#64 – Dick Bernard: the Health Care Reform Posts: a summation

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This is post #8 of 13.  Other Posts on this topic: July 24, 26, 27, 29, 30, 31, August 1,5,6,7,10,15.
“A lie can travel halfway around the world while the truth is putting on its shoes.”  Mark Twain (attributed)
Friday we took our 10-year old grandson to the local county fair.  It was his birthday, and he enjoyed the afternoon. (The Pig Race was the highlight: three heats, ten piglets.  That’s what Fair’s are famous for!  More in a moment on that.)
Walking the grounds, I saw our local state Senator standing by the DFL (Democrat) booth.  We know her, and stopped to say “hello”.  I asked her if there were many questions about health care reform.  She said it was amazing how much misinformation was out there, just from people who had stopped by and asked about this and that.
Her revelation was no new insight for me: just in my own little corner of the internet world, it is incredible – almost scary – to see the wild stuff that flows into my ‘in-box’, including from senders who know me.  (The stuff from people who don’t know me is far wilder.)  The lie machine is stuck on fast forward.  And people are believing the lies.  It seems that people know there is a serious problem, but are much like a person standing on a railroad track, watching a train barreling down on them, but paralyzed into non-action.  Not a good result…for the person.
Even in his hey-day, the late 19th century, Mark Twain was right: lies travel much faster than the fastest pig in that pig race at the Fair, while the truth is back in the barn, still “putting on its shoes”.  That’s why misinformation is so preferred a message, and so effective, at least in the short term.   But unlike the pig race, the lies are no laughing matter…including for the people who believe and often spread them, without knowing the difference.  Lies always have consequences.  The truth outs, but often not till the damage has been done.
When I  began thinking about this series of Health Care Reform posts a few weeks ago, I had no idea about what it would look like.  I did want to summarize how I saw the debate was developing , and I wanted to tell my personal story from 1963-65 – the time when my experience with the American health care system began.  The remaining six simply evolved on their own, ending with this post, the 8th.  (There may be more, but more likely from others.)
I’ve thought about this topic a great deal, largely because of my own history.
I’d like to leave behind a few very brief summary thoughts.
1)  The American Middle Class (the vast majority of us) is the real victim of the lack of deep reform of health care, and knows it.  Paradoxically, it is this same Middle Class which is being relied on to kill the very reform it needs, and the Middle Class comes through.  Sowing Fear, loathing, and manipulation of public opinion, especially by advertising, works wonders. 
2) An effective strategy to manipulate the public is to toss out fragments of the huge issue (i.e. will “illegals” be covered?).  This way the person can be against something, and help kill everything.  It is a good strategy, but offensive.
3)  Excessive profits (greed) is a very big problem. It is small consolation that in the end this greed will probably ruin even the profiteers.  Paradoxically, big business, which says it reveres competition, is not so adoring when the competitor (VA, Medicare, etc.) is more efficient (cheaper), and thus can compete.  Public efficiency doesn’t generate private profit.  Profits are the be all and end all.  In this case, competition is bad, killed or controlled.
4)  We Americans are victims of our own mythology of American superiority and invulnerability.  We still live in a fantasy world.  We should know better. Fantasy worlds have a tendency to collapse without warning. 
5)  Most troubling of all to me is that the now-minority opposition to reform demands negotiations, but then effectively refuses to negotiate or accept compromise.  It’s “my way or the highway” – a sense that the only right way is their way, alternatives be damned.   
At the County Fair which began this column, our grandson also lost a few shekels at a carny stand, the softball toss, and got a few midway rides.  Later at the pig race, all the ten piglets who made the round (one named BoarHog Obama – good laugh) each won the prize of an Oreo cookie – they’re no dummies.  Neither are the carny’s who can count on the rube’s. 
In the Health Care Reform debate, the Truth is, about now, getting up to the starting gate.  Will the common people who defend the status quo, and run the risk of being its  victims take any time to listen?  Will they demand change that is in their best interest?
Learn the issues and their real implications, and carry the truth.

#63 – Jim Reed and Carol Ashley: Comments on the American narrative and the demonization of words

