26 September 2009
Focus, Focus, Focus! Politicians Do Not Want Reform. . .
This is why it is so tough to change health care in America: no one who makes money in the present system will support any change. Ka-ching. It seems some senators wanted to revisit the $86 billion "deal" President Obama made with BigPharma to lower the cost of prescription pharmaceuticals to Medicare or to the public-option plan, I forget which. Such a deal. That's like asking BigPharma to take a 10 percent price cut for selling to the largest market it has. I presume that BigPharma decided that what it lost in pricing, it would make up in the increased volume when everyone would be forced to buy medical care insurance. I would conclude that BigPharma knows its game better than the Administration. The very idea that a government-funded program would negotiate the lowest prices available, why that's absurd! Why should taxpayers cheat private industry out of their profits?
You're right it is absurd! Here is an excerpt from FiercePharma, an industry blog today, Tracy Staton wrote:
You'll recall that Democratic senators backed an amendment to require bigger discounts on drugs for low-income folks on Medicare. Early estimates said it would have cost drugmakers $86 billion. Another provision would have closed the medicare doughnut hole, bringing the cost up to more than $100 billion over 10 years. Proponents, including Sen. Charles Schumer and Sen. Bill Nelson, said they weren't party to the $80 billion industry deal.
Opponents voted the measure down for a variety of reasons: Some Democrats said they wanted to stand by the promise made to PhRMA, saying "a deal's a deal." Republicans such as Sen. Charles Grassley called the mandatory rebates "price controls" and said they'd end up raising drug prices for private patients.
We wonder whether any of them thought about the millions and millions of dollars PhRMA has promised to spend on advertising in support of healthcare reform. They were certainly aware of the fact that drugmakers would be angry. Delaware Sen. Thomas Carper (D) said extracting more money from drugmakers would cause a backlash from the industry: "I know I would walk away" from supporting healthcare reform, he said.
Thomas Carper, the senior senator from Delaware, a close friend of Joe Biden, the Vice President whose pledged to carry out an agenda of health care reform, waffles on his support for the Administration's agenda. Someone else, perhaps Senator Dianne Feinstein, must have voted with the Republicans on defeating the Shumer/Nelson Amendment.
What happened to the Democratic Party on the day it clinched its 60-member majority of the Senate that could allow this to happen. What "backlash" could come from the industry, one wonders. We, the American people, are the biggest customer BigPharma has. It is about time that Democrats acted like they control the Senate. Do it, dammit, and then make it work.
Pass legislation that provides a Medicare for All health care system, discontinue Medicaid, and get on with it. Geesh! Between 65 and 70 percent of the voters--who, by the way, elected you to your jobs, say they want a public option. What could be simpler than providing Medicare for All, negotiated prices that Medicare pays for medications as it has always negotiated prices for professional fees and inpatient care, and let the insurance industry adapt to its changed market mix.
Do it, Congress! Do it, Democrats!
What happened to the Democratic Party on the day it clinched its 60-member majority of the Senate that could allow this to happen. What "backlash" could come from the industry, one wonders. We, the American people, are the biggest customer BigPharma has. It is about time that Democrats acted like they control the Senate. Do it, dammit, and then make it work.
Pass legislation that provides a Medicare for All health care system, discontinue Medicaid, and get on with it. Geesh! Between 65 and 70 percent of the voters--who, by the way, elected you to your jobs, say they want a public option. What could be simpler than providing Medicare for All, negotiated prices that Medicare pays for medications as it has always negotiated prices for professional fees and inpatient care, and let the insurance industry adapt to its changed market mix.
Do it, Congress! Do it, Democrats!
21 September 2009
What's It All About, Barry, Really?
This health care reform thing--what's it all about, Mr. President, Madam Speaker and President of the Senate? Why are people tearing at each other, breaking up friendships, losing any sense of decorum and civility in public meetings, let alone on the Internet?
I always think about health care reform in America in terms of ways to improve the overall health of our citizens. Why are we not looking at ways to improve the survival of new born babies? How can we avoid or eradicate or cure most cancers, human immune virus contagion and influenza? Why do we tolerate hospitals and clinics where we are more at risk for an infection than not?
