James Clay Fuller

Things We're Not Supposed to Say

Thursday, February 19, 2004

Be your own physician; no degree required

I don’t doubt I’m behind the curve on this one, and that many others figured it out before I did. It was only in the past couple of days that I understood the signals:

Health care for working people is going the way of telephone, electric power and cable television companies, internet “service” providers, natural gas utilities, banks, gas stations and many other businesses.

The norm with those outfits now is that you do much of their work and pay them for the privilege. Think ATMs, and self-service/self-pay gas pumps. If something isn’t working, the companies may or may not give you a little help on line or by telephone, but you’re expected to fix it yourself, to do the work that used to be done by the companies’ employees. Service is only, and I do mean only, an advertising claim.

The next step in health care is in the same direction – which essentially is back to the 19th century, or earlier. Home remedies and self-dosing, here we come.

(This does not apply to the rich, of course, but they’re already living in a different country from the rest of us, thanks to bought-and-paid-for politicians who see to it that they have a separate and much softer reality.)

I write this on the assumption that I am/was not the only one to be a bit slow in catching on.

We all know that health care is the biggest issue in labor contract bargaining, considerably outweighing pay these days. The shift of health insurance costs from employers to employees is behind almost every strike called over the past five or even 10 years. The shift is a major reason for the decrease in real wages most American workers have suffered over the past two decades.

Employers say they simply can’t afford to pay the annual double-digit increases in health care coverage --and maintain their present sometimes enormous profit margins, though this latter portion is left unsaid. Employees are being forced to take on more of the costs of coverage and, of course, their take-home pay is greatly reduced, since salaries and wages do not increase at anywhere near the same rate as health care charges.

News purveyors never, never question the legitimacy of profit margins, and almost never question the reasons for the continuing outlandish climb of health care charges. If the latter issue is raised, the reporters are told that, gee, it’s the cost of those wonderful scientific breakthroughs with which we are blessed every 20 minutes or so. The reporters nod their heads, write that down and the subject is dropped.

But working people, even those who think themselves untouchably middle class, are getting fed up with losing economic ground in order to have health care. There are strikes all over the country by people who are saying “Enough.” And employers are tired of taking the heat.

So here’s the part that’s only recently become clear, at least to me: Companies are going to install systems under which employees will have to talk on the phone to employer-hired nurses (at least we hope they'll be fully trained nurses) who will give instructions for home treatment and who will, only if absolutely and clearly necessary, approve a visit to a physician. Some companies reportedly are planning to institute “disease management programs,” though, frankly, I’ve not yet been able to learn what that means. As always, the corporate focus is on curtailing the employee demand for services.

The ideas are being floated to a large degree through corporation-funded foundations and public policy organizations, which is where major shifts in how people are treated usually are signaled. They are being touted, as such things always are, as a way to bring costs under control, and the fact is that they probably will bring about a reduction in over-all health care costs, at least for a time.

It also seems highly likely that they will seriously curtail the average citizen’s access to proper care.

Lest you forget: Although people in this country already pay far more for health care than do the citizens of any other country in the world, virtually all other developed countries have better health care as judged by almost any available measurement: longevity, infant death rates, maternal deaths during childbirth, incidence of heart attacks, basic health at all ages, access to treatment for mental health problems...You name it, we’re at or near the bottom.