Why Does Health Care Cost So Much?

Like many Americans, I’m satisfied with my health insurance.  As a retired government employee, my wife is covered with CIGNA and our premiums are mostly paid by the taxpayers.  But news that CIGNA’s top executive David Cordani enjoyed a pay increase of 25% last year, to $18.9 million annually, reminded me why health care reform remains an unresolved challenge for our country.

Cordani’s salary translates to nearly $10,000 an hour, compared to the $10.50 to $17.00 an hour that nursing assistants earn in Massachusetts.  Certified nurse assistants take vital signs, respond to hospital help lights, get patients in and out of bed and provide the hands-on care that make them the first responders of the medical world.  I’m not sure what David Cordani does to earn his exorbitant paycheck, except continue to ratchet up the price of insurance.  According to his corporate bio, he has a degree in business from the University of Hartford and lots of experience in marketing.

Bloated CEO pay packages and excessive administrative costs that consume 31% of every health care dollar spent in the U.S. are much of the reason we are poised to pour nearly $3 trillion on health care this year, a pile of dollars that if stacked one on top of the other would reach almost to the moon.  

Unfortunately, measures that are touted as “reform” (including the President’s Affordable Care Act due to be heard before the Supreme Court) do little to address these escalating costs.  The Greater Boston Interfaith Organization, which was a major advocate of our state’s 2006 mandated insurance law, is now calling for another mandate, a “cap” on the Bay State’s health care spending.  But so long as the profit-motive continues to drive the insurance industry, guys like David Cordani will surely continue to apply the first rule they learned in marketing school: Charge what the market will bear!

Cordani was the CIGNA spokesman five years ago who explained why his company wouldn’t pay for a 17-year-old girl with leukemia whom doctors had slated for a liver transplant.  The girl, named Natalie, was covered under her mom’s CIGNA policy and physicians gave her a 65% chance of recovery.  But business is business, right?  Cordani called the procedure experimental and wouldn’t cover it. Thanks to a lobbying campaign and thousands of phone calls generated by the state Nurses’ Association, the company eventually reversed its decision, but by that time Natalie was dead.  Those are the kind of tough decisions that earn you $19.8 million a year.

 

Isn’t it time to get private insurance companies and  profiteering out of medicine altogether?  Our neighbor to the north, the little state of Vermont, is poised to do just that, with a universal, single-payer plan due to take effect in 2014.  Instead of a dozen competing insurers, each skimming the system, there will be a single agency paying the bills—just as it’s done in Canada, in France, and in most of the rest of the civilized world where health spending is considerably lower than in the United States and where outcomes are better, whether measured by lifespan, infant mortality, survival rates for significant illness or almost any other index.  Organizations like Masscare calculate that our state could save $9.7 billion annually with a similar “Medicare for all” plan that eliminates the middle-man.

 

Of course, David Cordani would then be out of a job.  Do you think he knows how to empty bedpans?   

A Right To Die?

Should people faced with an incurable terminal illness, with less than six months to live, be able to receive prescription medication to painlessly end their own suffering?   The question affects real people facing terrible end-of-life dilemmas.

As a clergyman, I accompanied two of my parishioners through the final stages of their lives when they chose to stop eating and drinking rather than endure the alternative.   Margaret was diagnosed with an inoperable brain tumor that would inevitably destroy her mind and personality long before her heart stopped beating.  Jim had ALS, which left him completely paralyzed, progressively shutting down bodily functions  while leaving the higher cognitive abilities intact.  With the support of their families and physicians, both chose to stop hydration, dying of thirst over the course of several days.  Thanks to palliative care, the process was not agonizing, but not pleasant, either.  Both would have preferred a quicker and more merciful exit, but state law didn’t give them that option.

Residents of Massachusetts may soon have more choices.  After receiving a petition bearing 79,626 signatures last December, the House Joint Committee on the Judiciary is now considering a ballot initiative titled the “Death With Dignity Act.”  If voters approve in November, individuals like Jim and Margaret who are terminal with no hope of recovery will soon be able to ask a doctor for a dose of kindness.  Safeguards insure that the patient be of sound mind, under no coercion, repeating the request on three occasions, separated in time by an interval of at least fifteen days, properly witnessed by impartial, disinterested observers.

