The Meaning of Free

Free means no exchange of money for goods or services. Free means unrestrained physically – or free to move. Free means unrestricted mentally – or you can think what you want, form opinions, believe. Free means unencumbered by rules – or not restricted by another or a group or an organization or government. There are 20 definitions of the adjective free in the online Encarta Dictionary, and 6 more definitions of the adverb and transitive verb free. More than 25 definitions of free easily identified, often misused, sometimes intentionally.

There is no such thing as free healthcare. Whoever tells you that is using the word free incorrectly and they may be trying to sell you something while reaching into your pocket – the figurative pocket that holds your money.

Healthcare, like every other services or goods is paid for, not free, and just about every bit of payment of healthcare is earned. All the insurance benefits attached to your employment are earned by you. That takes care of the first definition of free.

Increasingly, you are constrained in how you spend those earnings. Regarding another definition of free, you are not completely free to make choices in healthcare. You are not completely free to choose the insurance company but are limited to a choice among companies contracted with your employer. You are not completely free to choose your physician, the gate-keeper to all your care. You are limited to the choices of physicians that are contracted with the insurance company you chose. Your physician is not free to refer you to all the services, specialists or prescribe drugs he might otherwise recommend because the insurance company does not reimburse for the referrals or for the particular services available.

You could work to convince the insurance company to pay for some healthcare you want, need or believe you have a right to receive. Time is not free either. Your time is potential earning time. If you use your precious earning time to garner healthcare services, those healthcare services cost you the worth of your time.   Worse yet, if you experience built-in procedures that lengthen the time to obtain healthcare, your health and life might be at risk. Now that’s expensive – and not free!

Housekeeping interjection: either get a box of tissues nearby, be prepared to shout your objections or cheer me on as I go into a diatribe. This diatribe is more meaningful to persons in the United States.

My husband earned the healthcare benefits we have by choosing to serve, by choosing to work, by being willing to fight, be injured and die, by pledging an oath to the Constitution, and to do all this for the span of an entire career in the military. My willingness to join with him during that career, to support his work and the potential dire consequences are my part of the earning. 

A PT colleague of mine once asked me if the military medical system had served my family well. She meant to support the idea that the government does a good job of providing healthcare. The short answer to her question was yes, but I could tell you story after story after story of my experiences with medical care in the military system – wrongly perceived by many as free healthcare. In those stories, which I might one day share (I bear a need for privacy in parts of my life) I would lead the reader to the conclusion that the healthcare in and of itself did not save our lives but that our participation in medical decisions was as critical as the availability of physicians and drugs.

I consider myself a relatively healthy person, now in mid-life, and I have extensive experience as a consumer of ‘healthcare’ as well as a provider. Since becoming a legal adult and for more than 30 years, I have interacted with and sought service from dozens of medical care providers in both the ‘private’ system and military medical system, including working with large, well-known insurance companies and Tricare. I still obtain care in both systems, while the rest of my family receives all their care in the military system.

Pretty much, the private and government/public-funded systems are equivocal in what they offer. Pretty much, both systems are racked with efforts to cut costs and sometimes deny services at every opportunity.

I summarily and strongly believe that each person must actively participate in their own care for the most satisfying outcomes. The most each of us can do is be informed about what is available, advocate to receive what is available, and do what we can do for ourselves.

Some of us are better at those 3 tasks than others. People who can do those 3 tasks fare better than others. Some of my care has been superb; some has been extremely dissatisfying. “Superb” care is subjective.

For yourself and your children, your participation is necessary and costs something. The unhappiness and disappointment I hear from parents about the healthcare provided (or not) to their children can be traced primarily to the cumbersome “system” which disables people from participating in their own care.

If I could teach you anything about the cost of healthcare it would be for you to clearly understand the misuse of words like free. Anytime you read or hear about healthcare, separate these words from the context, remind yourself of the meaning, and then interpret or judge the message for your opinion on the content.

The words you need to pay close attention to are: insurance, healthcare and access.

Insurance does not equal healthcare. Insurance is an organizational concept whereby pooled money is distributed (based on some catastrophe) to those who pay into the organization.

Sometimes an insurance company is for-profit and has shareholders who hope to receive more money than they invested. At all levels in an insurance company, efforts are made to conserve or recoup money whether that means limiting pay-out for services or increasing the cost of buying into the group. Just because you have healthcare insurance does not mean you will have the healthcare you want or think you need. In my experience, insurance means control - controlling my money and controlling my healthcare.

