I think that's one of the key sub-texts that gets overlooked in the broader argument over the movement to kill the current for-profit model and replace it with some version of a single-payer, universal-access system instead.
NOTE: Caution... long-winded screed follows. Read at your own risk. Do not drive or operate heavy machinery for an hour after reading.And here's an example of the price this system exacts from people who avoid corporate jobs in favor of the alleged joys
of long hours, constant hustling for more work, dunning glassy eyed AP department automatons for overdue payments, wondering if anticipated receipts are going to meet the monthly debt load, and generally living lives of relative independence from corporate meddling but with that illusive freedom always tempered by continuous and total financial insecurity.
My wife and I are both 57, work for ourselves and have for about 25 and 15 years, respectively. We both have those dreaded pre-existing medical conditions (and who doesn't by the time they hit middle age, unless you've lived your life exclusively in a bubble), and are therefore absolutely uninsurable through the alleged free market. The conventional insurers literally won't take our money on any terms whatsoever.
Oregon has this public/private partnership high-risk pool where people like us can get coverage at prices that make atheists see gawd. To even qualify, you have to be denied a policy by three conventional insurance carriers -- which we were in polite by unambiguous terms.
So here's a rough breakdown of the expenses associated with the high-risk pool we're "fortunate" to have. This year, premiums will total $14,088 for the two of us, and it's a 100 percent certainty that they'll increase in 2009.
Prescriptions are reasonable as long as you're using generics. If there are no generic equivalents, brand name drugs are either $50 or $70 per scrip.
Then there's deductibles, copays and random payments to cover the difference between the "negotiated settlement" that the insurance cheapskates paid out and what the doc actually billed for services. Sometimes that gap is a few bucks; sometimes its a hundred or so. Occasionally, it's considerably more.
So, assuming we continue to consume medical services and pharmaceuticals at the same rates as we have for the past five or so years, we'll probably spend between $18K and $20K this year on medical-related stuff -- including premiums. And mind you, we're pretty healthy for the most part.
There is no vision care or dental coverage available at any price under this program or anywhere else, since needing glasses is a preexisting condition, and so are cavities, peritonitis, poor jaw alignment and so forth. So in theory you can see an eye doctor as long as you don't need to see one, or just pay out-of-pocket. You can also, in theory, see a dentist as long as there's absolutely nothing wrong with your teeth, or just pay out-of-pocket.
The link between dental health and overall health is well-established (google any combination of "dental disease US deaths annual"), as is the fact the that symptoms of many serious diseases or chronic medical problems occur first in the mouth (diabetes, cardiovascular, obesity, osteoporosis). But apparently those aren't good enough reasons to include dental work in the same medical insurance policy. And it's these apparently illogical and idiotic restrictions that lead to an understanding of the fundamental nature of the for-profit medical model.
Thing is, it's not really medical insurance; it's protection money paid to an organized crime syndicate to keep them from stealing our house, cars, bank accounts and anything else that isn't fused to the earth's core should something serious (i.e., expensive and requiring hospitalization) happen to either of us.
Medical insurance has nothing whatsoever to do with health care except in the twisted minds of Friedman/Chicago School libertarian fanatics and free market zealots. Break that nonsensical, artificial link, dump the idea of for-profit medicine entirely, replace it with single-payer universal-access and spread the risk over the entire population in the form of a modest, progressive tax. I'd be willing to bet a pretty good sum that no matter what we'd end up paying in taxes to fund such a system, it's going to be considerably less than that estimated $18K - $20K we'll piss away on premiums and overpriced drugs this year.
So that's my personal tale of life in the land of the medically fucked.
Here's what an actual smart guy has to say on the subject of health benefits as social control mechanisms used by corporations to increase the level of insecurity their employees have to live with.
THE EFFECTS OF MARKET-DRIVEN CARE
The real effects of market-driven health care on people's lives suggest that the primary corporate motive for imposing this type of health care system is to allow employers to have more control over their labor force.
What are the results of market-driven health care? First, market-driven health care makes people feel insecure about their prospects for receiving health care when they need it. Second, it destroys the trust that patients once had in their doctors by making doctors "gatekeepers'' whose role is often to block access to care. Third, by making health care a commodity to be bought and sold like any other, it expands the growing economic inequality in the United States to include health inequality. Fourth, it pits health professionals against each other in competing physician groups and hospitals. These are four classic methods of social control: make people feel too insecure to challenge those in power, destroy people's trust in one another, make them more unequal, pit them against each other.
Even before the rise of market-driven health care, corporations relied on the insecurity of health care to control workers. For decades, large employers (and some regressive labor unions) have preferred to link health benefits to employment, knowing it gave them more control over their employees. According to a New York Times/CBS poll in 1991, 32 percent of workers did not quit jobs they disliked because they were afraid of losing their health benefits. In June, 1998 General Motors threatened to deny medical benefits to striking workers in Flint, Michigan in order to pressure them back to work. Raytheon actually did cancel health insurance for striking workers in Massachusetts in August 2000, to force them back to work. Additionally, making health benefits depend on independent agreements between employer and employees in thousands of different companies gives employers the upper hand by preventing employees from acting as a single nation-wide block. This is why American corporations don't want the situation in Europe, where wages and benefits such as health care, vacation, and maternity benefits are negotiated on a country-wide basis between representatives of labor, the government and corporations.
In other words, a scared employee -- thrown to the wolves as an overwhelmed individual rather than as a member of a union or some other organized counter-weight to full corporate totalitarianism -- is the perfect wage/debt slave and will do whatever he/she is told to avoid increasing their already suffocating levels of uncertainty and insecurity.
Just one more way the American dream works to enrich the piggies, control the (disappearing) middle class, exploit the working classes and keep the elites wallowing in their hard-earned dividend checks.
It's like there's a couple million Scrooge McDucks out there somewhere, sequestered in giant mansions left over from the Gilded Age and protected by armed security staff and two dozen crazed Dobermans. And they spend some time each day in large, fully provisioned bunkers and vaults with foot-thick steel walls and fresh air generators and purified water systems and food for 10 years, burrowing and crawling in and around and through giant piles of folding money as tall as Iowa haystacks, with bags of solid gold coins liberated from wrecked Spanish galleons and Dutch coastal traders on built-in display racks over to one side.
Paperwork attesting to massive wealth -- stocks and bonds and T-bills and statements from hedge funds and suicide notes from former associates -- piled to the ceiling on the opposite wall. At this point, a beautiful young consort should quietly enter the vault, remove her clothing and join this piggie in his monument to himself. But I'm not writing porn here; I'm supposed to be railing against the US for-profit health care system and the damage it does to everyone who doesn't happen to be insanely rich.
Off track again. You should have stopped reading several paragraphs ago (or maybe you did, clever reader).
wp