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Tag: health reform

  • Thinking out loud: Health care spaghetti

    18 August 2009

    What a mess.  The health care debates have become so cumbersome, so entangled, that for moments here and there, my brain sees nothing but a kind of fog, and haze of issues and terms and talking heads and bizarre signs held up at ridiculously chaotic Town Hall rallies.  If the fog clears, what’s left is a horrible spaghetti of words and intense passions and close to home issues like will I be able to care for myself if I get really, really sick.

    So, spaghetti strand by spaghetti strand, let me try to sort this out.

    First of all, it’s not just one big health care issue.  It’s a combo of health care coverage for more people, health insurance industry reform, and quality of care.

    One the biggest issues, in my most humble opinion, is the quality of care issue, tangled with a somewhat separate issue, the cost of that care.  We have a weird mix of the best and worst of health care in this country; certainly it could be better.  We have amazing technologies, and at the same time people dying because we can’t get health care for them.   In the current debate, this has become a side issue (except for when Canadian and British health care is invoked as some kind of demon of the health care world compared to our supposed perfect and superior system), but to my mind, it’s an important one.

    Whatever the quality, health care costs wildly too much for most people’s incomes, and for reasons which are their own little knot of noodles in the spaghetti bowl.  Deferment of the cost of caring for the un- and under-insured is part of the mix, health insurance charges is another.  For someone like me, health care and health insurance are literally unaffordable, and like many, my health plan is simply to stay as healthy as possible, and stock up on a lot of cheap home remedies, like good aspirin and thick wool socks in the winter.  But insurance? out of the picture.  The insurance companies do not offer plans which fit in my budget.  And if they did, would they cover my ongoing problems with allergies, lower back pain, bursitis, and the start of arthritis?

    Ah, yes, the insurance companies.  Another tangle.  Do they really need to charge so much?  And if they do, can it change from supporting outrageous profits, mass ad campaigns and the Gucci Gulf lobbyists, and instead put money into covering people who actually need to pay for their care, instead of booting them off for getting sick, exceeding unrealistic limits on coverage, or for enrolling in the program with health issues in the first place?

    And, oh my, the employer issue.  Another topic which is barely discussed right now in the face of people screaming about the very existence of health reform bills.  Our insurance, if we have it, generally comes through our employer, and does this really make sense?  I get it that the employer can support the financial burden of health insurance as part of an employment package, but should the employer be picking (or changing, or dropping) our health insurance for us?  Can’t we separate financial (and hopefully pre-tax) contribution, and whether it’s the employer or employee who picks the actual insurer and the medical professionals they will reimburse?

    Which brings me to choice, and rationing.  Lotsa bitchin’ going on right now in these discussions (or rants) about how health care will be rationed if Obama gets his way.  My first thought upon hearing about how the gov was going to ration health care (and I’m only now seeing it reflected in the media) was that we currently have rationed health care, because of how the insurance companies restrict the options we have, or cut off care, or eliminate people from their rolls.  My thought?  Maybe the government would play more fairly, which is why I like the public option.  The health insurance industry has certainly proven that it can’t, or more likely, won’t play fair with their customers.

    Okay.  The Public Option.  Quite frankly, I’m a bit confused by its details, but my basic understanding is that we’re talking about a Medicare-like insurance system which the government administrates, in order to reimburse private health providers for their services.  Again, sounds like a system that might actually play fair, hopefully for both clients and providers in the system.

    My limited understanding is that the objection to this sensible-sounding system is that it will sponsor the big bogeyman of capitalism, UNFAIR COMPETITION (!!!) to the poor, beleaguered health insurance companies:  read, lower profits to the executives.  Bring on the violins!  God forbid they should have to take one less European vacation, buy one less yacht or suffer through a summer with only one vacation cottage (of approximately 12,000 square feet, of course).  My god, they might have to fire a nanny, or a gardener.  They might have to sacrifice that $15,000 gown for a humble $3,000 outfit for the next banquet or ball or dinner out with the hubby. 

    Obviously I am not sympathetic.

    I think it’s fair to ask, should health care even be a source of profit?  Does it make sense for private companies to profit from the disasters of disease, injury and congenital health issues?  I’m not saying that people in the health insurance industry should be poorly paid (though that is tempting…) and certainly health care providers should be able to make a decent income.  But, in the case of the health insurance execs, does it make sense for their average annual income to be more than 11 million apiece?  Can’t they live on less, say a mere half million or something?  There is something seriously out of balance when execs are raking in the dough at the same time as they are denying coverage, kicking people off their rolls, and generally charging so much that average people can’t afford to keep or even buy into health insurance.

    And speaking of bogeymen, as I was a couple of paragraphs up there, what about this socialized medicine issue?  Does the proposed health care reform really resemble a socialized systems, or has the right just thrown the label around because it’s scary, and the word “communism” has been so overused that it’s lost it’s punch?  And if the label socialism applies, is that necessarily a bad thing?

