Note: You may wish to read Part I on this theme from April of 2012. It examines the state of affairs regarding health coverage in the US.

The so-called debate surrounding health coverage in the US is fraught on all sides with a disorienting mosaic of platitudes, generalizations, falsehoods, suppositions, and extremism. One cannot even begin to consider the validity of any of the speculations being made because so many are purely to convince us that our lives, liberty, health, or happiness are in danger.

Such is the way of policy-making in these times.

As one who relies on cold, hard facts and supporting evidence, I find this “discussion” to be offensively weak on what I would call substantive arguments. So when real stories surface that expose the cracks in the fear-based memes built around our policy, I try to learn from them. For the hard truth about this crisis is that it is directly affecting people’s lives and livelihoods every day.

I saw one of my caregivers yesterday. I’ve known and depended on her for a long time, so I’ll gladly call her a friend. She’s single, in her early 40’s, educated, owns a home, and she runs a small business for which she is the only employee. She does well enough, but has had to take a second job from time to time when the business wasn’t covering the bills. She’s a hard worker, a kind person, and is both responsible and accountable in her life.

After six years, her business started to really take off. She had more clients and a worthy reputation. As a result, she was finally able to quit her second job and focus on her practice which was much more profitable. However, the 2nd job had supplied her with health insurance.

She did the responsible thing; 13 months ago she purchased a major medical policy that covered catastrophic events. It cost her $150/month and included a $5000 deductible, for which she started saving, in case fate dealt her a rough hand. Over the course of the first year of coverage, she submitted a total of zero claims, costing the insurer nothing and representing a net profit to them of $1800.

Two months ago, she received her renewal invoice for the policy, announcing an unexplained 66% increase. Overnight, her health insurance costs would go from $150/month to $250/month for a policy she had never even used. That’s an extra $1200 per year, which to her is not chump change. So she did what any smart consumer would, she told the insurer to stick it and promptly began shopping for a new policy that would fit her budget.

But as fate is wont to do, that rough hand came up anyway. Two weeks into her search, a persisting abdominal pain was revealed to be appendicitis. A simple operation, to be sure, but between the tests upon tests, the surgery, and the overnight stay (she recovered quickly, so there was only one) my friend found herself holding a $27,000 medical bill.

The jury is still out on what, if any, of that amount can be negotiated away, or what sort of terms or payment plan they may offer her. But being responsible, the typical “Bankrupt” solution to which so many Americans would flock, has not even crossed her mind. Instead she is stepping up and preparing a way to account for repayment, even if it takes her a decade do it.

So let’s get this out of the way: should she have cancelled her policy before she had another lined up? She freely admits that was a mistake. But she also was not clear if she was beholden to the payments if she had signed on for another year and later cancelled. So rather than risk having to buy her way out of the policy, she took a calculated risk that anyone could see as acceptable.

A bigger question however, is the 66% increase in premium for one who never used the policy. What other industry creates and defends such an exorbitant price hike and is all but guaranteed to get it? I can think of none. And in case you’re inclined to blame the misnamed “Obamacare,” just remember the “Health Care Exchange” and “pre-existing condition” provisions of the law don’t take effect until 2014. So what is this, proactive charging two years before a speculative increase? Hardly feasible.

The most glaring question, naturally, is why the hell does it cost $27,000 for an appendectomy and one night in the hospital? That’s more money than 28% of US households earn in a year. More than half a year’s salary for over 55% of the country! This is a familiar ailment, affecting one in ten people at some point in their lives. It is treated by a common surgery, having been successfully performed for over 275 years. And while any invasive surgery must be treated with care and diligence, it should not be so expensive as to threaten with unmanageable debt the livelihoods of a potential 10% of households. Were it only the top 1% who were susceptible to appendicitis.

The reason it costs $27,000 for an uncovered appendectomy is because a health insurance company would only pay a fraction of that, often between 40-60% of the cost. So the non-living, non-breathing entity that requires no health care and can afford to pay more (the insurance corporation) actually pays less, while the very alive and real human who will always need health care and faces financial ruin from a single illness absorbs that grandiose discount the insurers receive and pays significantly more out of pocket.

Fort those who believe it is any entity’s right to negotiate a better price, for the corporation, which will never find itself in need of health care, that’s a easy task that can be accomplished through a slow and diligent process. To the person doubled over in abdominal pain, it’s a joke. The patient needs urgent medical care. Are they negotiating form a position of power with those who provide it? Would you lower your price if the customer in front of you desperately needed your product? Especially if it were a matter of life and death?

For the free-market capitalists who are bemoaning the right of any business, be it insurer or hospital, to charge what they want for their product, keep in mind that had she paid her extra $1200 for another year of coverage, that’s $1200 less she has to spend on consumer goods. Goods, mind you, which we want to be made by Americans’ hands again. It’s hard to convince companies to bring jobs back from China when more of our citizens’ money is flowing to health insurance. And if she now took the easy way out and declared bankruptcy, like so many others would, the impact on the collective economy would be even greater.

So here we have a poster child for the supply side argument: a self-made, independent, responsible businesswoman who took a calculated risk. But the supply side model just bit her in the ass when she was dealt a rough hand at the wrong time. And while I’m sure she’ll make it work, find new insurance, and pay back the debt, the impact of the entire ordeal on her ability to spend money is devastating. It has directly affected her and her pocketbook, but indirectly that drain on her finances will be felt through the economy for many years to come.

We can only hope that upon PPACA’s full implementation in a little over a year, hard-working people like my friend will be able to visit the health care exchange and find coverage that is both affordable and useful to them. So that their health can be maintained and their earning (and therefore spending) potential will not be hindered.

It’s easy to scold and demonize those who choose not to buy health insurance. To frown at them, deny all compassion, and shout, “Let him die!” from the darkened halls of a Republican debate. It becomes much harder when one moves past the generalizations and stereotypes and considers the very real situations that drive many to take that risk.

Unlike my friend, who chose a temporary loss of coverage while she found a cheaper plan, millions of others choose a permanent health risk, because up against the guaranteed alternative of not affording heat or electricity, or not paying the rent, or not feeding the children, the risk of getting sick doesn’t seem so bad.

There are good, responsible, hard-working people out there who need health coverage and are willing to pay for it. But they deserve a reasonable, affordable, and consistent price for the protection they are buying. And after 30 years of stagnant wages, there are millions more who will never be able to afford coverage but will continue to get sick. How much drain on our collective spending power are we willing to accept before we find a solution to this inevitable problem?

So if you want to chastise those who go without health coverage, consider that nearly 1 in 6 Americans are doing it now. Chances are you know a lot of them. And chances are their reasons, unlike the false premises that our politicians throw around, are very real and very reasonable. Ask around and find out who in your life takes the risk and why. Then see if you still have the nerve to shout, “Let him die.” If so, you can do it right to his face.

God help you if you do.

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