NARAL President's Ordeal: The Ugly Side Of American Health Care

Kate Michelman was a (presumably) well-remunerated Washington type with a college professor husband and a retirement plan in the bank. That is until the former NARAL head's uninsured daughter and well-insured husband suffered catastrophic injuries.

Michelman's daughter was paralyzed in a horse-riding accident in 2001 that left Michelman and her husband with nearly a million dollars in medical bills, this, a year before Michelman's husband was himself diagnosed with Parkinson's disease. She quit working to take care of them both, expecting her husband's health insurance and their long-term care insurance to pay, at least, for his care. Then her husband fell getting out of the car last October.

Her husband had fractured his hip and broken his femur bone. He was in the hospital for months before being moved to an assisted living facility.

Michelman thought most of the bills would be covered. "But when 'most' comes to be reality," she says, "you're left with thousands of dollars of bills that are not covered for one reason or another."

Even their long-term care policy covers only a fraction of the expenses.

Oh, that fine print.

Michelman is now contemplating a move back into the work force, both to potentially prevent her family from going bankrupt, and to work on the health care reforms proposed by the Administration.

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Ezra Klein identifies many of the problems Michelman faces as an argument for universal coverage (which is part of the Obama plan).

There are those who believe insurance a perversion of the market. It may be true, they sadly admit, that low-income Americans need subsidies and help. But there's no reason such distortions need to reach into higher income brackets. But this misunderstands the nature of health care costs. They are not on the scale of individual incomes. Even the rich find themselves rapidly impoverished by the staccato procession of treatments and medicines and daily care required in the aftermath of a health calamity. It is only aggregate incomes that can afford insurance protecting unlucky individuals against the full costs of catastrophe. Health care isn't about purchasing. It's about pooling.

The problem for Michelman was not her husband but her daughter. Her daughter didn't have insurance. And that meant that it didn't really matter that Michelman had money.

One thing Klein doesn't mention is that our current insurance system is, itself, fundamentally broken. Adding more people to the pool doesn't change the profit incentives that often drive insurance companies to deny claims, make one's life hell trying to get something covered or drop individuals from the pool when they individually become too pricey despite the practice of pooling risk (something the insurance companies have offered to stop doing if Obama's plan makes us all buy their products — they'd then probably just raise the rates).

Universal health insurance is a great short-term step, as long as it is undertaken as a longer process of insurance reform, which itself needs to be part of a larger effort to reform the health care system in this country. Insurance coverage is great, unless it's an hour to a hospital, or there's no one in your town to fill a birth control prescription, or the nearest specialist is half a state away, or everything is so expensive that access is just a myth anyway. Let's hope Michelman — and the other people in Washington who are working on this reform package — bring a lot more to the reform table than a health insurance mandate, electronic records and a couple of cost-cutting measures.

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Famed Feminist Faces Medical Tragedies [NPR]
A System From Hell [The Nation]
Kate Michelman And The Need For Insurance [Ezra Klein]

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