Commentary—

Putting Health Care In Perspective

By William A. Collins

My insurance

Does the trick;

Just as long as

I’m not sick.

America is different from other lands in many respects, especially health care. While most nations look upon medicine as a fundamental task of government — much like education or defense — we don’t. We prefer a mixture of government, non-profit agencies, and private enterprise, with no one particularly in charge.

And with no one in charge in Washington, the states, by default, have a lot to say about what goes on within their own borders. In Connecticut, the proud home of many insurance and drug companies, this freedom results in a harmful reluctance to control those two powerful industries. Conversely, Connecticut is blessed with a strong tradition of non-profit rather than for-profit hospitals. Thus it chances that only today are we about to see our first one — Sharon — fall to a baleful corporation. It’s been a nice run.

Local attitudes toward labor have also proved important to health care. With the export of so many of our manufacturing jobs, unions here have been materially weakened. And as Fairfield County has become ever more a satellite of New York City, corporate influence in the General Assembly has simultaneously grown. As a result, protections for health care workers have correspondingly eroded. This has allowed a growing managerial disdain for hospital nurses and for all nursing home employees, especially in their hours and pay. As a consequence we now suffer acute shortages in both occupations, leading to poorer medical care.

An even bigger cause of medical labor shortages, though, has been the rise of the dreaded HMO. Other nations don’t have them. Those nations run their health care systems much like our Medicare, but covering all ages. What our devilish HMOs do is offer good salaries and regular hours to thousands of overworked doctors and nurses. Their new job is simply to second-guess the very kind of work they used to do themselves, out there with patients. For nurses, a 9-5 job is heavenly. For doctors, working for an HMO means no longer working against them, or with cranky patients. For patients, there is simply less care.

So in the end, the patients are the ones who suffer from this whole bizarre system. And since no one is really in charge, no one sees to it that every patient is covered by insurance. At last count, about 17 percent of Americans weren’t. They constitute our biggest category of the suffering silent sick.

Here in Connecticut, another major downtrodden category is the mentally ill. Being politically weak, they suffer excessively. Mental illness, since it is expensive and non-life threatening, is generally shrugged off by HMOs, leaving coverage very thin. Meanwhile the state has closed two of its own three psychiatric hospitals, leaving many other folks without adequate care.

Another medially demeaned category in Connecticut is the really poor. They’re covered by Medicaid, but the state reimbursement rate to doctors for their care is so low that many doctors won’t see them.

For most of us, blessedly, health care is terrific. American hospitals are the best, and if we have decent insurance, we’re in fat city. Still, since very few lawmakers lack coverage or are mentally ill themselves, they often fail to grasp the level of tribulation that our unique system causes for so many others.

Seen in proper perspective, our health care truly represents the genius of America. We prosper from our competitiveness, our free enterprise, and our market democracy. Our only losers are those who have failed in life’s unavoidable battle for economic and political influence. That system decrees that they suffer in sickness, as a graphic example to others to work harder.

Actually, that whole philosophy sounds kind of sick.

(Columnist William A. Collins is a former state representative and a former mayor of Norwalk.)