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September 24, 2017

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Battling insurance companies over U.S. health care reform

Two years ago this writer suffered a serious back injury requiring surgery. The Taiwanese neurosurgeon operated for more than six hours, fusing vertebrae and implanting four titanium screws and a brace into my spine. The total cost of this procedure and five days in a Taipei hospital was US$3,171.27.

That summer, I returned to the U.S. and discussed the experience with a physician who had given up his practice to be a medical writer. He assured me that my surgery would have cost at least US$100,000 at any reputable medical facility in the United States.

Some years earlier my sister's son had a seizure caused by a glioma located very close to the cerebral cortex. Such brain tumors are fatal if not surgically removed. The patient was not somebody terminally ill, but a bright and otherwise healthy college student. Nevertheless, it took the threat of a lawsuit to get the insurer to agree to a surgeon qualified and equipped to do such delicate brain surgery, even though coverage was clearly in the insurance contract. That was a life saved despite the insurer's intent to save money above all.

But was it worth it to keep an unconscious elderly patient technically alive for thirty-seven days in an intensive care unit? Her heart had stopped three times in the emergency room, her vital organs had failed, and she had lost most of her faculties years because of a crippling stroke. The charges for that kind of "health care" for the dying exceed the lifetime savings of most U.S. families

About half of all health care expenses in the United States are incurred to keep end-of-life patients' hearts beating during their last few months. Add to the huge cost of dying the expenses of determining who pays for it and how much. Estimates of the number of people involved in transferring cost and processing payment are in the range of two to three million employees.

If these stories do not convey the message that health care in the United States is a national disgrace, probably nothing will. To add insult to injury, some fifty million Americans are without health insurance because they need to eat, have pre-existing conditions, or because coverage is so expensive that even middle class families opt to take their chances.

Affordable health care is not a constitutional right, but isn't the real issue availability, like the availability of potable water and electricity?

The U.S. health care system is unique. It is the only country in the industrialized world where you lose your coverage when you leave your job. Based on employment, it is inequitable from beginning to end. If you are self-employed, your insurance costs much more because you are not a member of a large group, and you pay for it with after-tax dollars. Worse yet, if you lose a job where you were covered by a group plan, you can only keep the coverage you had by paying the much higher individual rate, and only for a limited time. Only in the U.S.!

This mess dates back to World War II, when strict wage and price controls were in effect. To get around the wage controls, companies offered fringe benefits like health insurance back then. Now many companies no longer do so because of costs that have escalated out of control. It is time to revamp the system so that individuals can take their insurance with them wherever they go.

No wonder President Obama has made health care reform a top priority. He dreams of universal availability, lower costs and quality care for everyone. If reform comes, the initial costs will be enormous. Pick any figure between six hundred billion dollars and more than twice that over ten years and you will be within the range of White House and Congressional Budget Office projections.

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