Wednesday, August 19, 2009

Health Care Sound Bites

In my prior bog, I talked about the irresponsibility we have seen from many of those fueling and participating in today’s health care argument. As the negative mythology continues to be spun, let us try to separate out some of the real substance of this discussion.

“Death panels will determine which old people will be treated or let die” is the worst distortion, courtesy of Sarah Palin’s unilateral and unproven/unfounded declaration. Except it ain’t so. A Republican congressman (who has denounced Sarah and her distortion) sponsored a measure to simply ensure that Medicare would pay for doctors to spend time helping patients and their families determine IN ADVANCE what care THEY want at end of life. Such conversations thankfully help people avoid making bad decisions in times of crisis. It is no more than encouraging the Living Will that I have and all others should. So no more talk about death panels killing grandma. And no more listening to Sarah Palin about anything.

“Canada and England’s single-payer government-run health system does not work and people do not get adequate or timely care.” Sorry, no. All polls of those citizens continually report back a preponderance of high satisfaction with their system, and everyone in the country has access to it regardless of their ability to pay or their current physical condition. Unlike us. Waiting for services are no worse than we have here (e.g. my recent 1-month wait for a simple dental cleaning appointment).

“We don’t want a government bureaucrat between the doctor and patient.” As opposed to the administrative staffer/clerk in the insurance company who now already decides what treatments I will get or not, and is rewarded for cutting costs by refusing benefit claims? When my doctor prescribed three pills for me for a recent condition, it was the insurance clerk that said, “No, only two allowed.” I prefer to think my doctor knows more about what I really needed. I would prefer a government bureaucrat not to be in the middle, but frankly I trust the company clerk even less.

“75% of the American public likes their current health plan.” I suspect that 75% of the public likes their current doctor/provider! But have you ever tried to read and comprehend what your health insurance policy says? I contend that 90% of those 75% satisfied people have no idea what their policy really says or will cover or for how much. And they won’t know until they file a claim after an illness. Then that same company clerk will explain to them why they will get reimbursed a smaller percent than expected, or they were only covered for one day in the hospital, or were not covered at all for a “pre-existing condition.” Before I filed a recent claim, I was told that my plan covered 80% of the cost after a $150 deductible. It actually turned out to be 50% after all the exclusions / limits / caveats kicked in.

“If there is a public plan that is inherently cheaper to offer, employers will simply drop their programs and force people onto the public plan.” Well, employers are already dropping employee health plans. They have been for years. According to one report, 64% of Americans were in employer plans in 2000; only 59% are now. Health plans are a moving cost – always up! So businesses, especially small ones, cannot pay that cost and compete with the afore-mentioned Canada and England (or Europe), much less Mexico, China and Asia. Employers have to stay in business by being competitive. So higher health costs = less employer plans. Except now they are forced to dump people out to NO health care, with no public or other option available to people to fall back on. A recent study found that 73% of people who tried to buy individual insurance coverage over the past three years gave up. A vicious cycle repeats.

“A public plan will drive private insurance companies out of business.” Frankly, it is difficult for me to be too sympathetic to these companies. That said, I suspect they will do just fine, thank you. The problem now is that these companies cherry-pick to get the healthiest customers to insure (read: less payouts). Or they drive down costs to the company by limiting sick people’s expected benefits by imposing such things as “maximum limits,” “pre-existing conditions,” “limitations of treatments,” and other tricks. The “Fedex versus Post Office” analogy is a correct one. The government operates with a moral/legal imperative to support out-of-the-way cost-in-effective branch offices to meet the service demands of the entire public, while Fedex/UPS make no such commitment. They provide only profitable services primarily to corporate accounts. Truth is that private insurance is already making nice bundles of profits supplementing government Medicare coverage. They will do exactly the same with heath insurance, providing “bonus services & privilege benefits” to the wealthy who can afford it. The doctors will do the same thing – tiered services for those who can afford it, like Congressmen and corporate executives. That is OK. American capitalism and entrepreneurship are not dead; they will just work a new angle, because Americans are great at finding a need and filling it. But at least everyone will get a base level of care that cannot be pulled out from under them during the emergency times. It will be just like our current public-for-everyone versus private-for-who-can-afford-it school system of choices. And if the key to successfully providing insurance is to “spread the risk across the biggest base as possible,” then is not the biggest pool of all the entire American public, and therefore the most successful risk pool, one which no single private company can afford to take on?

“We have to help small businesses be able to provide health insurance to their employees.” No, we need to get ALL businesses OUT of health care responsibility. Employers do not pay my mandated auto insurance so I can drive a car; they do not pay my life insurance which I should have for my family for when I die. So why provide health insurance – the least controllable cost they have? Employers are retailers, builders, manufacturers, service and entertainment providers, not health care deliverers. Employer-based insurance is no help to the unemployed, unemployable, or self-employed. And with the “some employers do / some employers don’t” system we have now, a very large unreported percentage of our population is being held hostage to their job, a job they want to leave but cannot because their medical insurance will not travel with them. What toll of stress and unfulfilling lives is that causing?

