#58 – Health Care Policy: Some Unpleasant Realities to consider

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This post is #2 of 13 on this topic: The others are at July 24, 27, 29, 30, 31, August 1. 2,5,6,7,10,15.  A final summary commentary is at October 9, 2009.
Note the index for previous commentaries, including #56, published on July 24, 2009.  #56 includes the “talking points” the Republicans in Congress will be taking home with them for town meetings in the upcoming recess.  It is important to understand these, and some counter arguments (included), to be well informed in this debate.
Today I am (I think) very well insured.  This has been true for many years.  (I say “I think” because one never knows for sure what surprises lurk in the fine print, not to be found until you find a specific coverage is excluded for some reason.)
I wasn’t so fortunate as  to be insured in my early adult life.  Following are two stories from my own experience.  I think they’re worth reading.
Story #1 – submitted recently as an op ed to a major newspaper, and as of today not printed.
Today the front-and-center issue is Health Care, tomorrow it will be something else.  At the end of the day, we the people will get what little we deserve for our short-sightedness.  Our legislators do our bidding: it’s called getting elected or re-elected.
We make unwise choices all the time, without considering the possibility that those choices may have dire consequences for ourselves or others we love.
Consider one real example: my own.
In mid-October, 1963, fresh out of the U.S. Army, I took a teaching job in Minnesota.  My young wife had just started her first teaching job in another district.  There was no such thing as group insurance in those days.  We were in our early twenties and healthy…we thought.  When the hospital/doctor insurance man came calling, I couldn’t afford the hospital plan, but I did get the doctor portion.  (Had I been “smart”, then, and gotten the hospital portion, it probably would have disqualified “pre-existing conditions”, just as today.)
Two weeks after I started teaching, my wife had to quit her teaching job for health reasons.  Four months later our son was born…two of those months my wife was in a hospital 70 miles away.  She was hospitalized for several weeks after the birth. From then on she was either almost totally disabled or hospitalized. [*]
By May of 1965 her only possibility for survival was a kidney transplant, and one of the few hospitals doing that procedure then was the University of Minnesota Hospital.  We had no insurance.  They finally admitted her.  I’ll never forget our wait for that decision at the hospital.
Two months later, July 26, 1965, she died in that hospital.  She didn’t live long enough to get the transplant.  At 25 I was widowed, parent of an infant, newly employed as a teacher in the twin cities, and owing the equivalent of almost four years wages primarily for medical expenses, not counting the charity of hospitals or clinics who never billed us for services they knew we could never afford.
In October, 1965, I made a list of debts and made an appointment with an attorney to file bankruptcy.  It was something I didn’t want to do.
I never filed bankruptcy.
After a long wait, North Dakota Public Welfare picked up two-thirds of the medical bills – the University of Minesota portion; and a local North Dakota Community Hospital forgave another portion.  I was able to survive.  I could make a long list of other institutions that saved me from financial disaster that two years.  I was a charity case.
If anything, I have tended to be over-insured since that long ago time.  I am one of the lucky ones who had access to insurance through a group plan during my work years and can now afford the necessary supplements to Medicare today.  (I hope I have the right coverage, which covers the right things, whenever….)
But I’ll never forget when reality slapped us in the face in two very hard years, 1963-65.
There is no excuse in this still prosperous (and very self-centered) society of ours to not fully cover every citizen, and to have our government be the provider.  After all, government is “we, the people”.
Those who think they’ve got this all figured out, and can cover every contingency by their own great planning, consider the possibility: you might be wrong.  Or that child or grandkid or cousin or nephew or friend of yours might need the benefit you said it wasn’t the governments responsibility to provide.
Those legislators we elected are in the end analysis going to do our bidding on health care and other issues.
Let’s encourage them to make wise, and not stupid, decisions.
* – Updated October 9, 2009: Four months before she died, we thought she might be pregnant – which would have certainly been a death sentence for she and the child.  Abortion would have been the only solution to save her.  She turned out not to be pregnant, but this close call has made me, an active Catholic, irrevocably “pro-choice”.

