Why National Health Care Is Necessary for a Viable Food System
Sharon June 8th, 2009
A while back, at a talk I gave, a small scale farmer asked me why my family didn’t farm full time. I observed that one of the reasons we don’t is simply that we have young children and we feel that we have a need for benefits. He pointed out that my state, New York, has a program to provide health insurance for the children of the uninsured, and that we could rely upon that. My own observation was (beyond the fact that I prefer not to burden state safety nets if we can avoid it and the insurance provided is vastly inferior to the one we have now) that I do not expect that program to continue for very long, and thus, we would not give up my husband’s existing benefits to switch to a state program that I suspect will at some point be cut in the vast rush of states to cut social service programs to balance their budgets. While I suspect that my husband’s university may also eventually cut benefits, I’d still say the odds were a little better for hanging on to health insurance via his job.
And, of course, we can see that other states are leading the way here – most notably California, which plans to resolve its budget crisis not by legalizing pot or releasing non-violent drug offenders, by stripping benefits from children, the disabled and the elderly. But California isn’t alone – children’s health care is threatened or there are pushes to curtail it in nine other states, and I suspect it is only a matter of time before more states make the push to cut health care programs for children and the working poor.
Now with luck, the state budget cuts won’t matter all that much – if we can pull together a functional and meaningful national health care system. The problem is that that’s a bigger “if” than it may seem. Besides the endless debate about what type of national health care system to provide, there’s the very real possibility that our enormous deficits and bailouts may have made it truly impossible for us to have a system that looks like the one we have at present, and is sustainable. Even if we can implement national health care, the question becomes whether we can sustain it over the long term, as our demographic situation shifts towards an older and sicker population, and our national economic, ecological and energy system puts us closer to crisis. So far, as far as I can tell, most of the proposed programs for national health care do comparatively little to regulate costs, and assume levels of growth that we simply may not see.
In _Depletion and Abundance_ I included a chapter on health care – on the ways that could keep national lifespans up and spend much, much less than we do now – half as much or even less than that. It involves a great deal of system triage and difficulty, but it is possible – and IMHO, in the end, as long as we imagine that the goal of national health insurance is not keeping infant mortality low and lifespans high, but the serving of people accustomed to a large range of drugs and interventions with as may drugs and interventions as possible, we are facing trouble.
And yet, we need national health care desperately – we already have a tiered class system in the US where those who are poor and lack health insurance get sicker, die younger and suffer more. We already have a lifespan pathetic in the developed world – we are 44th, and lifespans are declining in many poor counties in the US.
We need national health care because otherwise we will see that class division, and the differences in lifespans and infant mortalities between rich and poor grow and grow. We need it because our current system is too costly and devours too many resources in every sense. We need it because it is a basic issue of justice, and because having the crappiest medical care system in the developed world is not an honor. We need it because we already bear the costs of medical care for the uninsured in our society, both directly and indirectly – we all pay for the poor mother who takes their daughter to the ER in the middle of the night for an ear infection that could have been handled with a ten minute office visit. We already pay for the people who age into Medicare with uncontrolled diabetes and high blood pressure, whose medical costs are double the costs they would have been if they’d had basic preventative care. We already pay – the question is whether we pay honestly and directly, or inhumanely and dishonestly.
But we need national health care for another reason as well. We need it because we need sustainable food systems, and national health insurance is the key to ensuring that we can have the Nation of Farmers we so desperately need to be. Because one of the things preventing people from farming, one of the things small farmers off their land is the cost of medical care.
Nationally, a survey showed that farmers pay twice as much out of pocket for health care as the average American. Most farmers large enough have to buy their health care coverage as individuals, driving up the cost, and because of the risks of farming, their premiums are higher than average. Others have no insurance, and have to put their insurance on credit cards, or pay with their savings. The average US farmer is nearly 60 years old, and many have pre-existing conditions that come with age – either forcing insurance costs out of reach, or driving them up. No wonder so many of today’s farmers, when polled, say they wouldn’t want their children to follow in their footsteps – but that leaves us with the very real question of where the population that grows our food will come from.
Among younger small farmers getting started, I’ve watched many of them struggle with the insurance conundrum – they start out young and healthy, and often are willing to forgo health insurance because they truly and honestly want to do something good. But farming pays poorly, and the first serious injury can be a disaster – and working outside all day, you get hurt sometimes. Or perhaps they have a child – even those able to take on a homebirth find that the cost of having a child is a few thousand dollars or more – on a small household income. Those who must have a hospital birth or more interventions can find themselves rapidly indebted. Soon, finding a job with health care coverage starts to look awfully good – and there goes the farm, or it goes down to a part-time venture.
Farmers who experience a major injury or illness risk losing their land to bankruptcy – while losing your home is always traumatic, there’s a big difference between losing the house you love but that mostly provides shelter and a good school district, and losing the land you use to make your living. Up to 10% of all agricultural bankruptcies are linked to illness and injuries - mostly among the uninsured. Once the land is lost, it is gone – most farmers once out of agriculture, are out for good.