    Let’s go to that ever-ready source for the modern info seeker, Wikipedia:

    Socialism refers to various theories of economic organization advocating state, public or common worker (through cooperatives) ownership and administration of the means of production and distribution of goods, and a society characterized by equal access to resources for all individuals with an egalitarian method of compensation.
    [emphasis mine; links lead to Wiki articles]

    Gee, sounds utopian.  And the part of our health care system which resembles this the most is that of the military:  completely government run, with the state owning the facilities, employing the workers, and basically providing the whole health service to folks who themselves are government employees.  Medicare sort of qualifies, to the extent that though it is administered by the government as a single-payer system, but the health care itself – doctors, hospitals, treatments – are privately held and operated.

    Enough spaghetti!

    So, I’ve identified quite a few strands in my glop of noodles:

    quality of care
    health care costs wildly too much
    the insurance companies
    covering people who actually need to pay for their care
    the employer issue
    choice, and rationing
    The Public Option
    UNFAIR COMPETITION!!! (or not…)
    should health care even be a source of profit?
    socialized medicine

    Now, I just need some sauce…

    And, by the way, we’re not going to put grandma in front of a death panel.  I didn’t want to include that in my list of issues, because it’s patently bizarre, but JUST IN CASE, let it be known that this flaming liberal doesn’t support death panels.

    I do, however, support a big improvement in health care.  Let the noodles be untangled!

  • Numbers and the General Welfare

    15 August 2009

    Steve Benen had a post in today’s Washington Monthly that tickled the back of my mind on an issue I’ve been pondering for months:  the issue of our General Welfare and the sheer number of U.S. citizens living today.

    I’ll start with Benen’s article.  He writes about citizen Katy Abram, who faced off with Senator Arlen Specter at a Town Hall meeting on health reform.  Like Benen, I choose Abram not to pick on her, but because she is at least articulate about her concerns, rather than screaming them across a crowded room in order to drown out the opposing views; I also think her concerns typify those of a significant minority of conservative Americans.

    Katy Abram fears health reform will assist in “dismantling” this country.  She was able to phrase her concerns in a reasonable if passionate manner, and asked Specter, "What are you going to do to restore this country back to what our founders created according to the Constitution?"  This brought applause in the Town Hall meeting, and in an MSNBC interview later, she amplified,

    "I mean, I — you know, yes, I mean, there are programs in place that, you know, the — the founders did not want to have here. The — you know, I know that there are people out there that can’t afford health insurance, that can’t afford a lot of different things. And, you know, with the founders, they had — they thought and hoped that the goodness of the people would allow the people to take care of those who could — who were doing without.

    While Benen’s article focused on the issue of uninformed conservative folk heroes (which apparently Abram has become) featured as political talk show guests, my interest is in this idea of Americans expressing this desire to return to some Constitutional Never-Never Land, presumably to honor our Founder’s vision, but also to return to some fantasy of a more pure American society.  Abrams was somewhat more articulate than some of the screaming Town Hall protesters we’ve seen in the last weeks, but wasn’t all that far from the woman at the Arkansas Town Hall meeting on August 6th, who sobbed “I want my America back!”

    What America, I could ask?  Is there even one “real” America? and has there ever been?  But that’s another discussion.

    Back to my somewhat amorphous topic.  What does the Constitution actually say about health reform or the public welfare?  Not much, but it does say this:

    We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

    Emphasis mine, because this key concept in the preamble to the Constitution frames my understanding of why it is appropriate for the Federal Government to get involved in the lives of its citizens.  The general welfare, to my mind, includes the health of communities in our nation, and the literal and figurative health of its human members.  That means having the government help people from falling through the cracks.  And it’s the proper interest of the government – federal, state or local – because if too many people fall through the cracks, the local community and nation as a whole are both much less stable.  Less healthy, if you will.

    When someone like Abram claims we need to get back to the way things used to be, I think they imagine something unrealistic in today’s world, that all the community’s social needs can be taken care of through volunteerism.  As she more or less said in the excerpt above,

    … the founders … thought and hoped that the goodness of the people would allow the people to take care of those who … were doing without.

    Now, I don’t know one way or another what the founders thought about taking care of those who were doing without.  What I do know is that however it looked in the late 18th century, the landscape of American society is very different in the 21st.

    This is where a look at the numbers becomes important.

    Take a community of 50 or a hundred people. When someone’s health or finances (or any number of other issues) gets rocky, it’s not too hard for their fellow citizens to step in and lend a hand, provide support, give leg-up or whatever it takes.  And I think Katy Abrams, who maintains faith in people’s desire to help, to volunteer, is right to think that we can rely on people’s good intentions to deal with those who are “doing without.”