Story #2

In August, 1994, I was in Cebu City, Philippine Islands.  Cebu City was and is a major city of nearly a million population.
One day my wealthy host was taking me on a tour, and at one point he made a statement which I have never forgotten: “In the Philippines, if you’re rich you can get as high quality medical treatment as anyone in the United States.  If you’re poor, you die.”
He made the statement in a matter of fact way, and we didn’t pursue the topic.  Later we went to Catholic Mass.  Cebu City claims the Cross of Magellan, who arrived in there in 1565.  It is the seat of Philippine Christianity (Catholicism).  My host and his family were devout Catholics.
That evening, we guests were given a ride to a tourist attraction overlooking the Cebu City area.  It was dusk, and by the time we arrived at the overlook, it was dark.  Along the unlit road up the mountain were occasional fires, and gatherings of poor people, their homes and shops often in the ditches.  It gave dimension to the cityscape off in the distance, far below.
No one seemed to catch the irony of the moment: a wealthy family taking American visitors through the midst of abject poverty to a tourist attraction.
A few months earlier, back in the states, Harry and Louise, the darlings of the anti-Health reform folks in the United States, had teamed with the middle class to beat back health care reform, derisively called “Hillary care”.  Three months later, the Republicans overwhelmed the Democrats in the 1994 Congressional elections, remaining in control of the Congress for a dozen years, and getting control of the White House from 2001 through 2008.  Health related industries became a cash cow for the already wealthy.  What was bad in 1993 has likely become worse, overall.
The Health Care Reform initiatives that were passed in recent years further enriched the already  rich, and created renewed pleas for true reform of a massive and ailing industry.
Now the Republicans and the Health Industry are calling for not rushing into “reform” (“let’s do it right”) while at the same time doing everything in their power to obstruct and confuse and disrupt responsible attempts to make positive changes.  Immense amounts of money are tossed into efforts to confuse the middle class who’ll pay the price.
The contemporary version of Harry and Louise has been created for media use, and success will be measured by failure of reform, which will then be termed a success….  It’s how simple propaganda works.
The desperately poor we saw in Cebu City that night had nothing, and had no clout whatsoever.  If they were sick, they had no choice.  In good Catholic Cebu City, they either got well on their own, or they died.  The rich could fly to Manila, or on to Japan or San Francisco for top shelf medical procedures.  The poor died in the ditches.
We in the United States still have means to impact the system and prevent our descent into third world status.  But do we possess the will to fight off the profiteers and the big corporations who look on Health Care as a profit center?  I’m not at all sure we do.
We have more clout than those poor Filipinos.  But will we use it?
Its our choice: to believe the propaganda, and go with the flow…or to get engaged in fixing a broken system.
If you are the one percent of the population that is considered wealthy, or if you think you will be, then there’s perhaps not much to worry about.  Like the guy in the Philippines, you’ll get your care.  But if you’re a part of the other 99, including pretty prosperous, then you better be very concerned about what’s ahead, and get engaged.
Caveat emptor.
Update: July 26, 2009
After posting this item we went, as usual, to the 9:30 Mass at Basilica of St. Mary in Minneapolis.  This particular Sunday the celebrant was Fr. Greg Miller from St. John’s University, and the Gospel was the one about the Loaves and the Fishes, and Fr. Greg’s general topic was “hunger and thirst for justice”.  He talked on three themes, all from the previous weeks news:
The Professor Gates/Cambridge police affair and its message about continuing injustice in this country.
The need for Universal Health Care
The need, also, for Immigration Law reform
I suspect someone wrote the Archbishop complaining about Fr. Greg’s meddling in politics.  No matter.  A long-time pillar of the Catholic Church – one reason why I remain an active member – is its commitment to Justice (which is very different from Charity).

