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Not all chronic health conditions are brought on by personal choice

I often walk to Whole Foods in St. Paul to get lunch. It gets me a one-mile walk and what I consider to be a pretty healthy lunch. The store also sells the best gluten-free bread I’ve been able to find.

I often walk to Whole Foods in St. Paul to get lunch. It gets me a one-mile walk and what I consider to be a pretty healthy lunch. The store also sells the best gluten-free bread I’ve been able to find. But I’ve limited my shopping to those couple of things for quite a while now and may have to reconsider even those.

I know Whole Foods isn’t a co-op, and far from it. I know it ships food in from all over the world, so it’s definitely not local. And I’ve heard complaints from our own community-supported-agriculture farm about its dealings with Whole Foods. Now its CEO, who seems to have a penchant for mouthing off in bizarre ways, has written an op-ed about the current health-reform debate that rubs me wrong in several ways.

Removing all of the manufactured, wild and often downright insane accusations that are flying around about the proposed congressional plans — because we all need to remember that Obama himself didn’t put forward a plan, simply the requirement that something be done — you’re left with some of the fundamental things people bicker about when it comes to health care. What type of plan is most fair? Who will pay for it? Why should I pay for someone else’s poor choices? Why not let the insurance companies, who obviously know the business, remain in charge of things? Does everyone deserve insurance?

One of the consistent refrains is, “Why should I, as a productive member of society, have to pay for the care of someone else who’s made bad choices?” That one really gets me going. As someone who’s lived for over a decade with two chronic conditions, primary lymphedema and Crohn’s/colitis, caused by some perfect storm of genetics and not by my own lifestyle, it hits a very tender nerve when people assume all chronic conditions are brought on by personal choice.

In fact, for me things are quite the opposite. I’ve managed to remain out of the hospital, have not required surgery, and have made difficult personal choices such as removing gluten (all wheat products such as bread, pasta, and baked goods) from my diet to improve my conditions. I take my medicines religiously and always wear my awful, ugly compression socks, even when the heat index is 105 and I wish I could wear a skirt, just once, on a nice summer day. I’ve never asked why. I’ve rarely complained. I’ve always paid for this on my own. And I’ve always kept a full-time job so that I can be insured, even though there are many other things I’d like to do and that would likely help other people more than what I currently do.

Uninsurable in private market
I’m one of the 36 percent of the population that is uninsurable privately. And it’s very probable that most in my small family are for one reason or another. This, despite the fact that we all live lives that are healthier, I would bet, than quite of few of these folks who would call me “unproductive” and a “burden on society.”

A good friend of mine who has Crohn’s and was very ill last fall has an HSA through work with a $2,500 deductible. As a raw cost, the medicine we take is $250 per month for the middle dose (six pills per day). Her doctor wanted her to be on the maximum dose of 12 pills per day to try to get her disease under control. She couldn’t afford to do it. She’s been rationing her pills for months, taking less when she’s feeling OK and then upping her dose when she’s not feeling as well.

It’s a vicious and self-perpetuating cycle, because when you low-dose yourself, the disease begins to take hold again. She continues to work through all of this. She worries she’ll lose her job if she doesn’t go in to work because she’s one of the last left in her position; several others have been laid off in the past year. Recently, she finally reached her $2,500 deductible for the year, so now she’s getting the maximum prescription and hoarding pills until the end of the year in case she gets laid off — or so that maybe next year she can consistently take six pills per day.

Another friend has an HSA through his work and a 5-year-old. When his boy gets sick, he has to make a decision that he’s not really qualified to make: Is it a cold or is it something that needs medicine? Why? Because the 10-minute doctor visit will cost around $200 and often he ends up being told it’s a virus and there’s nothing to be done. So he ends up only bringing his boy in if his fever gets over 103 degrees, and he never goes to the doctor himself (even one time when he had stabbing pains in his foot for a week — and he’s on his feet all day at work).

HSAs are no answer for (fill in blank)
So when people say HSAs make consumers aware of the costs of health care, I don’t disagree. They do that very successfully in many painful ways. But they certainly don’t work for people who have chronic conditions (these days, that’s nearly half of the U.S. population), mental health issues (or anything else requiring regular medication), children, or a whole host of other “anomalies” that are the whole reason for having insurance in the first place. All of these things force people to make what are often poor decisions about preventive and maintenance care, leading to greater costs down the line.

To say there’s no rationing under our current health-care system is ludicrous. It’s rationing done by hard personal choices every day to extend the often terrible coverage people have. And to assume that insurance companies have anything but their own bottom lines in mind when decisions are made about coverage is to assume that Wall Street was looking out for homeowners when they shuffled mortgages around in the dangerous shell game we’re now all paying for.

Health care needs to be rationed. That’s the ugly truth of it. Why? Because humans, and perhaps Americans in particular, have a tendency to take as much as they can get. We need realistic limits.

To say we’re not already paying for the mess of a health-care system we have is to not be informed of how things are actually covered. Medicare and Medicaid are, as everyone should know and understand, government-run health care systems. So is the coverage offered to veterans through the Department of Veterans Affairs. Many of the folks squawking so loudly about “not having socialized medicine run by the government” are in the same breath saying “don’t you dare take away or ration my Medicare.”

We’re all paying for uninsured now
How do you think we all pay for the legions of uninsured who, since they have no option for preventive care, end up in the emergency room of county-run hospitals? Well, since they’re run by the counties, you can bet we’re all paying for that. Wouldn’t you rather pay to keep someone healthy and out of the ER? I know I would. It would cost less and they’d have a better quality of life.

To those who would say the rich should have better coverage than the poor, I say sure! You can buy as expensive a plan as you’d like on top of or in place of the standard one that covers the basics for everyone. Who said supplemental plans for those who can afford them is a bad idea? I’m sure the insurance companies will come up with hundreds of indecipherable options to choose from for those wealthy enough to purchase one.

I hope that someday I’ll be living in a country, this country, where the people care nearly as much about their neighbors as they do about themselves. Where the question isn’t always “how will this impact me?” but instead “how will this benefit us?” The selfishness of our nation is an embarrassment deserving of its own scale of measurement.

Jess Durrant, of Minneapolis, is an interactive producer & strategist.