Without a national health care system, we can become a nation of hobby farmers and victory gardeners, but that won’t resolve the grain production problem, and it won’t feed our cities. A lot can be done by home scale agriculture, and I am an ardent proponent of it – but we need professional, full time farmers as well, and without insurance, the lure of any other work that covers the child’s asthma medication or the husband’s heart pills will always drive agriculture. What parents wants their child to go into a profession that leads in so many ways to heartbreak and loss at so many levels – including the fact that one medical crisis is the end.
We have spent four trillion dollars bailing out the banks already, and committed another 9 trillion at last estimate. Now whether you are a fan of big central government or not (and I’m not for many purposes), I think there can be little debate between honest people on the left and the right that the money would have been better spent serving the needs of people in need than bailing out the banks. And we simply cannot allow our venal foolishness in subsidizing the rich to allow us to forget that we can and should take care of the basic needs of the population.
It is certain that there will be costs and losses in whatever system arises – in _Depletion and Abundance_ I strive to acknowledge that we cannot do all the things we do at present, and that will hurt some people. That said, however, enormous cuts could be made in the costs we incur at critical times in our lives – for example, 1/3 of all medical interventions take place in the last 3 years of life. Some of that is inevitable – someone who gets cancer, has major interventions, but then dies two years later will fall in that category. But an enormous number of those interventions operate simply to draw out the process of death and add to suffering – my great-aunt, visibly dying, was pressured into having open heart surgery a few months before she died, simply because no one would say “you are dying, it is time to talk about relieving your pain.” My husband’s grandmother was pressured into giving her dying husband medications to prevent a heart attack that caused him great discomfort - at a point where a heart attack was the most benign and merciful sort of death possible.
Even if we were simply to radically cut back our interventions at the time of death and birth – for birth too is radically overmedicalized, and many nations successfully demonstrate that the safest form of birth, barring medical complications that affect only a small percentage of the population, is home birth with a midwife – and shift our emphasis not to treating disease, but to preventing it, we could afford health care that would keep lives long and infant mortality low, that would minimize suffering and allow us to keep our farmers farming and every other useful person engaged in subsistence and cottage industry business going, doing what we desperately need – increasing the self-sufficiency of our nations, states and communities.
Few of us think of the debate on health care in terms of food security and our agriculture – but we are on the cusp of a great shift in our food system, mostly driven by demographics. The average age of US farmers is approaching 60 years old, and there are not enough young farmers to follow them. If we do not make it possible to go into farming a profession – if we make it only the province of the young, the healthy, the childless, we risk facing a national food crisis far more acute that the one shadowing us due to other causes. The reality is that all of us have a real investment in our country’s continuing to produce sufficient food, and the right kind of food – and that investment requires that it be possible to become a farmer without sacrificing your health.
I do not doubt that we will struggle to afford the kind of national health care system being discussed right now. I do not doubt that we will find ourselves at some kind of impasse at some point in the political process. I do not doubt that our spiraling debts and unfunded mandates will stress our ability to provide health insurance – but we should not believe that this means we cannot achieve health care for the masses that meets most of our basic needs. And that we must do so.
Sharon
- agriculture , health
- Comments(55)
Living in Canada we do have basic health care that everyone is entitled to. You register with the provincal governments, pay your taxes, and you get a health care card. However, the problem here is their simply isn’t enough doctors. period. I live in a small town, and they built a brand new health clinic. I’ve been in it once to put my name on the waiting list, I’m number 1303. It is sort of like the field of dreams…build it and they (doctors?) will come. Ain’t happening. I’ve had to sit in the emergency department for 5 hours to get my son a perscription for an ear infection. Doctors are being recruited to big urban centers by big bonuses, that frankly small and rural poplulations can’t match. There is 1 walk-in-clinic available for approximately 35,000 people. You have to line up in the moring before it opens to put your name on the list, and after so many names, they close the list…your outta luck and have to go to the hospital. GRANTED we don’t have to pay for hospital visits (provided you have a health card) but you will have to wait.
Free/sponsored health care doesn’t do a whole lot when you can’t access it.
oh, a side note if you don’t have a private health care plan (employee sponsored) you pay more for certain services. I know we pay more for perscriptions in Canada than in the US.
Amanda
As a regular lurker on your blog, this is the first time I’ve felt the need to comment. I’m English, and a commonly heard phrase, when someone has needed medical help, is, “Thank goodness we don’t live in America.” There are many flaws in our National Health Service, and it isn’t free in that we pay for it through our National Insurance contributions, but it’s a wonderful system. When people are dealing with stressful events in their lives – illness, accidents or elderly family members dying, the one thing we don’t have to worry about is how we will pay for it.
In Britain, we’re currently in a crisis caused by greedy politicians corrupting their expenses system. Now they’re being forced to look for a better system I wonder why they don’t look at countries which have a system which works. The same applies to your health system. We have one which, despite its problems, works. Look at what we have. But then you might have to pay for it through your tax system.