#56 – Dick Bernard: Health Policy Sausage Making

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This post is the first of thirteen on the topic of Health Care and the need for its Reform.  The rest are at July 26, 27, 29, 30, 31, August 1, 2, 5,6,7,10,15.  More will likely be added.
Yesterday my coffee shop friend and I were discussing the issue of Health Care.  I mentioned a major (and, I felt, excellent) article I had read in the New Yorker, and when I went home I e-mailed it over to him. ( The article remains accessible at http://tinyurl.com/q5krj3.)
This morning he said he’d read the article and found it useful.  “Is the New Yorker liberal?”, he asked.  The question puzzled me.  I didn’t know, though I guessed it probably was.  The reason for the question came out: his spouse is a very liberal activist, and he didn’t know if she’d like the article.  Some conclusions at the end might not be exactly what she wanted to hear.
We went our separate ways.   But the short conversation between a liberal (me) and a (likely) moderate conservative (my friend) dramatized the huge dilemma faced by anyone hoping to tackle the health care mess in this country: the sides have been chosen, and unfortunately, they’re far more than simply two sides.  There are infinite special interests, biases and points of view, and the reluctance to negotiate towards a common ground makes potential resolution extremely messy.
The same day President Obama had his news conference on health care reform, I learned that my 7-year old grandson, a Minnesotan, had been injured and was hospitalized after being thrown from a horse he was riding in a distant state.  (He’s still hospitalized, we hope soon to be released.)
Parker is hospitalized in a large children’s hospital in a major U.S. city, but it is 500 miles from his own large city and large children’s hospital.
A neighbor – a nurse – wondered if that other state would have as good medical care as Parker could receive here.  Parker’s uncle, whose daily work is with a group of physicians here, told his colleagues what the physicians in the other state were doing, and they backed what their colleague doctors were doing at the other hospital.  It was as if there needed to be some local validation of the work by other people with the same qualifications elsewhere.
(We just returned from a trip to Canada.  It is odd how one feels a certain sense of relief when finally crossing the border back into the USA, and then into Minnesota, even if some kind of crisis would be as well handled, if not even better, if it happened in Manitoba.  It’s how we’re wired, I guess.)
Of course, Parker’s release from the hospital will only begin the adventure for his parents.  They have, I think, very good insurance, but then will come the matter of dealing with bills from what is almost viewed as a foreign land.   At least they have the insurance.  What if Parker had no insurance, or his parents had no money?  What then?
Meanwhile, back in the public debate, the sides are reacting basically as could easily be predicted months ago.
The medical  industry long ago announced a $100 million war chest to at least control the debate.  $100 million is not small change, and can and is being utilized in small and large and diverse ways to successfully disrupt and confuse the public: to bother our minds.
Entrepreneurs are positioning to cash in: medicine is lucrative if you can keep the “public” out of “public health”.
A singular Republican win in this debate will be planting the perception that the President lost, no matter the consequences to the public who elected them. (Their talking points back home, and some responses: http://tinyurl.com/n9qq23)
The 47,000,000 or so who are uninsured, and are the real victims of this charade, won’t be strong advocates in their own defense.  A great share of them are young children, and the bulk of the rest are probably poor, whether working or not.  They don’t have the luxury of doing all of the things that are required of a citizen lobbyist.  Their concern is survival from day to day.  Little details like falling off a horse in a distant state are pretty far from their minds.  Getting outstanding medical care if they did fall off that horse would be a very iffy proposition.
Meanwhile, the rabble that is all the rest of us, the middle class who will bear the consequences of bad policy or no reform at all, tends to run around in circles, unable, even, to agree amongst ourselves what might be necessary in some reform initiative.  For example, for years I have watched the attempt to resolve the issue of merging multiple insurance contracts into a state-wide single system for public school teachers.  It is the teachers with the supposedly better policies who have harpooned the efforts for greater efficiency.  Other well-meaning people have done and will continue to do the same.
If only we could get our act together and simply speak out to policy makers and shapers “from the heart”.  But that is tough to do.  Giving up is a common option for us.  We are lied to, regularly, by pious sounding people.  We tend to take our belief towards supporting our personal bias, whatever that is.  We don’t help ourselves in the process.
The President and his advisors know all about this sausage making process and are more than willing to play the game, and a game is exactly what it is – a dangerous game, granted, but a necessary game nonetheless.
How this conversation will actually end, I have no clue.
I am pretty certain, however, that one way or another, putting the issue on the table, and demanding debate, will result in some kind of substantive and important change that will positively impact on everyone.
President Obama knows what he is up against, and it is not pretty.  But he deserves acclaim for forcing the issue.  At some point, and in some substantive way, there will be something good resulting.
Write that letter, make that call…just do something!  Every day.

