DON NOLLET: The doctor might see you — eventually

Quite a few years ago now, my wife fell on the street while crossing, and jammed her little finger on one hand. Considering traffic and darkness, it certainly could have been worse. The local clinic, operated through the Mayo system, gave her an appointment with a GP, but that doctor decided a specialist should be consulted, so we got scheduled in Rochester. During that visit, despite the fact that all rehab would happen in Owatonna, each specialist wandered through, be it rehab, surgical, x-ray or otherwise. Ultimately, a splint plus some strengthening after it was off was what was needed. Her insurance through employment, Health Partners, while quite good for most things in-network, didn't cover some of what Mayo required. Ultimately, we paid about a thousand dollars out of pocket, for a jammed finger.

While that's not a huge figure, and I'm glad we have medical coverage, I can only imagine what it might cost the uninsured. That's an even bigger question, because I've fielded stories regarding what a hospital charges someone WITH insurance versus one WITHOUT insurance. As it turns out, sometimes it's better to NOT have insurance, because you are charged less—and remember, insurance costs monthly, so that figure needs to be added in as well. While a thousand dollars over several months isn't a major disruption to our budget, I know plenty of people it would break. We aren't eve talking about major surgery or extensive treatments, which are the single largest reason for personal bankruptcies in the United States.

My brother, who lives in Japan, gets an annual checkup as part of the routine medical care. Anyone with common sense knows that "an ounce of prevention is worth a pound of cure", an adage antedating my own existence. My wife's sister lives in Japan, and when her mother-in-law was placed in "memory care", she was housed, fed, and treated (exercises) for approximately $400 per month, depending on how the yen floats against the dollar. Here that level of care runs between $5,000 to $12,000 monthly, as if it was necessary to extract the maximum amount of remaining wealth from each person prior to death. And, it's an easy search to find stories of American tourists in European countries who find that many operations cost far less there than here, because most modern countries, especially democracies, consider medical care as both an essential human right and part of the proper, humane way to run a society for the good of all.

I know people in medical supply companies who tell me how difficult it is to walk people through various insurance programs to see what items are covered, at what prices under individual programs, and what percentage of that is allowed. Doctors, too, often spend as much time filling out forms for insurance, each one different, than performing actual medical examinations. Our current system is estimated to have 40% of all payments cover just these administrative costs. Countries with universal medical coverage spend about 2%-3% on administration. That's a lot of money available for treating patients.

What escapes many regarding our spotty coverage, is the ultimate unfairness to the individual or small businesses, vis-à-vis larger corporations. Ask anyone familiar with actuarial science what the per-capita insurance cost is for a huge corporation versus a mom-and-pop shop. The laws of averages play out in favor of the mega-business, giving them a cost advantage over individuals. That's why we so often see an independent businessman—farmers are the classic example—have a spouse that works as a nurse or teacher, just because the insurance industry is usually required to cover a spouse. And, yes, just look up what some farmers pay out of pocket for insurance when that benefit isn't in play. As my brother points out, universal coverage in Japan is why a family can exist running a small noodle shop, because the medical insurance burden is better distributed. No doubt, much of that is true in Europe, as I am told by any variety of visitors, including foreign exchange students.

Prior to the early 1970s, most medical coverage was doled out as a charitable act, with money to cover incidentals usually being quite affordable. Mayo Clinic started when some nuns began helping after a tornado, and saw the need to coordinate medical assistance. They work for very little. Go ahead, check a hospital stay form 1950. Even when you multiply that figure to offset inflation, we still pay far more than before. The theory was that competition would lead to market efficiencies, but the reverse is true. Now the shareholder and an overpaid management team make the decisions, not communities, doctors & patients. That's why rural care is slowly faltering, especially in specific fields, like OB-GYN. Not enough people in a draw area to justify the expense. And don't tell me that universal healthcare isn't possible in the wealthiest country in the world. No country that has it has decided to reject it. If we can cover our Congressional members for life, we should cover those they represent. Or, vote them out.