Health care is such an important issue… and I have no idea how the powers that be will ever come to a working compromise – knowing how our government works, one side will choose far less than we need, and one will choose a dream-world ideal for what we need, and I can only imagine that the compromise will be much closer to far less than we can afford to compromise to. I just don’t understand how the first things to be cut in an economic crisis are health care, education, and social safety – the three things that are vitally necessary – especially with the uncertainty of the economy… I think I’m preaching to the choir…
As for my two cents on a national health care system – the military has a great example of a potential solution – one we could use as a model for the national system. Unfortunately, it would yield very similar problems as Amanda mentioned, such as wait times. I can see some potential benefits, however – if we have a standardized system, then folks shouldn’t (dream-world here) fall through the cracks, there would be a great opportunity for health education, teaching folks about self- and alternative care options (hopefully) folks who might now be considered too ill, injured, or “medically unable” to work, will be able to find solutions to their underlying issues that may have been too costly before (now).
I also think that a system that has high pharmaceutical cost would encourage folks to seek alternative solutions; for example, currently, folks that have an illness or other set of symptoms that can be easily controlled by medication are given just, and only, that – medication, perhaps in a system where medications and companies that sell medications were not as prominent, patients might be more inclined to seek solutions rather than treatments – e.g lifestyle changes vs. medications. I know this is not an option for many people – but there are quite a few conditions where lifestyle changes can reduce or eliminate the symptoms of the disease or illness just as a medication would, but medications seem to be preferred ’round here.
Perhaps an incentive that could be offered (other than money) would be time. Three doctors share one or two full time jobs, but each receives full pay… probably not near the bonus that the city doctors get, but for those of us inclined to live outside cities – time is usually much more important than money (once a reasonable level of income is achieved…)…
Incoherently,
Erika
Sharon,
You’re forgetting one way in which the problem of farmers abandoning farming for jobs with benefits could be ‘solved’: jobs with benefits (or jobs, period) may become so hard to find, that farming without health insurance will look better than the available alternatives. I’m not saying this would be desirable; but do you see any reason to assume that such an outcome is unlikely?
While it would be nice to see a health care system in which everyone receives quality care, I’m not optimistic that such a thing will ever come to pass. Health insurance is a multi-BILLION dollar industry, and I can’t see those companies giving up their profits so that the government can make sure everyone stays healthy.
I grew up without health insurance on my family’s farm. My dad works on the farm and builds homes, and my mom stayed home. I remember only going to the doctor when we needed to for school physicals, and I rarely remember going to the dentist. I do remember the stress on my mom’s face as she wrote a check to pay for the doctor’s visits for me and my two younger brothers. I don’t ever remember my mom or dad going to the doctor, except for when my mom was pregnant. We were just very fortunate that we were generally healthy, didn’t need braces, and didn’t get seriously injured. I realize now that if some emergency had come up, my family could have easily lost our farm because of the debt from medical expenses. Now, my mom and I are both teachers, so our families are insured. In fact, our insurance coverage is excellent. It’s quite a big change from how I grew up.
However, the reality of our situation now is that I will not be able to stay home with my future children. My husband works with his dad as a builder, and our health insurance comes from my job. I will not raise my children without insurance, as I know what kind of stress that can put on a family and how tough it could have been if some medical emergency had come up. It is not only small farmers who need national health insurance, it is anyone with a small, family-owned business. The workers who have trades, skills, instead of or in addition to a college education.
What I’d like to see is a change among doctors. I’ve heard that they can command princely sums because of malpractice insurance they have to pay and all the debt they incurred during school. If that’s the root of high costs (the other being the pharmaceutical industry), what could be done to change the need for malpractice insurance and the cost of education?
And because their fees are so high, what are they going to do when more and more people lose their health insurance because they lose their jobs? How will that impact the number of doctors who can afford to continue to practice medicine? Will we see an out-migration of doctors from places with high unemployment as they themselves look for work?
Is it possible for the small town doctor to exist again?
Kerri in AK
As a US-born person living in Australia, I have always been distressed by the health insurance issue. Like Canada and the UK, we have an imperfect, tax-payer funded universal health-insurance system (with lots of incentives for middle & upper income earners to top-up with private insurance).
Rural and regional areas of course get the worst of it – too few doctors & under-resourced hospitals – but *no-one* has to lose their house or farm because of medical bills.
We will have to change the system, on a fundamental level, for our bankrupt government to be able to afford it. Health care will have to become HEALTH care, not disease maintenance. The “inevitable diseases of old age”- type II diabetes, atherosclerosis, vision loss, etc. are not necessarily inevitable. Research has shown that just eating your greens a few times a week drastically reduces the risk of cataracts, macular degeneration, and glaucoma (the major causes of vision loss in the elderly). What if more people knew this, and started eating properly? What if doctors told people with atherosclerosis about the lifestyle options instead of (or in addition to) whipping out the prescription pad and signing them up for frequent liver and kidney function tests?
Here in TN, with a population with lots of unhealthy habits, we tried to insure the uninsured, and almost bankrupted the state doing so, because few doctors even tried to help them change their habits (they have to pump too many patients through the system to take the time). If the government had to pay for checkups, prenatal care, and catastrophic illness for most people, that might work. I don’t see a way for it to pay for the levels of preventable chronic disease that Americans are currently generating.
One constant comment I hear about National Health is that you won’t be able to chose your own doctors.
