(Interview 1/2011. Oil on linen, 40 ins x 30 ins.)
Ten years after our interview, I am still very grateful to Murray for sharing his views for the Healthcare in the US painting series.
I caught up with him to ask what he thought about the Affordable Care Act (ACA) today. Here's what he said.
"The third party payment is a mess ..as it always is. The act itself is a poor product. It helps less not more but I saw that then. Not many surprises. I am a global person for decades. Information and time are always the proof. They resolves fact from fiction."
I am more bewildered than ever. My research has shown the exact opposite. The ACA's ten-year report card looks pretty good -- preexisting condition discrimination outlawed, guaranteed essential benefits established, no more annual and lifetime limits on insurance policies...the list goes on.
The healthcare law has fallen short in some areas, however. Consumer out-of-pocket costs continue to climb. Some coverage shortcomings did not get addressed until Congress passed The American Rescue Plan under President Joe Biden. The family glitch remains. That's a problem. And our system is the most expensive in the world without better outcomes to show for it. But overall, many millions have gained access to healthcare thanks to the ACA.
My intention is not to debate Murray but to record his thoughts. And for that he has my eternal gratitude and respect. I don't have to agree with someone to be curious about how he thinks.
How others come to their beliefs makes me curious about my own processes. I'm having a hard time seeing how insurance companies would want to compete for sick people whose medical claims cut into their profits. My thought process goes like this:
A libertarian would say that healthcare prices would drop if there were no government intervention or controls. We're to infer that robust competition would lowers prices and make healthcare more affordable. But insurers would never compete for sick patients with medical claims. Claims are payouts that lower profits.
Capitalism as a concept and economic force isn't the boogeyman here. Capitalism identifies where money can be made. How is that working in healthcare is the question. If sick people getting access to healthcare lowers profits, then there have to be rules to protect sick people. For-profit companies are for the profits, not for things that lower profits. The Affordable Care Act put in place some consumer protections so that sick people can get access to healthcare despite being a liability on the for-profits balance sheet.
Many healthcare economists and researchers have studied the way other countries regulate their healthcare systems to deliver comprehensive, high-quality, stress-free care to their citizens. Dr. Michael Gusmano, a guest on the Health Affairs podcast called A Health Podyssey, offers up great insights.
Too many of us are afraid to use our insurance. Even with insurance we could still be billed for thousands and sometimes not understand why. The US for-profit healthcare sector bullies Americans. I intuitively knew something was very wrong with our system when I started the Healthcare in the US series in 2008. Almost 14 years later, I now know how so many have fallen through the cracks.
I interviewed this unwavering libertarian for 3 hours. He opposes The Affordable Care Act, the healthcare reform law passed and signed by President Obama in 2010.
Murray's story is a compilation of answers to some very tough questions. He did not dodge any questions. Murray was very forthcoming and honest. I wish to express my gratitude for his participation in this project. His point of view, so prevalent in the US, is a crucial contribution to this Art As Social Inquiry look at health insurance in the US.
Organic Vegetable Farmer and Hedge Fund Manager (Former Campaign Manager for a Republican State Senator), Age 55, Insured
Murray describes himself as a hands-on farmer. He also has an office in New York City where he runs his investment company. He has 3 employees, all responsible for getting their own health insurance.
Murray considers health insurance an "investment -- distribution of risk- a numbers game." He had insurance intermittently throughout his 20's, 30's and 40's. He admits to possibly needing coverage more in middle-age, but says he is only insured on his wife's policy because she insists on it.
Murray does not get check-ups. During the years of sporadic insurance coverage, his children suffered minor injuries -- broken limbs, etc.-- which he paid for himself. Murray and his wife planned their pregnancies. They acquired health insurance to cover the costs.
Murray says, "In our system any citizen can go to any emergency room and get the best care from the best system in the world. All will get an identical response. All will be 'stabilized.' Rehabilitation afterwards is on the individual."
Murray says that all individuals may not get the best rehabilitation available after being stabilized in the ER, but all must take responsibility for their personal habits and circumstances. When an ER patient has been stabilized, he has been "given another day to live so he can figure out how to get back to the condition he was in before the accident occurred." Bankruptcies due to medical bills will eventually be erased from a person's record. “You can have only so much control over a person's existence."
Murray maintains that those who want reform really want "a warm cloak keeping them warm." For chronic diseases, Murray believes uninsured individuals should seek out philanthropic organizations as well as different departments of government that will pick up the tab depending on the state. "There will always be a slice of society -- people who fall through the cracks -- who will not be protected equally. This is not 'OK.' (I asked if this was OK with him.) But it is a fact of life.
"I would like a person to be stabilized in the ER then find a way to make it to 65 years of age when Medicare kicks in.
"But there is a limit to our control. We can shrink this number. It's getting smaller." Murray believes that healthcare reform "homogenizes everyone and stifles individual creativity."