I always think about health care reform in America in terms of ways to improve the overall health of our citizens. Why are we not looking at ways to improve the survival of new born babies? How can we avoid or eradicate or cure most cancers, human immune virus contagion and influenza? Why do we tolerate hospitals and clinics where we are more at risk for an infection than not?
The current efforts are addressing a system of private insurance company viability as businesses that grew from the 1965 introduction of Medicare and then Medicaid. We now have a health care system dependent upon the goals of private, commercial financial results--which is a sociological, economic and political realm. Please, read Adam Smith's second volume about community and capitalism. Do the proposed reforms address community needs and expectations of living a full life despite disease and trauma? Where is the profit in educating children and adults about how to live a healthy life so as to minimize the care needs provided by these same, commercial entities?
We need to reform the paradigm of societal expectations and norms regarding how we individually and in our community expect for living healthy lives, beginning with considering physicians, hospitals and clinics as working for us.
We need to reform the paradigm of societal expectations and norms regarding how we individually and in our community expect for living healthy lives, beginning with considering physicians, hospitals and clinics as working for us.
We hire them or check-in to a hospital because we believe that this or that is where we find help and answers about living as best we can.
I have had to seek emergency assistance when I sliced deeply into one of my fingers while preparing a meal. I cannot stop it from bleeding. I do not need an admission process that requires my entire life health history. I want my wound treated, not to sign away my financial future or absolve the Emergency Room from liability for any mistakes or accidents.
My priority is to find out what I don't already know, especially when the timing of treatment and period of care are unknown. I like to know what is going to happen in my life when there are other people involved in determining my situation and my future.
I have had to seek emergency assistance when I sliced deeply into one of my fingers while preparing a meal. I cannot stop it from bleeding. I do not need an admission process that requires my entire life health history. I want my wound treated, not to sign away my financial future or absolve the Emergency Room from liability for any mistakes or accidents.
My health care is being diminished for the lack of a single-payer system. I still bleed while my insurance is validated. I need someone to stop the bleeding and to stitch up the wound on my finger. That's all. With the admissions process having to ensure my treatment will be paid for and waiting for a physician to approve treatment so I can wait for someone to treat me, I spent hours for a 15-minute treatment. Then, later came the bills, invoices that are addressed to me, even though my insurance will pay them.
The current efforts by Congress and the White House is to legislate a process that does not have a health care goal or public expectation about health care in America. The goal of the Congress and the Administration focuses on the HOW and BY WHOM actions to attain a political goal that is so broadly stated in three words: Health Care Reform.
Other developed countries think about health and health care and their national programs' primary purpose is to meet the expectations of the people who live there. That purpose comes first and, though different countries have different means to meet those expectations, the health of the populace, individuals drive the means and the resources of the governments, the health care professionals result from the legislative process and public participation.
What do we Americans want? Seventy percent of us, according to published polls, want a single-payer system as an entitlement of citizenship and resident non-citizens. We declared our nation's independence to enable us to pursue unalienable [sic.] rights to Life, Liberty and the Pursuit of Happiness. We should be healthier for this goal. We have failed as a nation to remain true to the attainment of those Rights.
Other developed countries think about health and health care and their national programs' primary purpose is to meet the expectations of the people who live there. That purpose comes first and, though different countries have different means to meet those expectations, the health of the populace, individuals drive the means and the resources of the governments, the health care professionals result from the legislative process and public participation.
What do we Americans want? Seventy percent of us, according to published polls, want a single-payer system as an entitlement of citizenship and resident non-citizens. We declared our nation's independence to enable us to pursue unalienable [sic.] rights to Life, Liberty and the Pursuit of Happiness. We should be healthier for this goal. We have failed as a nation to remain true to the attainment of those Rights.
Labels: Adam Smith, health care financing, health care public plan, single payer
19 September 2009
My Reasons for Wanting a National Health Service for All
I have had to import medication from Canada because it was more affordable a few years back, I have too much money in my remaining IRA investments intended for retirement, accordingly, I have been spending down those IRA savings to afford my living expenses and health care expenses since 1991. I cannot access my veterans benefits nor can I receive coverage under Medicaid because of their means tests. And others have worse challenges than I have. How many parents discover that their child must wait two years for Medicare eligibility if, God forbid, their child develops an immune system disease or has brain damage from meningitis? The parents' private insurance coverage may alter or cancel their family's health insurance and, assuming there is an income-producing person in the household, the parents cannot afford the necessary health care costs until Medicare enrolls the child. The child would be eligible for disability income if they meet the criteria established by Social Security. Someone with lupus, for example, can work, live normally or a little slower and with greater fatigue, yet any physician office visit charges, lab charges and medication charges have to be paid by the afflicted person in addition to housing, food, utilities, cell phones, Internet access costs of daily living. Suddenly the afflicted person, before Medicare coverage, has new claims on the paycheck that may amount to more than the take-home pay for the month.