When my younger daughter arrived from India, the peditration said, make contact with the Pediatric Neurosurgeon. The woman who handle referals told me the name of the only on in our area who was took my insurance, and we went on a waiting list for an appointment. The referal, good for 3 months, expired, and we got another one, for a different surgeon, because the first one had gone off that list.
We got the appointment, handed down as if by God — you took it or went to the bottom of the list. The apt. took 10 mins — basically he wanted to see and examine the patient, and get information that might be hard to get from a hysterical parent in the middle of the night, since when a shunt goes, its generally an emergency. Dd the younger had never had a revision, and durning years that have gone by, three other doctors have replaced the one covered by the insurance, including, for a period of 2 months, on it Pittsburg (we live in NJ).
(I now have different insurance, which lets me pay a small fortune to see someone off the list.)
At one point, she was scheuled for ENT surgery to repair an ear drum as skin was growing through the hole. That surgeon wanted clearance from the other surgeon 2 weeks BEFORE the surgery, and if I didn’t get it, I’d lose the surgical slot. According the the other surgeon’s office, he’d only suppy clearance for a 2 week window that included the surgery. I spent weeks on the phone trying to sort that one, only resoloved when her godmother, who ran a department at one of the hospitals invovled, took charge.
I can’t imagine things being much worst (assumiong we still had medical care) if I wasn’t allowed to chose our doctors .
Oh, a friend who is pg is going for biweekly scans and fighting not to be induced a week before her due date — the reason for this extra medical attention — her first labor was less than 2 hours, and the doctor is terrified that she’ll deliver before she gets to the hospital and sue him. The scans are to prove that if anything is wrong the the baby it was before this hypothical delievery without him that might lead to a lawsuit. He claims, btw, that he’d be fine letting nature take its but his office manager won’t let him.
NYTimes had an article on general practice physicians making changes and not waiting for “the health care system” to do it: If All Doctors Had More Time to Listen. I’m looking for a practitioner like this in my area!
We don’t have malpractice here as it all goes through ACC. They provide cover for accidents and prosecutions along with funding for permanent injury etc. It is paid for by the public with business levies which are accounted as tax. Each business pays according to the risk factors of their work so forestry for example pays more than IT consultants. It costs us about $500 a year for our 2 man IT business. This covers all sorts of injuries including sports and house injuries, car accidents – basically anything that isn’t a disease.
Everything else is provided through normal taxes. Hospitals are free, doctors visits are part paid depending on your income. Children under 6 are free. Medications provided by the state system are heavily subsidized (I pay $3 for 3 months of asthma medication). If your medication isn’t on the list you have to pay unless you can argue for an exemption.
It isn’t perfect but its probably about as good as is doable in the present economic climate.
viv in nz
As a farmer who pays for his families health insurance to the tune of 1200 a month one has to have a large milk check to cover this expense. It has gotten so expensive lately that I applied for a federal job in USDA. I have been dairy farming since 1972 and had health insurance the whole time because to not have it one could easily lose the farm to one serious illness. Sharon you mentioned health insurance in your 2009 forecast I wonder if you think it could happen because if my memory serves me right you weren’t to optimistic of it coming to pass.
Thanks for bringing up the fact that covering everybody in the country with all of the very high-tech and high-priced options is absolutely not doable. Nobody talks about NOT doing all the bypass operations, all the knee replacements, all the organ replacements, and the truly incredible cost of prolonging death for the elderly in the hospital.
You could pay for wellness and emergency care for one hundred children for the cost of the long drawn out death of one elderly person in the hospital. Almost certainly the elderly person does not want to go through all the procedures either. But to say that our priorities are backwards would be to touch off a real firestorm.
Never thought of this aspect of health care (or lack thereof), but you’re absolutely right.
Because small farmers are also small businesspeople, they are in even greater financial straits if they injure themselves. (And we know the staggering sums small businesses pay for health insurance, those that can afford it, that is.)
However the US chooses to finance a healthcare system, universal coverage in and of itself is a factor in being able to have reasonable healthcare costs, something which conservatives (and too many others) seem unable to fathom.
You might want to check out this post, from March 13 of this year:
http://jenesaisrein.blogspot.com/2009/03/glimmer-of-good-news-for-13th.html, which touches on this observation.
I’m not arguing against the idea of helping people keep healthy. What does concern me, greatly, is the fact that the current approach being pursued by the House of Reps makes it mandatory for everyone to purchase health insurance.
I am uninsured, by choice. Financially, at my and my DH’s age (52 and 55), it doesn’t make sense for us to insure ourselves. We have no children. My DH and I got a quote for insurance a few years back, before I turned 50. It would have cost us $300/month at that time (no doubt, more by now) for high-deductible insurance that would not have paid a single cent until we spent $5,000. Add it up; we’d have to spend over $8,000/year before we’d get paid anything. We have a moral and financial objection to paying a corporation $3,600, which only makes them more powerful and us less so. So we choose to spend that $300/month on higher-quality food and in other ways that really do improve our health and also improve the community as a whole.
