Commentaries

May 29, 2009

 Commentaries is where Minnesota Public Radio welcomes your thoughtful opinion about current events and issues. Commentaries are like letters to the editor. To be considered for publication, your commentary should be issue-related, clearly written, and follow our Terms of Use. New insights into ongoing topics are especially welcome. Not all commentaries received are published. For topical interaction with others, visit the discussion groups.

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Considering health care

I am an American born and raised U.S. citizen who spent my adult formative years in Canada, only recently returning to the United States at retirement age to live. I had hospital work experience as a teen and a general notion of health care experiences for patients of both chronic and acute health needs. In my absence I retained that memory. I knew the U.S. health care system had changed, but paid no attention to what it had become. [MPR Midmorning: MPR's News Fellows discuss health care]

A good year prior to returning I began to explore what would be available to me here in the U.S. I was amazed at the complexity compared to my Canadian experience. I was further amazed, and began to become stressed, when I approached signing up for health care. And eventually fully stunned when first accepted, followed by my check being returned - I was rejected. I have no diagnosed chronic conditions, have a limited income, so have not opted for "uninsurable insurance" costs. Therefore - I have no health care coverage.

For my entire life, even with my full coverage in Canada, I have practiced - as one of your panel described - self care through learning about health conditions, lifestyle practices, and so on. To do so is not uncommon. I know many in Canada and the U.S. (in the U.S. including both insured and uninsured) who practice wellness similarly. So this practice is not directly related to the question of how health care services are delivered.

I was deeply pleased to hear the speaker from - I believe South Africa. She spoke to what I find nearly always missing in discussions around health care reform. She asked: "What are our underlying motivations?" In other words, she asked: "What is our 'mission statement'?" Is it to finance health care by adjusting the present system? Do we know why we even want to do this? Do we appreciate the value (the intrinsic 'pay off')to our entire culture by assuring care when needed?

It seems discussions often circle about before 'landing' on dollar cost in one form or another. Once focused on dollar cost, there seems to me to be a tendency to speak detail from the existing and familiar.

One familiar detail is that of employee/employer participation. This focus is often times explored without reference to the unemployed, the self-employed, and the small business employer/employee who do not participate. For me, the focus at such a moment needs to be brought back to coverage for everyone.

A second familiar detail is the "for profit" aspect. Logically a "for profit" system "must" pay attention to profit! One of your speakers made reference to the contradiction between providing coverage to everyone while maintaining "for profit" participation. Again - for me - this is a moment to shift focus to the question of conflict of interest between profit motivation and compassionate care. This contradiction appears, to me, at the very heart of the American system's difference from systems set up in other countries. It needs to be discussed. This also applies in discussion of compensation for skilled services rendered. An observation sometimes made in Canada was that physicians who were oriented to service stayed; those oriented toward personal income moved to the U.S. How far can we go in weaning ourselves from a persistent association with income while dismissing "serving" as a motivation?

Also related to the profit issue is the question of why the US per/capita dollar cost is so very high compared to the per capita cost in other countries. To me, this indicates there are already sufficient dollars circulating in the practice of health care. How can these dollars be used differently? I contend universal not-for-profit care would have two effects: greater citizen wellness (productivity/participation) and more dollars in the pockets of citizens to spend differently.

Those who explore possibilities need to confront themselves with regards to motivation - do we intend coverage for all, or do we intend to increase coverage but sustain a certain amount of "collateral loss" of those who cannot finance their coverage when profit is actually the motivation.

Underlying motivation is perhaps one of the biggest questions that I believe has not been explored sufficiently. Our present motivation seems more a reaction to cost than a pro-action toward what I call "intelligent, compassionate, health care coverage based on recognition of the value to all when all are valued."

I believe it was the speaker from Africa who said that if truly universal health care is ushered in, it will change the US experience in many ways. I agree with her.

Again - thank you and members of the panel for a thoughtful discussion. I am easily agitated by the issue of U.S. health coverage. I was reassured by the tone of sincerity in the discussion.

Maggie Pate
Trinidad, Colo.


Minnesotans approve more spending?

What next? I thought that the lottery was approved by the citizens of the state of Minnesota to help wildlife. What will the citizens of this state be made to approve of next? The Twins got the new stadium on the same blackmail as they got the metrodome, "If we don't get it we will move." Well let them move.

Victoria Huber-Haas
St. Paul, Minn.


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