Volume 20, Number 3

Whatever the Plan,
Access to Health Care is Crucial

Fred Schepartz

With the health care debate raging, I, like many Americans, find myself asking how I feel about my health coverage.

It’s a difficult question. What I can say for sure is that last month was kind of a mixed bag.

In the middle of the month, my wife had a laparoscopy to repair a hernia that had formed around the incision from an emergency appendectomy last December. The inpatient surgery took three hours. She was in recovery for two hours before they finally brought her into her room in the outpatient ward of the hospital. Three hours later, they sent her home with a prescription for Oxycodone.

The surgery was a bit more extensive than your average laparoscopy. I’d had a similar procedure done several years ago, which involved four incisions. My wife’s surgeon used nine incisions. She was heavily sedated and wasn’t really back to normal until the following afternoon.

Still, they sent her home. It might’ve been best if they’d kept her overnight except for one crucial point: Our health insurance covers outpatient surgeries 100 percent. Hospitalization involves a $500 deductible, despite the fact that this was a complication from the previous surgery.

The next week I went to the dentist for a crown. Our health plan includes dental insurance, which is nice. Check-ups and cleanings are pretty much covered. However, once you get into oral surgery, you start talking some bucks. One may try to put off oral surgery, but, well, you can only put off that kind of pain for so long. If you don’t believe me, check out Marathon Man sometime and then try to tell me if it’s safe.

Our insurance was going to cover about half the cost of the crown, but considering that my wife’s laparoscopy didn’t cost anything, I figured we were ahead of the game.

That is, until the dentist performed a closer examination of the tooth in question and told me I’d need a root canal first.

Please tell Lawrence Olivier that no, it isn’t safe.

My oral surgery bill just doubled and then some. So much for being ahead of the game.

Like so many Americans, I’m asking myself, how do I feel about my health care?

My answer is multi-faceted. I like my health care. However, I don’t like paying for it.

My wife and I get health coverage through the employee plan at my place of work, Union Cab, which is a 100-percent worker-owned-and-operated cooperative. Our health coverage provider is Group Health Cooperative of South Central Wisconsin.

GHC provides excellent health care. It’s a not-for-profit organization and truly is a model for how health care should be delivered. GHC is all about sustainability. All the health care professionals within GHC are employees. They’re paid a decent wage, but their pay is not based on how many patients they can bring in or how much money they can bill to third-party payers. Because GHC isn’t about turning a profit over to some fat-cat CEO or some far-off board of directors, the cooperative isn’t concerned with maximizing profits, so they don’t do things like drop members who get gravely ill.

What they do, however, is see that members receive the care they need in a timely manner. Oh, and GHC was one of the first, if not the first HMO in Dane County to utilize MyChart, an excellent software package that allows members to gain access to their medical records, schedule their own appointments and order prescriptions from their computer at home.

That’s the good news.

The bad news is that paying for health coverage is eating me alive.

A little over a year ago, my wife quit her job. Previously, she’d worked for the State of Wisconsin. The health coverage was good, though not quite as good as GHC. Still, other than token co-pay, the state paid almost every penny of the health insurance premiums for the two of us.

Unfortunately, the job was making my wife physically ill. She put up with it for longer than she should have and then finally quit last summer. She’s now in graduate school and has not yet found another job.

It is extremely fortunate that Union Cab has a health plan. However, the cab company is not able to pay anywhere near the percentage of our premiums that the state had previously paid. In fact, the company is unable to pay any portion of any health insurance premiums for a driver’s family members.

That’s the trade-off for working in that particular business. The wage itself is relatively high but, for the company, the profit margin is relatively small, so the benefit package is minimal.

I pay $600 per month for health insurance. We get paid every two weeks, so I’m paying $300 out of every paycheck to pay our premiums.

When you include co-pays and deductibles, I’m paying as much for health care as I am for housing. And let me tell you, compared to the premiums, the co-pays and deductibles may just be nickel-and-dime stuff, but added together, it’s death by a thousand paper cuts, especially considering that with just one bread-winner in the household, we’re on one very tight budget. We’re practically budgeted to the penny.

And how am I able to afford to pay these premiums?

