An ounce of prevention is worth a three minute bout.

When I heard about the health care package that goes into effect in ’14, I didn’t understand all of it (I still don’t, and really, who does?), but what I did understand, I was okay with.  Mostly,

I was happy that the nation was at least talking about health care and the importance of making it more accessible to people.

The part that always sold me on it was the “don’t exclude people with pre-existing conditions” thing. I have a strong memory of another life before health insurance: I having seizures that I couldn’t get under control and working three crappy-I-just-finished-undergrad jobs to support myself, made more difficult because I was also paying for blood tests, surprise hospital stays and crappy medication out-of-pocket.  I was turned down for Medicaid, and just got by on Patient Assistance Programs. It sucked.

So, if we can fix the system so that someone else doesn’t have to go through this, I’m all for it.

Then this happened: A nurse who works at the clinic in my building stopped by and asked us case managers to be sure to refer people to the clinic’s health insurance program.  “Because after 2014, you know,” she said, “they’ll be penalized if they don’t have insurance.”

Before I even knew that was happening, a little internal Mayhem Miller stepped forward, pounding gloves together and said “WTF?  How the hell is that gonna work?” I thought about my guys (especially the super sick ones) walking around with this fine over their heads, unaware. They don’t know that some people are choosing to pay the fine as a political statement, they don’t fit into this category. They don’t even know that the health care rules are changing.  It made me think hard about if this really is a good thing.  Might this become another “systemic injustice” that I’ll want to blog about next year?

I don’t know. I hope not.

I talked with some colleagues, one of whom brought this up: Most of my guys don’t have insurance right now and they don’t get medical care unless they’re desperate, in which case they go to emergency rooms for their primary care, and when they’re injured or super sick. Which they can’t pay for it. So not only do they have charges hanging over them (ones they know about) they are probably sicker than they would be if they had regular care. I can’t help but think that, economically and in the long run, this has to be cheaper for all involved.  Am I wrong on that?  What do you think?

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