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Well or Ill? It depends on how you feel and who you are


Well or Ill?
That is the question.

People politely ask, “how are you?” as a standard part of almost any opening conversation. Most of them probably do not really want to know. Let’s assume my readers ask, “how are you?” I would say,
“I have been under the weather,” the euphemism for not feeling well (enough to be on the computer) recently. Except to check e-mails every day, I have been “out of the information loop,” as the cliche goes. You are probably not interested in knowing that either.

These rituals of conversation are well known to most of us. And do you notice how much oblique language I have been using to describe my current state of being? But now I’m offering some plain talk about what happens to each of us when we get sick.

We stand in different lines for health care. A few reflections on being well or ill in the United States –
Based on a series of our traits and capacities, access to healthcare is often arbitrary and discriminatory. In my opinion, separation is all too often political/class/ethnicity/age/gender-based. Your experience with help for health care from your government (federal, state or local) may be very different, depending on the group/groups into which you fit.

  • Individuals or families without health insurance – people are pretty much on their own, except for those kids who can qualify for a CHIP (Children’s Health Insurance Program). This amount varies from state to state.
  • People who have health insurance with affordable premiums – These folks have a huge advantage because government provides certain requirements and/or rewards for employers who insure workers and their families.
  • Those who have very high cost/low coverage health insurance – If these peoples’ employers know to do so, they may be able, at least, to shelter the costs of insurance from taxes. But not everyone does this. These financially strapped workers and their families will likely be very unwilling to seek medical care because of high deductibles or co-payments.
  • Seniors on Medicare – All people over the age of 65 are tremendously advantaged, by the financial support for good health care, of their younger fellow citizens throughout the remainder of their lives. It is amazing to me that they do not express more resentment or revolt against this increasingly heavy burden. Perhaps they personalize the sacrifice as applicable to their parents or grandparents only.
  • Seniors, children and others in poverty on Medicaid – Very strict income guidelines mean many “working poor” make to much money to receive government financial aid for health care. Other factors include age, and how much your state allocates for its match for federal funds, and whether you need mental health care.
  • Women and men – Government support for medical research has traditionally favored men, only because so much of the research in the past studied more male cohorts than female. A bit of progress is being made here, though women have not yet achieved parity.
  • Ethnic minorities – If you are a minority you may make less money because of discrimination. Your access to health care may be more limited and of lesser quality. And health issues common to your ethnic group may not “make the government subsidized research radar screen,” only because rich conservative white males make so many of the governmental spending decisions.
  • Documented or undocumented immigrants – the extremely wide variance of access to health care by undocumented workers depends on the state in which you reside. Federal spending match to states for health care for undocumented workers outpaced their contributions to the system; the variance is wide state by state.
  • People living in urban or rural areas – At the federal level, help to rural health care programs has diminished over the years. Distance, quality and needs make access to health care vary widely by where you live. Some predominantly rural conservative state legislatures do not see the issue as a priority. In other conservative states, dominant urban lawmakers may forget their rural neighbors. Many doctors do not want rural practices with limited hospital support.

Your level of health care in the United States depends on who you are and where you live and work. The government is in so many ways the gatekeeper at the beginning of where the lines form. In which line or lines do you get to stand? It is not totally your decision to make. There is one decision you do get to make, however.

For whom will you vote in the rest of 2006?

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