Heath Care Reform

I have for years been frustrated with this country's medical system - the ever-escalating costs, the long waits, the seeming avarice of insurance companies, and the uneven distribution of services. I have written more than my share about Medicaid, the health insurance system for poor people, which at times has threatened to swallow up the state budget, as well as that of many counties. The feds pay half of the $46 billion program in New York, while New York City, the counties and the state pay the rest. The rise in costs has been inexorable over the past few decades since it was created in 1965. I also understand that Medicare, the program fully-funded by the federal government for health care for people over 65, isn't sustainable with us boomers about to tap into it, instead of supporting it with deductions from our paychecks. But now that I'm a major consumer of health care services, my perspective has changed.

We are embarking tomorrow on a series of meetings over the next two weeks with a number of cancer specialists, both in Albany and Boston. We are going to get first, second and third opinions on just where we should go from here in terms of my treatment. It will be all or mostly paid for by my company-provided health insurance, which now seems to be not only generous, but what I deserve after working most of my adult life for Gannett. Company representatives have been incredibly helpful and efficient as I have gone through this process.

Under a more rational, cost-effective system, such redundant consultancies probably would be banned, or at least I would have to pay for them out-of-pocket. To us, however, these consultancies don't seem at all redundant: we're eager for any scrap of information that might improve my chances of recovery. We went through a similar, but more hurried process, when picking a surgeon, and ended up having a well-known, experienced doctor from Beth Israel Deaconess Hospital in Boston do the operation, instead of a less-experienced doctor in Albany.

At a recent college reunion, Emily was talking to one of our Colby classmates who spent his career as a physician. He said that under any plan to provide universal coverage those now at the top of the pile are likely to get less care, and those at the bottom more.

That sounds pretty good theoretically, unless you end up in a spot like I'm in.

Now I'm a hungry consumer who has already devoured tens of thousands of dollars worth of health care. And poised to use up a lot more. It's not fair, but because I have held a steady job with a big company for 35 years, have accumulated some money, and have strong advocates working on my behalf, I have access to top-quality care. I may turn out to be one of those people on whom 90 percent of their health care expenses comes in the final year of his life.

The whole point of these consultations and treatments, of course, is to turn the clock back on that final year as far as possible.