    When the community is bigger, say a thousand people, it’s still a small enough number that folks can keep an eye out for each other, but it’s a little harder to coordinate, and there are also a larger number of people in need.  But still, it’s quite possible for the community to take care of its own.

    When that group jumps to a city of five or ten thousand people, things start to change.  It’s harder to see who is in need, it’s harder to coordinate, and the sheer numbers of people in need is much higher.  At that point, the citizens pool their resources through some kind of group effort organized by, say, the City Council or the Health Department or some other small government agency.  Doesn’t cut out citizen involvement, but the government backing of the effort to help the needy makes it more possible to spot the need, address it, and keep people from falling through the cracks.

    When you are dealing with a major city of 100,000 or better, involvement of the government in taking care of those in need is absolutely required, or it just doesn’t happen.  No one neighborhood, church, or volunteer group can take care of everybody at that point.  It’s time for the city or county or state government to step in, not to interfere or control, but to do what it’s supposed to be doing:  provide a citizen-based coordinated effort to help the citizenry take care of its self.  The government, after all, is US, its members drawn from our own ranks, not interlopers from some other universe.

    People like me and Katy Abrams and a number of other good souls can volunteer up a storm, but it still won’t be enough.  More numbers:  Let’s say in our village of 100 people, there are 3 very needy folks who just can’t do it by themselves.  That’s 3 percent of the population.  I have no idea how this relates to actual numbers of people in need, but for the point of illustration, I’ll pick 3 percent.

    In the town of a thousand, we now have 30 needy people. In the town of ten thousand, we offer our help to 300 people. In the city of 100,000, that’s 3,000 folks who need a helping hand.  In a major metropolis of a million, that’s 30,000 of our citizens.

    And in a country of 310 million citizens, we wind up with a very large number of people:  some nine million or better.  And I doubt this reflects the real percentage of people in need – I think I’m ballparking very low here.

    We need more than volunteerism.  No doubt about it, and America has rightfully taken pride in our history of helping ourselves.  But it’s not enough.  We also need our government to step in and help us all take care of each other.  And that, I think is totally supported by the Constitution which advises us, demands of us, to consider the general welfare of our nation to be a the center of our reason for having a government in the first place.

  • Enemies List

    14 August 2009

    Seems like the hoopla about an White House Enemies List hasn’t been getting as much attention lately, though I have no doubt that it’s simmering under the surface of right wing nuttery.  Having learned about a real Enemies List during the Watergate years, and been raised by the generation that lived through the McCarthy hearings, the specter of an enemies list gathered around the health reform issue just seems bizarre to me.

    What did the White House actually request?  Tell us what alarming things you’ve heard, forward them to us, and let us address the concerns you have.  Pretty innocuous.

    Or so I thought.

    So, according to The Paranoid Ones, the evil secret Muslin Kenyan dictator sitting in the Oval Office must be using this for Nefarious Data Collection!  It’s a ruse!  They just want our E-Mails!

    Which seems really silly to me.  If the national security agencies capable of protecting this country haven’t figured out how to collect data on pretty much anyone they wish by now, they’re not doing their jobs right.  It’s not that I am in favor of being spied on by the government, or by anyone else, for that matter.  But certainly, with all the expertise these security agencies have cultivated over the decades, they’ve come up with more efficient ways to gather data than inviting us to send emails to the White House.

    Still, I’d bet on it if I was a gamblin’ woman:  the Enemies List will resurface, in a few days or a few weeks.  Paranoid fears about the evil President require that he be keeping a List, like a fascist Santa.  That’s how the plot works:  the evil tyrant has to have an Enemies List.  And if you’re McCarthy or Nixon, yes there might be something scary going on.  But Health Care? it’s such a … milk-toast issue.  It’s so incredible somber and nit-picky of an issue.  It’s not like Communism, or trying to get the goods on the people who are trying to Take You Down.  It’s all about disease and finances and what an insurance company can get away with.

    The issue of this Enemies List is just another in a ever regenerating line of fake controversies – like the Death Panels, the Birther issue, the Socialist Takeover, you name it .  The extreme (and some not so apparently extreme) folks who are looking for anything to cling to that will tell them that Progressive Change, black president or no, equals The End of America as We Know It.

    Let me tell you something I believe about the American Experiment.  It is meant to change.  It is meant to evolve.  A stable society, such as the Founders hoped to establish, is not the same thing as a static society.  The Constitution was meant to distill down to core principles the form and purpose of our government, but I don’t believe it was ever meant to relate only to some frozen form of late 18th century American life.  No, the Constitution was meant to set up a representative government which could respond to the changes and demands of the citizenry itself.

    The citizens have demanded many things about health care and health reform (and they are not the same thing) but one thing we have not demanded is that our Government – White House and Congress – ignore our questions.  So maybe it’s a little silly to the criticize the White House for wanting to gather those questions, particularly around disturbing claims of socialized medicine and Death Panels, in the most convenient form of communication of our time, Email.

