#68: Dick Bernard: Putting the "n" back in "commuity"

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Other posts on this topic: Jul 24,26,27,29,30,31,August 1,2,5,6,7,15.
There is no such word as “commuity”, but that is what effectively happens when you remove the “n”, as in “negotiate”, or “neighborly” or “nice”.  Put the “n” back in, and you have, again, “community”.
We all have a pretty clear sense of “community”, and how a good “community” works.  Most of us live in such environments.  People may not know each other well, but when chips are down, they chip in and help each other.  Reluctant as they sometimes might be, ordinarily there is some kind of negotiations to make changes for the greater good of everyone. 
There are efforts to define “community” in very narrow ways.  Community, really, is all of us, together.  We are not isolated homes, villages or farms, and if honest about our history, we’ve never been able to exist on our own.  This is especially true today.    
This thought comes to mind as a well orchestrated and small, (and very well publicized) group of very ordinary appearing “thugs” are out and about attempting to make it seem like the current debate over health care reform will result in riots and chaos if such reform is passed. 
It is tempting to think that the situation is nearly out of control.  This is what we are led to believe, especially by media accounts.
But, I would ask, stop for a moment, and take a look around in all of the “circles” that you personally identify with: the people on your block and the few surrounding blocks; the neighbors down the road; the people who go to your church, or who you work with, or see frequently, whether they are friends are not.  Just ordinary people, like you.
What percent of these folks are likely to become a fascist militia to run riot if some law is passed which will improve they and their families lives? But that is exactly what this mis-named “debate” is about: inculcating Fear and Loathing.
I have done this little circle of communities exercise with myself.  I have a lot of circles I’m  one way or another part of.  Most of these circles are not full of people who think exactly like I do.
I would submit that the “thugs in waiting” in these circles are very few and far between – I guess less than 5% and that’s guessing very high. 
If we don’t capitulate (by inaction), and keep letting lawmakers know that we support the need for change, the likelihood is that the sense of crisis will dissipate…mostly because we are not talking, here, about radical changes (except, perhaps, as seen by some of the key ring-leaders against change who want chaos, but prefer to stay hidden in the shadows, and send out their own volunteer militias to attempt to make trouble.) 
I grew up with many sayings.  One which comes to mind, now, is that “quitters never win, winners never quit”. 
Well over 70% of the U.S. population wants change in Health policy.
Are we going to let some folks well inoculated with Fear derail progress in this area?
Seriously, look at your own “community circle census”.  It’ll restore hope.
Then get back to work.  Dealing with change is not a spectator sport.

#67 – Dick Bernard: Communicating Health Care Reform

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Other posts on this topic: July 24,26,27,29,30,31,August 1,2,5,6,10,15
Early in this round of emotional overkill on Health Care Reform debate, someone sent me the link to a draft bill on Health Care Reform, and put the spotlight on three “sections” of the bill.   I opened the document, which turned out to have 1,018 pages, and looked for the cited sections, but they didn’t exist.  I wrote back, reporting this to the sender.  The response from my correspondent was that he was referring to “pages”, (not “sections”, as he had mentioned).  I likely couldn’t have given him a satisfactory response to his question anyway – his mind seemed to be made up.  This seems to  be how it goes:  “Don’t bother me with alternative thoughts.  My mind is made up.”
The exchange I describe was with someone I really value knowing and with whom I’ve had a lifelong relationship.  Now, how would this go with some stranger I’ve never seen in my life, and will likely never see again?  I’m trying to prepare myself mentally for this reality.  Each year I volunteer at the DFL (Democrat) booth at the State Fair on Senior Day, and each year some “flamethrower” will wander in, unannounced, among all the very nice other people, and attempt to disrupt and confuse.  What to do?  There are many thoughts.  There is no adequate preparation that can be made.
The quandary: a half-dozen of us met for almost two hours earlier this week, trying to decide on a handout piece for the State Fair – one that people would at least look at, possibly carry home, and perhaps even use.  The meeting was important, and useful, and even so, we’ve done only one side – a simple listing of our state’s federal lawmakers and their office phone numbers including an encouragement to simply make a phone call when they get home. 
Unfortunately, we can’t go home with the people, actually pick up their phone, dial it for them and convey their message, whatever that message is.  That’s a reality, and the lawmakers know that far better than we.
(A year or two ago, I participated in a sit-in at a local Congresswomans office.  I volunteered for a certain hour for a number of weeks, and was there each time.  This was during duty hours.  The receptionists desk was across the floor from us, and what struck me during that duty was that the telephone almost never rang at the receptionists desk – and he had a genuine old-fashioned telephone that actually made a sound.  Simply, there weren’t incoming phone calls.  That is odd, given Congressional districts comprise more than a half-million population, most of whom are potential callers….)
Then there are The Louts:  I’ve been noticing that all of the news media have given an inordinate amount of attention to a tiny number of incidents of truly outrageous (in my opinion) behavior by a few louts in assorted town halls around the country.  The Louts are some real “LuLu’s” – I can imagine a neighborhood conversation with them.  NOT.
I keep wondering to myself: how much good are these Louts doing for their cause, even amongst the other people in the crowded meeting rooms.  I’ve been in these meeting rooms from time to time in my life, and the vast majority of the people who attend such meetings are there to learn something.  The Louts are teaching the participants a lesson about Loutish behavior.  They aren’t helping their cause.
A simple exercise: I think of my own little “town” – our homeowners association of 96 homes.  We’re mostly senior, all middle class, very moderate income, probably a reasonable mix of conservative and liberal. 
I can think of only two in this association, where I’ve lived for ten years, who are probably cheering on the Louts.  I doubt that many of the others would resonate with the Louts shrill and obstructive message….  There is no ‘town crier’ going up and down our streets….
Whatever your view, stay in positive action.