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This is post #7 of 13.  The others: July 24, 26, 27, 29, 30, 31, August 2,5,6,7,10,15.
Moderators note: During the posting of this Health Care Reform series, a number of individuals wrote me on various aspects of the problem.  James Reed and Carol Ashley had two quite different takes on the target (my opinion) of this intense debate: “middle class” American people.  Both Carol and Jim make important points.  The reader can interpret.  Both posts are shared with the writers permission.
James Reed, July 29, 2009:   The greatest obstacle to overcome is the public’s belief in America’s exceptional-ism, the belief that the American version of any endeavor is necessarily the best.  That belief projects America’s military forces as the most capable, its schools and universities the most instructive, its products the most inventive, its sports the most entertaining, its care for the young and old the most comprehensive, its economic system the most fair, its lifestyles the most advanced, and by extension, its health care services the most beneficial.  Those beliefs underlie all the arguments against change and undermine all efforts to introduce change.  Those beliefs allow stories of failures in other health care systems to be accepted without question while stories of America’s failures are dismissed out-of-hand.  Those beliefs make statistics on America’s health system meaningless except for the few cases, like number of treatments for prostate cancer, where America claims superiority.
Unfortunately, America’s middle class are those most entrenched in American exceptional-ism.  Taught so throughout our school system, we in the middle class hold tightly to that belief because the belief adds status to our lives.  Whatever our life history, occupation, or economic status, we belong to the best system the world has ever seen.  What change could be necessary in a system that produces the best?
The challenge for those seeking change to the health care system is then to devise change in a way that continues that sense of exceptionalism.
Carol Ashley, July 30, 2009:  I’ve been on Medicare for a very long time due to disability. I’m very grateful for it.
But what I really want to shout into some reporter’s mike is that we have a lot of socialism going on.  Do people want unsocialized police departments, fire departments, court systems, roads, education?  If we didn’t have socialism in these areas, rural areas like mine wouldn’t have or would have inadequate police departments, fire departments, etc.  And can you imagine paying tolls on all roads?  I wonder how many people would like that?
And there is non-governmental socialism in existence like car insurance (though mandated and regulated by government) and our local electric cooperative.  Yes, in the latter, we each pay our own electric bills according to usage, but that covers getting electricity restred to places when it doesn’t affect me.
Right now, we have a form of socialism called private health insurance which pays for emergency room visits from the non-insured through increased costs.  The public pays in very indirect ways through multitudes of bankruptcies that occur due to lack of or inadequate health insurance.
It’s time for people to stop panicking on the socialism thing and to decide when, where and how they want it.

#62 – Dick Bernard: Long Term Care: moving from Charity to Profit Center

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This is post #6 of 13.  The others: July 24, 26, 27, 29, 30, August 1, 2,5,6,7,10,15.
What follows is my response to a long editorial in the July 22, 2009, Minneapolis Star Tribune “Don’t ignore costs of long-term care“.  My response was sent U.S. mail to the writer of the editorial and the legislators mentioned.  I did not write it for publication – it is too long.  I may shorten it for submission as a regular newspaper column in August.
It is important to read the editorial first, as it provides the context for the response.  The editorial on which the letter is based should remain archived at www.startribune.com, (click on Opinion, click on Editorials and look through the archived list.)  I have typed the text of the editorial at the end of this post. 

July 28, 2009

Dear Editorial Writer (“Don’t ignore costs of long-term care”, July 22, 2009)

I have been letting your editorial of July 22 settle for a bit before responding.  I am armed only with personal experiences, your editorial and the enclosed [June 2, 1995 ] editorial by former Mn Governor Elmer L. Andersen.  I didn’t know about the Center of the American Experiment symposium, and in any event wouldn’t have been in their loop anyway. 

 

 To be succinct, the saying “fox guarding the chicken coop” came to mind as I was reading the proposal for (possibly) more taxes made by the Minnesota Free Market Institute representative.  Of course, in this case, the “fox” wouldn’t eat a few chickens and dash away; he’d “monetize” them by careful stewardship of the “eggs” – tough luck for Farmer Jones (the taxpayer) who accepted the “deal”…so it goes.  Money in the bank.

 

It happens that the Sunday before your editorial I was standing in the churchyard of the magnificent Cathedral of St. Boniface in Winnipeg.  We were there to close out a fascinating delving into the last days of my great-grandfather Octave, who died destitute in 1925 at what was described by my father as the “poor farm” in Winnipeg.  I envisioned what this must be.  I’d written about these recollections in a June 21st piece in my blog, and one thing led to another.  “Poor farm” came to be called “rest home” and by July 19, it turned out Great-Grandpa died in the Old Men’s section of Hospice Tache, the hospital of the Grey Nuns in Winnipeg, next door to the Cathedral.  In other words, as was true in those years, he was dealt with as a charity case, and the good nuns, who took seriously their vow of poverty, cared for him in his final days (he is buried in northeast North Dakota, appropriately at rest.)

 

In 1963, Great-Grandpa’s daughter, my grandmother, died.  This was before Medicare.  I was 23 at the time.  To my recollection, she spent most of the last six years of her life in a private room in a small town Catholic hospital.  Her husband had died.  She’d had a stroke, but she could hobble around with a walker.  Dad used to say that her hope was that she would not run out of money before her death.  She had little money to begin with.  I think she probably achieved her goal, probably with the the hospital administrators “wink” at bills. Her care was very inexpensive, and caring. 