Often, I should note, the providers will have a sliding scale fee structure so a person without health car coverage should ask the physician or lab or pharmacist about such arrangements. They do not want to charge full rates if they see that they will not be paid anything. So, we ask for financial arrangement that help, but still may overwhelm one's budget.
It seems that every federal program for the good of Americans, including veterans health care, requires the recipient to be impoverished. Find me one that does not- for health care. Try living on the SSDI stipends for shelter, food, transportation and miscellaneous expenses of living. Because I am single, my net $1,700 monthly SSDI income puts be above the poverty level.
I know the health care system very well, because of my executive role for a major university medical center, research laboratories, patient care in two hospitals, administrative process and budgeting, and construction of new laboratories or hospitals or upgrading facilities in place. I led the office that evaluated those operations for 12 years, until I could not handle the stress of my job mentally or physically. Is it not ironic that I cannot make a living from providing guidance and opinion, because my PTSD of institutional politics and my inability to reconcile political and reality perspectives do not allow for full-time employment. You see, my disability prevents me from focusing on a subject or tasks of a job for more than two hours after which I must disengage completely from work type situations and discussions. My former employer, Stanford University, went psychiatrist hunting to avoid paying me any disability income and access to other benefits,even though their first psychiatrist and my psychiatrist validated the nature and effects of my disability. It was several years before I could even think about taking the institutional and legal steps to restore them. I would have difficulty today, psychologically, making the effort to claim disability benefits to which I was entitled as an employee.
I have two more years to go before I will have depleted my IRA that had been created to supplement my pension income from an employer. I was not able to work long enough to generate any pensions, so I will become entirely dependent on government programs for life and pursuit of happiness. There should have been a point after which my IRA did not have to be used for health care related expenses. For me, a national health service with a single payer, would have enabled me to remain in my home and lead a decent, middle class life without having to access any future government programs. My paying out-of-pocket my entire investment portfolio value cash in distributions could have been avoided had we had a national health service for everyone, regardless of income, assets, job, etc. In retrospect, what I should have done is go to France or Italy in 1993, after being enrolled in Medicare A and B, and used my Social Security and Medicare benefits as my contribution to their national health systems. We have bi-lateral treaties with other countries that enable such exchanges, depending on the country where you pay income taxes.
My own health suffered from trying to do too much and the cost of ongoing psychotherapy and associated medications were depleting my IRA at a rate higher than my rent. Another trip to Italy, using the points awarded from charging so much medicine costs, convinced me there was a better way to live, a way without worrying about going broke paying for health care while living on my SSDI for all other living costs. What delayed my obtaining the visas was gathering the required paperwork and submitting my application. What takes most people an hour or two on the phone or filling out forms with accompanying support documents, takes me weeks and months to do. This post has already consumed ten hours today and additional hours of editing just to arrive at this draft.
Now, I may not have sufficient financial resources to move to Italy which still has a much better approach to health care than does the country of my birth and that I defended.
Until a single-payer, like Medicare for all, demonstrates that this country puts the health of its citizens before the profits of private insurance companies and the pharmaceutical manufacturers, I don't see myself as letting go of this issue and my anger.
12 September 2009
Ed
On August 30, 2009, Edward R. Kuhn, DMD, ended his life early in the day, using the semi-automatic rifle he had at home because he had been a lieutenant colonel in the Air Force Active Reserves. I received a call from a mutual friend about four hours later. Neither of could say anything; we were in shock. Marion said he would pick up Ed's daughter at LAX along with his own son and drive them to Palm Springs. Later that afternoon I called Ed's wife and when her cousin answered the phone, I asked her to relay my deepest sympathies to her. I had to go to Palm Springs to be there at their house. I did that, stayed overnight with friends, and went to Ed's home again on Monday. Those are the facts of the beginning of a period of grief, sitting with Ed's in-laws not knowing what to do or how to be helpful. The sudden loss due to suicide does that.