I don’t disagree with your point about health insurance making it easier to attract and retain young farmers. Or about health insurance being a social justice issue. But there is so much more involved too. Like what is considered standard-of-care. At my age, standard-of-care is a yearly mammogram. I refuse to have one. The radiation from the test is a known carcinogen. It’s not like a Pap smear, where the screening test is harmless. But when I tell this to an MD, I get a big argument, because the MD is forced, via the threat of a malpractice suit, to do everything in his/her power to get me to take that test. This is a broken system, broken by corporate power. I’m not interested in playing corporations’ games. For this reason I haven’t seen an MD in close to 10 years, though I visit a chiropractor every other month. The chiropractor has time for me and can take care of many of the small ills that an MD would. I’d like to have an MD with whom I had a good relationship in case of an injury or if I were to come down with a major illness, but I need to find one who won’t push me to do things that do not, to me, make sense.
Mandatory auto insurance, which we have in my state, makes sense, because driving an auto is a privilege. I could do without one if necessary, and if I did, I wouldn’t be paying for auto insurance. However, life is not a privilege in that sense. We are here and living. To force us to pay for something called “health insurance” that is really only another way for corporations to make themselves rich at our expense is an abuse of power. At a minimum, any national health insurance program must allow individuals to opt-out without being fined or jailed.
I’m currently without health insurance. I’ve found that going to a naturopath to help troubleshoot problems, and then negotiating with my primary care doctor to be charged less if I pay cash has worked well. The doc referred me to a blood lab which charges 50% less for tests AND COMES TO ME instead of me going to the lab! Another lab will charge 70% less for an ultrasound if I pay cash up front instead of asking to be billed. My primary care doc was flustered at not being ALLOWED to know exactly how much insurance procedures cost so that he could help his patients better. I had to do the footwork on costs, and they really opened my eyes for how insurance companies can be more of a hinderance than a help.
I’m doing my best to eat right, exercise, control weight and stress so that my health expenses are low. Can’t prevent the unforseen accidents, alas.
That article by Christina was very interesting! Kind of a high-tech version of the old town doc that makes house calls.
Correction, article LINK POSTED by Christina. Miss a word or two and it changes the whole meaning. Sorry.
Mea, the issue you cite – not being able to choose your doctor – is an aspect of national health *insurance*. What Sharon proposes is a change to national health *care*.
Medical care in the US is dedicated to optimizing insurance payments, and profit for hospitals and some physician groups. It was insurance plans that dictate a doctor over schedule appointments, so that he doesn’t *lose* any time – and medical care becomes an indirect tax on employers, consuming inordinate amounts of time simply to assure “efficiency” in billing out the doctor’s time.
Likewise, hospitals and insurance companies have planned how to make childbirth “efficient” – i.e., at the birthing room, in the hospital.
Hospitals wail and moan about misuse of emergency room visits. If they cared – it would cease. Simply keep a doctor on staff for office visits around the clock. Simple. The reality is that bogus visits pay the hospital really well.
Sharon, I think you could have been just a bit more explicit that the change needed is actual health care, and that health insurance as practiced today or proposed at the federal level should no longer be allowed to increase the cost of medical care.
I have an inside view of this problem, and I have written a little on it in these posts
http://thetinfoilhatsociety.com/2009/05/12/entitlements/
http://thetinfoilhatsociety.com/2008/11/18/the-moral-and-economic-need-to-ration-healthcare/
I will probably post more, there’s always more to think about when you work in this field yet have no faith in it. (and yes, belief in our HOSPITAL system is a type of religious faith I think)
Boy, this is such an important issue. I am hoping that the Obama health plan goes through Sooooon! I hae been cobra-ing my health insurance from my last job, because I was laid off last November and my new job doesn’t have insurance. I am essentially self-employed. And we really need and use health care since my husband is disabled and very ill.
Many people may not be aware, but there are many reasons that some people do not have health care. For us, we were on state healh insurance for many years because of my husband’s illness. We had to do that because he was denied insurance due to his illness. The only way he can get health insurance is to work at a job that has a large group insurance plan. But, no that he can’t work any more, we are stuck. A lot of medical problems will do this to you, most notably diabetes. Cancer, heart attacks, strokes and mental illness can also do that. One really interesting thing that happened, was that the state health insurance people told us that you had to be denied by an insurance company and said to contact any health insurance company, say you’re diabetic and need a letter of denial, and they will give you one. Then you take the letter back to the Medicaid people. And that’s what we did. My husband contacted one of the big medical insurance companies, told them he needed medical insurance but was diabetic, and they gave him the letter. He asked if they would give him the insurance at a higher price, and they said no. But it was interesting that they knew all about the proceedure to get a letter of denieal for Medicaid.
In any case, I sure hope this issue is resolved soon. I know several people who have similar issues. Adding the farming issue adds an important perspective to this issue. Thanks for bringing it up!
I was under the impression that the Grange movement/national organization was a source of group health insurance for farmers. But perhaps they also charge too much. Is the Grange active in Upstate New York?
Our family farm is sort of a full-time farm. Which is to say that we have something we’re working on all year (we have a few different crops). But the only person who’s full-time is my FIL, who’s 84. My MIL makes maple candy and cream as needed, sometimes with help from one family member or another (wrapping, packing, shipping, etc.).