 

About 1970, I was at a meeting with a Minnesota state legislator about some local issues.  Nice guy.  It was some years later that I learned that he and I were shirt-tail relations on Great-Grandpas side.  Some time after that I learned the legislator had made a lot of money through Nursing Homes he owned.  He’s long passed on, maybe visiting with Grandma….   Times had changed.  Cheap care had gone missing.  It was now in the Marketplace.

 

In the early 1990s it became my great good fortune to begin a dozen year friendship with Elmer L. Andersen, former MN Governor. 

 

He and I became acquainted through a column he’d written in the Anoka Union.  He was a good writer, and I looked forward to his columns, many of which I kept, including the one that is [below, following this response].  It too, speaks for itself.

 

At some point, in some other context, I learned of the problem that (so far as I know) may still be a problem in American society: people with money (or their heirs) developed strategies to protect their assets so that when it came time to go to the nursing home, their inheritance was protected and the state (“we, the people”) would pay the bill.  Of course, this was a perfectly “honest” strategy.  I seem to recall legislated efforts to close that loophole – probably they still happen – but my guess is that someone with a good lawyer and tax man can figure out ways to shelter their funds while the state pays the lion’s share of their costs.

 

The business of making money is rarely a kind and gentle one.  The astute capitalists figure out ways to figuratively pick people’s pockets.  One of those groups ripe for the picking is, likely, the older age health care sector, which is why the Free Market guy is so compassionate towards the future needs of baby-boomers: there’s lots of money to be made from them….

 

As for myself, for a long time I’ve had what I understand to be the “top of the line” Long Term Care insurance (another lucrative business).  Whether it is more than I need, or if there is a loophole that will deny me essential coverage because of something I didn’t notice, or if it becomes prohibitively expensive to maintain – all of these and other questions are unknown to me, now.  I can’t afford the necessary lawyers and accountants.  And I’m perhaps more astute about this than the average consumer.

 

Bottom line for me is that the profiteers are the ones who have driven the health care industry into the state of crisis in which it now finds itself.  I’m skeptical about the gushing “honestly and courageously” statement near the end of the editorial.  Altruism is of little matter, so long as plenty of money is made, and there is nothing to be lost if they’re hypocritical by criticizing the government at the same time as they’re making sure the government keeps their own trough plenty full.

 

No doubt your editorial is getting wide circulation in the “right-of-center” world….

 

Sincerely, Dick Bernard

 

Enclosure: Editorial of former MN Governor Elmer L. Andersen, then newspaper publisher, in the June 2, 1995, Anoka County Union:

“For the fiscal year ending June 30, 1995, the state Department of Human Services had a budget of $9.2 billion.  That is an enormous amount of money and an incredible responsibility to administer.  Commissioner Maria Gomez, a highly qualified and dedicated professional, has issued a “Report to the Public” that, in plain straightforward language, states the mission and priorities of the department under federal and state law.  Copies of the report are available by calling 612-297-5627.

 

Money flows through County Human Services units, supervised by the County Board of Commissioners and directed by a professional social worker.  Services are also purchased from non-profit church related and other community welfare agencies.   There are misconceptions which the report seeks to correct with clear factual statements.

 

Foremost in the minds of most people is the question.  “Where does all that money go?”  Health Care related expenditures account for 72.7% of the entire total.  By far the single largest item is nursing home care for the elderly.  It has become a part of our culture to place older people in nursing homes at public expense.  The nursing home industry has responded with facilities and programs that provide a variety of services to meet needs in generally pleasant situations.  Increasing population as well as an increasing percentage of older people and an increasing percentage of them in nursing homes, plus rising costs of everything results in soaring expense.  The department is encouraging a program to aid older people to live independently and thus postponing the need for residential care.

 

Aid to Families with Dependent Children is 8.7% of the budget.  All other programs account for 13.2%.  Child care is only 1.2%, Food Stamps .7 of 1%, work readiness .4%. Minnesota Supplemental Aid .9% and “other services” still smaller.  It should be observed that to “get people off welfare” affects relatively small budget items, is welcomed by recieipents and administrators alike but may not accomplish as much as hoped because of the nature of disabilities and will require up front investment.

 

We can be proud to be part of a society that is concerned for the well-being of every individual but we must realize it is a huge, complicated and costly operation.  People who read the report will understand better all that is involved.”

 

Minneapolis Star-Tribune Editorial July 22, 2009

Don’t ignore costs of long-term care

 

The symposium sponsored by a right-of-center Minneapolis think tank was an unlikely place to propose a new federal tax and an even unlikelier place to find agreement that it’s time to consider one.

 

Yet that was the situation of a thoughtful gathering on entitlement programs – Medicare, Medicaid and Social Security – conducted recently by the Center of the American Experiment.  The conservative Minnesota participants – Chuck Chalberg, Laurence Cooper, Tom Kelly, Peter Nelson and moderator Mitch Pearlstein – called passionately for cost containment as baby boomers age.  Toward the end of the program, when the subject of long-term care came up, things took a surprising turn.  Kelly, a Dorsey and Whitney attorney who’s chairman of the Minnesota Free Market Institute, shared perspectives from his parents’ and grandmother’s long-term care experiences.  “We should…simply say that if you have the good fortune to live into the twilight years when you require this care, it will be provided for you.”  Pressed by Pearlstein on how to pay for this, Kelly replied: “We would have to have a tax…the same as we do for Social Security.”