As a cab driver, I’m paid by commission. I can’t tell you how grateful I am to work at a place like Union Cab, which has seniority pay increases with no cap. At any other cab company, I would not be able to support the household without my wife working. This notion horrifies me because, given my wife’s health issues over the last several months, without what I get paid at Union Cab we’d be just another statistic, just one more defaulted mortgage.

Still, we make ends meet, I’m working an extra shift every other week. I’m not taking about some dinky six- or eight-hour shift. I’m talking about a full, ten-hour shift, which usually ends up being more like twelve hours. On top of that, I usually work past my end time for my other shifts as well.

Last week was one of my long weeks. I worked somewhere around 55-56 hours. I’ll work fewer hours this week, but I am averaging somewhere around 48-50 hours a week.

So much for the Haymarket Martyrs. So much for the 40-hour week.

I feel like such a crybaby about this whole thing. I’ll just be doing this for a little while, but there’s people who work full time and then some their whole lives. It’s just their lot in life.  It’s just them doing what they have to do.

Well, that’s just a lot of Protestant Work Ethic bullshit. The number 40 is not some arbitrary number that some bomb-throwing anarchist pulled out of his ass. This experience has taught me that there’s a huge difference between working 40 hours a week and working more than 40 hours a week.

The 40-hour work week gives the worker time to rest and leaves the worker with enough energy to spend quality time with friends and family, to get involved with civic activities or even create art if that is what he or she chooses to do.

I’m working beyond the 40-hour workweek because there is no other choice. My wife and I are both in our mid-to-late 40s. Going without health insurance is simply not an option. Otherwise, what would we do? Wait until the pain is so bad that we show up at the emergency room with cases so acute that they have to treat us?

The system as it exists now is flat out unjust and immoral. I’m given a choice of working myself to death or letting illnesses and conditions get so bad that they have to be treated in the ER, which, of course, costs everyone much more.

But at least I have a choice. Somewhere around 47 million Americans don’t have this choice. Their access to health care is blocked by simple economics.

We need relief. A public option that provides full medical coverage with little or no cost to those who earn up to 400 percent of Federal Poverty Level income would be a good place to start.

The simplest and easiest thing to do would be to expand Medicare so it covers all Americans. I guess you could charge premiums and co-pays, preferably on a sliding scale, though I think it would be easier to charge nothing at all for expanded Medicare. Instead, raise taxes considerably on the super-wealthy, less on the wealthy and even less on the upper middle class.

All of that said, I do have to say that something that bothers me greatly about the health care debate is the focus on the delivery of payment for health care services. This problem is double-faceted and requires a two-prong solution.

Yes, we need to deal with the issue of delivery of payment for health care services, but we also desperately need to fix the problem of delivery of health care services.

The key word here is access.

Lack of access to health care causes tremendous problems that we all pay for. And when I say pay, I mean that in the most literal sense. When our fellow Americans are denied access to health care, it hits us all in the wallet with greater health care expenses.

Economic access is only part of the problem. A good part of the problem is also geographical. The problem is sometimes cultural.

We need to understand and adopt a simple concept:

To be a healthier society, with a health system that works better and costs less, we want all Americans to see medical professionals more often rather than less often.

This runs contrary to the mantra of Republicans with their so-called free-market health-care solution. They would prefer that individuals purchase their own health insurance and pay their own health care expenses—with the aid of tax credits and deductions, of course. Their reasoning is that if people make their own health care decisions, i.e., pay for it themselves, they’ll make more prudent decisions, i.e., put things off because they can’t afford it.

This is morally bankrupt as well as intellectually dishonest.

We want people to see medical professionals more often, not less often. This means that people with minor ailments can get the care they need before the minor ailment turns into something major. This means that major ailments can be discovered sooner, thus increasing the patient’s chances of survival and reducing the expense of treatment. This also means increased opportunities to educate the public about health, which can save lives as well as money down the road.

As they say, an ounce of prevention equals a pound of cure. Or in other words, a dollar of prevention is worth a hundred thousand dollars of high-tech treatment down the road.

We need to unleash hordes of nurse practitioners and physician assistants who can do the basic work of doctors for a fraction of the cost.

We need to multiply the number of community clinics by at least 100, if not more.