I met Ed and Marion at the Officers Club in Pionier Kaserne, Hanau-am-Main, West Germany in early 1969. Over the next two years, we became friends, good, close friends in the special way that bonds soldiers stationed together. I have never had such close friends before or since. I had other friends from my own unit with whom I kept in touch years after I finished my term of duty. But none was as close as were we, known at the Club as the Mod Squad. Marion was the Provost Marshal in Hanau. Ed, one of Marion's platoon leaders was stationed in Auschaffensburg as provost marshal. Ed, whose hair never made it short enough for US troop standards, and I was the intelligence officer for our combat engineer brigade who, like them, would rather be in the States and were politically and morally against the war on the other side of the planet. We hated the racism that began to infect the troops on base. Marion and I would get into deep discussions about racism in our culture, and what US troops encountered with the Germans. Plus, back home society was having its own war between the mores of The Greatest Generation, hippies, and African-Americans. Martin Luther King and Bobby Kennedy had been assassinated just months before. Anger and frustration characterized the times. Also, the Tet Offensive happened in Viet Nam during this period and the level of fighting ratcheted up another notch. Ed would participate to some extent in our talks, yet was rarely seriously engaged and angry. He was the hippy of our group. His relaxed way of talking was soft and earnest, but I could tell he'd rather be out on his surfboard off Goleta, waiting quietly for a good wave.
Ed knew just the time to break into our significant discussions with his eyes twinkling and a devilish smile. Ed found humor in our daily lives that we were too serious to notice. Ed would quietly ask if we wanted to go to his apartment, one he often shared with his current girlfriend of the season, and get high. For the rest of that evening we would laugh at ourselves, our circumstances and listen to the music of the times. I think we drank German beer from flippies, inexpensive brews in bottles kept closed by a porcelain cap one had to flip open to drink those really good beers of Germany.
Ed and Marion were transfered to Korea for 1971, while I remained in West Germany. Our three-year commitments were over in the Christmas and New Years holidays beginning 1972. Marion and I corresponded a lot while he was in Korea and he kept me current on Ed.
We kept in touch over the next three decades, celebrating marriages and children, professional education that made Ed a dentist and Marion an attorney. I became an administrative executive in higher education and health care institutions. I was in the San Francisco Bay area for most of the intervening time and Marion was studying law at the University of California, Berkeley. Ed bought a practice in Palm Springs. As fate would have it, Marion moved from his job in Detroit to Orange County and was able to enjoy Ed's company on bike marathons, hiking and was Ed's patient even. Time passes and we led our unique lives, always knowing were the other two were.
In May 2008, we had a reunion of the Hanau Mod Squad in Palm Springs, Marion with his wife Amanda, Ed with his wife Patti, and me. The three of us felt the bond of 40 years friendship. I had moved to Southern California, too, so it was especially comforting to me to live close to them. In fact, it Ed who was one of the reasons I was planning to move to Palm Springs, as well as the other attractions and people I liked there. To me, Ed was the linch pin of our group. The three of us truly enjoyed each other as a family. Then I received Marion's call.
During the 1980s and '90s I was living in San Francisco during the worst years of the AIDS epidemic. Friends and partners were dying, I would go to concerts and memorial services at least once a week; a one point, I was overwhelmed with the loss of a generation of San Francisco's most talented, creative and interesting, mostly gay men. I had to choose carefully among which memorials I would attend. It was during that period that I read Antoine de Saint-Exupéry's "Wind, Sand and Stars," written during his French air corps experience early in the 1940s. This one passage captured the survivor's life during the AIDS epidemic; it came to mind after Ed died:
...hidden gardens, gardens inaccessible, but to which the craft leads us
ever back one day or another. Life may scatter us and keep us apart; it
may prevent us from thinking very often of one another; but we know
that our comrades are somewhere 'out there' ---where, one can hardly
say---silent, forgotten, but deeply faithful. And when our path crosses
theirs, they greet us with such manifest joy, shake us so gaily by the
shoulders! Indeed we are accustomed to waiting.