 

It was a striking exchange, one calling attention not only to long-term care costs, but also the opportunity afforded by our shared experiences to explore meaningful solutions to the challenges of caring for the nation’s elderly and disabled in years to come.  Most families have seen up close how costly and frustrating the process can be.  More than just about any issue, there’s common ground on which to build real reform: policies that reduce reliance on expensive institutional care and encourage more personal savings.

 

Whether that involves a new taxpayer-supported social insurance program remains to be seen, and it’s too early to support any type of tax.  But make no mistake, it’s time to act.  The nation’s long-term care system is in crisis.  The reason is that far too few Americans save for long-term care expenses, yet the majority of them will need it – nearly 70 percent of people over age 65 will require this kind of care at some point.  Private long-term care policies pick up just 7 percent of the nation’s long-term care costs.  Those without insurance go through their savings and then turn for help to Medicaid, the $360 billion-a-year medical care program for the poor that is administered jointly by the state and federal government.

 

Medicaid’s costs are unsustainable.  In 1971, Medicaid consumed 0.7 percent of the U.S. Gross Domestic Product.  That total had climed to 2.1 percent by the early part of this decade.  Long-term care services comprise about one-third of the program’s total spending and are expected to consume dramatically more dollars as baby boomers age.  Despite the money spent, and despite recent policy fixes, families remain frustrated by the program’s institutional bias.  It’s designed to put people in nursing homes, not keep them in their own homes.

 

Minnesota is fortunate that its politicians understand the issue’s urgency.  In the state Legislature, Rep Laura Brod, R-New Prague, and Paul Thissen, DFL-Minneapolis, teamed up admirable this spring on a bill that would have allowed Minnesotans to open up tax-advantaged savings accoutns for long-term care expenses.  The bill wasn’t passed during the 2009 session, but it deserves a second change in 2010.  While a small step, it’s a start in getting more people to save for their own care.

 

Newly installed U.S. Sen. Al Franken, who sits on the Senate’s Special Committee on Aging, also understands the issue’s urgency.  Just days after taking office, Franken told the Star Tribune that long-term care must be part of the health care reform debate going forward, and his ideas bear watching as he offers specifics.

 

The new Senator’s focus is welcome.  Even during this summer’s historic health care reform discussions, long-term care has unfortunately remained an after-thought.  The U.S. House bill, introduced last week, essentially ignores it.  On the Senate side, Sen. Edward Kennedy has introduced a program that calls for Americans to voluntarily pay long-term care premiums into a new government-run long-term care insurance program.  That program, called the CLASS Act, deserves a higher-profile debate than it has gotten.

 

Kelly and his colleagues at the Center of the American Experiment symposium spoke honestly and courageously about long-term care.  Their conclusions are correct.  Drastic action is needed and all options must be on the table.  More blunt talk is needed if the nation is to continue providing the quality affordable care its most vulnerable citizens deserve. 

 

