A Health Care Letter to the President

Mr. Barack Obama
President of the United States of America
1600 Pennsylvania Avenue
Washington, DC  20001

Dear Mr. President:

I have a little problem.  My little problem, however, is part of a big problem – Health Care in America. It is a problem for all Americans.   I want to help you fix this problem. My individual experiences make me both passionate and uniquely qualified to help change health care in America to make our country a better place to live and work.

First, a short history of my little problem: I am a 49 year old American who moved to the UK ten years ago. I was a Chief Financial Officer (CFO) of an international health care company, and I accepted an assignment in Glasgow, Scotland for a 6-months stint that somehow turned into ten years. While staying true to my American roots, I have enjoyed my stay in the UK and enjoyed a successful career – except for one little glitch when in 2005, I was diagnosed with tonsil cancer. Six months of intensive treatment (surgery, chemotherapy, and radiotherapy) has been followed by three years of aftercare.  All of my care was provided efficiently and effectively by the wonderful, capable doctors and nurses working for the National Health Service (NHS) here in Scotland. In some ways, I consider myself fortunate that I was diagnosed with this terrible disease while in the UK where I had access to the NHS to provide care.

But, now my little problem: I would like to move back to the U.S., but cannot – because no insurance company will come near a cancer survivor like me.  So, every summer, I visit my family for two weeks, and every April 15th, I send the IRS a check for my U.S. taxes for the privilege of being a U.S. citizen. And I now wait until I am 65, when I will be covered by Medicare, to return to my home  – this, of course,  is fifteen years away.   This, Mr. President, is no way to run a country.

Ironically, since I have worked as a financial executive for various health care companies for over 20 years – I understand all too well why insurance and health care companies run the other way when they see me coming. As a cancer survivor, I am a big, fat financial liability waiting to happen.  I also know that there are ways I can “sneak” into the U.S. health care system by getting a job with an employer with an insurance plan or otherwise getting into a group plan and hoping that preexisting conditions do not trip me up sometime in the future.  But then again, I know those insurance underwriters are smart and vigilant (that is what they are paid to do); they are continually finding ways to exclude the high risk patients from their insured population. And even if I do get into an insurance plan, I would imagine the fine print of the policy would find a way to exclude me if I became a major liability.  So, is this really any way to live my life?  Is this really any way for anyone to live their life?  Is this any way to run the greatest country in the world?

So for now, I will remain here in the UK. I know the UK is not perfect, and it has its own health care issues. But I know one thing is certain – if I show up at the hospital in the UK diagnosed with cancer again, I will be treated, and I will not be financially ruined.  The peace of mind this gives me is more than enough reason for me to stay here in the UK until we solve our little health care problem in America.

As I said at the beginning, my little problem is really an American problem.  The real problem is that millions of other Americans who have similar or worse tales of woe and do not have a solution.  They come in all shapes and sizes. Someone gets ill and then loses his or her job and health insurance coverage, and someone’s illness is excluded from insurance because of the fine print in the policy, for example because of preexisting conditions that were either conveniently or inconveniently forgotten at the beginning of a policy. The circumstances are wide and varied.   Far too many people in America live in fear or ignorance of a health care event which can be catastrophic to themselves and their family.  The free market system of American health care has developed in to a multi-headed hydra which is designed more for making profits than for caring for the sick – or even keeping people from getting sick in the first place.

I am passionate about helping fix the problem.  I offer my services to you as cancer survivor, as an experienced financial executive, and as an American who wants to make the country a better place in which to live.  I will consider any role in your administration (or indeed anywhere in the U.S.) which will put me in a position to help fix health care in America.  I want to come home and help, but the irony is that I can’t come home until I get my health insurance sorted.

My compensation for providing such services is simple.  My compensation will be to once again live in a country where if I (or anyone) am diagnosed with cancer (or any major disease), I will be treated and I will not be financially ruined.  The peace of mind that comes with this end result will be more than enough reward for any service that I can provide.

Thank you for your consideration.

I remain a U.S. citizen, proud of America, and missing my home.

Warren McInteer

Glasgow

United Kingdom

P.S. I have written also written a two part series for Demockracy.com on the subject that goes into more detail regarding the problems and solutions of U.S. health care.  If you are so inclined, please look at these pieces and let us begin the work to fix American health care:

Health Care in America: A Time for Change

Health Care in America: A Way Forward

Health Care in America: A Time for Change

The purpose of this two part series is to set forth my views on changing health care delivery in America to make it more efficient, more effective, and, most importantly, more compassionate.

In Part 1 of this series, I will explore my personal experiences that led me to write this series and outline the problem. In Part 2, I will lay out my solutions for a way forward to solve the health care problem in America.

My credentials for my views come from both my personal and professional experience. I have 20 years of experience as a financial executive and CFO in the health care industry in America and Europe. As a CFO throughout my career, it was my job to create value (i.e., make profit) through the marketing and delivery of health care to the general population. This involved understanding the rules and complexities of both private and public health care systems from a financial viewpoint. In the later stages of that career, I have founded, owned, and managed health care companies in both the US and the UK and have experienced firsthand how the corporate world prospers in both market-based and government-supported systems. In addition, while living in both Europe and America during this time, I have experienced health care as a patient on both sides of the Atlantic.