"Bit by bit, nevertheless, it comes over us that we shall never again
hear the laughter of our friend, that this one garden is forever locked
against us. And at that moment begins our true mourning, which,
though it may not be rending, is yet a little bitter. For nothing, in truth,
can replace that companion. Old friends cannot be created out of hand.
Nothing can match the treasure of common memories, of trials endured
together, of quarrels and reconciliations and generous emotions. It is
idle, having planted an acorn in the morning, to expect that afternoon to
sit in the shade of the oak.
"So life goes on. For years we plant the seed, we feel ourselves rich;
and then come other years when time does its work and our plantation is
made sparse and thin. One by one, our comrades slip away, deprive us
of their shade."
¸
Antoine de Saint Éxupéry, Wind, Sand and Stars, 1943
ˇ
Ed, rest in the peace you sought. We miss you a lot.
Labels: Friendship, military life, suicide
11 September 2009
Decorum
When has it become acceptable behavior to shout out "You lie" at the President of the United States giving an address to a joint session of Congress?
How did this individual, an elected member of the House of Representatives, believe that it is proper to act this way, in these circumstances, toward this man? What outcome did he want from vocalizing these words? Why would it even occur to him that doing what he did would be the right thing to do? There seems to have been more media attention to this man's action than to any criticism and subsequent action by his colleagues to show disapproval and sanctions for it. This guy walks among them.
Clearly, the standards of civility and decorum, even appropriate dress codes, have changed significantly in the past forty years, by two generations and condoned by "the Greatest Generation." Through experience, I do believe the social maxim that "you act according to the way you dress." Every so often, young people will discover this and I am somewhat heartened by the life span for this maxim.
As I was learning to write in grammar school, in the early 1950s, I was taught that one always capitalized the "p" when writing about the President of the United State, but for no other presidents. This spelling maxim applied to any derivative of 'President' as well. Sure that was a time of hyper-patriotism, yet I still consider the maxim appropriate as the proper title's spelling, even when used without the current President's name.
All my life, when the President of the United States gave a nationally broadcast speech, on radio and later television, I was raised to listen closely, attentively and even at home, respectfully. I will admit to ignoring most of GWB's speeches after 2004, yet he was our President and deserved the high respect considered for that office. When I reacted, having read GWB's speeches, by sending him letters by fax, I was courteous and respectful of his office even though I could not respect the man. Until the 1968 election, I heard Presidents Truman, Eisenhower, Kennedy and Johnson being accorded the respect of his office by the press and the audiences. That public respect did not mean there were no dissenters or extremists in opposition to those Presidents; however, people respected the Presidency.
By 1968, however, President Johnson was the target of significant numbers of public demonstrations against the Viet Nam War. Maybe this cause created more disrespect for the Office than respect. Even though most soldiers were draftees, the common reaction to a man in uniform was antagonistic rather than grateful. Television brought that war into our homes so that the realities of war's evil conduct and outcomes became visible to all, not just to the soldiers, adding significant numbers of persons who became antagonistic to any participant in it. Then, the treatment of opposition groups assembled to demonstrate at the Republican Convention in Chicago fortified war opponents and the candidates for the Presidency in 1968.
I was stationed in Europe for most of Nixon's first term of office, after having been relatively isolated to what was happening in the public arena since February of 1968. When I returned to the States in late December 1971, I had missed what I consider to be a social revolution that had changed America. Everyone was using first names at the office, even the executives. President Nixon had implemented most of LBJ's "Great Society" vision with Congress, and Senator McGovern was running for President as an opponent of the Viet Nam War.
So, besides the significant degree of change in society's interpersonal mores, seen in popular music, on television and in the theaters, when Watergate occurred in 1972 and Nixon's unwilling resignation from office in 1974, I believe that most of the nation had lost their traditional respect for a President. There was no longer any distinction between the Office and the man who was President.
This change, for me, has been most unfortunate. Civility in social discourse seems to occur only under power-based circumstances and not automatically. A person's integrity can be challenged and damaged without having any basis in fact. Criminal trial trials seem anachronistic when the public has already found blame in the person on trial. Our courtroom-based television shows do not portray a defendant or a suspect as presumably innocent of any crime, and the prosecutor has to be the hero bringing justice to the victims. The screenwriters actually present the way British juris prudence functions, that the defendant has to prove his or her innocence of the charges. American juris prudence has its stated ethos that a person is innocent until the state's prosecutor proves the person to be guilty of the charge. Just the opposite paradigm from the British system.