The government acts as a healthcare insurance company when it collects taxes for distribution through the programs Medicaid* and Medicare. I’ll choose to diatribe on those programs at another time. This post will be long enough for today. Earning healthcare insurance is vastly different from being taxed and required to use one system.

If you think the healthcare services for children with diagnoses is insufficient now, less will be available under a mandated, government-controlled dispensing of free healthcare.

Access to healthcare is available to every breathing human in this country. (In some cases, even breathing is not a prerequisite.)  For every person laid at the door of a medical facility, the facility is required by law to respond without assurance of payment. Of course, that’s not a very pleasant way to get one’s healthcare but for those who do not earn their healthcare and those who are unconscious, they are provided care. Again, those who are less able to participate in their medical care decisions typically fare worse than those who can and do.

Conditions that reduce, limit or otherwise codify access are intended to have the same effect as limitations in place from insurance companies. There is no free healthcare, and changes to the details of access and who controls access will not improve the plight of those who are unable to participate in their care. More likely, attempts to ‘increase access’ to care for some will likely reduce access to care for all.

We live in a benevolent society – a society that wants to give to the less fortunate, to care for children and people who cannot easily care of themselves. These are honorable motives and prompt us to not only give to organizations that collect and distribute money for a specific group or cause, but also to prompt us to support government programs for people identified as needy in some way.*

Elimination of government programs is not the answer, but expanding them for all is clearly contraindicated (medical term; means bad for the patient).

I hope you have revised your understanding of the word free.

My online friend, Eric, A Real PT, has an excellent post today, Memorial Day, 2008.

Those who died in battle to defend our constitution earned our freedom to continue to live as we do now. Today I urge you to honor the military dead voluntarily, of your own free will.

Honor their sacrifice and the sacrifice of those who loved them. With every military career and death they earned our freedom. Honor them because you can. Because of them, we live in freedom, or in a state of being free.

I remember them and I honor them.

Comments

[Leora]

I hope some of your parent readers read this. I mostly spend a lot on health care for myself. My kids, thankfully, don't need much.

You are not completely free to choose your physician
I basically do, meaning even if they are not in my insurance network, then I pay out of pocket. Sometimes we get some reimbursement, sometimes not.

I read the blog of someone in Britain who has to wait and wait and wait for basic psychotherapy. Like you, I am leery about government-based health care.

I wonder, though, how parents who are overloaded with expenses will react to being told nothing is free.

I'll keep reading.

[Barbara]

Leora, thanks so much for coming back and commenting.

I appreciate your sensitivity of parents to whom the costs just add stress for parenting a child with a diagnosis. I did give a rant today, and hope to post on other topics for the next near future and let insurance rest - except for responding to more comments here. And, sorry, one more point related to my emphasis on this issue, I don't want parents duped into more of the same in healthcare insurance.

You make an excellent point about choosing a physician. Everyone can choose their own physician if they are willing to pay the MD out-of-pocket, just like the plumber or the car mechanic (services that have not been overtaken by the concept of insurance). I cannot tell you how many times a parent has told me their child cannot have a wheelchair or braces, therapy or a drug because insurance would not pay.

It's a brainwash that we cannot buy our own medical care. It's not easy and it is expensive, but start at the place of "it can be done".

[Shannon]

I came across your blog from the Olive Lead Ministries and I want you to know that I love all the information you share! I am going to put your link on my blog for my preemie mom blog friends. Stop by and see my precious miracle!

[Barbara]

Thanks so much for your comment, Shannon, and for sharing my blog with others. I truly hope the information and opinions provided will benefit as many parents as possible. Barbara

[Abigail's Mama]

Hello Dr Boucher!
I'm sorry to have to use your blog to make contact - I couldnt find your email on your site. A fellow Mother of a little girl with Jacobsens Syndrome is in hospital at the moment and has lots of questions I can't answer - some of them relating to 'Medicaid' (forgive me if I sound ignorant - we have different names here in France). I would like to give her your email so that she can contact you for some advice about who she should turn to - she feels very lost and feels like the doctors don't want to answer her questions. I don't have any advice to give her when it comes to health care in the USA, but I know that you are a good person and a brilliant Dr with, no doubt, some precious advice she could do with right now, articularly when it comes to health care. My email is *****. Thank you Dr Boucher.
Alison

[Barbara]

Alison and I will be working on helping this mother by email today. If anyone from the area around Kansas City or St. Louis areas can recommend medical services or physicians, please leave a comment. Thanks.