In 2005, my health care experience became more personal when I was diagnosed with cancer while residing in the UK. I was treated for the disease in both the UK and the US and directly experienced how each of these countries dealt with the diagnosis, treatment, and aftercare of a person with a major health issue. As a patient with a major illness, I suddenly had a very different perspective on what constitutes best practice when it comes to delivering health care. After one year of treatment and three years of aftercare, I am now a cancer survivor and am on a mission to bring about affordable, efficient health care to all citizens of the US.

Overall, I believe that my 20 years of business/health care experience gives me the expertise to help make a difference in health care delivery in America. My experience as a cancer survivor in America and Europe makes me want to make a difference

My Vision or (How I Learned How to Stop Worrying and Embrace National Health Care)

First, let me state my bias; I believe the UK health care system is better than the US system in many ways:

1. It is more efficient than the US system in terms of costs per capita.

2. It provides better outcomes than the US system (based on measures such as life expectancy and infant mortality rates).

3. It is more compassionate than the US system because all citizens are cared for regardless of income or net worth.

4. It allows for rich people to “opt out” and go private.

What’s not to like – better, more compassionate care for less money, and the ability to pay more to get an even higher standard of service?

My vision for US health care is certainly affected by my experience with the National Health Service (NHS) in the UK and Europe. The UK health care system is far from perfect, and the purpose of this series is not to critique that system. I also know that individual anecdotes seldom tell the whole story. Nevertheless, my health care experiences in a foreign country are worth mentioning.

In 1999, soon after moving to the UK, my son, aged 7, fell and broke his arm. I rushed him to the emergency room and I was in a fair amount of anxiety, not just because of the injury, but because I did not know how the medical system worked. He was in obvious pain, and upon arriving, the attending nurse quickly gave my son some drugs for the pain. After a 30 minute wait, the doctor diagnosed a broken arm, an x-ray confirmed the diagnosis, and after about 2 hours, my son left the emergency room with a cast on his arm. Both he and I were tired, but relieved that everything was going to be OK. While at the ER, we did not fill out forms, and there was no mention of money or insurance. The only thing that appeared to matter was that my son was in pain and injured, and the doctors acted on his injury. A light bulb went off in my head – this might be a better way.

Five years later, while still living in the UK, I was diagnosed with tonsil cancer. Six months of intensive treatment followed including two surgeries, radiotherapy, and chemotherapy. Three years of follow-up care (still ongoing) continued afterward. Interestingly, in terms of health care administration, my bout with cancer exactly paralleled my son’s broken arm incident. There were no forms, mention of money, or insurance and what was covered and what was not. More importantly, there were no discussions of employment gaps or pre-existing conditions or how future insurance coverage would be affected. Instead, the only thing that appeared to matter was that I was ill, and the doctors acted on that illness. I imagine there was some administration and paperwork somewhere, but I didn’t see it. All I saw was a focus between doctor and patient regarding the care, well being, and options of the cancer patient – me.

The light bulb in my head was now a spotlight in my face. This had to be a better way.

The Problem – Health care in America.

American health care, as in many other facets of American life, can lay claim to being the best in the world. America arguably has the best doctors, the best equipment, the best medical schools, the best research and development, and the best hospitals in the world. Many US hospitals are known throughout the world as “The Place” to go to ensure the best health care possible. The Mayo Clinic and the Sloan Kettering Institute are two examples of organizations which lead the world in health care practices. However, from the standpoint of efficiency, effectiveness, and perhaps most importantly, compassion, the US system falls well short when compared to other countries.

For example, studies have shown that the US spends about twice the amount on health care per capita when compared to other Economic Developed Countries (EDCs). (These other EDCs generally use a socialized or government sponsored health care system.) More interestingly, of the total US expenditure, about half is actually spent by the government that generally foots a large portion of the bill for over 65’s (through Medicare) and the “non-wealthy” through the Medicaid system.  (I put non-wealthy in quotes, because nearly 40 percent of the uninsured population in the US reside in households that earn $50,000 or more, so this group is not the indigent poor.)   So, even though there is a popular opinion that the US primarily relies on private health care, the US government spends about the same as other developed countries on a minority of its population even before one factors in private expenditure.  The US already has a national health care system whether it knows it or not.

So the issue is not whether the US should or should not have a national health care system–the US already has one. The issue is how the US as a country can spend twice as much on health care as other similar countries, AND

1. Obtain medical outcomes (as measured by key health care statistics) that are no better and, indeed, worse than many other EDCs.

2. Have approximately 1/6^th of its population (approaching 50 million people) with no insurance or health care plan other than a trip to the nearest emergency room when trouble occurs. This segment of population lives either in ignorance or fear of the liabilities which could occur if their health takes a turn for the worse.

But let’s put these statistics aside and get to the real issue – the human issues of people who are sick and suffering from not only sickness or disease, but also from the anxiety caused from the personal financial repercussions of injury or illness. When you or a loved one is sick and unsure if you have the financial wherewithal to deal with the sickness, the financial/personal issues can become more important than the sickness itself.

So what is wrong with American Health care? One thing that is not wrong is money – as stated previously, twice as much is spent in America on health care when compared to other countries. So what IS wrong is that this money is being spent on the wrong things, and I will sum that problem up in one word - TRIAGE. I will explore this and much more in Part 2 of this series.

A Progressive Health Care Solution

In one of my earlier posts, I said that I hoped President Obama would be progressive. I further tried to offer a definition of progressive, to be contrasted with liberal and conservative. That didn’t go over too well. I’m trying again, this time by using the concrete example of health care. How would a progressive go about health care reform? This is the question that I answer in Demockracy’s first-ever podcast – take a listen:

Progressivism and Health Care