#61 – Dick Bernard: VA and Medicare

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This is post #5 of 13.  The others: July 24, 26, 27, 29, 31, August 1, 2,5,6,7,10,15
Side note: I notice that the presentation of the FEAR case against Health Care  Reform is intensifying.  This was expected.  The anti-debate will concentrate  on the emotional.   Most of the campaign will be through dishonest and misleading marketing techniques, like television ads, talk radio, internet stuff….  The pressure on legislators to “kill the bill” will intensify. 
Along with Social Security, Veteran’s Administration Medical care and Medicare are crown jewels in America’s social safety net.  Because they are federal programs and susceptible to the epithet “socialist” the opponents of single payer option and universal coverage for all would like to hide them in a closet, or slowly amend them to death.  But they are difficult to hide, and likely impossible to kill.  They’re all around us…and they’re big success stories.
MEDICARE:  I’ve been on Medicare for four years, which gives me a bit of experience from the consumer end. 
A couple of days ago, Medicare celebrated its 44th anniversary.  President Obama celebrated the occasion at a gathering of the American Association of Retired Persons, and got a good laugh when he told about a letter he received from a lady who was against his program, and against socialized medicine, “keep your hand off my Medicare“.    That’s how confusing this topic gets.  People can rail against the government, but in one way or another, if they are of a certain age, “keep your hands off my Medicare” is a pretty firm retort whether conservative or liberal.   Some history at http://encarta.msn.com/encyclopedia_761568111/Medicare_and_Medicaid.html
I’ve had a good experience with Medicare so far.  There are well documented instances of fraud, but they don’t reside with the consumers of the care like me, rather with alleged providers (“entrepreneurs”?) who game the system…criminals.
It is not necessary to go on at much length about Medicare as most everyone knows someone who’s on Medicare.  It is absolute proof positive that you have turned 65.  The people who want to get rid of Medicare generally talk very softly or obtusely.  They can’t go after it, at least not directly.  “Keep your hands off my Medicare“. 
Medicare isn’t perfect and it isn’t free.  Tens of thousands of dollars went into my Medicare account during the last twenty-four years of my working career.  Medicare recipients pay a premium for the insurance (it’s deducted from Social Security).  It has a deductible ‘out of pocket’ amount to be satisfied, and people who can afford to are well advised to buy supplements to fill the holes in coverage.  People on Medicare without other financial means are vulnerable.  The program is subject to quiet legislative mischief.  What you thought was covered, may be changed, information buried inside the big book of benefits you receive once a year.
What is very well hidden by the Free Marketers is that every Medicare dollar goes into the economy, just like their dollars.  It is not money down a black hole.  Simply, Medicare is an efficient competitor without the profit motive.
The major 2003 Medicare amendments, which basically prohibited competitive bidding on things like drugs, have proven to be an immense burden on the system, but these amendments were enacted for the primary benefit of the medical and pharmaceutical industries, not to enhance the efficiency of the system as a whole.  They were advertised as making Medicare better; they made it worse, in my opinion.  They were written by and for big business interests.  They hurt more than helped.
In my opinion, since Medicare couldn’t be killed outright, efforts have been and continue to be made to kill it quietly and slowly and thus privatize it, too. 
I think it’s fair to say that 43 million elderly and 2 million disabled recipients of Medicare would say, almost with a unanimous voice, “Keep your hands off my Medicare.”
VETERANS ADMINISTRATION PRACTICE OF MEDICINE
I’m an honorably discharged U.S. Army veteran and thus theoretically eligible for VA benefits, but the odds of my ever truly qualifying for the wide array of VA care, including hospitalization, is not good.  There are eligibility criteria: potential recipients are divided into categories.  You can view the 8 Priority groups here http://tinyurl.com/dgknug.  They are basically self-explanatory.  Most likely I’m in category 8; I’ve never even tried to qualify.  (I am told that veterans, regardless of likely eligibility status, should make application anyway.  Certain benefits, like prescription drugs, may well be available through VA at lower cost than commercially.)
My grandfather, a Spanish American War veteran with less active service than I, and never part of the “regular Army” to my knowledge, got most of his medical treatment through VA, and died in a VA Hospital in 1957.  A veteran was a veteran, then.
I had extensive contact with the VA system during several years of major medical treatment for my brother-in-law, who died in November, 2007.   I was his representative; the rest of his family was gone.  For years, the VA system was his primary care.
I was extremely impressed with the services provided at the VA Hospitals at which he spent a considerable amount of time.
Along with his other problems Mike had been mentally ill since 1977, considered totally disabled by the illness and on Social Security Disability since 1982.  In the 2000s he was hospitalized on two occasions for major aneurysm operations.  He survived both surgeries, but a result of the second was lower extremity paralysis due to the length of the surgery and the location of the aneurysm.  He was warned of the possiblity of paralysis before the surgery.  Without the surgery he would not have lived at all.  Mike spent a lot of time in VA Hospitals.
In all of the time he was at the Minneapolis and Fargo ND VA facilities, he received outstanding treatment from a caring staff.  It was not a chore to go to see him.  In 1977 he was hospitalized at the VA Hospital in St. Cloud MN when his mental illness manifested itself.  There, too, the treatment and followup was first rate.
The treatment at these hospitals is likely rationed due to the fact that there are huge numbers of military veterans like myself, whose need for treatment in a federal facility ranges from very low to very high.  Unspoken, but probably a factor in under-funding of the VA (I was told the Minneapolis VA hospital had unused wings when my brother-in-law was there) is the matter of its competing with the medical, insurance and pharmaceutical industries.  VA Hospitals are efficient operations.  But they are a ymbolic and reat threat to “free market” types. 
So…Who do you know who’s on Medicare, Medicaid or is or has been a patient at a VA facility?  What is their story, and your interpretation?

#60 – Dick Bernard: Health Care Reform and the Middle Class: The Middle Class fighting against its own best interests?

