WICHITA, Kan. - Last week, the Senate approved their version of health care reform, quite different from the House version. Among progressives, a cry is going out: either include public option or kill the bill. A public option, it is reasoned, is the only way to control costs, and since both bills include a mandate, not including a public option forces the American people to buy into an industry that has proven itself as little more than a money-making machine allowing access to little in the way of true health care. But many Democrats are pushing back: at least it's reform, and we can change it later if we need to. Health care reform died under the Nixon Administration because Ted Kennedy would not accept the public option compromise and fought only for single-payer. When reform was brought up again under the Clinton Administration, it died a painful death. We need something, the argument goes. Both arguments are completely valid, and both are still quite short-sighted.
I am one of those Americans who cannot buy insurance on the private market, and it is only through government regulation that employer-based insurance must cover me. I am partially disabled under the law. Because I have the ability to work, I cannot receive any benefits. I make enough money when I am working that I have never qualified for any government benefits such as food stamps or Medicaid even while unemployed. When I had "good" insurance through work, I was paying nearly $200 a month for prescriptions. In addition to my annual wellness exam, I have to have regular blood work done. The number of doctor office visits I had varied, but I would go at least every other month. And each visit came with its own cost. In addition to my own chronic condition which has rendered me disabled, my family has a history of cancer. None of these makes me a good risk for insurance companies. I tell you this because millions of Americans are in the same boat as I am. And each year, 45,000 Americans die each year from lack of health insurance. Their reasons for not having insurance are as varied as they were.
I want a public option. I really do. But what I want more than that is coverage. I know there's a really good chance I would spend too much money on premiums to afford to use the coverage I would have. I probably would not have the prescriptions I want (I can live without them, but my quality of life is substantially less). My office visits would be limited to emergencies. But I value having insurance in the event of a catastrophe to being left out in the cold still.
In addition to barring pre-existing condition denials by 2014, both bills bar companies from imposing annual or lifetime limits. They both require 85% of money paid by customers to go to medical benefits. Preventative care such as wellness checkups and cancer screenings would be free. Both have annual limits for out-of-pocket costs. Low-income families with chronic illnesses have even lower caps, with only 7-19% (depending on which bill) of their annual incomes being spent on health costs.
One round of chemotherapy can cost $30,000. A pre-term baby spending a month in NICU costs upwards of $1,000,000. Pregnancy and childbirth costs over $10,000, assuming no complications. Newer drugs easily cost over $300 for a 30 day supply. These are real numbers from real people. People who find themselves in catastrophic medical events, such as cancer, sometimes have to declare bankruptcy in an attempt to eventually start over. But those of us with long-term chronic conditions, especially those with life-threatening conditions, do not have that luxury.
I don't like not having a public option, and mandating people to buy into a corrupt system bent on making people sick is horrifying. Social Security, when it was first introduced, did not cover most women and minorities by not covering agricultural laborers, government employees, and many teachers, nurses, hospital employees, and librarians, and created other regulations that left women and black Americans - especially African-American women - out cold. I am not trying to be pragmatic and say "just pass something, anything!" We should strive to benefit the American people as best we can. But we should not be making Americans suffer because we could not alleviate the suffering of enough. Centrist Democrats should not be proud of this bill because it does is not just and fair, just as Social Security was bad in 1937. Bludgeoning through any level of reform, without providing the maximum possible benefit, causes undo suffering for those who previously were not suffering. So where do we find the balance?
Try as I might, I cannot help but personalize this debate. If I have either employer-based insurance or must buy my own, I will benefit from both bills. When I have depersonalized this, I supported killing the bill over the mandate and no public option. Then I went to bed, found myself in my usual unpleasant position, and realized I am certainly not alone. And I realized what I want, what I really want:
I want to go to bed without wanting to saw my leg off from pain. I want to wake up in the morning without heartburn working its way up telling me I must eat immediately. I want to sleep through the night. I want to be able to walk the five blocks to the store without my back seizing up in pain. I want to be able to stand for more than several minutes at a time without pain shooting through my hips, ankles, and feet. I don't want to be normal, but I do want to spend time with normal people. I want to be active instead of feeling lazy when, in reality, I am just trying to manage the pain and fatigue. All of these things are largely alleviated with medical intervention, intervention I have no access to right now, intervention I stand a chance of having access to under both the Senate and House bills. To be sure, the House bill has more benefits for those of us with chronic conditions, but either bill gives us the chance. If we "kill the bill," life remains as it is: people suffering, some to death, because we do not have access to the system.
We must fight as hard as possible to benefit the most people - both those in need of coverage and those having to pay for it - but we must not cause harm when we do not succeed. I ask that we work to pass the House version of health care reform. But short of that, I ask we pass the Senate version. Most of all, I ask that we stop making people suffer for living with disabling illnesses. Is that too much to ask?
Really good, Carolyn Marie. Thank you so much for writing and sharing this.