Self-interest plays key role in health care debate

Self-interest plays key role in health care debate

By Harold Reutter
harold.reutter@theindependent.com
Published: Monday, December 7, 2009 10:59 AM CST

Some wags claim when it comes to crime, "A conservative is a liberal who has been mugged."

A similar joke on health care says, "A liberal is a conservative who has been hit with an illness in the family."

Northwest High School teacher Chris Eberhardt would not describe himself as either a liberal or a conservative on health care.

However, Eberhardt's family has certainly been mugged by an illness during the last 12 months when son, Carter, a senior at Northwest, was diagnosed this past January with Focal Segmental Glomerulosclerosis, a disease that attacks the kidney's filtering system and causes scarring.

In January, Carter had stage 4 kidney disease, one stage before kidney failure that requires either dialysis or a transplant. He received his transplant in June, before reaching kidney failure.

Nevertheless, the image Eberhardt uses is not of a medical crisis mugging, but of Dorothy and her companions standing mesmerized by the sight of the disembodied head and thundering voice of the Wizard of Oz. But the supposed "wizard" was just a man behind a curtain.

That's how Eberhardt sees health care debate. He feels too many politicians, lobbyists and interest groups use glittering generalities to creates a curtain to hide reality.

For Eberhardt, the truth is that most people -- and companies -- act in their own self-interest. And in America, self-interest is often closely tied to money.

Eberhardt said one term used clouding proposed reforms is "socialized medicine." He thinks the words are cynically used as a weapon to scare people, make them angry and get them talking about defending freedoms instead of the real issues.

Other people talk about socialized medicine because that's what they truly believe health care changes represent, he said.

But U.S. health care reforms would retain the existing system of private physicians, private nurses and private hospitals.

Private health insurance would continue, although some critics contend any "public option" represents the camel's nose under the tent, with the inevitable result that all private health insurance would eventually be destroyed and thus socialized.

Eberhardt does not exempt himself as a person acting for his family's self-interest. However, he says he also struggles with the big picture.

The Northwest school district pays more than $1.5 million per year for employee health insurance premiums.

But Eberhardt noted there are some high school students in Grand Island who work part-time jobs and whose families have no health insurance. Those teens' income taxes help support Northwest Public Schools, as do the sales taxes students pay when they buy anything.

That means teens with no health insurance help to pay the $1.5 million annual health insurance premiums for Northwest school employees. Likewise, a portion of that uninsured teen's paycheck goes for FICA Medicare, the health care system for senior citizens age 65 and older.

Eberhardt questions the equity of a system where a teen with no health insurance helps pay insurance costs for government employees and for senior citizens on Medicare. Those teens and their families are in the gap between Medicaid and earning enough to pay for private insurance. That leaves them economically vulnerable in the event of an expensive medical crisis.

Eberhardt counts himself lucky when it comes to paying for Carter's medical bills. He pulled a pill bottle from a kitchen cabinet at his home and asked, "Have you ever seen a bottle of pills that cost $2,500?"

But he said his out-of-pocket cost for the medicine is only $50.

The same kitchen cabinet holds many more pill bottles, collectively costing additional thousands of dollars. But because of good insurance and a good cafeteria plan afforded by stable, good jobs, Eberhardt said, he and his wife can afford the out-of-pocket expenses for those medicines.

Eberhardt and his wife, Jody, envision this as Carter's good scenario: He attends college, with family insurance covering all medical expenses. Following graduation, Carter gets continuing coverage through COBRA.

COBRA coverage lasts until Carter gets a job with insurance benefits, with his COBRA coverage also lasting until his new insurance policy's waiting period for pre-existing conditions finally expires.

But Jody said she fears this scenario: Carter encounters a health emergency that causes him to temporarily drop out of school and lose insurance coverage.

Perhaps that is needless worry.

That is especially true because Carter's kidneys are his health problem. Medicare does provide financial help for people with end stage renal disease regardless of age. That provides a little more safety net than a disease such as cancer.

But Eberhardt said he and his wife have done some research and are still uncertain on how much help Medicare provides in each of the big three expense areas for ESRD: Dialysis, transplant and immuno-suppression drugs.

As part of self-interest, Eberhardt likes the idea of universal health coverage, so Carter is covered no matter what.

His personal definition of such coverage is no cut off of insurance because of a pre-existing condition, no cut off because of lifetime limits on insurance coverage have been reached and no cut off because of a change in status as a dependent college student or loss of a job. He tends to believe that is good for everyone.

Eberhardt, however, said he also believes in personal responsibility. He said all people should help pay for their own coverage, because that gives them a personal stake in holding down costs.

Beyond universal coverage, Eberhardt said he also favors cost containment, because the country could go bankrupt trying to pay for universal coverage if costs are not controlled.

He said it seems as though different private insurance companies and Medicare will all negotiate a different price for the exact same procedure or medicine.

So, he asked, what is the real price of health care? And if no one knows the cost, how can it be controlled?

Eberhardt is also nagged about the principle of self-interest.

In the battle over health care reform, people with good private insurance like himself and people on Medicare will be looking out for their self-interest, while doctors, hospitals and private insurers will be looking out for their self-interests as well, he said. So will politicians.

As a result, he said he is cautious about rhetoric coming from either party on health care reform. Consequently, Eberhardt said he wonders if reform does happens, whether it will really be an improvement over the current system.

http://theindependent.com/articles/2009/12/11/news/local/11061843.txt