Compelling Healthcare Issues: No Comparisons for Then and Now
Earlier this year, I talked about the need for us to look into the healthcare and health issurance state in the 1960s compared with now. There have been many changes and transitions during that time. In the 1960s, as asserted in that earlier post, most people lived the traditional life of working for an employer, in whatever capacity, who provided health insurance for the employee. An extra benefit was covering the health care issues for immediate family members. For the most part, citizens had reasonable medical care. The ones who were not covered were temporary and contract workers as well as the unemployed.
It could be argued that the unemployed still had health insurance by way of taking COBRA. Unfortunately, unemployment benefits barely cover one's basic needs as far as paying rent. Frivolous things such as transportation costs, food, utility expenses, and maintenance costs (laundry and dry cleaning, toiletries, and so on) were not part of the unemployment benefit umbrella. COBRA monthly payments are essentially about three times the cost of one's rent. Unless you had some serious dollars stashed away in savings and some really good job search connections, COBRA simply was not an option.
Many insurance providers had some type of co-payment arrangement for doctor visits and prescriptions. Everything was easy to understand. Brochures were readily available and mapped out comparisons of the different types of coverages available through that insurer. If their terms were not attractive (i.e., as afforadable as the employee wanted), there were other insurers who were easy to contact and receive similar brochures.
But time and practices and events have a way of changing one state of affairs. Things evolve into a new way of handling matters and the population is affected by those changes. Thus, people were essentially forced to start relying on publich health care. Initially, it was the welfare alternative for people. As soon as they were back on their feet, the public health safety net was abandoned in deference to the traditional health insurance and private physician mode. The interesting thing that's happened as we've marched from the 1960s to the 21st Century is that increasing numbers of the population have become permanent recipients of public health care. No one took notice of this until the 1980s when the practice of keeping statistics about the number of those using public compared with private health care was implemented. There's no way to do an accurate comparison between then and now.*
Many of those who used to be the recipients of private care and the luxuries that afforded them are now part of the public health care system - and very lost about what to expect, how to get what they need, and befuddled about the deterioration of the care that's extended to them.
Is there quality of care? For some, there is. For some there is not. It, to some degree, depends on how you define "quality of care." Preventive care under the public health care system is definitely a luxury. It is definitely the less expensive route for keeping a healthy, thriving, productive population.
In some areas, traditionally ethnically and economically challenged, it's difficult to find what the old school would consider quality of care. What is delivered is care that will attend to the most challenging, most urgent conditions in order to get the person back on their feet and facing the daily challenges that are posed. The homeless population is also included in this population of patients. In the most urgent of situations, the patient is treated with reasonable discretion. As the healing process continues, the quality of care does not.
One of the biggest problems with public health care is knowing where to turn in order to gain reliable information that will lead to reasonable options for care. It's difficult to learn how to receive the proper services. Hollywood accurately portrays the masses sitting in the waiting room waiting for attention to their needs. All of them are merely anonymous pods of consumers lacking any type of humanity. The basest of racist attitudes are foisted on many of those waiting for quality care; sometimes these attitudes are snarled at the patient, essentially accusing them of bringing on their poor health by their own devices and told they deserve whatever they get because of their practices. Others find theirselves treated like live medical school cadavers that can be used for practicing and learning how to do procedures. In the alternative, the patient is told their symptoms and condition are merely part of their imagining that they are ill and their complaints are discounted and ignored.
Some of the staff are very articulate and well trained. Others are lost or don't care. Still others are on anti-depressants and it's obvious. The patient must grit their teeth and trust whatever God to whom they pray that their care and outcome will be good.
Last year's Board of Supervisors meeting with regard to keeping King/Drew Hospital open finally came down to looking at the specter of having at least some care is better than having none at all in the area. At least with some care, residents are not forced to drive more than 25 miles in order to receive life-saving emergency care. At least they are assured that they can get to a hospital so that they can hope (and pray) for life-saving efforts instead of having to wait in triage for 8 to 18 hours. My argument then and now is it's better to have a facility where people can go and know that they will receive proper care. To sit in triage for hours on end and then be treated with a high unlikelihood of surviving the flu because the facility's medical workers just don't have the minimally requisite skills is the same as having no facility. Actually, it's worse because the expectation for survival is lower.
It's a very confusing, bewildering situation, especially for those who still remember - and want - those days of quality care from the '60s. It doesn't help matters that many of our state and federal health care systems are nearly bankrupt. That means getting approval for highly necessary procedures and appropriate after care is extremely difficult to gain. The patient is treated with complete disregard for their welfare. Their discomfort and increasing disabilities are simply part of the system that takes on a "take it or leave it" appearance. To complain means loss of coverage or loss of authorization for care. Those who complain or speak out are penalized. According to research, the patient will be blacklisted and they will not receive care nor insurance authorization for needed and necessary procedures.
Indeed putting aside Obama's attempt at reform, I still contend that someone needs to look into the state of health care as it exists now and as it was in the '60s. Dramatic changes have happened to us and as we endured the many political ravages that brought us to this point in time, we've lost much. We didn't notice the deterioration because we were fighting so mightily to keep the fibers of existence held about us. Some means of returning to the days of having easy to read and understand information available to all needs to be established. It isn't a question of who is worthy and qualified. It should be all are worthy and qualified to expect and receive quality health care. If that means we simply throw in the towel on private insurance and resort to socialized medicine in order to make health care available to all on an even level, then so be it.
* "The CensusBureau site says 1987 was the first year 'comparable health insurance data were collected.' So not back to 60s." From @PublicHealth via Twitter.
* AHRQ on "Quality of Care," generally.