HEALTHCARE POLITICS-Four years ago I was unable to afford this week’s great joy in cooking a special meal for family and friends, a meal from the heart and soul. What follows is a highly personal vignette that outlines the blessing of functional public politics, and how deeply egality matters – for health, for education, for social well-being.
Visiting Canada on academic sabbatical constitutes an official visitation that politically confers temporary membership in the government’s health insurance. When a bicycle fall ruptured my spleen, I could have lost my family forever but was restored to them by a health care system that runs of and for the people. It is a societal system, a mindset and concept of the commons unknown here in philosophy or actuality.
While it took too long to identify the threat to my life (a flaw common to the US emergency system), in time I was immersed in a system of sharp noises and sounds that ultimately staunched my acute peril. It is the ancillary aide, the chronic assistance, the derivative freedoms of universal health care, that Americans do not appreciate.
For several years I suffered with a chronic, debilitating neurological pain syndrome – imagine a “funny bone” that will not stop triggering. The insurance-dictated assistance available here included some physical interventions, a smattering of physical therapy and eventually, an indefinite amount of very expensive, heavy-duty systemic pharmaceuticals.
While physical therapy provided anecdotal relief to me (at some considerable personal expense), “the numbers” showed insufficient value statistically to justify continuation. I will never, ever forget weeping in a stair well following the pain and disappointment of a session devoted not to any therapy for me whatsoever but instead devoted entirely to metrics for the exclusive benefit of the insurance company. It was an outpouring of frustration, fear and grief at an unmanageable future.
After servicing the emergency, which by its nature is not equivocal in need, the Canadian system offers a realm unknown here in the US to any but the 1%, untouched by astronomical health care bills.
In Canada, I was invited to an understaffed, under-resourced basement facility where a team of specialists taught patients the job of rehabilitation, coincidentally addressing the chronic alongside the acute. Without a roomful of expensive whizz-bang equipment gracing their severely hampered American’s counterpart, a collection of garden-variety tools and the knowledge and will to explain how to derive benefit from them, provided me with the means to overcome my own forlorn future. There was never any talk of “preexisting conditions”; there was talk only of addressing need.
This Canadian facility was available for as long as patient and therapist agreed mutually it was needed (one missed appointment was grounds for exclusion, as belying the mutual commitment required for success). The therapist was a teacher, schooled in training her patients about the hard work they needed to assume in order to heal. Any 1:1 availability with the teacher was brief while she shared her expertise with others, an allocation of resources and responsibility in marked contrast with the American, for-profit, insurance-imposed system.
There is a world of parallels here with the American threat to public education.
I was told in America that while the only treatment known to provide long-term assistance was physical therapy, its success was so unpredictable that the cost of this risk was unjustifiable for the insurance company. Individual variability sufficiently jeopardized a model of wholesale decision-making, that the provision of resources for individuals was denied not for the sake of that individual, or even for the group’s success rate, but instead on account of the derivative profit-structure’s benefit. Instead of restructuring the system to share resources, the most expensive model was unreflectively, unaccommodatingly, required — and therefore flatly denied.
In striking parallel, teachers are denied our children as a necessary resource in America’s public schools. Instead of restructuring the system to accommodate individual learning variabilities, a single blanket-system is imposed on all for the seeming benefit of a derivative, profit-seeking middle man.
Rather than address the needs of individuals or the group as a whole, a lowest-common-denominator, one-size-fits-all rubric is forced. 1:1 resources (iPads/US therapist who works 1:1 per patient in contrast with Canadian who works among several patients working for themselves) are offered exclusively, when and only when they benefit that derivative middle-man, though a shared system could accommodate an arrangement that boasts a better prognosis, through individual-directed, shared responsibility. Pernicious, derivative metrics are substituted for direct assistance (tests vs instructional time/insurance measurements vs physical therapy) and erroneously relied upon as dictating an invariant course though this was instituted for the express purpose of pretending these metrics justified that course.
Ultimately, there is only one way to maximize efficiency in spreading risk, and that is to combine risk in the largest possible central pool. [[http://redqueeninla.k12newsnetwork.com/2013/06/13/size-matters-and-small-is-not-always-good/ ]] This involves competent middle-management administration and decision-making that is high-stakes by virtue of its centrality, admittedly. But it results in distributing cost equitably, it results in better outcomes for more, and it also, collaterally, disenfranchises a whole class of parasitic derivatives (e.g., private insurance industry/private testing industry). The path is not easy, but it is the only way to slice the pie fairly.
There are additional, collateral benefits from spreading the risk and instituting single-payer health insurance. In Canada where all health care is covered, there is no need to factor medical liability into auto insurance, in fact there is hardly any need for private auto insurance at all. There is a cost to license your vehicle which covers road maintenance, and that’s it: done. No uninsured motorist risk, no medical liability, no specious claims relating to these and its concomitant fear among the responsible for falling afoul of such fraud. No lawyers and investigators and prosecutors to chase after same. Instead, all that ancillary money is available to: heal. And the social buoyancy that results from this absence of fear is palpable throughout society. You can feel it walking down the street, you can feel it in the way children play on playgrounds. It has huge social ramifications, the relieving of society from parasitic intermediation.
Likewise, in constructing a public schooling system large enough to accommodate one and all, “special” and “gifted”, vocationally- and professionally-oriented, there is no concern of finding a school that is the right “fit”. There is no worry of winding up with insufficient or inappropriate classes – they are all available. There is adequate resources to share among all so that everyone winds up in classes of a size that can be taught by the resource in the front of that room: the teacher. There is no need to choose between a school with a functional music department or a school with a functional library or a school with small class size or PE program or working bathroom facilities: these are part of the collateral benefit that accrues from not parsing and replicating all schools into tiny insupportable fiefdoms – these shared resources will be available to be shared.
Centralized – and therefore fair — sharing is good; one set of people (central administrators-consultants/insurance agents) sequestering a larger share of the monies means there is less available for the rest of the system to concentrate on its core purpose — to, say, provide facility for working at one’s own physical therapy, or, say, learn from within adequately staffed and supported facilities. It is wasteful of resources to freight a system with derivative servicers.
When I tried to talk with Canadian friends about their health care system and its almost-certain failings – nothing is perfect, right? All I ever managed from anyone was a sort of quizzical sideways look and occasionally a response of this sort: “We think you Americans are all just crazy. What’s to talk about? Why would you choose not to have your most basic needs met by the state? What is the point of that sort of “choice”, between good-for-you and not-good-for-you??” And I have to admit – choosing mediocrity makes no sense at all.
No one deserves an inferior health care plan anymore than they deserve an inferior charter school. The public sector has its share of problems. But farming out the good of the people to a private sector will do nothing but make the good unattainable for 99% of us.
(Sara Roos is a politically active resident of Mar Vista, a biostatistician, the parent of two teenaged LAUSD students and a CityWatch contributor, who blogs at redqueeninla.com)
-cw
CityWatch
Vol 11 Issue 97
Pub: Dec 3, 2013