View from the choir

I am a Catholic layperson and Secular Franciscan with a sense of humor. After years in the back pew watching, I have moved into the choir. It's nice to see faces instead of the backs of heads. But I still maintain God has a sense of humor - and that we are created in God's image.

Sunday, August 09, 2009

Government Health Care - A Current Tale

Government health care already exists - in the form of Medicaid and Medicare. Do they provide a snapshot of what we might face under a larger program under health care reform? Perhaps.

If so, here's a story that shows the potential complications.

One of my middle daughter's friends graduated from college last year. Her family health insurance plan covers children only until they are 21 or graduate from college. So as of last May, she was off the family plan.

The young lady got an apartment with a friend in another city. She had a part-time job she hoped would turn full time. The economy went south, though, and there were layoffs. She did not lose her job, but she did not get a full-time position and did not qualify for company supplied health insurance. She applied for full-time jobs elsewhere, but no luck.

Her income is so low she qualifies for Medicaid.

She has a degenerative bone disorder. Even though she is only in her early 20s, she needs hip replacement surgery soon. She's already using a cane - and lots of pain killers.

To get ready for the surgery, her doctor says she should get an MRI. Medicaid won't pay for it. Her doctor suggested she take the "poor people's" route and go to the Emergency Room to see if she can get one that way. No luck.

They can go ahead with the surgery without the MRI, but the doctor says it would be far better if they had an MRI. Is he right? Or is he just protecting himself from any potential lawsuits? Medicaid certainly does not deem it necessary. Are they right? Who decides?

Her family is already facing some health and money issues - with one member on the list for a heart transplant. They are trying to fight their insurance company to see if they can get her back on the family plan. No luck so far.

Now there's all sorts of issues here. The young lady could move home and give up her apartment. Independence is nice and all, but does it make sense under the current circumstances?

At the same time, though, that would mean giving up the job she has, and it's not clear she could find anything in her home town given the economy. And even if she did move home, she would still not be on the family insurance plan.

Now maybe the family could have chosen a plan that provided more coverage of children - my own unmarried daughters are covered under my plan until they are 25, and under a new state law, that might even stretch until they are 29.

Then again, maybe they could not afford more when they got it. Maybe that was the only plan available to them at the time. Maybe things went along fine for years and they never thought to look for something more or better. Maybe they could not afford to switch because some plans don't cover pre-existing conditions, and that heart problem would not allow them to switch.

As for the current situation, they could go ahead with the surgery without the MRI, but would that be like the surgeon was operating with one eye closed?

On the other hand, thanks to a government health plan, even though she does not have the money, she can get the hip replacement surgery. Without a government program, she might be facing huge medical bills - or being crippled.

And, to be fair, there are stories like this even when the family does have insurance coverage - all that fine print and the cost analysis that goes on.

It's not an easy situation. There are many factors. There may be many more about which I'm not aware. I have no easy answers.

And I'm not trying to paint anyone a villain.

I favor health care reform to make sure low-income people get the health care they need. But in a larger government plan, would there be even more such stories?

Or is that just part of living in an imperfect world?


Blogger Ben Anderson said...

good write up, Lee. I think your last question really hit the nail on the head - everyone thinks we can make the world perfect so that there is no more pain, but we simply can't.

9:02 PM  
Anonymous Riva said...

This is interesting. My question is, are CATS covered under Obama family health care plan?

12:22 PM  

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