical editor, and I know a thing or two about identifying which medications work best for certain diseases, how to find and assess information about specific conditions, and I'm even a pretty good amateur diagnostician (to date, I have accurately diagnosed in humans 3 cases of appendicitis and 1 each of Type 1 diabetes, iron-deficiency anemia, obstructive sleep apnea, and non-Hodgkin's lymphoma). So between us, we can handle almost any issue that comes up on the farm, and we can also make a fairly good call for when to bring in the vet. But we're far from perfect, and still have much to learn — which is why Boris is living with a bunny instead of his brother.
But here's the thing about farm animals: no matter how much you care about them, if they get sick, the extent of their care is determined, ultimately, by how much you can afford to spend on them. I called the vet in on Hayley only because I needed to have her come out and give vaccinations to the horses anyway, and having her take a look at the sick pig while she was here did not add substantially to the bill. Had he been the only reason for her to come out, I never would've called her, and he'd have died sooner.
It's sad when we lose an animal that could've been saved, but beyond that, as farmers, financially it costs us big time. The pigs who died were purchased at a cost of $70 apiece in the hope of raising them to a size where we could sell them, or their meat, for substantially more than that. I'm out of pocket $210, plus the cost of the various medications we used trying to save them, plus the cost of the milk replacer I had to feed them once I learned they were too young to eat on their own. But I'm ALSO out the money I'd have made from selling them. Money that would have gone toward paying for hay for our horses and sheep, and that would also have gone toward paying some of the farm's expenses. Not to mention the fact that the meat I'd have put in our own freezer is gone, too (I think I made it clear that eating Boris, after 2 weeks of bottle-feeding him and fussing over him, is no longer an option). So while the $210 I lost on the face of it isn't much, the value those pigs could've brought us down the line, simply by virtue of having better health care at the start, is potentially 10 to 15 times that.
So consider, now, another small creature on this farm for whom I care day and night. My youngest son, Eric, has a chronic disease called Type 1 diabetes. Now, before the ignorant trolls start in on me for feeding a little boy too much sugar, let me state for the record that eating too much sugar DOES NOT cause diabetes — not Type 1, not Type 2. I am not going to wax eloquent on how I know this, but accept my assurances that I've done my homework on diabetes.
Eric was diagnosed with diabetes at 18 months of age (yes, he was my T1 diabetes diagnosis). At the time, he was on his dad's insurance policy, one of those el-cheapo catastrophic care policies that saves you the cost of an ER visit and little else. I had put him on it despite having a more comprehensive policy through the job I had at the time because I never imagined a little guy like him would get sick, aside from the usual viruses and colds and stuff like that. It was a bad decision, and it cost me dearly: I'm still paying off his medical debts almost 4 years later. The costs subsided to a certain extent when I was able to put him on my employer's insurance policy, however.
Savvy people will perk up their ears at that last sentence: Say WHAT? How could you put him on other insurance and obtain coverage? What about his pre-existing condition?Aha, but those savvy people may not realize that until the passage of the Affordable Care Act, that mammoth bill given the unlovely moniker of ObamaCare, there were two states in this great nation of ours that had already passed laws making it illegal to discriminate against policyholders based on pre-existing conditions: Massachusetts and Maine, the latter being my home state. Of course, in Maine (dunno about Mass) there was this caveat that one had to have been insured for at least 12 months prior to the diagnosis; Eric, thankfully, had been on his dad's policy for 13 months. Thus, I could move him over to my comprehensive policy and Aetna (later Anthem) couldn't stop me. Although they certainly tried. And I don't really blame them for trying, given that having paid out of pocket for Eric's diabetes supplies, I know exactly how expensive it is. Anywhere from $1200 to $2000 per month, for those who're wondering.
And when the job that supplied Eric's insurance laid me off last fall, I was thankful to discover that I could keep Eric on COBRA — the cost of which has VASTLY decreased since the last time I used it, just after his birth in 2007 — for 3 whole years. Which, considering the noises being made by Maine's governor about wanting to throw people off MaineCare wholesale regardless of whether Maine is really insolvent or not, makes me feel a little more secure that Eric will get the continuous care he needs. Because let's make no mistake about it: Eric will die if he doesn't get insulin. Diabetes, contrary to popular belief, is not some minor inconvenience. This is not an "oh, he can't have candy? Too bad." situation. This is a painful, unpleasant, slow, awful death in the absence of insulin.
But Eric is just shy of his 5th birthday, and those 3 years will pass quickly. What happens to him if I cannot find work at a place that offers comprehensive insurance? Well, if the Affordable Care Act remains intact, nothing much, because by the time his COBRA benefit runs out in 2014, the non-descrimination clause will have kicked in. BUT if the ACA is struck down in court, it could prove disastrous for us as a family. I simply am not able to support the cost of his medical needs on what I earn as a freelancer. Eric's dad works as much as he can, but he's hampered substantially by chronic pain. And so we would turn to charitable organizations, request special support from drug companies, all of those techniques people use when they are trying to keep alive someone small and precious who is terribly and unalterably sick.
If the ACA stays put, of course, society will pay the costs of Eric's care. And some in society may feel he's just too expensive. But there are two issues with that: one is that every person has value in our society. EVERY person. That's a moral imperative, not a financial one, so it's probably difficult for capitalism to wrap its collective psyche around the concept. And the other is that we cannot know what contribution a child like Eric will make to the greater well-being of our society. He's a bright, charming kid, and I venture to say (as most parents do) he'll go far. Unlike with my piglets, though, I cannot calculate what Eric's worth to America might be someday — what the "return on investment" could be for his healthcare. All I can do is look at someone else who had a debilitating disease who went far — Franklin Delano Roosevelt — and consider that Eric has the potential to offer America the same level of value that FDR did, polio or no polio. Will he? I can't say that he will... but no one else can say that he won't. Unless he doesn't get the chance.
But at the same time, there's a sneaky little part of me that wishes the ACA would go away and we'd have the fight about single-payer healthcare that's been brewing for eons. Because I think that it's a cop-out to have individuals or businesses make the health investment when it is ALL OF US, collectively, as a nation, that benefits by making healthcare available to everyone. Yes, I know healthcare is expensive — but part of what makes it expensive is the fact that it's NOT currently available to all, so that the people who don't have insurance wait till they're sicker to obtain services, or they use the most expensive and least efficient outlet — the emergency department — as their source of care. There's no connection between caregiver and sick person, so there's no ability to tap into the patient's history... which means that any healthcare given to someone ad hoc is really just a shot in the dark. Not efficient. Not effective. Wasteful, in fact.
So I'll continue watching the debate in SCOTUS, half of me hoping for one outcome, half of my dreading the other... and another half of me hoping I get what I dread.