#52 – Dick Bernard/Carol Ashley: Views on Economic Stimulus

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UPDATE:  Carol Ashley joined this conversation July 11 (her substantial contribution follows the initial post.)  This will be held open till July 21, 2009. 
Dick Bernard: This is the first blog post I have specifically posted in Draft form.  I solicit specific, brief,  comments to my regular e-mail address.  When this paragraph is removed, the Draft will be in more or less final form.
Among the kettle-full of national and international issues roiling about this past week, discussion was stirring about the Stimulus.  The usual suspects were saying the usual things about whether Round One was working or not, and whether or how a Round Two should be.  Apparently the President is not in favor of a Round Two, at least not at this time.
All I can say is that I am glad I am not having to make these decisions.
It appears that, after the major crisis of 2008, that ordinary Americans are both saving more and spending less.  Fewer people are earning any income, and those who are earning an income are not making as much as they were before.  Times are tight.  It doesn’t take a lot of looking to see that we’re not as flush as we were.  Some think we’ll never recover; that the worst is ahead of us.  Some would welcome such a failure, for differing reasons.  Opinions are a dime a dozen.
Lately I have been wondering if, perhaps, we Americans are, right now, our own worst enemies.  We are a nation whose prosperity was built on consumption.  We can argue whether that is good or bad, but that is how capitalism thrived.  And we are a capitalist society.
If my observation is a bit correct, rather than waiting for the government to print more money that we don’t have, perhaps a reasonable solution to propose is that we loosen our own individual pursestrings, and spend a little more of what we have, including our savings, to help stimulate the economy, particularly for those who really need the money the most.  I’m not advocating randomly throwing money on the street, but finding ways to help people who will truly put the money in circulation, and help the economy recover.
We are not, even now, an impoverished nation: A single dollar per person would generate $300,000,000 in circulation; a little over $3 per person would generate one billion.  Before long, there would be serious additional money in circulation.  And if we did the seeding reasonably carefully, it would be spent to help others who need it.  I once heard that a dollar spent multiplies by seven times if in circulation.  $1=$7.  It really isn’t funny math.  Some folks would make the multiplier a different number than 7, but economists would agree that there is a multiplying effect when money is actually in circulation.
Of course, my idea of spending to prosperity isn’t new.  I remember well the proposition of George W. Bush adminstration after 9-11: we Americans were admonished to go shopping.
The difference I see between his proposition, then, and mine, now, is a pretty stark one: were we to dig deep enough, the motivation for his proposal was to maintain and even build profits for business, using money we didn’t have (credit) to do that.  We have seen, and we are experiencing directly,  the results of that foolhardy policy.
In my case, I am proposing using money that is actually in existence to help people with real needs either stay on their feet, or get back on their feet.
Saving is great: I’m all for it.  Spending is okay, too.  I think we can help build our own recovery…and change the direction of our nation in the process.
Your thoughts?
Carol Ashley: I like your idea, but not because I think it would stimulate the economy. Helping others out with whatever we have that’s extra is a good idea because it is compassionate and there are so many people in need. In terms of the economy, I think we as Americans need to rethink how we live…as many are. We need to focus on what we need and not on what we want. We need to think about a more equitable society. The talk of stimulus is just a way of thinking in the same old ways that have, in part, brought us to this impasse. (And I do think it is an impasse.)
We need to create jobs that focus on real needs. Renewable energy is a good start because we need at least some energy, even if we all devote ourselves to conservation of energy. I expect that large companies will be the ones to do this because that is how our society is and larger companies are the only ones who could afford to do it. That is sad because we need to focus on smaller businesses that won’t be too big to fail.
There are lots of other things that we could do that are unrealistic to suggest because they just won’t happen because our country is too split and too selfish.
And now, as an aside I turn to something I’ve been hit with recently.
I confess that I am a Baby Boomer. I don’t do that easily. You see, I’ve always had the Boomers connected in my mind with the 60’s social justice issues. That’s in spite of stories my nephew has told me, in spite of what I’ve seen and heard from others of my generation, in spite of hearing us referred to as the Me Generation.
It wasn’t until I read more of The Fourth Turning by William Strauss and Neil Howe that I realized just how selfish my generation is. Of course there are exceptions. But I think my generation has had a lot to do with the current attitudes and the resultant crisis we are in. All the way from the good values of the 60’s to this! Of course, I now realize that many young people in the 60’s were in just for the ride, the excitement, the rebellion against authority. Perhaps they each had good reason and good cause. Perhaps most came to accept the broader values that came to the front at that time. But after the riots, after the end of the Vietnam war, and after a bit more equality for women, the Boomers really turned and stayed inward.
The focus turned to self-actualization, personal growth. I saw in the Charismatic movement of the 60’s and 70’s the focus on personal “spiritual growth.” The message was that if they saw a problem in your life, the answer was that you either didn’t have enough faith or the devil was in your life. If you were poor, sick or otherwise suffering, it was your fault. I saw the same thing from the New Age Movement. Many of the New Agers I have met through the years had originally turned from traditional churches to the Charismatic Movement and then became New Agers. The common theme I heard was that Christians were too judgmental, but I heard the very same judgment from them. If you were poor, sick or otherwise suffering it was your karma, you had not grown beyond that. It was your fault.
The one thing that bothered me as I followed that Boomer movement was the lack of compassion, the lack of any sense that we lived in a society that did have effects on people and a lack of any regard for science.
I do think a distrust of authority wasn’t all bad. I don’t think self-actualization is all bad. But anything can be taken to an extreme. It’s not good to throw out the baby with the bathwater, pardon the old cliché.
And now back to your suggestion. I think it is a good one, again not because of a need to stimulate the economy, but to take things into our hands to create a better society where we can help others out. I would like to see us use extra money we may have to start cooperative businesses that provide needs as well as provide jobs for people who have lost theirs. I think this would need to be done community by community.
What do you think?
Carol