We need to fund outreach programs where medical professionals go into the inner city and the hinterlands to treat the sick and educate everyone about how a functional health care system works.

We need to increase Medical Assistance funding for taxicabs to transport people to and from their medical appointments.

We need to do everything we can to either get people to a health-care clinic or bring the health-care clinic to them.


Because these measures work. Increasing access to health care leads to a healthier populace and saves money as well. I’d say that’s pretty much a no-brainer.

Still not convinced? Here are a couple of examples.

Holland has a single-payer system, which is one of the best in the world. Interestingly, the Dutch system includes a mix of government-run and privately owned clinics. Recently it was discovered that something was dragging the whole system down. Emergency room visits had increased, which led to a dramatic increase in the expense of the Dutch health care system.

In response, the Dutch government created a program where they sent doctors out on house calls. This might sound crazy and absurdly expensive, but the rationale was that the money spent up-front would be more than compensated by the money saved on the back end.

And they were right. Emergency-room visits dropped, thus saving the Dutch government a great deal of money.

Another dramatic example can be found right here in Dane County. The 1990s featured a mass migration of African Americans into Dane County. The new residents were largely poor and, frankly, needed a wide variety of social services. Sadly, the city and county were slow to respond to this demographic shift.

Parenthetically, I have to state that I have been railing about this neglect, about this head-in-the-sand approach for years, and now I have my smoking gun, an actual quantifying of not just a problem, but also a solution that actually works.

Last year, the county released the results of a study of infant mortality rates. The results were surprising, if not shocking.

Prior to 2000, infant mortality among African Americans was 19 out of every 1000 births. After 2000, that number dropped to six. During all the years of the study, infant mortality among whites held steady at four out of 1000 births.

No one could explain the sudden decrease in infant mortality among African Americans, though there was mass rejoicing among city and county officials, even though the discrepancy between whites and African Americans is 50 percent. Still, this is great news.

The only problem was that they didn’t know what they were doing right. The Public Health Department of Madison and Dane County was given a half million-dollar grant to figure that out.

As Dr. Tom Schlenker, Executive Director of Public Health of Madison and Dane County said, "We need to discover the driving forces behind these trends to protect and sustain them and to share them with the rest of the state and nation."

I don’t think Schlenker leaves his office much. Otherwise, he might already know the answer, and he might’ve been able to save $500,000 in grant money.

Infant mortality among African Americans in Dane County decreased by 70 percent because of Union Cab, the place where I work.

During the late 1990s, the state mandated that the counties use Medical Assistance money to pay for transportation to help low-income residents go to and from their medical appointments. The program is very simple. HMOs and other medical organizations pay Union Cab to perform this task. They forward our bill to the county. The county bills the state.

I have extensive first-hand knowledge of this program, and I know it is a tremendous help to these women who for one reason or another have difficulty in getting to their medical appointments without having a cab pick them up. Sometimes it’s because they live out in the suburbs, far from any kind of mass transit. Sometimes it’s because they physically are unable to wait for the bus or ride on the bus. Sometimes there are childcare issues.

There are numerous issues, but we are the solution. Our efforts save money and save lives.

And just how important is pre-natal care? The results are obvious, but let’s take a closer look. The woman who receives quality pre-natal care is more likely to enjoy a non-eventful pregnancy and most likely won’t need to go to the clinic as often, which saves money. Her chances of giving birth prematurely decrease, which saves us money. A healthy baby is less likely to suffer from chronic health problems, which saves us a boatload of money.

More importantly, by taking action as we have, we are making great strides to help newcomers to our community feel like they are genuinely part of the community, all because we, as a community, made a concerted effort to provide access to health care for people who need it the most.

So let’s have our debate about how to fix health care. There are no shortages of ideas out there, so we need to listen closely and keep an open mind to any and all good ideas. But mostly we need to understand how we pay for people’s health care is only part of the solution. If we don’t address access, we’re not really working to fix the problem. All we’re doing is slapping a bandage on a gaping wound.

* * *

Regarding the disruptions at town hall meetings across the country, there’s a lot I could say, but I’ve said a lot already, so I’ll be very, very brief:

The silent majority is neither.