    Lordy!

  • Sarah Goes Off an Even Deeper End

    8 August 2008

    Sarah, oh Sarah…

    Ms. Palin, has received a lot of attention for her most recent Facebook posting, including this nugget,

    Palin-StridentThe America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

    This woman is nuts.  She’s not helping, either, by spreading lies.   I don’t believe there’s any “death panel” being mandated by Obama, where Evil Bureaucrats decide whether people are worthy of health care.  If such a system were being proposed, it would be evil.  But it’s not there.

    As far as I can tell, this whole “Obama wants to kill off the infirm” is based, with hysterical overlays, on a small part of the health care bill, where doctors will be able to bill for a patient-requested consultation on end-of-life issues, once every five years.  Note:  patient requests it, it’s not mandated, it reimburses doctors for something they currently must do for free with their Medicare and Medicaid patients, the consultation is done by the patients doctor and not by some government Death Panel.

    Good lord!

    What is wrong with these people?  I know the left can get kinda hung up on conspiracy theories from time to time, but this stuff is  unbelievable.  As many have noted over the last few days, you couldn’t write this stuff.

  • About the Screaming Idiots at Town Hall Meetings

    6 Aug 2009

    If you pay any attention to the news lately, you can’t miss the hollering, rude fools interrupting Town Hall meetings around the country.  They don’t just voice their opinions, they shout them, and they often keep anyone else from being able to voice their opinions in these gatherings.

    schoolhouserockbill2 But if that’s not bad enough, their understanding of how Congress does things is appalling.  I’m thinking we need to start mandating Civics classes again.  In the meantime, perhaps people should be required to review choice episodes of School House Rock, or at least the one on How a Bill Becomes a Law. 

    Where the screaming stops long enough for these otherwise disruptive people to voice a somewhat coherent point, they seem clueless about how government works.  One questioner grilled her representative on whether he would vote on the health reform law, whether he had read it, basically trying to pin him down with a commitment that the bill would be voted on exactly as he had supposedly read it.  The poor representative tried to explain that there were already about 70 amendments to the proposed bill, and that it was still in process.  The poor gal didn’t really seem to understand that this is normal, that bills go through many changes on their way to hopeful passing by both houses of Congress.  It’s not to create subterfuge, or to trick the public – legislation changes as it moves through the process.

    Hence my feeling that How a Bill Becomes a Law should be required viewing for all Americans.

    It’s times like these that I don’t feel much faith in my fellow citizens.  In fact, they kind of scare me.  In fact, they kind of seem like flocks of big, misled sheep, or maybe it’s cows, because they’re all stampeding towards the edge of a cliff, mooing and moaning desperately about something completely imagined.

    Maybe we need some wolves to turn the stampede?  Hmmmmm.

  • The important, but irrelevant issue of Health Care Reform

    21 July 2009

    Today, a friend of mine asked me what I thought about Obama’s proposed health care reform platform.

    Her question found me at lost for words.  Not that I haven’t thought about health care, and  health care reform.  Believe me, every time I feel a suspicious ache I think about health care.  I have none, you see, and can’t afford any, and so aches and pains are an open question. A not-well-planned for question.

    But I don’t really look at actually acquiring health care coverage.  I can’t fork over three or four hundred bucks a month for it – and being 50, I’ve noted that the few among my contemporaries who are buying health insurance are indeed forking over several hundred a month for the privilege of having something like 75% of their potential  medical expenses paid for through insurance.

    Now, it’s not that I have no health care coverage.

    First of all, there’s workman’s compensation.  For injuries while I’m being a "workman" of course.  Should I be injured on the job, I’m covered, at least up to some sort of cap I haven’t really bothered to investigate.

    And then there’s the car insurance.  For a few bucks a month, any (human) body damage endured due to a car wreck is covered.  Good, yet small comfort.  Particularly because there’s yet another cap once I hit some high water mark on medical bills.

    So, as long as I’m working or in my car, I’m okay.  Hmmmmm…. So, anyway, back to my friend’s question.

    Though I haven’t been tracking every detail of the health care debate, I am not unaware of the changes to health care being proposed by the White House and members of Congress.  I am not unaware of the potential, the great advance this would offer to our society and our financial crisis, and I do not believe that some kind of socialist system will sneak in.  It’s pretty hard to label something as socialist when the plan is to create a competitive market for health care options.  Competition, market… sounds pretty NON socialist to me.

    But in my situation, with absolutely no money to spend on health care other than  out-of-pocket, nickel and dime expenses, all I can hope for is that the Obama administration can push things that much farther, getting closer to a time when I can afford basic health care.

    I won’t get it during this term, or most likely the next, but eventually all the struggle around something I cannot afford will ripple down to me in some form of cheaper options.

    I hope.

    We’ll see.