Monday, May 7, 2012

A New Orientation towards Health Care

With our move to Cape Town we had to think anew about health insurance, life insurance, car insurance, house insurance, and so on. I wanted to talk about a rationale for going without health insurance, even when everyone around you might consider it essential.

There's two important caveats: 1) Medical aid in South Africa is generally not very good if you don't have any work benefits- it's expensive and doesn't cover everything, or even most things (for many people, it really only covers catastrophic events). 2) We're pretty healthy so I mean absolutely no disrespect to all the folks who absolutely need insurance to cover chronic medication, surgery and the like. I'm largely writing about those of us who are insured in the event of possible emergencies.

A while ago, I talked about South African banks and I wonder if we need to imagine something creative for health insurance, also. This isn't limited to South Africa, though small groups of wealthy South Africans (I count myself among you) may be uniquely positioned to do something brave. South Africa is also trying to create a more cohesive National Health System, but it's a long ways off.

A group of young people who call themselves The Simple Way (best known for Shane Claiborne) in Philadelphia pools resources to insure one another. I'm throwing it out there, with very limited knowledge, because I think that there are more humane, less capitalist ways to imagine coverage for emergencies. Where we have a safety net, but the safety net is other people (and in S.A., also the government health system). I don't think going totally without a safety net is a good idea, because there are too many stories of tragedy doubled because of finances. Our safety net is currently about a two years expenses worth of emergency fund. (Our budget is pretty unique because we don't have a consistent monthly income). This safety net means we can take risks without becoming a burden to anyone if something does happen. Insurance is set up to make insurance companies money, so the chances that we will save money are fairly high.

Regardless of whether foregoing insurance is foolhardy or financially savvy (which may depend a lot on your own health and age), I've found paying for health care has been counterintuitively healthy. I thought it gauche to find the cheapest care or refuse care because of cost, but it's actually empowering. I got a cash discount on my hemoglobin test, and I refused the other tests because I knew I'd had them before. Having Eli at home was both cheaper and better. For Eli's care we're shopping around- we could spend a few hours waiting in a queue and get his BCG and weight check free, or we can get an appointment with a nurse and pay about $8 (R50), or we can pay much more and go to a pediatrician (we're taking the middle $8 road). Whereas in the past I've been ok relying on tests as a measure of my wellness, I'm now holding us to a higher standard. Medical care is vital, I'm all for it (and we will always get Noah and Eli the best care we possibly can). But I've looked to doctors for answers and when I didn't find good answers, I thought I needed to look to other doctors rather than try out different things myself (I'm not talking about doing surgery on myself, but on weighing things like side effects of medication and so on).

For the most part, as a young family blessed with pretty good health, answers lie with us. When we have back problems or wrist problems or stomach bugs or even high blood pressure, the cause and the solutions are often pretty clear, and they're not at the bottom of a pill bottle.


Angie S said...

You have looked long and hard at life, Jo, and have garnered a great deal of wisdom along the way. This does, though, remind us what a burden the National Health system lifts off our shoulders here. Long may it last... Lots of love to you all in your thoughtful decision making.

Concrete Gardener said...

And love to you, Angie! All 29 years of wisdom. hehe.

For all the shortcomings of the NHS, I do agree. I wait for the day when SA has a unified system rather than one system for the poor and another for the rich.

Financial choices around health take a lot of energy, when maybe the burden really shouldn't be on us. I remember a study of parents of very premature infants in France and the U.S., where the parents' wellbeing one year later was less related to whether their babies lived or died, and more related to whether they felt they had made the right decisions with regards to care. Also, in France, where they had less autonomy, they tended to do better because the doctor had stood by a particular decision on their behalf. Only tangentially related, but the tyranny of choice and the power of fear can be worse than the disease.