(HOST) Commentator Deborah Luskin used to manage a medical practice that went out of business – because they could no longer afford health insurance for their employees.
(LUSKIN) Usually, when you go to a store, you pay at the door. Rarely do you take what you need and expect someone else to pay – unless you have insurance and what you’re purchasing is health care.
It wasn’t always like this. But one of the things that has precipitated our current health care crisis is the de facto health insurance reform that has evolved since our collective failure to pass true health care reform during the twentieth century. Instead of taking control of the health care delivery system, we have allowed the insurers to take control – and to profit from – our lack of political will.
For 16 years, I managed my husband’s medical practice. The "Mom and Pop Doc Shop" I called it, because it was like an old-time general store. But like a lot of small proprietors in Vermont, we had to work harder and harder for diminishing returns, until finally, we closed.
Unlike the general store people were not driving by our office in favor of a larger health center the way they drove past local stores in favor of big box chains. Our practice was booming. No, what put us out of business was health insurance.
Our small business had five employees, including me. We always made payroll, but there were weeks when the doctor didn’t get paid. But I did, so at home we squeaked by. We also bought health insurance for ourselves and our employees. But as insurers continued to decrease their payments for the medical services we provided for their beneficiaries (our patients), they also increased their premiums. Ironically, one of the contributing factors for closing our doors was that we couldn’t afford our own health insurance anymore.
Ours is a single case, but indicative of how difficult it is to be a small business that provides health insurance to its employees and how difficult it is to be in the business of providing primary care. Because of Americans’ stubborn refusal to shoulder the expense of universal health insurance, we have evolved a system that costs more, insures fewer, stymies employers, and handcuffs employees to their jobs.
I’m sure that there are some industries where size matters and where economies of scale make sense. Health care is not one of them, especially not basic, primary care.
Primary care depends not only on money and medical science, but also on human relationships. Few of us want to undress in front of strangers, fewer still maintain health or develop illness in isolation. Our health, just like our job, our kids’ education and the roads we drive, are part of the community in which we live. Primary care is community care. If we all pay for it – it’s something we can all share.