L and I help out with things year-round (him more than me) — although in particular he helps out with hay (loading the truck or wagon for deliveries, etc.), the chickens, and sugaring. He and I do the farmers market for the folks. Last year he ran the tapping along with one of the nephews and ran the gather crews; this year thankfully one of the other nephews with more current tapping experience was able to take the lead, although we still helped out with other things. We do a bit of firewood from fallen trees, which are brought down by one of L’s brothers.
Another brother has a construction business and so sometimes he brings equipment down here (like the lift for working on the barn), helped with boiling this year, and of course certain times of the summer, most everyone pitches in with the haying.
Oh and my SIL D comes over from central MA to help with various and sundry things too, esp. before and during fall festival.
So, almost all of us have insurance from other jobs, with just the parents having medicare. Insurance or no, even my MIL works part-time doing bookkeeping and my FIL has always done handyman jobs, painting, and still does a tiny bit of roofing (there are only two slate roofers in our area, although he’s more than happy to let the younger fellow take the big jobs).
We consider the farm to be a working farm, but to my knowledge it has never been the only thing the family has done. The only way to keep it a going concern has been to be creative, adaptive, and willing to do more than mind the critters and crops. Which is not to say that national health care wouldn’t be welcome if it helped out some with expenses! Hm…. I guess I’m just saying, in a long and rambling way, that it would be a help but not the solve-all solution for keeping farmers going. I do look at what’s being discussed so far on the national with some concern and trepidation, for sure.
History, if it is any consolation, we have the same long lines for non-emergency care here in the US. It took over a month to get my younger son in to an orthopedic clinic. And each time I have ever been to an emergency room, all through my life, whether I have had insurance or not at the time, it took at least four hours… even when there is no one else there and seemingly nothing going on. The doctors and nurses mill about and ignore you. I honestly think they are just waiting for you to give up and go home.
I don’t have insurance for a multitude of reasons. If it was just money, I would have it. But as me, my husband, and both of my sons have medical conditions that make it impossible for us to get conventional insurance it would cost us about $400 a month each to get an 80/20 plan with a $10,000 deductible. No Thanks. (My husband works for a small company that offers insurance, but it would cost him about 70% of his income to get the family plan.)
Like Claire, I am ideologically opposed to supporting such a crooked system. And as usual, it is the hard working, middle class who get mucked over by the government.
I sincerely hope that they will do something that is fair for eveyone. But I have never known them to do anything like that, so I’m really not counting on it.
Cassandra
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=true
an in-depth case study discussion why costlier health care (as delivered here in the US) has poorer outcomes for patients
Sharon, you’ve raised some inmportant points here. The health insurance issue impacts not just farmers of course, but also any who would want to start their own businesses.It works to keep many who would like to venture out on their own, whether they be a carpenter or website designer or whatever, to not do so unless they have a spouse who has health insurance benefits through their job.
As a farmer myself, I haven’t had insurance through a job since 1997- fortunately my state is reasonably civil regarding health insurance- they have a great plan for kids which was I used for my son. I looked at private plans but the cost was way beyond anything I could afford so eventually I signed up for the state’s plan for lower income adults as well. The income cap is pretty low but they now have another plan to cover those who make more money but not enough to afford private insurance. I do worry that budget cuts will impact these plans though.
The major problem as I see it is although we know we need a national one-payer plan, the insurance companies and lobbies are so powerful they will work to keep it from happening as they won’t give up their income. Unless we have a government which will put them in their place and persevere regardless of the pressure, we won’t get anywhere. We can’t afford a government plan with the private companies still feeding at the trough. This won’t happen unless enough citizens demand that it does- and too many people with private insurance are not willing to fight for this as they don’t see it impacting them at present . Likewise they are vulnerable to the fear that insurance companies manufacture that lead them to believe they will lose their benefits or choice or whatever…… I can just see the ad campaigns against this now…….
Other issues such as the type and level of care are also huge as has been discussed here. Care given to elders or those who are terminally ill is an issue. Why don’t we learn to accept that we all will die someday and that death is not necessarily a “failure”- just a reality?
I have also seen so many older people, including my own grandmother, using the care of medical people as a way to fill their days and have social contact. I do believe that many of the visits to doctors and such are more motivated in this group by a need to have someone listen to them, pay attention to them, touch them, whatever- this is lacking in their lives and they use the medical system in an attempt to get this. Perhaps if we had a better social structure and community we could cut down on plenty of unecessary medical visits by providing elders with what they crave but without using the medical system to do it which is a crazy and expensive use of it. I know my grandmother went from working every day into her 80′s into someone who would just relate what doctor she was seeing that day-it became her life and she did nothing else-I lived far from her so didn’t see her much and tried to figure out another way to meet her needs but couldn’t do it from here. I see this happening so much with other elders as well. I wonder how much money we could save in health care if we dealt with this issue head-on? And with the baby-boom generation getting older we will be looking at this problem in greater numbers. I’m not at all suggesting that we don’t provide care to elders- just that we find a way to tease out what is truly needed care and what is just a cry for a way to fill their days and provide social contacts.
As to wait times with national healthcare –
My dad is retired, has Blue Cross, lives in a rural area, has been seeing the same doc for 20+ years. He has to book appointments a month in advance, wait to see his doc for hours even with an appt. We already have the same problems in rural areas with our current system that people talk about with single payer.