#66 – Dick Bernard: The practice of the viral lie.

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Other posts on this topic: July 24,26,27,29,30,31,August 1,2,5,7,10,15.
In #60, posted July 29th, I commented on an e-list I somehow found myself on.  The list sends what could only be described as hysterical fear-mongering, mostly against Health Care Reform, and offers to send faxes to all 535 members of Congress for members for only $25 a month.  July 29, I reported having received six e-mails from this source.  This morning it is up to 15.  I am keeping them all in my ‘junk’ file.  Each e-mail includes a disclaimer at the end.  The disclaimer is reprinted in full at the end of this post.  The outfit works out of a PO Box in Orange CA.
July 25, in the morning, I received the first more-or-less “normal” salvo in the Health Care Reform lie campaign of 2009.  It was a YouTube segment of an undated, apparently recent, radio talk show.  The audio had, helpfully, a cover gallery of Nazi photos as wallpaper background on the YouTube screen, doubtless to remind the viewer/listener where we were headed if we didn’t stop this Health Care Reform business.  I didn’t know who the talk show host was – it turned out to be former Senator Fred Thompson.  The guest was identified as Betsy McCaughey, purporting to give the truth about the Health Care Reform proposals, especially about euthanasia for old people. 
The e-mail came to me and two others; the sender of the e-mail had been one of four who had received it the previous evening.  It came with a note “shocking if true”.  The subject line said “A warrior for Health Care”.  It was a viral e-mail.
At the time I viewed the YouTube segment it had been watched 36000 times. 
In between July 25 and today, McCaughey’s arguments have been outed as more than dishonest – well, let’s call them what they are: lies.  No less than an editorial in USA Today commented on their dishonesty.  Yes, they are carefully worded lies, but if one intends to deceive, it is a lie nonetheless, and that is what McCaughey, and her ilk, are doing. 
When I last looked, today, 11 days after the initial mailing, the YouTube segment has been viewed 180,000 times – about 10,000 per day.  One of those viewers is me.   I also sent it to my own e-list.  Perhaps some of them watched it as well.
Many (but by no means all) of those forwarding and watching the video will accept it as the truth, even though it is untrue. 
That is how it goes in the land of the viral lie.
So, what to do?
I simply pointed out the dishonest facts about the segment to the person who sent it on to me, actually sending additional documentation about the dishonesty in past days.
Beyond doing that, I don’t know that there is much more that can be done.
You hope, hopefully not in vain, that the recipient of the corrected information will pass it back on up the line as these are people who he/she knows in person, and they have no idea who I am. 
Assuming the worst – that there will be no clarifying going back up the line – (the most likely scenario), the only thing I think we can do is to continue to slog on, doing our best to be truth tellers in a time when truth is an extraordinarily scarce, and even despised, virtue.   
If polls are at all accurate, the vast majority of Americans believe there are very serious problems with our current system of Health Care delivery.  Most people know the system is broke and they its current or potential victims.  The vast majority of Americans are perhaps sufficiently skeptical to not “buy the [dishonest] kool-aid” of the outrageous claims made by the enemies of reform.  But lies are enticing, and can be made believable.
I will keep checking in on that YouTube segment to see how the numbers grow over the coming weeks (occasionally I’ll post updates).  It would be reasonable to expect that it will go over 1,000,000 – by no means will all of those who watch it, believe it.  And even if everyone who watches it believes it, they remain a tiny drop-in-a-bucket of the total U.S. population, and they are the type who’ll be on that other e-list I described at the beginning of this post, and trying to shout out dialogue at town hall forums.  It is important to keep that fact in mind. 
Meanwhile, I know that for anyone who has even the tiniest bit of interest, there are multitudes of sources out there which respond to all of the charges which have been made.  With sophisticated search engines, and a tiny bit of care in what search words one uses, truth-telling information is available, particularly on the internet.
Here’s the disclaimer referred to in the first paragraph of this post: “This mail cannot be considered spam as long as we include contact information and remove instructions.  This message is being sent to you in compliance with the current Federal Legislation for commercial e-mail (H.R. 4176 – SECTION 101 Paragraph (e)(1)(a) AND Bill s. 1618 TITLE III passed by the 105th Congress.”