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This is post #4 of 13. The others: July 24, 26, 27, 30, 31, August 1, 2,5,6,7,10,15.
Please note comments filed at July 24 and 26 posts.  I also added a brief update at the end of the July 26 post.  The final planned post on this series will be tomorrow.  I hope they elicit at minimum some thought.  If there is to be change, it is up to us, not to somebody else, to bring it about.
This post is particularly difficult to write, even though, except for a couple of too-close calls to long-term “poor”, I’ve always been middle class.  Even with some serious ‘speed bumps’, I’ve been pretty fortunate so far.
It is the middle class (most broadly defined) in this country which bears (and will bear) the consequences of chaotic health care “choice”, misleading sales pitches, and profiteering by assorted entrepreneurs committed to maximizing the “monetizing” of Health Services through many assorted means.  The pinnacle of today’s medical industry, most broadly defined, is about making money, lots and lots of money.  World Class Care is a distant second, and care for all is bad economics if the monetary bottom line  is the objective.
It is ironic, then, to see that the middle class is actively recruited for – and willing to – lobby against any substantive attempts to reform the system that in far too many instances hurts them. 
If anyone will, it will be the American middle class that will truly kill health care reform. 
It is not hard to figure out how “recruitment”  happens.  Fear.  For just one example, somehow or other I got on a nationwide e-list that is, charitably, anti-government and thus anti-tax.  (I’m actually glad I’m on this list (passively) since it opens a window into the exploitation of the Fear people have of change.) 
Here’s the subject lines to date (I may update as new ones come in, as they will): July 3 – generally anti-Taxes; July 18 – Congress plans to Outlaw Private Insurance; July 26 – the insurance reform will cover 12,000,000 illegals; July 28 (three e-mails) – Congress won’t enroll in its own Government Health Care; Obama-care Night-mare; call for One million Tea Bag faxes targeting two Democratic Senators.  The bottom line for this initiative: keep the middle class fearful and confused and divided.  Works well.  Who funds this initiative?  Whatever the case, it exists.
The tone of these e-mails are on the verge of hysterical (and written to sound believable), and my guess is that plenty of middle class folks bite.
But of what benefit to the middle class is the continuation of the current system, essentially unchanged?  If you are very lucky, you are enrolled in a large group plan, you aren’t facing layoff, and the plan has a retirement supplement option which won’t disappear and which you can afford.  That is the kind of plan I’m in, I think.  But I’m in a pretty sheltered environment.  And the part of my plan that covers what Medicare doesn’t – the supplement – is never certain.
(A year ago all retirees of the company were called together for a special session where the benefits people introduced ten or more competing alternative plans that we, the consumers, were invited to look at.  There were hundreds of people there.  Why is Plan E cheaper than Plan A?  What does Plan E take away that you would get with Plan A?  The devil is always in the details, or in the fine print.  Most of us don’t have the skills or the time to navigate this morass.  But this is the choice we consumers are constantly asked to make – and then it’s our own fault if we make a dumb choice.  So, I pick a choice that barely covers chemotherapy because I don’t need that coverage, and I end up with cancer?  My problem.)
The Health Care crisis didn’t happen last week…it has been evolving for years (read tomorrow’s post).  But like the person with a suspicious symptom who refuses to go see the doctor for fear of what the doctor might find, society (based on the rhetoric of its political representatives) seems to believe that refusing to acknowledge the problem will make it go away.  Not.
I know the general parameters of the field of health care pretty well.  In addition to personal experience over the years, and close relatives in the field, for nearly 30 years I was intimately involved with negotiating and administrating several hundred collective bargaining contracts for tiny to large union locals, all of which had some form or another of group health insurance. 
These plans were good, bad or sometimes awful.  Sometimes the participants paid nothing for the coverage; in other places they paid a lot.  In every case, to belong to the plan they had to be a contracted employee, and if they were laid off or left for some other reason, their health benefit ended at some early point. 
Long before I retired in 2000, efforts were already being made to pool the small plans into a much larger state-wide plan, which would spread the risk, and thus create greater efficiencies (lower cost).  To date, so far as I know, such efforts have failed, in large part because the have’s are not (if we’re to be really honest) interested in compromising parts of their quality plans to help the have nots.  In the end, both the haves and the have nots suffer from this short-sighted approach.  But logic doesn’t often fit into this debate, which is emotional.
I’d like to see light at the end of the tunnel, but absent citizen outrage the problem will get worse.  People are and will continue to be forced to make decisions based on bad or manipulated information which, of course, will have bad consequences.
In the end the American Middle Class will decide whether to do the common sense thing and go to some kind of single payer option, or choose instead the status quo which will (my opinion) only continue to get more and more chaotic. 
The decision will be up to us….  What are YOU doing to impact?

#59 – Dick Bernard: Should there be Health Care for all? A simple exercise.

