I did not closely follow the debate or rather public squabbles about “Obamacare” -- a word that was
coined as an insult but which, if it all works out, could become a badge of
honor, like “The Marshall Plan” (which really was Truman’s plan but, for
various reasons, he gave the
risk/credit to Marshall).
The issue is crucial and is becoming moreso as the population ages, and as -- a separate issue entirely --
ever more expensive and at times outlandish or even immoral medical
interventions become possible.
But the ratio of noise to information in what came streaming out of the media did not replay attention.
The Republican/Tea Party side of the spectacle was often
especially bone-headed: but that
is because this party has become -- almost explicitly and avowedly -- the Party
for Stupid People, so that they are bound to muddle things up even in cases where, underlyingly, there
may be powerful arguments to be made on their side.
So anyhow, since I confessedly know little of value (and,
along with the rest of you, am told less) about the intricacies of the issues
here, I shall remain mumchance;
yet venture to observe, simply as a sociological fact about being in
one’s sixties in the present century, that the debate seemed to concern, not
life on Earth, but some parallel civilization on a closely-akin but still
different planet. A
planet on which having medical
insurance means you are among the privileged, while those without are in dire straits.
My own insurance comes from the federal government, and thus
is the supposedly “cadillac” premium plan sneered at by those opposed to
federal workers. I’ve never
had a large medical bill, and don’t know what would happen if I were to incur
one; but I do occasionally have an
issue with teeth. And, despite
having purchased a special dental insurance over and above the basic federal
medical one, reimbursement for the biggest bills has been as follows:
Crown (including the work that
leads up to it). Cost: between
$1000 and $2000 depending on the tooth.
Reimbursement: A couple of
hundred.
Root canal. Cost: $1000. Reimbursement:
Zero.
In my immediate office there is a young father of
three, with certain highly
specialized skills useful to a mission that even those who like to throw
brickbats at the gummint would no
doubt shamefacedly admit is essential, who -- months ago -- had a tooth
removed. He carries the same
insurance as the rest of us (though, again, he separately purchased extra
dental protection) -- but it is useless, it won’t pay for the needed replacement
at all, so now he walks around with a giant hole in his mouth -- worse off even
than George Washington with his wooden pegs -- the neighboring teeth slowly
toppling into the gap. This,
if you please, is one of the privileged.
And again just today, I saw my ophthalmologist, who is sixty-two, and has
been practicing successfully for decades.
He seems to be in excellent health. But he can no longer afford his own insurance, the
price of which was just raised to something like $15,000 a year -- and that,
with a six thousand dollar deductible! Which means, he gets absolutely nothing out of it, and
financially would be better off just to drop it. But, under Romneycare (and its later extension, Obamacare),
that will be illegal, and the criminal (you) will be subject to a fine.
Something doesn’t compute.
Well! At
least health-care providers must be making out like bandits, since society
spends so much money in their area, right?
Probably so, somewhere along the links of the serpentine
money-chain -- nursing-home operators and beneficiaries of kickbacks from drug
companies and the like -- but I can tell you this: It ain’t nurses.
My wife is an RN, with a bachelor’s in nursing from a good
school, and decades on the job.
She has worked in a number of areas, but for the past ten years, in
homecare for the severely disabled.
The cost of this care is picked up entirely by the taxpayer, since the
patients have no assets. Her
pay is at the bottom of the RN payscale -- hard so say even why she stuck with
it for so long; something to do with the Stockholm syndrome, I suspect. Anyhow, the pay is even less than it looks,
because there is a cap on the number of hours that will be reimbursed per week,
and she regularly was forced to work substantially more of them -- both in
direct medical care, and in running tedious errands for her patients (like
buying them groceries, often out of her own pocket, which for some reason their
family refuses to do). In other words, when she worked
overtime, instead of getting time-and-a-half, she got … zero. Sweet deal,
right? (For the bosses.)
Then a few years ago, Medicaid further reduced the amount
they would reimburse, at which point -- to their credit -- the nursing agency
she works for decided to swallow the loss rather than reduce the nurses’
already modest paychecks.
Eventually she realized what a dead-end this is, and she quit
(apart from pitching-in part time in emergencies) to go back to cardiac care
(good choice! exclaims your
servant with the wonky ticker).
So her income has dropped to near zero, less than the cost of tuition
and textbooks for the various courses she needs to make the switch, not to
mention the year’s worth of malpractice insurance she was required to by as a
prerequite to even being admitted to her Nursing Refresher course.
At today’s meeting of that course, there was an interesting
guest lecturer: a lawyer who, for
twenty years, has specialized in defending nurses against lawsuits, and who is
herself a Registered Nurse;
indeed, she took that same refresher course herself a couple of years
ago, just to keep up with the field of her clients the defendants.
The lecture was not encouraging. Nurses in local hospitals are in increasing danger of
being sued. En revanche, should a nurse contract a serious illness as a direct
result of her job (a growing
danger, what with MRSA), she cannot expect the hospital to pay for any of the costs of her care. So, the nurse cannot sue, but she
can be sued.
But the topper, la
goutte qui a fait déborder le vase,
and which finally led me to put aside wrestling with the Riemann
Hypothesis and to write this post
-- and which brings us back to the insurance question with which we began -- is
this. The attorney, as a
fruit of long experience in this area, urged the nurses not to purchase individual malpractice insurance. The reason being that plaintiffs can find out if you have any,
and if you do, they will specifically list you by name as a defendant, in
addition to the hospital. At which
point you embark upon a world of pain.
Welcome to the world of work in the twenty-first century.
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