If the experience of states like Oregon and Washington which have passed similar legislation are any guide, the right to self-administer euthanasia is rarely exercised.  In the first fourteen years after its passage, just 401Oregonians took advantage of the law.  Given any reasonable chance for a viable quality of life, few people elect to hasten their own demise.  But knowing the option is available has given peace of mind to thousands of others, for there truly are some fates worse than death.  

I empathize with individuals like Jim and Margaret, because for almost one year I lived tethered to a dialysis machine.  Three times each week, my blood circulated through an artificial kidney in a process that took hours and left me physically drained.  I survived and eventually received an organ transplant.  But from firsthand experience, I can also understand the decision some others have made (mostly elderly or unable to find a suitable donor) to simply unplug the device.

Should anyone in such a situation be kept alive against their will?  Virtually all medical ethicists recognize the patient’s right to refuse treatment—even a treatment like dialysis that might save or prolong one’s life.  How different is that from the right that Jim and Margaret were requesting, to leave the world through their own volition?  Physician assisted “suicide” is the wrong term for an act that is really a final assertion of autonomy, dignity and self-control.  Neither Jim nor Margaret were cases of suicide, for the choice they faced was not whether to live or die, but only whether death would be more or less cruel, degrading and prolonged. 

Whose life is it, anyway?  There can be only one answer for me and members of my church like Jim and Margaret, who want to make their own decisions right down to the very end.     

Still Waiting For Justice

Some people, literally, get away with murder.  That’s what happened forty-seven years ago, on March 11, 1965, when James Reeb was hit over the head with a club and killed in Selma, Alabama.

Reverend Reeb was a Unitarian Universalist minister, one of the hundreds of rabbis, priests, nuns and other clergy who responded to Martin Luther King’s plea to come south in support of civil rights following “Bloody Sunday,” when peaceful protestors were attacked by police dogs and blue-helmeted troopers wielding rubber hoses wrapped in barbed wire during a non-violent march toward the Montgomery statehouse.

As Reeb walked out of the Blue Moon café in Selma with two colleagues, the three clergymen were attacked from behind.   Reeb, a father of four from Boston, died of a broken skull soon afterward.

Three men--Elmer Cook, William Stanley Hoggle and Namon O’Neal Hoggle—were tried for murder before an all-white jury after African Americans had been systematically removed from the panel.  One of the jurors was the brother of a key witness for the defense.  Two of the jurors told the judge they despised white activists who shared meals with blacks, but were allowed to sit in judgment nonetheless.   The attorney for the defense told the jury during the trial that “certain civil rights groups have to have a martyr, and they were willing to let Reeb die,” as if the real guilty parties were the NAACP and King’s Southern Christian Leadership Conference.  Despite these tainted proceedings (or because of them), all three defendants were declared not guilty.

Reeb’s murder shocked the conscience of the nation.  Four days after he died, President Lyndon Johnson presented the Voting Rights Act to Congress, which brought the ballot to millions of formerly disenfranchised citizens of color.  For the first time, there was fair representation at the polls.  Selma added 7,000 black voters to its registration rolls, and the sheriff who presided over the brutality of “Bloody Sunday” was voted out of office.

But justice at the ballot box and justice in the courtroom are two different matters.  In recent years, there has been a renewed effort to pursue Civil Rights era crimes across the span of decades.  Edgar Ray Killen, for example, an 80-year-old former Klansman, was convicted in 2005 and sentenced to 60 years in prison for his role in killing three civil rights workers in Mississippi and burying their bodies in an earthen dam.  Four years ago, Congress passed the “Emmett Till Unsolved Civil Rights Crime Act” to encourage the U.S. Department of Justice to race the clock, bringing belated charges against the perpetrators of heinous crimes like the lynching of the fourteen year old Till—the boy allegedly was seen flirting with a white woman--before time runs out.

With that aim, the FIB announced a year ago on March 11, the anniversary Reeb’s  death, that it was re-opening the case.  At least one of the men who was charged with attacking Reeb and his friends remains alive and at large.  But when I phoned the Bureau and spoke with Greg Comcowich to learn if there had been developments or progress made, he told me that the investigation had once more been closed. So there is a strong possibility that at least one of James Reeb’s murderers is still walking free. 

It took the all-white jury just 97 minutes to acquit him, back in 1965.  After almost fifty years, we are still waiting for justice.