Unmanaged Care: The Bush Way

Terry McKenna is back to conclude his series on health care and the unfathomably destructive Bush proposal for further sickening the people of this country. I call the Bush model "Unmanaged Care", because it puts all the burden of preventive care and health maintenance on the back of the little guy, while offering catastrophic insurance for dealing with...well, you know...catastrophes. That, after all, is what our foreign policy is all about—why should things be any different here than they are in Iraq?

Mr. McKenna, onstage:

In Paul Krugman’s column in the Monday (January 16) New York Times($$-trial subscription required), he pointed out the wrong-headedness of the Bush health care model, which features a de-emphasis of managed care in favor of catastrophic-illness insurance coupled with tax-advantaged health savings accounts.

Mr. Krugman used the example of diabetes to point out how little we get from relying on catastrophic care – and how much more expensive it is. Thus, a catastrophic insurance plan may spend $30,000 for an amputation but not pay for regular preventive foot care (as little as $350 per visit). Under the Bush model, the individual is responsible for day-to-day care (paid for by the health savings account).

I thought I’d add my own experience with health care – my health insurance follows the HMO model. My plan delivers both catastrophic care, and gives me access to a doctor (I see the same one each time) at $10 per visit.

My visits are typical for a middle-aged man. I started seeing my doctor regularly after she noticed that my blood pressure was a bit high. (Until then, I saw her only for small matters like poison ivy). I was not yet 50 when first diagnosed. We settled on a regimen of one drug, quarterly doctor’s visits, and an annual physical. The annual cost of care is probably $2000. My costs are $600 out of pocket for drugs (I take two, one is for mild asthma) and maybe $1200 for my share of the group health care premium.

In the course of my annual physicals, we cover cancer (skin checks, urine tests to pick up blood in the urine) heart disease and stroke (the doctor listens for heart sounds and to the carotids); and via blood tests, she screens for liver disease, kidney disease, and for diabetes.

But the president’s model presupposes healthy clients who recognize when they need to seek care. In real life, this is almost never true. The hypertension that I had was minimal. I had no symptoms – no headaches, no heart palpitations. Left untreated, maybe in 6 – 10 years, I might finally notice a problem. But by then, either my heart would have enlarged, or my blood vessels burst somewhere – or I would have kidney disease - and there would no longer be a way to return me to health.

Diabetes behaves similarly. The damage to the kidneys and to the circulation can occur long before an undiagnosed diabetic experiences symptoms.

And we all know about colon cancer. It is a silent killer – unless you get periodic colonoscopies - every 5 years for those 50 and over.

But if we de-emphasize regular care in favor of big ticket items—as the current system and the Bush model do—we have the worst of all cases. The spending goes up and outcomes are worse.

And by the way, we are not all equally educated about health care options. What sort of decision would the proverbial “Joe Six Pack” make about when to spend his health care savings – that is if he had any!

But the president and his cronies are so much against any solution but the “free market” that they will force us down the wrong road no matter the consequences. Is it any wonder that Western Europeans (despite higher rates of smoking and alcohol consumption) experience higher life expectancy than we do?

—T. McKenna