Lastly, “America has the best health care in the world.” No, America has the best health care skills in the world, hands down. But “care” is only if you have the money, or position, or home asset, or savings account to afford all those high end medical gizmos. And most people cannot. A gourmet meal is not very tasty to those standing outside the restaurant peering through the window. Almost every developed country in Europe outranks us in terms of health care outcomes and successes.
Medical competency is not the issue in America. Access to that competency is. As we baby boomers start flooding into the system demanding high-quality highly-sophisticated care, and more of the population becomes under-/un-employed and on their own for benefits, it will not be Medicare that collapses. It will be the whole medical care system brought to its knees, and with it our economic future. That will be the true doomsday from our non-action.

Saturday, August 8, 2009

Words of Hate: What Goes Around ...

Healthcare Reform. That is supposed to be the prime agenda item for this country right now. The topic I had intended to write about this weekend. But first things first.

Seven months of talk, and now Congress has adjourned and gone home for a month to hear what their constituents think about this topic. Except, it increasingly looks like no such worthwhile or beneficial discussions will take place. Why? Because instead, our needed national discussion is being sabotaged by manufactured opposition with no other objective than self-serving personal advancement.

Remember the late 60s/early 70s? It was our most recent period of great public social unrest. The Left, predominately led by young adults, mounted public protests against the administration then in power (Johnson, then Nixon). Abbie Hoffman and similar self-appointed spokespersons called to their sympathetic peers from the steps of Columbia and the campus grounds of Berkeley and led their collective discontent into public forums. When people tried to speak different viewpoints, Abbie’s armies shouted them down and refused to let speakers speak. The news media never lacked for a story, and gave it all full play regardless of substantive or objective content.

In reaction to all of this, Middle America recoiled. They switched the political party / president of choice in the White House and, over time, in other elections. A Vice President (Agnew) became the lead spokesperson for blaming all problems on the Washington / New York elite news media (shoot the messenger), those “nattering nabobs of negativism.” A “Silent Majority” of Americans was asserted to be arising to reclaim “true American values.” And their rallying cry? “America; love it or leave it.”

Flash forward to 2009, 40 years after the Age of Woodstock. The Left won the election. For better or worse, they have the White House, House, and Senate. They are now “the administration.” The sons and daughters of 1970’s Silent Majority are now on the defensive, and their party of Republicans claims only 20+% of the electorate. So how are they responding to their new minority status? Certainly not with reason and class. Abbie Hoffman has morphed into something called a Rush Limbaugh, with his sidekick the court jester called Glen Beck and a whole cohort of Fox News “personalities” (not to be confused with actual news reporters). Instead of speaking through bullhorns from the steps of our universities, they literally scream through microphones from the insulated safety of the TV studio. They seize upon the very real fears, frustrations and confusions of a slice of the American population, and manipulate them into controlled actions of orchestrated protests as smoothly as Tiger Woods putts a golf ball. We have scripted Tea Bag rallies: small numbers of people making loud noises generating great (if distorted) TV visuals. They overwhelm attempts at town meetings and shout down legitimate speakers. If necessary, the scripts become uncontrolled and physical violence is resulting. And a similar former governor of a small-population state and (would-be) Vice President blames all the discontent on biased news from the elite media. Abbie Hoffman, meet Rush Limbaugh. Spiro Agnew, meet Sarah Palin. Replays of the past descend eerily upon us, except that they are mirror-imaged.

In the 70s, some extremists on the Left crossed a line and became violent political terrorists, resulting in a protracted scary period of investigations and prosecutions. Is a 2009 version of political terrorists from the Right coming next, from which our citizenry will need police and legal protection?

The “big lie” concept perfected in Hitler’s Germany still works. And it is rapidly working here today. The words of exaggeration, outright lies, and over-the-top hate seeping out of Rush & Company are no longer comical but truly frightening, because words are becoming actions. Words that have nothing to do with protecting this country, finding solutions that will help our citizenry, or unifying us to do the hard work together that needs to be done. No, it is blatantly all about glorifying egos of 2nd-rate lightweight personalities, ready to say anything to raise ratings without regard for any resulting larger consequences. “Who, me? My Fault?” Those who have been zealots for 2nd Amendment gun rights while comfortably seeking to limit 1st Amendment free speech should be thankful that their speech now remains equally protected, even to speak stupidly and dishonestly. That which you once decried is what you have now become. That which you hate so much is making you into hate itself.

The world has changed, sons and daughters of 1970’s Silent Majority. You lost the 2008 election. We have a black President, and he was elected with only a minority of white voters; white British descendants no longer control the show. We have a Latina Supreme Court associate justice in spite of most Republicans accusing her of being racist and unqualified with no basis of fact in her legal record. Thereby shooting themselves once again, this time in their own racist foot with Latino voters. American capitalism and innovation are still alive and ultimately our best economic hope, but a decade of Bush/Republican deregulation and economic anarchy can no longer be tolerated. Corporate irresponsibility by a minority of executives will give way to protections for consumers and a commitment to take care of our people. The near-total Bush/Republican economic collapse we were facing last winter has been halted, and another Republican-sponsored Great Depression #2 no longer looms around the corner. And 90% of our workforce is still employed. Is it really so hard for a Rightist to give some credit where credit is due to a Center-Leftist?
We have a ways to go. Solutions and rational words are what are needed, not political terrorism. And if you cannot see that and get on board with having a civil dialog, then maybe it is your turn to “Love [the new] America or leave it.” And in the ensuing quiet resulting from your departure, let is all have an honest, fact-based, intelligent adult dialog about how to get proper health care to our citizens. The real issue.