#65 – Dick Bernard: The latest Poll…and the "protests".

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Other posts on this topic: July 24,26,27.29,30,31,August 1,2,6,7,10,15
The latest Poll.
Towards the end of last week news reports were that the public was becoming disenchanted with President Obama’s performance on the Health Care Reform issue. 
His poll numbers had dropped to the point that as many people disapproved of his performance, as approved: 46% to 46%.  He had gone from superhuman to merely mortal.  Basically, that was where the visible coverage (the coverage people notice because that’s what the media intend) ended. 
I decided to look up the specific poll.  It seems to have been a TIME Poll for July 27-28.  1002 people participated in the poll, with the results + or – 3%.  In other words it was a statistically valid poll.
You can probably still see the complete results of the poll, if you wish, at the  website pollingreport.com, then go to the surveys on health.
The TIME poll appears to have been one of those mind-numbing polls to answer, with Health Care Reform only one portion of the poll, and the Health Care portion having as many as 21 questions.  Whoever agreed to participate spent a long time on the phone, hopefully at a time they weren’t busy with something else. 
The specific question whose responses led to the headlines was apparently the first one in the Health Care Reform category: “Do you approve or disapprove of the job President Obama is doing in each of these areas…handling health care policy.”   
The questions all appear to have been forced choice, rather than graded response (“on a scale of 1 to 10, etc.).  Judging from my own very limited experience in responding to such phone polls – I can recall one seemingly interminable one some years ago – there is no room for reflection, or changing one’s mind.  It is a test of first impressions given to a sample of about a thousand people nationwide.  Valid?  Sure.  But truly useful information?  Probably not, unless you want to find some way to formulate the questions and then interpret the information to fit your own bias.
Down the road in the 21 poll questions is this one: “Who do you trust more?”  Obama 46%, Republicans 32%, Unsure 14%.  Error + or – 3%.
The “Protests”
“The days of rage” have apparently returned, NOT.
I put the word “protests” in quotes because the assorted expressions of anger at the back-home meetings, all breathlessly reported, are not protests at all…they are scripted, orchestrated and probably rehearsed street theatre. 
Personally, I think these “protests” will backfire on the organizers – most people want to hear rational discussion of the issues – and my guess is that as the month goes on the “protests”, while they will not disappear, will become less visible, including in their local areas.  I doubt that any of the politicians being targeted are befuddled by the protests.  Stay tuned.
“Protests” are not an exclusive province of the Right, of course.  Neither is the long term tactic of “P. R everything – disrupt – confuse – display anger” something new and innovative.  I put those words in quotes because they were part of an organizing strategy used against an organization I was part of in 1974, 35 years ago.  Years later I became a colleague of one of the organizers who had used those and other organizing tactics against us, and he gave me a copy of the notes he had taken at a training session he had attended in another state.
So, the protests we are seeing are really very old (and very tired) tactics.
Were I to be in a position to plan counter-“Protest” strategy, I would organize things to dissipate the energy/effectiveness of the protestors, without making the “protestors” seem like victims.  There are things that can be done.  I’ll feed in some suggestions….

#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.