Sharon, what a great post. This country’s health care system SUCKS, SUCKS, SUCKS!
One of my former co-workers, who’s here on a Visa from India, said if he breaks his leg, he’ll fly back to India for treatment because he fears what the medical bills would be for him in the States. Now that may be pushing it, but a lot of us live in fear of, “What will happen if I get sick or hurt?”
There’s a 25-year-old woman in my area whose got leukemia. She has two young children and an unemployed husband. Her unpaid medical bills are nearly at 1 million dollars after many trips to Mayo in Rochester, MN. They lost everything in an apartment fire this last winter, too. How are these people supposed to make a living with this kind of debt over their heads?
My mother-in-law has a still undiagnosed immunological disorder. After two years of dicking around at a local hospital, she’s been sent to Mayo Clinic for another series of ground assaults. My disabled father-in-law is now starting to worry about the bills starting to rack up. He’s afraid they’ll lose everthing because of what’s happening. They really only have their home and a couple 401Ks.
I recently fell through a rotten board in an old barn we’re tearing down. The contusion on my calf was horrible, and I was afraid I broke something. I immediately did the RICE method and layed low for days. I drenched the wounds and applied a good amount of topical antibiotics. All I’ve been thinking about is,”No, not more medical bills!”
In the future, we’ll be seeing a lot more home treatments, home remedies, and deaths from people refusing to see doctors in fear of the shackles of debt. Sure, it’s not worth it to die avoiding the doctors, but what’s the frickin’ sense in working your ass off your whole life, only to watch it eaten away by a crooked system?
I’ve always heard if you want a preview of America under nationalized healthcare, go visit a VA Hospital and talk to a vet there.
Something I think would help a lot is if people could become doctors without having to take on so much education debt. If doctors could get “malpractice insurance” for an inexpensive fee rather than the huge premiums they’re forced to pay. Then maybe we’d see more people willing to become doctors.
Because no matter what “System” you have in place, you are in the end limited by the number of doctors vs the number of people. It wouldn’t matter if a doctor saw people for free, they can still only see a finite number of people each day.
Brad K — sorry, I wasn’t clear — I was trying to say that when people grouse that with National Health they won’t be able to chose their doctor, I’m trying to point out that now, without National Health,I don’t get to chose. I’d rather have National Health, and everyone one get a bit of the pie, that what we have now, with some getting none, and others getting helpings they don’t want.
@ Maeve
No you are not limited by the number of doctors in your medical system.
There are a lot of other kinds of health-care providers, and a standard tactic in cutting health care costs in other nations is to move work that COULD be done well by some other kind of health-care provider, to other health-care providers in many cases.
The one, I’ve studied most is midwifery. In the US, the vast majority of births are in hospitals and doctor attended, and most hospitals get more than half their income from births, and have a huge incentive to push as many women as possible into C-sections, because those are more profitable. In Europe, it is far more normal for the vast majority of births to be midwife attended and non-hospital, with hospitals reserved for emergencies and particularly high risk cases. And they can get lower infant mortality rates, higher patient satisfaction rates, and vastly lower overall costs. Oh and it free up doctor’s time to be spent on other things. There are similar accomodations that are possible in many other cases too.
The question is not how many doctors you have in your system, but how many things can only be legitimately done by a doctor!
@ Margie-
I thought of the Grange, too. However, the Grange group insurance only covers auto, home, etc. – not health. I wonder if they could? The Grange was as close as farmers have ever come to unionizing, but working together they got great changes to happen (broke the RR monopoly on grain prices, rural mail delivery, etc.).
Emily
Heather- Change the names and you’ve got my family’s farm. It’s been in our family for over 350 years, and we ALL have other jobs except my grandmother, who runs the farm market. You really have to in order to survive on a small, family, New England farm.
It’s all stonewalling. Every other country has a national health program. All we have to do is look over theirs and select what will fit with us. Copy and paste. But then there are the lobbyists…
Sharon, you guys already have the whole thing under your very noses.
It’s called Patch Adams.
http://lmgtfy.com/?q=patch+adams
and he’s still A L I V E !!!
Hi all – as I’ve said elsewhere we here in Oz have universal health care paid through our taxes. Sure, its not perfect but having said that, it is wonderful!
Anyone can present at a public hospital and be treated. Yes, there might be a wait if they are busy but just be aware that next time you are in a car crash, you will be seen before the person with the headache who has been waiting for hours.
We privately insure ourselves for private hospital care. It costs about $140.00/ month for a family which is however many are in the family – no limit. This mainly allows us to have optional surgery like knee replacement or cosmetic surgery if we want it. It also covers for private gynaecologists/ obstetricians for child birth.
If we present to a public hospital, we are treated free as a public patient, no questions asked and most people use this for semi urgent things that you can’t opt to wait and see a private doctor.
If we go ‘public’ we can have any procedure at a public hospital free of charge like heart bypass surgery or suchlike. They are really quite good and if you present life threatening, they will treat you immediately. If you can wait (like cataract surgery) they put you on a list but it is completely FREE.