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This is post #3 of 13: the others are July 24, 26, 29, 30, 31, August 1, 2,5,6,7,10,15.
Posts #58 and #56 (July 26 and 24, 2009) are also on the Health Care Reform issue; Post #60 (not yet begun) will be on Health Care and the Middle Class conundrum; and #61 on Nursing Home and Long Term Care.  I’m not an “expert” in this area (I doubt even the “experts” are, but I know quite a bit from work and life experience.) 
What started out as a simple idea has become more complicated than I thought, but the simple exercise, below, might help individuals begin to get an idea of the complexity of health care systems in this country, how a simple system can become bewildering – a system promoting individual disasters. 
Take a single sheet of paper, crease it down the middle, making two columns.
In the first column make a list of everyone you know in your own family, among friends, colleagues, their families, etc., who in one way or another cannot economically navigate by themselves.  This could include people with serious mental, physical or emotional handicaps; people in jobs without adequate insurance, or those who might be laid off from such jobs and be without insurance for short or long terms, ETC.  (There are many et ceteras.)
In the second column, make a similar list of everyone you know personally who is “wealthy”.  For purpose of discussion, this could be anyone who could financially survive a catastrophic medical event even if uninsured. 
There could be a third column – the big majority of us, with all the unusual arrangements which make up our own health care – but the first two are good to illustrate how our system works (or doesn’t).   #60 will speak directly to the Middle Class insurance problem. 
My first column is quite lengthy, even though I come from a family that values hard work and self-reliance and would be considered middle class, and is white.   I can ask myself, and I ask you as well: “which of the folks on the first list should be set adrift, to ‘sink or swim’ on their own?  If they die, tough.  Don’t send me the bill.”  Most of the people on my personal list already receive one public benefit or another, as they do in all families, including a very large number on Medicare. The often-reviled Medicare law of 1965 assured that: when you turn 65, as I have, you’re on Medicare – no choices.  But also on my list, and probably on everyone elses, are some people now in the “middle class”, who very well may find themselves, their kids or grandkids in crisis down the road, marooned outside the health care system.  If health care for all is a gravy train, as some may suggest, who do we throw off of it?  Do we solve the problem by getting rid of Medicare and Medicaid?  These are not simple questions.  (More on Medicare history at http://encarta.msn.com/encyclopedia_761568111/Medicare_and_Medicaid.html)
My second column includes a single name.  He was a very wealthy businessman, and almost 50 years ago was a governor of my state, and before that a respected state legislator.  He developed his small company into a Fortune 500 International Corporation.   He and I came to be very good friends.  He died in 2004.  It was a great personal gift to get to know him.  Most of us don’t even know a single truly wealthy person.  Not all of them fit the caricature. 
I could go on at great length about the people in my first list.  My “Exhibit A” is the relative who was caught on a home movie at a large family reunion 16 years ago.  I looked at this home movie just a week ago.  This person, who appears on screen by herself for only a few seconds, was an adult, and she was clearly cowering in the corner of a building, most likely terrified by the throng at the festive gathering.  I didn’t know of her then, but later learned that she was chronically and quite severely mentally ill and simply could not function in “normal” society.   So far as I know, she is no different today.  She lives at home; most certainly she receives public assistance, as she should.
Each of the others on the my list – and yours – have their own stories, some possibly self-inflicted (as chemical abuse); most through bad luck or no fault of their own. 
My points about these lists – and yours – are these: 
1)  Every one of us, if honest, can make similar lists of people in our own circles.  Every one in our society could.  These folks are part of humanity, deserving of treatment for their ailment, and care beyond minimal needs.  They exist everywhere in our country, no less than around the world.  They just happen to have dis-abilities.
2)  That single wealthy guy on my list?  He was no pariah, worthy of scorn.  He has important public buildings named after him.   Were he around to engage in this health care debate, it would probably be a no-brainer for him: if it is for the good of society then everyone should be covered, he would probably say, today.  He spent a good part of his young life as an orphan, and he understood what it was like to be under-privileged.  In his public policy days, group insurance was basically unknown, but medical care was also very inexpensive.   He’d probably say, “let’s figure out how to get this problem solved”.
3)  Probably the real dilemma comes for the folks in the middle – the vast majority of us.  Some of us have insurance, some don’t, some pay more, some less, for better or worse coverage.  We deal with great uncertainty, and it is in our interest to get some consistency for all. #60, on July 28, will deal with this issue.       
4)  To those who say “this is all well and good, but don’t expect me to pay for illegal aliens” or, “we can’t afford this”, or “fill in the blank” pet exclusions to universal care, a simple thought: we are in a global world, and among the problems we face is that communicable disease does not stop at state lines, or town boundaries, nor country borders.  Wouldn’t it at least make sense to take care of the basic care for all, since it would lower the odds of that killer disease reaching our doorstep?  And shouldn’t health care, like education, be a basic human right for all of us?  It is, after all, in our own selfish interest.

#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.

