Every day, science is moving us closer to personalized health based on our own genetic makeup. The government is actually part of this progress – http://www.hhs.gov/myhealthcare/ – which is why I’m a little stymied by the concept in the health care bill of having a Health Choices Commissioner in Washington, DC deciding on a one-size-fits-all insurance coverage for preventive medicine. I’m not talking about catastrophic coverage; I’m talking about the preventive components defined as essential basic insurance, which currently includes at minimum the items in the Task Force for Clinical Preventive Services grade A/B - e.g., HIV screening, tobacco prevention counseling, and aspirin – as well as vaccines, maternity care, well baby and child care, oral health, vision, and hearing services.
Every law-abiding U.S. citizen will be required to purchase this level of insurance, which necessarily takes away choice in a very simple way. Consider the two scenarios below:
Scenario 1
Lila works at the computer 8 hours every day at her primary job and another 3-4 hours every night for her second job. So her risk for repetitive strain or related injury is nearly 100%. She had numbness in her hands and a physical therapist recommended her to get regular massages to reduce the strain in her neck and back, on top of the stretches and exercises for her arms and wrists.
She suffers from anxiety and depression, or what she views as just plain stress, which contributes to her weight and her blood pressure, which are of course contributing factors to other potential health issues. Exercise and meditation keep the symptoms at bay enough so she can avoid prescription medications and their known and unknown side effects. But it’s a vicious circle that makes it difficult to keep up a regimen without an external commitment.
Finally, based on information that she has read in reputable medical journals, she believes that pesticides and preservatives may increase her risk for health issues suffered by others in her family. So when she has extra money, she chooses to shop organic.
Lila is otherwise healthy. Due to a bad experience in the past, she hasn’t been to the dentist in 15 years, choosing instead to take meticulous care of her teeth, such that she doesn’t have a single cavity. She has no intention of ever getting a cervical exam; she has accepted the possible consequences. For minor maladies, she prefers home remedies to going to a doctor.
So with her limited budget, she has chosen catastrophic insurance with a high deductible, to cover any huge unforeseen circumstances. This has the lowest premium so her health budget can include periodic massages, organic food, dance lessons, and books on holistic medicine.
If the current health bill passes, she will surely pay a higher premium because her required coverage would include universal preventive care such as dental visits, gynecological exams, and other screenings that she will never undergo. Instead, she will have to forego some of her personalized health choices.
Scenario 2:
Bill has recently discovered that he has the gene for ALS. There is no treatment for ALS. Although it is not certain he will develop the disease, he has already started to experience the same early symptoms that he saw his father and brother go through. He would rather die of a heart attack or a car accident or a hundred other common maladies, so he has decided that he will exercise what little control he has and never go to the doctor or the emergency room again. He has filled out the paperwork and his wife has agreed. Yet to be a law-abiding citizen, he will still have to pay for the government-mandated health insurance instead of putting his money toward long-term disability insurance or a daily living fund for his wife after he becomes disabled.
His wife is barren, so fortunately they don’t have to worry about their children inheriting the gene. But she will still have to pay for insurance that covers maternity care, well baby, and child care rather than grief counseling.
Both of the scenarios above are real people. I’m sure you know others. In fact we could come up with a real-life scenario every day for the rest of the year in which mandatory preventive insurance will directly trade off one individual’s personalized health choices in favor of someone else’s general preventive care. Whether intentional or unintentional, the consequences are the same, and deeper than the surface of the bill. Again, this isn’t about the part that keeps people from going broke if they get sick; this is about the scope that extends beyond catastrophic care and pushes the boundaries of freedom.