We also fund with taxes a pharmeceutical scheme where there is a sliding scale of charges for medications. For instance, pensioners or unemployed people get all medications no matter what for $3.00 per script. If I am employed, I might pay $15.00. The government pays the rest if the doctor prescribes meds that are on the benefits scheme. This is just about everything so while there is a small cost, its nothing like the true cost of meds. They believe that to finance the health of the nation ultimately helps the nation and it isn’t really a cost but a benefit to everyone.
I just hope that this country never goes down the road to an american system where the government is not ultimately responsible for the health of the people.
Hi…
Modern capitalism is about extracting as much profit as possible.
The US health system is run by capitalists for as much profit as possible. If your pips are NOT squeaking from the charges, well, they figure they should’ve charged more.
A successful treatment can be defined as a treatment which leaves the patent not-dead but has extracted as much $ (often to the limit of their indebtedness) as they can get. By leaving them not-dead, the patient is likely to come back into the system at a later date so will result in more $ charges.
There is no morality in capitalism. Greed is good.
I am not American, but what I see when I look at America is – a nation built by business, for business, enthralled to business: Capitalism as slavery.
It need not be like this. A balance is possible.
The only hope I can see is a co-operative approach, in which an insurance society owned by myriad small groups (farmers?) can come into the market and provide key health services for the people, in the name of the people. They would be not-for-profit, so their charges would be reasonable.
But in most countries, all that’s the government’s job.
Self-employed small farmers, people out-of work, and other otherwise healthy but uninsured and cash-poor individuals being forced to pay for national health coverage out of pocket does not sound like such a great idea to me.
Isn’t that why national heath schemes are pay for by tax money?
Sharon,
This is a very complex issue and I appreciate your attempt to tackle it. Healthcare for 300 million people is complicated and multifaceted. Although this conversation could go on forever, I will briefly touch on two points:
1. Like many who claim that nationalized health care is a “necessity”, you make it seem like we will all die off without it. You forget that America was a nation of small farmers for hundreds of years without any national health care system. The way you portray it we’d all be dead! Somehow, here we are, their descendants, alive and kicking. In fact, our nation became healthier and healthier from the 1800s into the 1900s, all without national healthcare. A miracle? Or were other factors at work? Hmmm… There are plenty of reasons why it worked. To name a few: people then ate healthier diets, got more exercise, and, what I think most important for small farmers, helped and relied on the local community.
2. Sharon, as someone who writes about a future of limited resources, I am surprised you missed that “modern medicine” is so energy-intensive that, just like oil, it too is a limited resource. It’s nice for us to sit here and dream up a utopian fantasy of unlimited health care for all, but if we do not talk realistically about limited resources, (and yes rationing, turning people away, and making tough choices) then we are making the same error in judgment as those “cornucopians” who assume infinite oil will allow economic growth to go on forever.
I strongly recommend reading the two links posted by Susan on 08 Jun 2009 at 9:59 pm. Susan is one of the few people getting to the crux of the issue, unlike most of us Americans participating in this childish national discussion, talking excitedly about what “goodies” we’re going to collect from a national healthcare “bailout.”
Unlimited free healthcare is a pleasant fantasy, but not a sustainable solution. We can either start taking responsibility for ourselves now, or the limited resources of the coming decades will force us to do so. Perhaps it’s easier to tell ourselves to use less modern car transportation than to use less modern medical treatment.
“Isn’t that why national heath schemes are pay for by tax money?”
Not completely.
“…requiring that Americans who remain without insurance either purchase private coverage or buy into the Health Care for America Plan.”
http://usgovinfo.about.com/od/healthcare/a/nathealthplan.htm
Talk about eating your young. I am a dentist. This also makes me a small business owner in America. I currently pay 75% of my employees’ health insurance rates. The math makes it out to be another week of payroll expenses per month. If congress passes a bill that makes it mandatory for employers to provide health care for their employees and themselves. Look out! My costs will go up at least 15%. I pass that cost on to the consumer which means…you got it, higher health care costs. Thus, the government will get involved and tell me what i can charge per procedure. Two choices here. Be unethical and cut corners to see as many patients as you can to recoup costs or simply leave the profession. I’ll keep my ethics and leave the profession. Politics seems like it would be a good money maker and I wouldn’t have to participate in the national health care machine. Surely, you dont think our congressmen senators and president are going to wait in line for a medical procedure???
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“even those able to take on a homebirth find that the cost of having a child is a few thousand dollars or more – on a small household income. Those who must have a hospital birth or more interventions can find themselves rapidly indebted”
This sounds insane, coming as I do from Sweden. Giving birth to children is free here. I would presume it’s for the most part regarded as a benefit to society that children are born. Maternity/paternetity leave for 16 months with 77.6% of your ordinary income*, daycare is heavily subsidized (I pay a little more than 200 USD/month for my two kids), school is free & university education is free.
* Some caveats: The rules and the forms you need to fill out are not non-trivial. 77.6% of income for 390 days, less for the remaining 90 days. 77.6% of income up to 5000 USD/month (but some employers chip in if you have a higher salary and/or raise the 77.6% to 90% of income).
Sure, taxes are lower in the US but I don’t really see how those taxes create value for ordinary citizens (except for having the most powerful/expensive military might in the world).
Daniel, they don’t.
Sharon
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