#41 – Dick Bernard: Lobbying

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I watch commercial television infrequently, usually local and national news programs in the early evening.  Some times I’m stuck with it, as when we draw baby-sitting duty and some kids channel is on.
For a lot of years I totally boycotted the medium (I didn’t lose anything; on the other hand, it was probably over-kill on my part.)  But what I noticed is that the main purpose of commercial television is to advertise, which is to say, manipulate public opinion.  I had to get away from the medium to see this.
Advertising (lobbying) is incessant.
In the last few days, I have noted from assorted sources something that has long been obvious: Big Business through individual entities like the energy companies, pharmaceuticals, the American Medical Association, the United States Chamber of Commerce, etc., is set to launch major and expensive lobbying campaigns to, essentially, assure that their own status quo (profit making machines) is minimally changed, if at all.
Their target is lawmakers, yes, but really the main target is every one of us.  Prepare for the 2009 version of “Harry and Louise” (the immensely successful 1993 advertising campaign to stop health care reform.)  
Those who we elected to serve us will be bombarded with finely tuned positions.  So will we.
The constant temptation for citizens is to say, in one way or another, “I can’t make a difference anyway”, and then proceed to prove our point by not getting on the court.  This is a dangerous attitude.
The process is easy enough: find out who your own elected representatives are, their local phone number and address, etc., and send them your own brief and polite messages frequently.  It is ideal if they actually know you as people (you’ve worked for them in campaigns, donated or etc.) but regardless, they all know you as the most important person of all: “potential voter”.      Recognize that they have an exceedingly complex job: many constituencies, many priorities. 
Too many of “we the people” still have the attitude I once saw at a polling place: a very grumpy guy went into the booth next to me, came out and said, “now I’ve voted and I have the right to complain.”  I don’t know what he meant by this declaration: was he voting for (or against) somebody; did he mean that all he had to do was vote, and that ended his role in making decisions: did he feel his vote reserved his right to gripe about how terrible things are, but not work to change them? 
He seemed to be leaving the most important part of his job as a citizen behind.
Everything I remember about his attitude that day indicated that he thought he had absolved himself of any responsibility for the outcome between the elections.
Not true.
There are endless sources of information about how to more effectively lobby for your issues.  Here’s one worth looking at: http://www.wellstone.org/organizing-tools/being-successful-citizen-lobbyist.
Get on the court.

#32 – Dick Bernard: Health Care Reform ("Good Morning Vietnam")

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Yesterday was spent with a group of about twenty persons.  We were having our annual meeting.  It could be fairly said that with very few exceptions, we all knew each other reasonably well.
Someone observing us from the outside would quickly note that we were about the same age.  We would appear to be homogeneous in composition,  of roughly the same economic status, all accustomed to being leaders in one context or another.  And we would even agree  on the major issue facing our constituency, and that issue was Health Care Reform.
Near the end of our meeting the group was presented with a proposed statement of position on Health Care Reform.  The draft was very brief and general: two paragraphs, one-half page.  
Rather than simply approve the draft and go home, there ensued a vigorous debate and a number of amendments to the contents of the fifteen lines of text.  What two pairs of eyes had thought would be a relatively simple action statement became considerably more complicated when 20 pairs of eyes looked at the same sentences.
And we were all basically similar in our points of view on the general issue.
It took about a half hour of vigorous discussion, but finally a generally acceptable draft was approved and we went home.
It occurred to me that if our little group had so much trouble agreeing on a general framework, how much more difficult it is when the constituency is over 300 million, as is our U.S. population.  Change does not come easily.
But change does happen, and that’s why the “Good Morning Vietnam” addition to the subject line of this post.
I was in the Army in 1962-63, the beginning of the Vietnam era.  So I saw the entirety of the Vietnam conflict as an adult American. 
Vietnam was a long, destructive, contentious and divisive war among the American people.  Wounds still fester 35 years after the conflicts official end.  
But there is a lesson from that era that is directly applicable to today’s debate about Healthcare reform.
Years ago, very slowly but very surely the national conversation about Vietnam changed.  People can key in on different events which led to the change – there were many such events – but that part of history is less relevant than the ultimate fact that at some point a tipping point was reached, where the status quo of continuing the War became politically unacceptable, and the politicians sensed the change, and the war ended.
In my view the same general dynamic is in play today regarding health care reform.  The tipping point either has or soon will be reached in the debate.  Unlike the unfortunate end to the Clinton initiative in 1993-94, today’s efforts are not as clouded by public rigidity to change in the inefficient status quo.  People know that something needs to be done.
But as evidenced by the debate over a small statement of position by a small organization yesterday, the process of moving from the status quo to a new standard will be extraordinarily messy, and the initial outcome will be unsatisfactory to most who will legitimately see this defect or that in the resulting creation.
The very least we can do as individuals is to make certain that our personal positions are made known to our elected leaders at state and national level.  And, in addition, to enter into the debates in our organizations – as we did on Saturday afternoon – to take organizational positions on the abundant issues as well.
At the same time, we need to acknowledge the reality that this will be an extraordinarily difficult and imperfect process. 
As we enter this debate, I offer my favorite song from “Good Morning Vietnam”: http://www.youtube.com/watch?v=vnRqYMTpXHc.  Louis Armstrong went up against long odds.  He was not a quitter.