I am a retired physician, and since 1961 have been a provider of health care. I had a stroke in 2000 and became a user of health care. Today, my medical coverage comes from Medicare and I am very satisfied with it.
My main income is Social Security and it does not cover the yearly expenses for my wife’s medical insurance (she is not yet 65 and has a pre-existing condition). The going at times is difficult, and if it’s hard for a former physician, I wonder about the plight of the average American who has a small business or has lost employment.
I have experienced all the facets of medical coverage, from direct payment, private insurances (GE was the big dog in the early 1960s ) to Blue Cross, Blue Shield, third-party payers. In the early ’60s there was no Medicaid or Medicare, and people who did not have the means to pay for their medical or surgical care were treated by physicians on call and the interns/residents on staff. They were labeled “service cases” and the hospitals took care of them.
Today we have a great number of private insurance companies providing medical coverage; and while this system has created some very wealthy individuals, the medical world has never been in such a dire condition.
I can’t pinpoint exactly when it happened, but over the years a group of investors and business people decided that there were millions to be made in diseases and sickness. They managed to infiltrate and take control of medicine. Doctors were only too happy to let “suits” and “bean counters” handle the business side of medicine they did not care for anyway, and some financially minded physicians joined forces with the invaders.
Working doctors became providers, and efficiency and cost-cutting were the buzzwords. CEOs, business folks, entrepreneurial physicians became quite wealthy.
At present, the fields of health care, as I see them, can be compartmented in three tiers.
— Tier One includes the rich and the high-level politicians. They receive superb care when needed. Life is good.
— Tier Two is one step below. Americans belonging to this tier don’t have to mortgage their homes or have neighborhood bake sales in order to cover medical expenses. A fair number of working Americans fall into that group. Tier Two is shielded by powerful unions and lobbies. They are the teachers, firemen, policemen. They are the middle- and low-level politicians, the state workers, federal workers. They are the armed forces, the reserves, etc. They and their loved ones are covered for life. They don’t have to worry about getting sick. Life is good.
— And there is Tier Three, the rest of us. It has been estimated that more than 50 million Americans either are not medically covered, are insufficiently covered, or have a very hard time meeting medical expenses for themselves and their families.
Some members of Tier Three have had to sell or mortgage their homes, choose between food and heat and medications. They are the ones dying after being nixed by millionaire CEOs, discharged from hospitals before reasonable times.
Tier Three does not have a Palin or a Limbaugh in their corner. They are the group that does well in France, Canada, Great Britain, Germany, Sweden, etc., but not in America. Many of them are taxed and contribute to the well being of Tiers One and Two.
Making it work
Health care in America, the richest, most powerful country in the world, should not be the privilege of a few lucky or scheming ones. It should be a right for all. The system cannot go the way it is now. It is heading for a total meltdown. Possibly we’ll never have a perfect medical care system. Nothing is perfect in this world. But our leaders should be allowed to tweak it, modify it, make it work.
What about a Medicare and the same medical care for all of us? After all, we live in a democracy, right?
Remember, haves of today. You may well be the have-nots of tomorrow.
Roger Malebranche lives in Broadalbin and is the former chief of surgery at St. Clare’s Hospital.
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