In the never ending battle to better understand this health care system of ours, and what has and might be done to improve it, there have been a great many articles, essays, papers which I've found tough to read. Largely self-taught, I've come to rely upon a handful of trusted, high quality websites for the accurate information that I seek. Sometimes the reading is arduous, technical and intimidating. I'm not complaining, mind you. I don't think this is the type subject matter that lends itself to a simplistic approach. Its complicated stuff, and its slow going quite often to correctly understand what the very bright and knowledgeable people who do this for a living are trying to say.
One such resource I use daily is called the Incidental Economist. They describe themselves in part as, "This is a blog (mostly) about the U.S. health care system and its organization, how it works, how it fails us, and what to do about it. All blog authors have professional expertise in an area relevant to the health care system. We are researchers and professors in health economics, law, or health services. By avocation and as bloggers we’re actively trying to understand our health care system and make it better. Our goal is to help you understand it too, and to empower you with research-validated information so you can be a more informed observer of or participant in the ongoing debate over how to reform our system."
This morning I read a piece by the founder of TIE, Austin Frakt, which blew me away. Austin is a health economist at Boston University, with an educational background in Physics and Engineering who earned his PhD in statistical and applied mathematics. Read the rest of Frakt's bio here...
He's a serious guy.
Today's offering from Frakt was possibly the most personal thing he's shared with his blog's readers. He talked about how the concept of having a thing called health insurance has effected him. Not in an academic or wonkish way, but in a human way. The way a husband, a father, a friend would feel about it. There are no charts, no graphs, no formula to digest. Mostly, the concept that people can come together as a community and solve a problem that as individuals they won't or can't solve by themselves.
I thank Austin for his permission to share his words from this morning with the Reasonable Conversation family. Here they are, as they appeared on his blog:
I could not have known this would happen at the time, but since the passage of the Affordable Care Act, health insurance has played a large role in the lives of some family and friends. Last year a colleague was diagnosed with cancer. He’s insured through work. Earlier this year, a family member with a serious medical condition requiring many surgeries, was caught — perhaps saved — by Medicaid. Recently the five-year-old daughter of friends was diagnosed with leukemia. They’re insured, I suspect through a non-group plan.
All of these people and their families now face high medical costs for care, or would if they were not insured. I doubt all of them would receive the same level of care without coverage. All of these people live in Massachusetts. That fact may not be decisive in their insurance status, but it could be, and it certainly is for many others. These people are not so different from me or my children. They are not so different from millions of others in other states with weaker safety nets and a culture less committed to health insurance as a basic necessity. Massachusetts is unique in that it has a coverage mandate.
I live in Massachusetts. For its safety net, its culture of coverage, its mandate, and its expensive and, yes, wasteful health system, I pay more in taxes. I pay more in premiums. What would otherwise be my wages are helping to care for my sick family members, friends, their loved ones, and many others I don’t even know. Next year they might be paying for me.
I’m grateful for it. I assure you, I would not voluntarily put aside thousands of dollars to help pay for the care of my friends. I’d likely not do it for anyone outside my nuclear family. I certainly would not do it for strangers. This is not because I’m callous or greedy. It’s because I probably wouldn’t think of it. Even if I did, I might not want to dwell on such unpleasant thoughts. Thankfully, I don’t have to.
Our society, or at least the one we have crafted in Massachusetts, in its messy, political, imperfect way, has already thought it through. Through decades of struggle, thought, and effort, policymakers have cobbled together a way for me to care for those I love and those just as deserving that I don’t (but someday might!) — and for them to care for me — without each of us having to think it through on our own. Even though we’d each like access to what would otherwise be health care too expensive to afford in the moment, we would likely not provide enough privately to make that possible. I certainly would not trust that my neighbors would pay for all of my chemo with their retirement savings if and when the time comes.
We have solved a collective action problem. It’s called insurance. Of course it could take many other forms — and many of those would be just fine, if different. Certainly we could reorganize the health system it funds to be more efficient. And we should! But at least we have done something, in Massachusetts, that solves a problem I’d not have solved on my own. Now more than ever, I’m grateful for it.
Sometimes its healthy to step away from the micro-level stuff and get a view from thirty thousand feet or so. Frakt shows us that while people may disagree on the details of how we fundamentally care for each other as a community, there is an "everyman" aspect to this. We all have friends who with or without insurance, have faced intensely difficult times related to health issues. To appreciate that a community can, sometimes, find a way to assist these people, is very human, I think.
(You can follow The Incidental Economist here and I strongly encourage you do to do so. Bookmark them. Make them a part of your daily reading. Tell your friends about them. Frakt, Dr. Aaron Carroll and the rest of TIE team provide fresh topical content on a daily basis. They welcome comments and respond to readers emails and questions. You WILL learn more about health policy, how things work and why things are the way they are if you do so.)