The State of My Union Isn't So Great

While the media wonks and policy geeks banter about what President Obama will or won't say in his first State of the Union address, I'd like to offer my own view of the unfolding U.S. health system crisis. I'm a patient in this system, and I am a wife and mother who has maneuvered this system for my family for more than 35 years. So I am claiming my status as an expert. I have earned it.

And especially for those policy folks who now say it was dumb for the President and Congress to take on healthcare reform because it's a fringe issue not as important as the other issues we face, I say you are so lucky you can see the world that way - you must be healthy or wealthy or both. Because in my real world healthcare dealings, this messed up system is draining time, money, energy and health.

This is my first state of my union address, delivered January 25, 2010.

First, forgive me for repeating myself so many times, but the U.S. healthcare system doesn't revolve around providing me care. The U.S. healthcare system revolves around making money. The state of my union as a patient is not so good.

For those in the family who carry private, for-profit health insurance, our ability to get preventative care and seek basic healthcare services when we get ill is totally dependent upon our insurance companies and the providers who have contracts with our health insurance companies. The treatment we are allowed to receive is also totally determined by our health insurance companies - not by our medical needs. That's the state of our union.

First question asked when we seek care? "What kind of insurance do you have?" and not, "What is your medical problem?" First question at the front desk of the doctors' offices? "How will you be paying your co-pay today?" and not, "How are you feeling today?" First question at the hospital admission cubicle? "May I see your insurance card and your photo I.D.?" and not, "What brings you to the hospital today?" That's the state of the union for patients, too.

For me and for my family members, our other huge concern when we may need medical care is whether or not we may miss work and thereby lose income or status or both. Most working Americans earn sick leave time - at least a little bit - every month. But most of us feel as though we dare not use that sick time. It is seen as weakness to be sick or as a lack of true commitment to one's employer or laziness, so most of the people I know go to work sick or hurt if their symptoms don't knock them completely out. The recession hasn't helped that at all. That's the state of our union every day.

One might think we have the work ethic run amok, but it's more cruel than that in working class America. It is a survival of the fittest mentality cloaked in warped Christian values (I say warped because true Christian values would be far different).

Have you been to a local emergency room on a Friday evening lately? Lots of people go there after they managed to hang on through the work week feeling pretty terrible and they just want some medical care to happen on their time off without anyone at work needing to know. Some might have called a doctor and sought some care earlier, but most doctors don't like to talk to patients on the phone anymore - most cannot bill the insurance company for a returned phone call. That's the state of my union.

Another huge issue for U.S. patients is being able to afford the medications or treatments our doctors may order if we are able to get care. Anyone who has been to an American pharmacy counter knows that people are having trouble getting their medications. Insurance companies often decline coverage or have tiered coverage so complicated that few patients (and few of our doctors) know which medications are covered and for how much. It's a crap shoot every time you step up to the pharmacy counter and hand over the script. And the out-of-pocket costs are outrageous. That's the state of our union.

For most of us, it's like being on a really shady used car lot to seek medical care in the United States. Everything is waxed up and shining, but under the hood things can be pretty bad or not. You just cannot trust that the services being suggested are being offered because you need them or because you have a source of payment and the provider needs the revenue. Even in those medical settings where we have developed a relationship, the care issues are driven by who will pay what for which service.

The state of my union is one of always feeling like I have to outsmart people who know a lot more than I do about which medical issues are serious and what kinds of treatment are most appropriate. I try to diagnose on the internet whenever possible and always check out the suggested treatments and medications before pursuing new appointments or purchases.

On a larger scale, healthcare now consumes more than one-sixth of the nation's economic activity. It's big business, and as a friend of mine often says, "The profits are dear." And unless Congress and the President act much more boldly than the recent effort showed me, the state of my union is going to get a lot worse going forward. Taxing high-cost healthcare plans isn't going to change much, I'm afraid, except to push more people into even more dire situations. Not a good way to go.

I have 10 more years to survive in this mess or worse until I can be on Medicare, if by then the Medicare program isn't thrown over for market-driven medicine by the Republicans or handed completely over to private insurance companies to skim for profit. I don't know if I'll make it.

What I do know is that the healthcare state of this union stinks, as my mom would say, to high heaven. We have to change it and make it work far better, and tinkering with some insurance regulations won't do the trick. This is one area of the state of this union we could really change if we had but the courage to do so. Join me. Let's demand Medicare for all. That would be one bold move, eh? And what a state of change and compassion this union would see.

Everybody in, nobody out -- state of the healthcare union, one and all, much improved.

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