One huge reason to care about health care reform

It comes down to this: people who can't afford health insurance don't get any. People who can't afford health care ... get it anyway. And guess what? You're helping to pay for it.

Insurance companies generally make decisions when all is relatively calm. Even a time of crisis for an insurance company is a slow-motion crisis, such as deciding whether to cover ongoing cancer treatment. It lacks the urgency of a bullet hole in the chest, for the insurance company at least, if not the patient. Rarely, if ever, do people writhe, retch, seize, or bleed on an insurance company's floor. But they do exactly that in ambulances, ERs, and ICUs every day. Insurance companies enjoy the luxury of saying "no." Hospitals do not.

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Those writhing, retching, seizing, bleeding patients get treated. Thank goodness, despite the egregious deficiencies in our approach to healthcare for all, we don't just leave people to bleed in the street. They get treated even if they are poor and have no insurance. They get treated even if they are not poor, but self-employed and uninsured. They get treated even if they are unemployed. They get treated if they can't afford their co-pay or deductible. They get treated in an emergency no matter what, and the bill comes due later.

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But when it does come due, it doesn't get paid. So hospitals-which have to say yes when insurance companies say no-simply have to absorb those costs. In what other industry do you have to provide services to those who can't pay for them?

Hospitals may try to pass on their uncompensated costs to the rest of us by charging more for their services than they otherwise would. These charges are passed along to insurance companies which, of course, pass them along to us by hiking our premiums. Are you worried about paying for the care of the uninsured out of your taxes? You are already paying for that care right now out of your insurance premiums.

But since the uninsured and under-insured don't seek discretionary care, they wait for a real crisis. Often, a crisis that need never have occurred with that earlier, discretionary, less expensive preventive care they don't get. This is not theoretical; I've spent years in these trenches. I've seen those unnecessary calamities up close. They wait for a crisis-and the huge bill that comes along with it. And then all of us pay that bill.

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It's a tax, but not called a tax. It's a tax over which we have no control, a tax not subject to our vote, a tax that is insidious, invisible, and unidentifiable. And, it's a tax that pays for the worst possible kind of care-crisis intervention for preventable crises. And, yes: it is taxation without representation (unless you have a friend on your insurance company's board of directors who cares about representing you). Health care premiums bloated by the unpaid bills of the uninsured are a tax, and you are paying it now.

For better or worse, insurance companies have more than one means to deal with hospital charges. They can, up to a point, pass those expenses on to us. But their other option is to refuse to pay them in full. Hospitals charge Y, and insurers pay X. Once again, hospitals are left to absorb the difference. Why? Because they don't have the luxury to tell a patient retching, writhing, seizing, bleeding 'Y' to just knock it off when they get to 'X.' "You've met your insurance company's quota for hemorrhaging- stop bleeding now!" doesn't seem to work.

The so-called health care system in this country is a travesty, a daily violation of human rights, a quintessential example of taxation without representation, a farce, a tragedy, a violation of the humanistic principles on which our nation was founded, a national embarrassment. It kills people daily. Sometimes, it also kills hospitals. And when it kills a hospital that was doing a good job at saving lives, it kills more people.

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