Fictional, criminal cases on television and in movies concentrate on the likely person that the police or detective is looking for, rather than on the viewpoint of the district attorney who must find sufficient evidence to arrest and charge the suspect, let alone to have sufficient evidence to convince a jury or judge that the defendant at trial is culpable for crimes against society. The same "bad guy" person will be portrayed in plots that involve the President. Even if innocent of any criminal behavior by someone in his Administration, innocence becomes equivalent to incompetence as President for not knowing about the criminal activity. The last time I checked, incompetence is not a crime in and of itself.
Respect in social settings seems to have fallen victim to an inversion effect, so that most persons worry about the respect they are shown versus any respect they accord as due to others. In the recent town meetings of August 2009, individuals among the constituents in attendance showed no respect for their elected representative, senator or President. The media reported only the most "exciting" reactions to the announcement of President Obama's speech to the nation's children in school. Mothers were accusing the President of interference with parental rights, with dictating school curricula that are the right of local school boards to make.
Several parents said they would not allow their children to see the President of the United States address the nation's children because it would harm them. The media dwelt on these incidents of disrespect without commentaries that such conduct is the wrong attitude to have to judge the anticipated content of the speech without knowing the content. No one criticized these individuals about their behavior and lack of respect for their own elected official. Indeed, there were organized groups shouting opposition to any Presidential address who traveled from location to location. The degree of expressed anger, outrage and righteousness far exceeded civility, let alone respect.
07 September 2009
National Health Service This Year!
I wrote the following piece in 2009, yet failed to publish it. I publish it now because it has become relevant to the current discussions about health care given the passage of the Affordable Care Act of 2010. The Republicans of 2017 are attempting to repeal and replace the ACA and the Democrats are trying to salvage the best of the ACA and improve its coverage. We now the problem: the insurance industry and Big Pharma have the American health care system hostage to huge bureaucracies and anti-competitive pricing models. Neither part seems willing to attack the problem! So, I offer the following still relevant commentary--old names intact--to readers awaiting the wisdom of our current leadership in Washington.
In 2009:
In 2009:
Candidate Obama won votes when he and his campaign pledged that, if elected, he would put into place a national health care system equivalent to the one members of Congress have. That plan still sounds very adequate for healing Americans who become ill and for encouraging preventative measures in diet, exercise and living patterns for healthy living. What we, the American public, have not heard from President Obama is the enactment of an equivalent insurance plan available to all Americans.
Why not? The people whose jobs depend on the current, disfunctional system want to continue their jobs, their employers in government and private entities depend on the revenue streams of the current, disfunctional system and do not want changes that might inhibit their options for increasing revenue streams. The supporting network of industries and service providers depend on the current, disfunctional system for their businesses.
Some Americans are quite content with the health care they receive from the current, disfunctional system. Representatives and lobbyists of these groups are hammering individuals and stakeholder groups in the White House and Congress with reasons for not messing with the current, disfunctional system because of their self-interests.
Some Americans are quite content with the health care they receive from the current, disfunctional system. Representatives and lobbyists of these groups are hammering individuals and stakeholder groups in the White House and Congress with reasons for not messing with the current, disfunctional system because of their self-interests.
Those 40+ million Americans who, from conception to death, are not satisfied with or do not have access to the current, disfunctional system, however, have no single voice, no one lobbyist or advocate, to have the access to members of Congress or to the White House as do those groups with vested interests in the status quo. Many of these dissatisfied people are parents, indeed so are children and babies, the elderly without the ability or money to control their lives any longer, the immigrants who have difficulty with learning English or Spanish, the unemployed persons, the unemployable persons and the disabled persons. The working poor and what remains of the middle class pay in the range of 41 percent of their incomes on heath care premiums and for what is not covered. For comparison, the mortgage industry used percent of income amounts for qualifying home loans applicants. In a tight market, the advisory amount of household expense including mortgages was between 30-33 percent. In boom times, the amount increased to 50 percent for qualifying. Now, people are being priced out of their homes, communities and social norms, having never anticipated the crushing power of inflation in health care, investment fraud, recalcitrant and uncooperative banks limiting access to loans, and an economy starved for cash and credit at all levels with which to function.
