Public Health

People seem to be wondering how the hell a truly national health insurance system would be paid for. What I found out by direct experience yesterday, however, is that we really do already have something a lot like one.

Seven months pregnant, my wife was strongly urged by her doctor last month to get a flu shot this season. As it turns out, this isn’t an easy season to get a flu shot. Because of the bad batch from the UK, the United States has less than half the vaccine it’s supposed to.

By the time I was calling the various doctors’ offices and hospitals, I was told there was no more flu vaccine to be had. The only alternative would be public health facilities, such as the Department of Health Management Services – a New York State facility with a few branches around the city.

The Chelsea branch – in a fashionable district of Manhattan with a high gay population – had already been featured in the news. Old people were waiting for four hours outside in the rain, and then being turned away. The branches in Westchester were already out of flu shot, altogether. It looked like my wife would just have to tough it out with no flu shot – and stop reading those web sites that talk about how the flu can be fatal for pregnant women and their fetuses.

But, as Brooklynites, we decided to take the opposite tack as most flu-shot-pursuers. Instead of looking for a public health facility in the best neighborhood, why not look for one in a place other New Yorkers fear to tread? So we looked up one in “the projects,” which turned out to be the closest one of all of them to our home. We hoofed it over there, and were greeted by a delightful West Indian woman presiding over a room filled with people of color, getting their flu (and other) vaccinations. We were number 124, and managed to get her through the whole process in a little more than hour. (fyi, very old people, people with chronic potentially fatal illnesses, and pregnant people are the only ones who are allowed flu shots under the rationing provisions – which seem to be fair and working)

As I stood there (all the chairs were taken) reading some of Bush’s attacks on the Kerry health plan as unaffordable, a woman from the Department of Health came up to me and asked if I had health insurance – because if I didn’t, she could sign me up for some kind of State health plan to supplement my Medicaid, at no cost.

And that’s when I realized national health is not out of reach at all, but practically happening as it is. The people in the State health office were far more competent and accomodating than the losers in the private conglomerate-owned blood lab we had been to the week before for my wife’s glucose test. And this place was a lot cleaner, too.

Yes, I admit, if my wife or soon-to-be daughter were to get some intense awful catastrophic rare illness, I’d want the best, most reputable doctor to see her. More importantly, I’d want to be able to pay for the treatment that would give her a chance to live but is too expensive to be approved (so I dont’ end up like Denzel Washington in that movie movie where he holds the hospital hostage for his daughter to get an operation).

But as a safety net, a national insurance plan is not at all out of reach. The best sort of plan would even take catastrophic illness into account, and pay for it out of a central fund. Indeed, a problem with as much mutual liability and mutual responsibility as public health may just be best addressed through public policy.

Insurance is a collective act, not a private enterprise.