Updated: Sep 1, 2020
noun: 1. the state of being united or joined as a whole
We continue to hear “we’re all in this together” on TV, social media, or even the packaging of items you purchase at the store. I get that it sounds like a cheesy concept, but cheese aside, is there anything about that statement that’s false? Just how much of our lives truly exist in a proverbial vacuum, versus how much is interconnected to our fellow man? Honestly, not much. I’m 94.6% confident that I can find the ripple effect in anything thought to occur in a vacuum. Regardless, I’m going to choose the path of basicness, and write about the topic every other man, woman and their mothers are discussing. COVID. But hear me out, in this article the topic of ‘COVID’ serves as a vehicle to a parallel concept; COVID mirroring our healthcare system, and the necessary path we must take to reform health insurance today. But, first a quick little, maybe boring-ish history lesson on health insurance…mostly for posterity.
Health insurance, as we know it today, didn’t happen overnight during an executive round table meeting. It was the natural progression of a pre-paid type of arrangement that hospitals would offer, starting in the 1920s. And prior to that access to healthcare was profession, or industry based. Such as with the soldiers who fought in the civil war. Really, who doesn’t love Abraham Lincoln? Don’t answer, that’s rhetorical. Other professionals, such as miners, and lumber mill workers had this access to industrial clinics too. And eventually “accident” policies would be sold as a pre-industrial form of “job benefits.” Small clinics and medical house calls continued to function, but about 38 years into the future, America experienced a new environment for healthcare -- the advent of hospitals. As a result, medical care costs understandably began to rise; not only did the doctors need to be paid for their time and supplies, but newly included in the fee were hospital running costs. Hey, that overpriced salad bar isn’t going to pay for itself. In comes the dreaded medical debt of doom affecting patients, and unpaid patient bills affecting hospitals.
You’re probably wondering what any of this has to do with unity. Get to the point already! I know, I know, I am. You see, this problem required a solution that couldn’t be found on either side alone. Problems don’t occur in a bell jar, and neither does resolution. When we leave affected people out of the solution, we eventually find ourselves with a new problem. Do you see where I’m going with this yet? I promise I’ll be wrapping up this section soon!
Truth be told, the employer health coverage plan you may be opted into, informally, took shape in the late 1800s after employers in dangerous trades realized that sick and hurt workers were bad for their bottom line, typical. So doctors were paid by the employers to care for the employees. However, the health insurance industry earnestly began after WW1, with a teacher’s union and the Baylor hospital in Dallas, who thought to resolve both high medical bills and the hospital’s financial loss by coming together. The teachers paid a monthly fee to the Baylor -> Baylor was able to build a reserve -> future services would be accessible to any teachers taking part in the program in the event that they need them -> Baylor could operate without falling into the red. Wait, that sort of resembles socialism, no? Looks like it ¯\_(ツ)_/¯. And sort of irrelevant, but something I’d like to bask in a bit -- their payments, wait for it….50 cents! Oh, the olden days….I can’t even buy a bookmark with this much! Okay, in all fairness 50 cents meant a lot more then than it does now, but hey, I can still fantasize. Healthcare access to patients – check. Hospitals able to fill beds, get paid and keep the lights on – check. This lightbulb moment occurred when it was realized that working together yielded better results than working alone. A joint effort provided a resolution. And all this incredibly long winded mumble jumble is say, how many problems do we face today, that can be solved together? Now to the point of my point.
I’d like to give a little context to the discussion of health insurance in America and explain why we all should care about the topic, in one way or another. Talk of COVID incites new conversations on how we view insurance. We have a pretty gnarly virus spreading across the entire world, a virus introduced through no fault of those falling ill. Provided no extenuating circumstances surface, those with health insurance can get the care they need, yet those without health insurance can what exactly? Visit SOL creek? Mind boggling, since the uninsured are just as blameless with COVID as the insured.
Pre-COVID, a time that now seem to be fading more and more into our distant memory, health insurance was still, visibly, a major problem. At the point when the U.S. began seeing critical issues with health insurance (as late as the 1960s), just about every presidential administration since Nixon had at least addressed it, if not tried to improve it. In addition, including health insurance as a platform for major political seats, has often been a significant determinant in elections. So, while many of us have long seen the holes in the system, the guiding thought has been that health insurance is an isolated person-to-person matter. But it’s really not so “person-to-person” as some might think.
In 2018, close to 28 million Americans lacked health insurance. And data from 2019 reveals that a whopping 45% of those between ages 19-65 have insurance deemed inadequate. So it’s no surprise to find out that in the same year, around 25% of Americans delayed seeking medical care for serious health conditions because of costs. Why this matters -- according to a Harvard study as much as 46,000 annual deaths are attributed to lacking health insurance. That would make lacking health insurance in line with the 10th cause of death in the U.S., suicide. This death rate is only what was “recorded” from the uninsured population; it doesn’t, however, include deaths from inadequate insurance. It’s easy to look at numbers as simply that, numbers. These deaths were all made up of individual people from individual families though. Each one, a tragedy on its own. Which might explain the tendency to dismiss health insurance reform as necessary – it’s not always seen as a collective and endemic issue. Put simply, it isn’t “my, your, our” problem. You figure out how to get through your life, and I’ll worry about mine…. right? If you were wondering, the answer is “no.” We should care that so many of our citizen brothers and sisters are facing such odds. But I’m realistic and realize this won’t always be the case for everyone. So, let’s examine why else those odds might be of importance to you.
