Why The Public Option Is So Important

In the various battles on Capitol Hill and elsewhere, working out the details of health care reform, many compromises have already been made. During this time, the most critical part of health care reform, the public option, has been teetering on the chopping block. I believe that many Democrats view the public option as a "nice to have" thing, but are prepared to toss it away like some kind of trump card if it will seal the deal. But if we throw this card down, we lose the game, period.

Shortly after I married back in 1980, I took an entry-level 2nd shift job in a local factory. The pay was nothing to write home about, and the twelve hour shifts left me bone-weary when I stumbled through the door at 3 a.m. six days a week. But after an initial probation period (3 months, I think), my company's BCBS coverage kicked in, which was one of the main reasons I worked so hard for so little pay. And then a few months later the bomb was dropped: Blue Cross/Blue Shield required a 270 day enrollment before they would pay for childbirth.

If I remember correctly, the whole thing (pre-natal, delivery, hospital stay, etc.) cost about $1,900. Which doesn't seem like much now, but, you know. For us back then it was a fortune. The bean-counters originally demanded that we pay $250 per month, but that was impossible. I finally talked them down to something like $90 per, which we struggled to comply with. My wife was back on her feet waiting tables as soon as she could walk across the room, and after a couple of really lean years, we were able to stamp that one "paid". We made it through, but it was a tightrope walk.

Unfortunately, many folks fall off that tightrope every year:

This year, an estimated 1.5 million Americans will declare bankruptcy. Many people may chalk up that misfortune to overspending or a lavish lifestyle, but a new study suggests that more than 60% of people who go bankrupt are actually capsized by medical bills.

Bankruptcies due to medical bills increased by nearly 50% in a six-year period, from 46% in 2001 to 62% in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners, according to a report that will be published in the August issue of The American Journal of Medicine.

If it were just the unemployed that were at risk of financial ruin, or even those who have a job but can't afford health insurance, it would be a tough nut to crack. But it's not just them:

They concluded that 62.1% of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10% of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point.

“That was actually the predominant problem in patients in our study—78% of them had health insurance, but many of them were bankrupted anyway because there were gaps in their coverage like co-payments and deductibles and uncovered services,” says Dr. Woolhandler. “Other people had private insurance but got so sick that they lost their job and lost their insurance.”

As you can see, this problem is not merely static, it's growing at an alarming rate. And it was growing even before our current recession pushed our jobless rate so high.

Let me give you another personal anecdote, totally free of charge. When I first returned home after a couple of hitches in the Army, I managed a furniture store for about nine months before moving into manufacturing. We offered in-store credit through a couple of different finance companies, and we would fax the customer's application and then wait for a reply. Of those that were rejected, a solid 90% or so were due to unpaid medical bills. The lost sales we suffered in that store alone ran into the tens of thousands per month, and that was twenty years ago. But the cost to my customers in lost hope and dignity was etched on their faces deeply, and broke my heart each time I had to tell them why they couldn't take that furniture home.

It's too much. Too much of a burden on patients and doctors, too much of a threat to our economy. If our government doesn't step in and bring some compassion and common sense into the equation, the ranks of those who are crushed under the wheels of this out-of-control freight train will continue to grow until our consumer-based economy breathes its last breath.