What do I do about this? When I had some disposable income, I did send small one-time donations. I do not have the time or the disposable funds to contribute money. E-mails from every progressive political group and political party thinks I should fund their efforts, though who knows where that money goes. Much of it is not tax deductible. So, I write letters:
I fax these letters to their Washington offices in hopes that a human must look at them. I sometimes receive a polite, snail mail response with a thanks for writing. (My emails usually elicit nothing or an email response instructing me to go to the addressee's web site and use its form for providing input.) In these letters, which are one page, no big words, I remind them of the Declaration of Independence's declaration of our Rights as humans to Life, Liberty, and the Pursuit of Happiness. I tell them that two of the three depend inextricably on health, so any national health plan for America must include a public option, of which I favor a single payer design.I write letters to Committee heads from both parties in both houses of Congress,I write letters to Special Counsel to the President Nancy-Anne DeParleI write letters to the President and the Vice PresidentI write letters to Speaker Nancy PelosiI write letters to my senators, Barbara Boxer and Dianne FeinsteinI write letters to my Congressional representative, Darrell Issa, 49th Congressional DistrictI write letters to Barbara Lee, head of the House's Black Caucus and 9th Congressional DistrictI write letters to Henry WaxmanI write letters to other senators and representatives
I also inform them that the lack of a public option has cost me over $500,000 in prescription medicines and co-payments, because I was 46 when I became disabled in 1991. No healthcare insurance company would sell me supplemental insurance for Medicare for 18 years because I was not 65 years old. During this period, I paid Medicare co-pays, but also the full professional fees for specialist physicians who did not take Medicare patients and for all medications.
Politicians, news pundits and those individuals with jobs, and those who believe them, are very quick to hoist the "Reduce Cost" flag whenever some issue goes to the legislature for resolving. As a result of years of reporting about government waste and purchasing stupidity by the Defense Department and the military branches, the public rightfully regards our tax burdens as too much. The high costs of government can get a politician elected to office and news and commentary on radio and television can have a sure, audience grabbing, program just by focusing on government waste, especially in the entitlement programs. The absence of concomittant government rule enforcement and corrections because Congress either fails to budget for these agencies meant to discover and report waste and abuse, or, if there is an approved budget item, Congress can withhold appropriating money intended for this activity. The enforcement agencies, the inspector generals and internal auditors make their reports and recommendations, but no one person who reports to the President or Vice President is accountable for resolving issues in those reports. There is no civil service chief of staff, so action depends on a political appointee in the current administration. Nevertheless, market forces have not led to price equilibrium or customer-friedly marketing schemes sufficient to rein in the costs for health care.
During the years following WW II, "the greatest generation" voted into law a series of entitlements for good cause, righting the wrongs of past generations such as racial and gender discrimination in education, housing, job accessibility and retention. That generation also imposed additional costs of production by enacting the OSHA laws for worker and community safety and ADA to recognize the impediments to job, home and living persons with disabilities encounter daily. The resulting list of entitlements, grouped by name as "welfare", raised the expense budgets at every level of government, they cost manufacturers and merchants, restaurants and construction to include many new requirements that increased the cost for providing the final product.
President Clinton cut welfare benefits that he and the Congress believed were creating a permanent class among Americans whose society and culture turned around government entitlement programs. That approach cannot work for health care services because everyone needs health care. There will not be a permanent underclass among Americans without health care services, due to natural attrition--infants, children, adults and old people die off early.
Why must we Americans be 20 years behind the cultures and countries our predecessors left to make a better world in America? Do we have such high incomes that allow us to spend too much money for our health care without realizing the abundance of money involved has enabled inefficient, outdated protocols, facilities and manual data management? Has the abundance of cash float in the health care and private insurance industries fostered the phenomenon of the litigious patient? Has the dispersion of paying for health care among insurance companies, government programs, patient co-payments and institutional write-offs hidden these wasteful and behind-the-times character of health care in America from the American public? I believe it has, just as we solve our other problems with paying out cash.
I do not intend to give up on the current attempt by President Obama to put into place a national, reformed health service this year. I regret that some Progressive groups are already looking at 2010 for creating what we need now.