It’s actually very enlightening to think of the amount the United States spends because of our health coverage system. As the article by Brookings Institute put it, ‘it’s unsustainable.’ In the late 50s, healthcare was 5% of the annual expenditure, and by 2018 it had gone up to close to 18%. That’s like opening your birthday card from Nana and finding a $10 bill. Then before you can spend it on three boxes of Lucky Charms cereal (no lie, that’s totally what I’d spend it on), dad walks in and demands $2 for the Pepto you ran through after he accidentally gave the house food poisoning. Um, how is that fair dad? $3.6 trillion out of $20 trillion is spent on healthcare each year. Yes! TRILLION! Can we even begin to think of all the things that kind of money could go towards if not all needed for healthcare? Or the things that we go without because of that cost? What your country spends, and the available amount of money your country has available to spend for sure affects every one of us. Military spending, natural disasters costs, programs for disadvantaged children, education, and all those government employees that keep our country running – yes, these are all things that affect us – both the adequately covered [health insurance] and the not adequately, covered (if covered at all). So again, if not out of true humanely concern for others, the topic most definitely affects you, so it should be of interest to you.
As we find ourselves in the time of COVID, we are in many ways quite literally forced to be aware of how we are all affecting each other: social distancing mandates, business closings, curfews, and constant news feeds. Yes, mama COVID has sent us to our rooms and told us we can’t leave until we learn to get along with our little sister, or brother… interestingly the same shared responsibility that will slow COVID. But even broader, this is exactly what it will take to re-envision a system that will, as it did in the 1920s, work to amend a healthcare crisis. With COVID, your problem is no longer just your problem if your problem can easily be sneezed into the air that I’m about to inhale. Whew, almost created a word salad there. And the normalcy of empty store shelves, zoom appointments, and masks in public, constantly reminds us of this point (seriously people, just wear a mask). I have to now care about how my decisions will affect my neighbor, and my neighbor has to care about how he or she (I know…after 5 years I should probably know their gender) will affect the cashier at the grocery store, and the cashier has to now care about how they will affect me (did you hear the Lion King song, Circle of Life, too?).
When looking at the ‘new COVID normal’, it’s hard not to see the parallels in our healthcare system. It’s given us pause to consider whether we should treat other systems in the United States this way, specifically health insurance. Pause to consider the ways in which an insufficient healthcare system can affect others, and how what happens to ‘one’ can easily happen to ‘all’. But more importantly, it gives us pause to examine how shared responsibility, unity, is so vital for so many things. Because beyond being a bit rude, not caring also has the potential to boomerang. In using the COVID metaphor, that time you decided not to care whether you were an asymptomatic carrier, and left the house without a mask, might have been the time that you accidentally infected someone while out. And that newly infected person could be the start of a catalyst resulting in someone you care about becoming infected too. Cosmic backfire? COVID karma? The 360 effect? I’ll work on it later.
We’re still very much grounded in our rooms, arms crossed, and too stubborn to acknowledge that the only way we’re leaving this room is if we join forces with our annoying little brother Jimmy, or sister Jenny. When it comes to health insurance, I don’t exactly know what the healthcare system should ultimately look like in the future. That’s not really what this soapbox appeal is meant to answer. I much rather inspire a reconsideration of how we view the world. And I’d rather encourage people to at least be open to the idea of how interconnected we are. What I do know is that every resolution starts with a question. I do know that we have come together to solve questions before. I know that problems, especially on a large scale, do not get solved alone. I know that without mass support, problems aren’t always on the radar for those who are in positions to effectuate a resolute response. And lastly, I know that the way you eat an elephant is with one bite at a time. Ew, who has really eaten an elephant though? So lets start at the first bite. Simply seeing our citizen brothers and sisters as extensions of ourselves and listening. In doing so, more often than not, we find the amount that we “don’t” not have in common is huge. Annoying unnecessary double negative, but I wanted the emphasis. We share a lot of the same ultimate goals, and what’s better than easing the burden from each ONE of us by finding a solution TOGETHER? Whether directly affected by lacking health insurance or not, it affects you, it should be important to you.
In doing so, viewing healthcare as a “we issue,” those directly affected by a lack of insurance become more than people who mean nothing to you, and access opens to them. And everyone else who are fortunately, not in that category, can begin to avoid the indirect harms of an inadequate healthcare system. It wasn’t a “kumbaya” moment that propelled the teacher’s union and Baylor hospital to come up with the first widely established precursor to health insurance. It was merely the practical and functional thing to do. So maybe pulling out the dreamcatchers and acoustic guitar, then pilling in a circle around a bonfire, is a very romanticized idea of unity. The good thing is that unity, regarding the issue of healthcare, doesn’t need to be romantic, or layered in a sponge cake of mush. It just requires us to set aside petty grievances and political ideologies. Requires us to see each other as part of the collective whole. Requires us to understand that, just like with COVID, we affect each other. And requires us to accept that each of us wants a functional healthcare system, and a thriving and healthy country to live and raise our families in. So how do we get there? How do we bring along all of society on our way to that destination? Together. As every single cliched commercial has hammered, “we’re all in this together.” It’s maybe eyerolling, but nonetheless, true. Like it or not, we’re stronger in numbers… unless eating cheese fries because that plate is all mine.